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Tuesday, July 02, 2013

Doctor Google and Nurse Pharmacy

Predicting the future of healthcare is a massive subject and one consuming increasing amounts of time of Governments (who are terrified about the costs), companies (who perceive a huge business opportunity) and older people (who are anxious and confused) about how their future healthcare will be funded and delivered.

What follows is my view, in the broadest of brush strokes, about one future scenario. In one form or another something like this will happen. What we don’t know is when and exactly how it will look.

What do we know for certain?

We all know that in the US, Europe and much of Asia Pacific there are rising numbers of older people who consume more healthcare costs than any other age group. In most countries, 20% of the population accounts for 80% of the healthcare costs and most of these are older people.  This is happening at a time when the ability to increase personal or government spending on health provision is at best static and more likely to be declining.

The problem signs are all around us. The NHS in the UK is now regularly referred to as the National Hysteria Service, rocked by scandals of poor standards and lack of care – it is in bad shape. The US already pays an astronomical amount for its healthcare and yet it is still has numerous problems. Recent reports from China suggest that things are no better, probably a lot worse, in this rapidly ageing country.

The result is that healthcare provision is fragmenting into the expensive and very good (for the few) and the mediocre to downright awful for the masses.

This is an ultra-simplistic view of a complex subject but I don’t think it is that far away from the reality.

My doctor friends all say, often with a tone of annoyance, that there is a growing group of patients that arrive having already completed an extensive search on Google about their symptoms. They are armed with a list of questions and often an initial diagnosis.

To improve their diagnosis these patients are increasingly using a selection of the diagnostic devices and services from their local pharmacy.

This is a list of the products sold by CVS Pharmacy, a company with 7,500 locations throughout the US:
Thermometer
Diabetes (Glucose) testing
Blood Pressure measurement
Alcohol level tests
Steroids levels
Cholesterol and Glucose testing
Drug testing kit
HIV testing kit
Urinary tract infection diagnosis kit
Gender prediction test

In addition to the local pharmacy there are numerous specialist medical equipment web sites that sell products and services that test for:
Anaemia Haemoglobin
Bladder infection
Blood group
Bowel disorders
Chlamydia
Ketone levels
Bladder infection

It is unlikely that this trend for self-diagnosis is a short-term fad. Instead, it marks a fundamental shift in the power balance between patient and professional medicine.

Of course, this desire of patients to become more involved with the health should not be seen as a threat to the traditional doctor-patient relationship but rather as way to improve its effectiveness.
 
My interest in this subject first started when I read about The HeartCheck  Pen that is a handheld ECG recording device, cleared by the US Food and Drug Administration (FDA), Health Canada and provided CE certification for consumer use.

The device and accompanying PC based software is an over-the-counter product intended to record, store and transfer single channel heart rhythm signals.




The company, CardioComm Solutions from Canada, very kindly sent me a device and the software to evaluate. Not from a medical perspective but from a marketing and ‘age-friendly’ viewpoint. 

Holding the device, as shown in the illustration, records the ECG information that can then be loaded to your computer via a USB cable and then uploaded for analysis by a professional ECG call service.  Reports can be printed and then shown to the person’s doctor or specialist diagnosticians when they go see them.

It takes about 30 seconds to record an ECG and very little time for the upload process.  When I recorded my heart signal for review by the company’s medical call centre in the USA, I received a physician’s ECG interpretation and ECG report to keep in around 10 minutes. Fortunately, my heart seemed to be in reasonable shape.

When you think of the time it takes now to have this ECG test and then for your receive the interpreted results and recommendation (if needed) from a physician, you can see that HeartCheck  Pen is a real game-changer. Imagine catching an arrhythmia when you experience it, regardless of when or where it happened.  

It is not just the reduction in time to have the test but the impact it has on overall health care costs. The HeartCheck Pen costs all of 259 US dollars and the cost for a North American physician interpretation of an ECG is 12.50 US Dollars. Testimonials on the use of the HeartCheck PEN and the SMART Monitoring service are now being listed on the company’s website.

This video gives a more detailed explanation how the product and software work.






I reviewed using the device using the AF Audit Tool that is explained in my most receive book – Marketing to the Ageing Consumer. The company was anxious to get my feedback about what worked well and things to improve.

This is an ultra summarised version of the feedback of my findings:
When a device is sold directly to consumers the design has to be intuitive. When there are no opportunities for the customer to ask the doctor or pharmacist about its operation the interface has to be extremely well designed. In most ways this device works well but there areas for improvement. There is always the option to email or call the company’s customer support for assistance.

The same argument applies to the documentation. Jargon must be minimised, wording simplified and the most common customer questions anticipated. These are things that should be done as standard by all designers. 

By the nature of the product, the majority of its users are likely to be in their 50s, 60s and older. At this age, physiological ageing is having an effect on the customer touchpoints, in particular the product design. Failing eyesight, dexterity and cognitive powers compound the challenge of creating usable products and easy to use documentation.
There are things about the HeartCheck Pen that can be improved but these are not insurmountable challenges when compared with amazing innovation required to create the product.

With the HeartCheck  PEN, CardioComm Solutions has pushed the boundary of home health monitoring and diagnostic services. The company is working with many distributors interested in providing the product in in Europe and Asia Pacific.  The products are available online until then. Dick Stroud

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