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Quackery and snake oil – maybe that IS the state of health tech

Firestorm from the American Medical Association.  A few weeks ago, the CEO of the AMA, Dr. James Madara, said what few others will say: "…the explosion of direct-to-consumer digital health products, to apps of mixed quality – it’s the digital snake oil of the early 21st century."  And if that weren’t enough, he compared the technology innovations today (including "ineffective" EHRs) as analogous to the challenges confronting 'quackery' when the AMA was founded in 1847.  Then came the chorus of rebuttals from health IT folk and the Boston Brahmins of digital health, including Dr. Joseph Kvedar ("telemedicine is unstoppable") and Dr. John Halamka ("no snake oil to see here!").  But adults are downloading health apps – in one study, at least half of the surveyed population had downloaded at least one.  Using, not so much.

Was this 'the emperor has no clothes' moment? Despite defensiveness all around, he is right. Consider the Google Play store, where a search for "senior health apps" includes Eddie’s Health Shoppe (100 downloads), LinkedIn (50 million downloads) and Solitaire (5 million downloads), plus an app for searching for senior living communities in Florida.  Are any of these apps curated by someone?  Are the apps useful or is the only metric we have that they were 'downloaded' – in which case, it appears, 90% are tried only once (and then deleted).  Consider this article, which might be better titled Most Health Apps Are Junk.

Now consider Dr. Madara’s EHR observation.  The AMA CEO also made this comment about interoperability: "We were told that interoperability was the future; we didn’t expect that it would always be in the future." Doctors are noticing that the EHR replaced the doctor-patient relationship with the EHR-patient relationship – the doctor cannot look at the patient and the screen at the same time – and the visit isn’t long enough for both.  We all have examples of this with our doctors – who are becoming used to watching the screen versus the fully clothed patient.  One glance over at the patient between screens, then shake hands and done. There is lots of talk about the annual physical being obsolete, and should be skipped by healthy people.  Along with other self-treating, we are to self-assess that we are healthy? Should we do this with a symptom-checker? If you have no symptoms of these diseases (checking off your body parts one at a time, of course), then can we declare ourselves healthy? 

Version 3.0 will be better.  Consider that online health system portals ("Don't call us, get your test results here") and WebMD symptom searches pioneered version 1.0 of health tech. Now consider that the tsunami of ‘health’ apps and zombie health companies are part of today’s version 2.0 – the over-investment and under-deliver stage, in which billions are invested, turned into zombie companies to be seized by bigger firms, likely to accelerate time-to-market of either a product name or the kernel of a good idea.  In the v3.0, health apps will be curated – recommended or not for a health-related use.  The symptom checker will be augmented with a voice-enabled search -- it's easy now to say to a smartphone "what are the symptoms of arthritis?" and get an abbreviated Mayo Clinic answer.  So then one day a bit of AI will be added: "Here are my symptoms...what do I have?"  And voilà! The silly Firesign Theatre 1968 Beat the Reaper vision will have been tech-enabled.  


Physician heal thyself. When James Amara pointed fingers at the digital health app ecosystem he forgot to do the self-flagellation that should come with it. Apps and the medical profession should work hand in hand. There is an equal amount of snake oil in the medical profession. And, as long as health care consumers feel the need to find their own solutions, apps often offer a good experience -- sometimes equal in satisfaction to a doctor's visit.f

And all the while the AMA and others conduct efficacy trails of telemedicine vs traditional care not using real patients but actors with made up conditions. Then they denounce the utility of the entire telemedicine industry; Firesign Theater indeed. I basically agree regarding singular apps, but I have reviewed an AI driven app (platform really) which replicates the traditional physicians bedside interview factoring in remotely harvested vital signs and environmental data. The results are accurate as adjudged by traditional clinical standards of success.

Maybe I'm just cynical, but do ANY of these apps provide anything of value to me? Or is all the value reserved for only the vultures to whom they want to remarket the information harvested from me? I've pretty much assumed that there will be zero value from any kind of health app until data breaches are prosecutable and the companies that build broken security or do illicit data sales can be fined or held liable when it winds up in the hands of others. Until that point they've no motivation to serve the customers -- except as an entree.

Wise words for me as I develop my dementia app! Thanks!

 Consumerization of healthcare is inevitable as the mobile-first, social-first generation ascends. And like early CRM systems, designed for 'the bosses' rather than the users, faltered, so are EHR systems designed for bureaucrats rather than clinicians. Add vendor & institutional impediments to interoperability and no wonder it's a mess!