Mobile healthcare services:

Opportunities for GCC hospitals

Dr Mohammad Al-Ubaydli
A bit about me…

Trained as physician at the

University of Cambridge.

Trained as programmer and

worked as NIH Staff Scientist.

Honourary Senior Research

Associate, UCL Medical School.

Continuing research on PHRs from

2,700 US hospitals, new book in
2010: book.patientsknowbest.com
The power of decentralization
The power of decentralization
The power of decentralization
Patients Know Best
Customers use our platform to
save money from shared workflow
1. Ramsey Health Centre and London
Medical wanted us for online consultations
2. Bupa and Great Ormond Street hospital
wanted us for electronic prescribing
3. Next year, 15 more NHS hospitals join
4. Global service to EU, USA and GCC

We can do what Microsoft,

Google and the NHS cannot do
 Roadmap
1. Basics: definitions, and why do this at all?
2. Today: letting go of assumptions
3. Mobile: what is worth doing?
4. Tomorrow: embracing possibilities
GCC: unique environment
 GCC: unique environment
Possibly the world’s best ecosystem for m-health
Wealthy population embraces high technology: 194 mobile phones / 100 UAE residents

Willing to travel across state lines to receive high quality medical care

Used to paying out of pocket for health care and for mobile phone premium services

You must plan how to win these customers for your hospital
Some definitions
Clinicians Patient

Electronic patient records Patient portals Personal health records Personal records
Some definitions
Clinicians Patient

Electronic patient records Patient portals Personal health records Personal records

Data by clinicians
for clinicians
Some definitions
Clinicians Patient

Electronic patient records Patient portals Personal health records Personal records

Easing the patient’s burden

Scheduling appointments

Ordering medication refills

Secure messaging

Access to the EPR

See: Pyer et. al 2004, Ralston et. al 2007.

Some definitions
Clinicians Patient

Electronic patient records Patient portals Personal health records Personal records

Data by patient for patient

Powerful but unstructured

NHSmail users have mailbox shrunk

06 Feb 2008

NHS staff who use the health service’s email service NHSmail have been informed that
after a recent move to Microsoft Exchange their mailbox size has been capped.

Some 80% of NHS accounts have been capped at just 200Mb, which
appears miserly compared with the hefty 6Gb offered by Gmail for free, or
the 5Gb offered for free on Windows Live Hotmail.
Some definitions
Clinicians Patient

Electronic patient records Patient portals Personal health records Personal records

Markle Foundation’s ideal PHR:

Access controlled by patient

Lifelong records

Information from all

Universal access

Private and secure

Transparent

Easy exchange

See: Connecting for Health, 2004

Why do this at all?
There is no other way to cope
Aging and obesity mean more illnesses per patient

Modern medicine means more clinicians per patient

Budgets and workforce have reached their limits

Your patient is the newest and best

member of your team
Google means patient more useful than ever

Work together online to reduce stress in clinic

Doctors are waiting to do this, if only

management will them proceed
See: Chen 2009
 Roadmap
1. Basics: definitions, and why do this at all?

2. Today: letting go of assumptions

3. Mobile: what is worth doing?
4. Tomorrow: embracing possibilities
Patient-held records already here
Some parts of some health systems have already had them
In continental Europe and much of GCC, this is the norm

UK private health care, and US fragmented care, patients end up doing this anyway

NHS maternal notes and child personal health record use the patient to cross silos

Distribution is arbitrary, but users assume otherwise

 Conflict is gone
Discomfort clinicians feel is due to limitations of paper
Piece of paper cannot be in two places at the same time

Transporting paper takes time and money

Clinicians do not feel safe unless they hold the only copy of the paper

Digital records eliminate the conflict

Patient-controlled records awesome
This is the only way to bridge the silos
Within “integrated” systems like NHS and Kaiser Permanente, clinicians do not talk to each
other across community and hospitals

Within single institution e.g. hospital, clinicians do not talk to each other across departments

Within same department, clinicians do not talk to each other across specialities

The patient is the only person who turns up to all the

appointments, so give them the records
Patients should manage their clinicians
Unique patients require truly patient-centred care
In a rare chronic disease, the patient knows more than most of the clinicians they meet

There are 30 million people with rare diseases in Western Europe and the USA

But even patients with common diseases have unique combinations of diseases and
circumstances

Every patient is unique

 Roadmap
1. Basics: definitions, and why do this at all?
2. Today: letting go of assumptions

4. Mobile: what is worth doing?

3. Tomorrow: embracing possibilities
SMS: the mass medium
Alerts for timely, intimate information
Reminders about appointments, medications

Prompt to check web site for test results and other

information from clinicians

Receive some limited data (e.g. “Are you better, the same or
worse today?”)

But do not include clinical data

 Collect data
Patients are producers, not just
consumers, of medical data
Patients: affordable data collection device

Clinicians: track data never before possible

Managers: monitor patient satisfaction

Researchers: layer on location data

Powerful feedback loops

Authentication and
authorization, not storage
Resist the temptation to store data
Repeats the same problems of paper: no simultaneous
viewing, and difficult synchronization

Whatever you think is the standard, you are wrong: do not

lock up your patients

Data cannot be migrated between handsets

Data cannot be trusted by health providers, or used in a

timely manner

ICE: spread the meme

 Web, not apps
App stores are temporarily sexy
Each app store fragments development efforts

Approvals processes increase costs of development and

distribution

Arabization and accessibility are big problems

Treat your patients, not their handsets

Follow your patients…

 Roadmap
1. Basics: definitions, and why do this at all?
2. Today: letting go of assumptions
3. Mobile: what is worth doing?

4. Tomorrow: embracing possibilities

Patients with HIV publishing all notes
Patients use (much) better tools than you
Patients use (much) better tools than you
Patients have better genetics tools than
99% of clinicians do (or ever will)
Patients will collect data you never knew
Patients will collect data you never knew

Useful web sites

Patients Like Me for HIV: patientslikeme.com

23andMe for genetic sequencing: 23andme.com

RelifeInSite for pain documentation: reliefinsite.com

Lifepsychol for monitor quality of life: lifepsychol.com

Personal health records: A guide for clinicians

Al-Ubaydli, 2010, John Wiley & Sons
http://book.patientsknowbest.com
 Mohammad Al-Ubaydli
Patients Know Best
team@patientsknowbest.com
www.patientsknowbest.com

Thank you for listening