This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.
Friday, August 04, 2017
The Financial Review Looks At Digital Health, Smartphones And The Like. Fascinating Stuff!
The Weekend AFR had a series of articles of articles on Digital Health last week.
The airplane had just taken off when one of the passengers lost consciousness. Eric Topol pulled his smartphone out of his pocket and immediately performed an electrocardiogram (EKG) on the passenger. He used the device to do an ultrasound scan of the man's heart and measured oxygen levels in his blood.
He was then able to give the all-clear and the plane could continue its journey. The man had lost consciousness merely due to a temporarily slowed heart rhythm.
Topol is a cardiologist in La Jolla, California, and it wasn't the first time he had encountered such a situation while flying. On one occasion, he used his mobile phone to determine that a passenger had suffered a heart attack and the plane had to land immediately.
Of particular interest to Topol, though, is the fact that anyone can perform such an EKG, whether a professor of medicine, a flight attendant or just a simple passenger. All one needs is a $200 sensor and a smartphone with an app that can analyse the heart's rhythm.
Hardly any other object has changed the world to the degree that smartphones have. It has become completely normal to use our mobile devices for shopping and managing our schedules. Political revolutions have been organised by smartphone and you can use one to find a life partner or to plan a funeral. Every single day, 10 times as many smartphones are sold around the world as babies born. And now, smartphones are conquering medical care.
For millennia, sick people have been dependent on help from others, a healer or a doctor. But now, mobile devices are beginning to change that age-old state of affairs. Coupled with the power of artificial intelligence, the mobile phone promises to fundamentally change medical care. Many medical examinations that were thus far only possible in a doctor's office can now be undertaken at any time by anyone – even while sitting at home in your easy chair.
With the help of small and affordable accessories, smartphones can measure electrical activity in the brain, intraocular pressure and blood pressure. They can perform an EKG, recognise atrial fibrillation (a type of abnormal heart rhythm), check pulmonary function, record heart murmurs, take photos of your inner ear, perform breathalysers, perform aorta scans and even sequence DNA.
Soon, there will be little difference from a technical standpoint between a general practitioner's office and a fully equipped smartphone. On the contrary: it is already the case that patients are sometimes better served by a mobile phone.
In Australia, a patient with cancer can track symptoms on their smartphone, then use the same phone to access medical records held on their GP's software. Later, their oncologist can use a different smartphone to calculate medication dosages.
And all three phone apps in this scenario – CancerAid, MediTracker and DoseMe – would be Australian inventions.
Future patients could use an Australian invention to diagnose respiratory diseases by merely breathing into their smartphone's microphone. ASX-listed company ResApp is researching this, supported by millions of dollars from investors.
Many outback patients drive long distances to see a doctor or pick up a prescription. Imagine a patient who could consult with a doctor over video or track their symptoms with wearable devices that stream data back to the clinic.
Yet despite the potential upside and the individual success stories, Australia is nowhere near the vanguard of any digital health revolution.
The most notable foray into digital health is the taxpayer-funded My Health Record, launched as the PCHER in 2012. It was designed so multiple doctors could work off the same, shared patient record and has signed on 5.5 million patients so far.
Five years, one rebrand and $1 billion later, doctors remain unconvinced that it has any clinical value. They cannot use it to look at test results. It has no complete medication list, even though one of its main goals was to reduce medication errors.
Another sticking point for Australian digital health is the cornerstone of the healthcare system, Medicare. Patients cannot claim rebates for Skype consultations, for example.
A market exists for privately-billed digital health, such as NZ app Firstcheck, which recently arrived in Australia and charges patients $19.95 for remote dermatology consultations. But the explosion of "dial a doctor" video consultation technology, notable in the United States, is unlikely to occur in Australia unless the Medicare Benefits Schedule is revised.
For all its brilliance and its benefits, there is one thing machine medicine it can't do. It can't heal.It can diagnose and it can recommend treatment, but without a human soul it can't provide that intangible element that makes so many people feel better.
One day smart devices may be able to deliver much of the science of medicine but they will not be able to practice the art of medicine. How could they?
This art is expressed in the way doctors apply the science to patients. It is a nuanced, social and cultural process that deals with grey zones, employing intuition and compassion in the context of the patient's personal situation. In the art of medicine, it's often said that the doctor is the drug.
It's the good doctor to whom patients can bring their health worries. It's the doctor who will listen to their story, make them feel seen and heard, contain their anxiety and empower them to heal themselves. Many chronic conditions can't be cured but a skilled, empathetic physician can help patients gain perspective and regain some control over their management of these conditions. There is a personal relationship between doctor and patient and, in a way, they travel the road together.
The first article is a wonderful collection of anecdotes gathered from all over the world showing just how amazing things are becoming whereas the latter two explore some of the negatives. All are well worth a read.