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Apple, WWDC and Health

Next month I’ll be in London for one of the Monty Python reunion shows. In their 1983 movie, The Meaning of Life, Michael Palin played an condescending hospital manager who wanted to make sure everyone appreciated the machine that he had bought, the one “that goes ping”. The joke was based on the notion that hospitals-know-best and that technology was one way that healthcare can assert its power over patients.

31 years later and the iPhone in my pocket outstips any machine the hospital has that goes ping. For instance, the computers in my hospital run Windows XP Professional, an operating system from 2002. Meanwhile yesterday, Apple announced Health, an app that will come as standard in iOS 8, the next revision of Apple’s mobile iPhone/iPad operating system. It’s not the do-everything, life-saving app that some people will have been expecting, but it’s a subtle statement of intent and when taken into consideration with Apple’s announcement HomeKit and SDK extensibility yesterday, there’s a smart long game ahead.

Let’s break down what all that means:

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Why must we wait so long, before we see?

Here we go again…

There is a story in the news, this time from Australia, about charging patients who “shouldn’t be in the emergency department”. Here’s someone tweeting about it:

The Sydney Morning Herald reports:

…state-run hospitals will be given the power to impose a fee of about $7 to stem a potential rush of patients from GP clinics to free public hospital emergency rooms.

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Every chance, Every chance that I take, I take it on the road

It has been an interesting few days as the hospital I work in has been in the news for overcrowding. There sometimes feels like there’s a disconnect between overcrowding and patient safety. On one hand, the international evidence repeatedly shows that ED overcrowding has a negative effect on patient outcome, with increased morbidity and mortality. On the other hand, we are all working in busy EDs, and many patients are getting timely, appropriate care from hard-working staff in spite of these pressures. We are hanging on, doing our best, etc, etc.

The disconnect is because while overcrowding does increase patient risk, it doesn’t change the outcome for every patient. The best way to explain this is by the speed limit analogy.

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Clang, clang, clang, went the trolley…

Earlier today, IEMTA, the Irish Emergency Medicine Trainees’ Association were in the news for a letter they sent to Irish statutory body HIQA ( the Health Information and Quality Authority) highlighting the dangerous level of overcrowding that’s currently happening in Irish EDs. You can read about it here.

It was the lead item on the national lunchtime news here. Some thoughts…

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Changes are taking the pace I’m going to…

Interesting little article from Forbes Magazine about venture capitalists looking for opportunities in healthcare. As the article points out, in the US, healthcare is 17% of GDP – there’s money to be made in any tech disruption that catches on in clinical practice.

The disruption is more likely to come from the outside-in though, isn’t it? Healthcare institutions are slow to move and change. If venture capitalists and others are trying to find weak points in the healthcare system which are ripe for exploration, investment, innovation and ultimately success, why not focus on patients? By that, I mean the patients should be the carriers/distributors/end users of the disruption. There are more patients than clinicians and patients are individuals while clinicians are invariably part of an institution. If this disruption is delivered to patients, and it delivers a useful change for the patient in how they receive healthcare, well then it should hit a critical mass and it will have to become a utility for clinicians and healthcare institutions.

But what will that disruption be? I’m still trying to figure that out…