Wednesday, 24 June 2015

ClinicSpeak: the uberization of health care

How quickly can we uberize the management of MS? #ClinicSpeak #MSBlog #MSResearch

"At the EAN in Berlin I gave a short talk at an Innovation Exchange about the future of tracking and assessing MS using mobile technology. I presented the concept of the uberization of healthcare; i.e. the provision of healthcare by rapid access eMedicine apps supported by concierge type service where neurologists, or robots, come to your home or place of work to examine you. In other words your neurologist, or a neurologist, will be available at very short notice. In addition, with this type eMedicine service there would be no geographic boundaries, in other words a neurologist physically based in Paris could be managing someone with MS in Quebec City. I deliberately chose these cities as they are both French speaking, but with new simultaneous, real-time, translation services emerging language need not be a barrier. I got real pushback from the audience who think I was presenting a science fiction vision of healthcare. I really don't think so, this type of service is a reality already. I get one or two email requests for neurological advice per day. Due to time and legal constraints I say no. But there are already many fee-for-service email, skype, or eMedicine portals that charge for advice of this nature. In some parts of the US this is supported by a rapid access concierge service where a neurologist is prepared to visit you in your home to examine you. This all costs money and it is hard at present to envision this business model being transferred to a socialist healthcare system. I say why not? There is a massive push in the NHS to take services into the community so why not into the home? The latter may be prove to be cost effective if it prevents MSers being admitted to hospital and improves outcome in general. We already do this with nursing and palliative care services so why not other specialist services?"

"When I was planning to do an eMedicine test run, using Microsoft Healthvault, last year I contacted my insurance company for clearance. They stated that I would be not covered for an eMedicine service if the patients were not resident in the UK. I argued that if someone in the US got an airplane and travelled to London and was seen by me in private practice that would be fine, but giving advice via the internet to someone in the US would not? They still haven't gotten back to me on this; clearly the insurance industry needs to catch-up with technology. There are clearly solutions to this as many eMedicine services in the US take all-comers regardless of where they live."

"How do you feel about your MS being managed using eMedicine?"





CoI: The innovation exchange was run and funded by Novartis.

7 comments:

  1. Some form of new technology must be embraced by the NHS. The cost of going to see a consultant for a ten minute consultation is becoming unrealistic, both for the patient and the consultant.. It is easy to do an initial diagnosis by Skype and then if necessary a face to face meeting can be arranged. I have telephone consultations with my GP
    From what I understand the NHS is already moving in this direction with the accent on community nurses and encouraging people to stay in their own home where they are much more relaxed and comfortable than in a hospital bed.
    If technology is available then try to harness it

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    1. I agree, my only concern is this doesn't lead to replacing *all* face-to-face appointments. Otherwise, I see how this could work for the relatively tech-savvy, though not sure about those that are not, this consideration would need to be built in to the design.

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    2. I would like to be able to email my GP or Consultants. I wouldn't expect a personal reply, but at least my query would be in my own words not a receptionist or secretary's interpretation. I always feel such a pest when I have to call.

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  2. Could it be that the future of medical care will probably be more data centric than expert centric? Then that means that people will probably have some kind of real time monitoring device. This technology is in the early stages of development. I like the cue medical device and think that is an interesting start. I read an article titled ‘Peripheral Blood T Cell Dynamics predict Relapse in MS patients on Fingolimod’ on plus one april 28th 2015.

    I was thinking about building some kind of at home MS monitoring device. Am not sure if this journal article is well respected but I would like to create something based on a cytometer that could be used at home. I did price a cytometer recently but it was $40G which is too expensive for me, I see that some manufacturers have a cheaper, smaller device that is only for sale in the developing world. Could a device be built for around $2G that works with a small amount of blood working from a finger prick that would generate useful data? What might be the information that would be medically useful? Would it help to trend a patient every day? From my understanding of the specifications a single laser cytometer would be required.

    Aidan

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  3. There are already symptom tracker Apps available though 'symtrac' is not well designed in my opinion. However, the concept of being able to create a daily 'diary' of my symptoms which can be accessed by my neurologist and nurse is useful since I know for sure I forget to mention things in my (less than) annual consult with my neuro. I would love to have more frequent telephone consults backed up with annual face to face meetings.

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    1. I'm glad I'm not the only one that doesn't find Symtrac helpful. It is very badly designed, in my opinion. Much easier to keep a diary on my iPad.

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    2. I didn't mean system technology other than email. I have various comorbidities that conflict with each other and sometimes the symptoms are connected. I just need a quick answer that can probably be done in one sentence. MS monitoring was not what I meant, I make a list of those problems.

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