"When living with chronic disease, one of the least exciting innovations to float to the surface, in my opinion, is a shiny new app requiring more effort than it’s worth..."
Andrew Spong's insight:
I'm hoping to find the time to write an end-of-year blog post before the holiday shutdown. If I do, this theme will certainly feature.
In essence: we are cursed to live in one of the most tedious ages healthcare has seen. The history of technological innovation is one of consolidation. Miniaturisation and acceleration are drivers of this change, but the motive force propelling it forward is the desire to aggregate functionality, not the fact that things get smaller and faster, which merely facilitate this.
There are interesting times ahead for health, but if we view success in terms of improvements in patient outcomes rather than health tech bubble funding rounds and out-of-control hype, this era does not qualify.
Maybe you have a fitness tracker. Maybe you've gotten your genome sequenced before. Probably your medical records are kept in electronic, instead of paper, form. Now some companies are seeking to combine all those things and more into a talking, personalized, health-advice app. Not sure when to give yourself your next insulin shot after having a croissant for breakfast? You can ask the app. How much exercise should someone with your genetic makeup be getting? The app will give you suggestions.
Digital health is bigger than a business model, but it is no more than an aspect of a matrix of economic, cultural, and social change which is difficult to map, let alone react to, due to the speed and scale of its growth.
Right now, digital health is having its moment, and as such it is challenging for its most high-profile proponents to accept the fact that their businesses will not be swept away, but simply left behind.
The future which digital health’s evangelists are so sure they will be a part of will accelerate past, and then away from them.
Some days, the health conversation on the social web can make you believe that this is not the case. And on days like that, it is worth remembering something...
Wikipedia says "Participatory medicine is a movement in which networked patients shift from being mere passengers to responsible drivers of their health, and providers encourage and value them as full partners.”
That movement gets a big boost in credibility today: the Chief Residents at the Mayo Clinic have invited SPM co-chair Dave deBronkart, a.k.a. “e-Patient Dave” to be their Visiting Professor in Internal Medicine next March.
The announcement is being made today, during the patient panel at Mayo’s sixth annual social media summit.
The generation that practically invented Youth ™ will be able to effortlessly track -- and possibly better manage than anyone in history -- our getting old.
Andrew Spong's insight:
I'm not sure *what* I think of this article, to be honest.
Is this generation (and for the record, I'm on its cusp) providing us all with a blueprint for effective health self-management, or is it merely further evidence of boomers failing to recognise their position as a generation who've held future generations' prospects hostage at the expense of their own?
"The digital health revolution has failed... so far. The industry that has grown up around it -- to cheer it on and promote its potential -- is thriving. But while those who organize conferences, found coalitions and work as consultants gain acclaim, write books and give TED talks, patients and physicians wait for the promise of the digital health revolution to become a reality.
We're tired of waiting.
For those of us with chronic disease, a digital health revolution is the best chance we have. We need it to succeed. We're desperate for innovation that works. We have experienced tremendous developments and intuitively grasp the potential, but when we peruse the app store and download a few, their usefulness rates as "meh" at best."
Andrew Spong's insight:
I have a great deal of sympathy with Anna's position.
At present, digital health is more hype than help for patients.
Of interest here is not the speculation about a beta Google service that is a trial, and seemingly only available within google.com searches, but the insight into how short a distance the participatory medicine movement has travelled, and how much work there is to do.
Encouraging legacy media to reconsider what a definition of 'real medicine' might contain is certainly one educational need disclosed.
The definition of how healthcare is designed and delivered that is implicit within this WIRED article is resolutely dictated and monological, rather than participatory and dialogic
It bears little resemblance to the ongoing conversations around every facet of health and healthcare that take place across geographies in multiple languages that the Internet and social web supports.
This is not a real description of 'real medicine' by any reasonable standards.
Users can track and follow how their temperature improves or falls by the hour, day and week, and easily share that information with their clinician. If an immediate diagnosis is necessary, the temperature readings can be shared instantly by adding the person to a sharing list.
The Blue Button is a public-private collaborative initiative from the US Office of the National Coordinator for Health IT (ONC) that aims to give patients easier and more sensible access to their health data. What began as a pilot within the Department of Veterans Affairs (VA) Health has shifted into an industry-wide focus.
The thing that stands out for me here: patients want disease information and practical support, yet developers (and their sponsors) are more likely to publish trackers and diaries, which only make it to third place.
I know some interesting integrated solutions which attempt to hit a number of the targets in this chart are on the way, but if this PatientView data tells us anything, it is that 'single solution' apps aren't of a great deal of interest to patients -- unless, perhaps, they focus on disease information.
Samaritans, an enormously well-respected suicide prevention charity, has launched an app which it says should “help support people struggling to cope and ultimately save lives”. But the app is causing upset among those it is designed to help, and some have now called on the Samaritans to withdraw it
There is a subtle form of power-politics implied in just about every deployment of ‘patient engagement’ you’re likely to encounter that serves to deprive the patient of authority rather than promote the autonomy of the patient.
Fitbit isn't eager to team up with Apple, because many popular apps -- including MyFitnessPal, MapMyRun, Walgreen's Balance Rewards, and Microsoft's HealthVault -- already pull data from its trackers. Fitbit's main app is a full-featured dashboard for tracking daily activity and connecting with friends.
In other words, the company has already constructed a mobile health ecosystem on its own, which would fall apart if HealthKit lures away those allies. Fitbit's app would also seem redundant if all of its health data appeared on Apple's Health app. If that happens, Fitbit could be reduced to a single fitness tracker without a mobile health ecosystem. Moreover, it would fragment its user base among iOS, Android, and Windows Phone users, since HealthKit only runs on iOS 8.
Apple has said that it will remove the ability to manually enter and view glucose values in its Health app, while the company comes up with a fix to allow HealthKit to handle the milligrams per decilitre (mg/dL) measurement of blood glucose levels used in the United States, as well as the standard millimoles per litre (mmol/L) used throughout the rest of the world
Discussion points from the ENGAGE 'Innovation in Patient Engagement' Conference
Andrew Spong's insight:
Some of these suggestions have utility, some of them don't ring true to me.
Principally, anything that describes itself as 'patient engagement' is seemingly predestined not to be.
Actually, I've come to really loathe the term 'patient engagement'.
It makes people sound like unknowing participants in a social experiment, and is deployed in pitches, articles, and conversation with no clear idea as to what it actually means.
Trying to define what 'patient engagement' means to you is more than likely going to give you the uneasy feeling that if you described your observations to the very patients you're hoping to support, they wouldn't recognise themselves in your account as the people they are.
Your plan is in pieces before you've even developed it.
How can you overcome this?
By adapting, responding, and reiterating on a day-by-day basis.
This poses another problem: is your company capable of doing this?
Probably not -- and you're not alone in this regard
You may have seen a sketchy news item on the feeds this morning about facebook’s possible plan to make something approximating to a structured intervention into the millions of healthcare discussions that take place on its platform every day.
Currently, the social behemoth is very much on the outside of these discussions.
However, it would appear that facebook would like to turn this state of affairs around and become an active participant in the innumerable, vibrant interactions addressing every aspect of health in diverse languages across geographies on its platform.
On the basis of what we know so far, it isn't going to work.