E-health dossier – Korben

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thanks to Juan and Lou for this article on e-health, which I hope you enjoy.

Everyone is talking about e-health, but is it really useful?

In recent years, we have heard of "e-health", whether on television, in newspapers or on the radio. This is a very large field, and most of the information comes from companies that develop their own solutions. Therefore, it is difficult to sort out the good from the chaff.

In this article we will first establish an inventory to then segment the approaches by having a medical vision of the market.

report published in January 2015 by the Council of the Medical Association

M-health concerns smart health connected objects and intelligent sensors as well as applications related to health and well-being. Some examples of smart health connected objects are for example blood pressure monitors, glucometers and smart health connected scales. New objects are appearing such as urinary sensors (cf. Scanadu) and blood sensors, but which have not yet been approved by the FDA (Food and Drug Administration, an organization responsible for medically validating new procedures or objects in relation to health).

smart health connected blood pressure monitoring

a list of registered blood pressure monitors as part of market surveillance by the National Medicines Safety Agency (formerly AFSSAPS).

These calibration variations can lead to over or underdiagnosis problems in some cases. And there is no study to date that proves that taking your blood pressure every day several times a day guarantees better management of high blood pressure.

smart health connected scale

MyBiody Balance do not just give weight: they break down body masses (water, bone, fat mass, muscle mass) and give precise indicators thanks to bio-impedance technology.

Bio-impedance is the measurement of blood pressure by sending a light electrical current through your body.

The user discovers, for example, the number of pounds of excess or deficit body fat, and can compare his personal situation with that of a healthy person of his age and sex. He can thus set goals (gain muscle mass, etc.) and observe their evolution on a daily basis.

smart health connected glucometer

Nielsen's marketing data which show that most of these objects are bought by young people between 25 and 44 years old, rather of medium-high socioeconomic status. The age group is the least sick, it is likely that she was already paying attention to her health before buying them. In addition, such a short use does not allow any analysis as the survey says “One third of wearable device owners stopped using them within six monthse ?.

In conclusion, their public health impact therefore remains very precarious, not to say nonexistent.

The Dr Pierre Simon, president of the SFT-ANTEL, noted, in an article published in March 2013, that “most of the trials analyzed until the end of 2011 did not show a significant impact of these mobile technologies on the health of people or the patient and healthcare professional behavior "

Prevention nevertheless remains a major problem for doctors, just as important on an individual basis as in terms of public health. But much more serious problems like addiction to tobacco or alcohol have a significantly greater public health impact than walking 10,000 steps a day. These new technologies have shown recurring failures. Take the example of apps to quit smoking.

The European Commission has created an application called ExSmokers here are the latest comments:

DMD post embarked on the daunting task of analyzing them. They showed that of the more than 100,000 apps on the app store, there are only a handful of apps that are really useful from a medical point of view.

Telemedicine is the set of means for monitoring the patient remotely whether at health home or in relatively sophisticated cabins. The field can concern all branches of medicine, orthopedics, radiology or even psychiatry.

We can see that the demand is real by observing the success of Doctissimo, nevertheless the real patients are not followed by a website, but by a very real doctor.

Several media refer to it as a solution to the low medical demography. It is likely to be part of the answer, but unfortunately incomplete. For example, imagine a state-of-the-art cabin in a village hoping that this cabin can replace a retired attending physician.

Problem: Babies and young children cannot use this type of product. So what to do?

Their purchase, maintenance and operation require significant sums of money. Wouldn't this money be better spent training and encouraging new generations of doctors to settle in these less populated regions?

Applications like myDiabby or Cardiauvergne are interesting and promising, but it is still too early to measure their impact in real life.

To give you an example (and make you a little more aware of reading medical studies), with this last project, the study has no control arm, that is to say that it does not compare the using this device against not using it. If we don't compare, how do we know if we're doing better?

They also planned to recruit 2,000 patients, but after a year they did not recruit any. that 558. You should know that an insufficient number of patients makes the results uninterpretable. This is the very definition of the power of a study. In addition, the difficulty in finding patients reflects the fact that the criteria (autonomy, for example) to include them in the study are strict and that the population that responds to them is rare among patients with the same disease. We could deduce that with an identical disease (heart failure), there are differences in severity which lead to a loss of autonomy. In addition, the patients who cannot travel to study are the patients who are most affected by the disease. As a result, the population covered by the entire study is not representative of all patients.

And unfortunately, the results consequently cannot, in the state, be extrapolated to the whole of the patients having the same disease.

Another example, which appeared in a study published on May 26, 2015 in the Journal of the American Medical Association (widely respected internationally by doctors), the title of which is “Antibiotic Prescribing for Acute Respiratory Infections in Direct-to-Consumer Tele-medicineé? (Prescribing antibiotics for acute respiratory infections directly to patients in the context of telemedicine?), Shows an overprescription of antibiotics, which poses a problem of emergence of resistance, which ultimately costs society much more dearly. .

However, we can cite some very simple examples of operation which have proven to be effective: this is the case of SMS intervention as support for treatment in asthmatic patients, or to improve adherence to anti-platelet treatment after implantation of stents (Timone AP-HM cardiology department).

Telemedicine is certainly part of the world we are heading towards. She uses m-health in a medical context to make sense of the variables we measure. It is important that this approach develops more and more. However, there are still elements that must be associated (but we will come later) to this approach in order to be able to constitute a coherent, practical, useful and lasting whole in the care of patients.

Telehealth includes what we talked about earlier, but I’m adding all that is forum and patient associations on the internet.

It is obvious that the success of these platforms reflects the need that exists among the population. Doctors have less and less time during the consultation when the pathologies are complex not only from an organic point of view, but also in the patient's organization of life, as is the case with diabetes for example.

For the management of chronic diseases, referring the patient to a community of patients has always been in French recommendations. Obviously, new technologies have made it easier to connect patients, as they have done with the general population. We can only encourage this type of approach.

Likewise, the arrival of serious games is applauded by all health actors.

The definition of “serious gameé? for those of you who don't know it is being able to play a game and at the same time learn something about an illness. An example is this game. There are a thousand on the internet.

When it comes to online medical advice, as a healthcare professional it is almost impossible not to be apprehensive about the possibility of treating a patient from a distance. It is a process that is widespread in the field of psychiatry in France like abroad. However, its use in conventional medicine is problematic, as examining a painful shoulder, abdominal pain, headache, or even a rash requires contact with the patient.

All of these elements are part of what we call e-health.

We cannot talk about this subject without the first question that comes to mind:What is the use of using all the previous elements if my attending doctor is not aware of and cannot use this data?é?

Unfortunately, we all know, this is far from being the case. This is explained by a myriad of reasons. The lack of reimbursement, oligopolies on business software, doctors limiting the transfer of information to keep this famous oligopoly, the lack of ergonomics for the doctor, etc.

This extra-hospital problem has its equivalent inside hospitals. At Pitié Salpêtrière, the appointment scheduling software is not the same for each hospital department. And the same goes for reports after a consultation or hospitalization. So you should know that when you come to the emergency room of a hospital saying "Do you have my whole file?é ?, the answer will be negative most of the time. We have, in the best of cases, part of the file, but certainly not all.

It is therefore illusory to think that in 2015 we could talk about Big Data in healthcare in France. If we had a little bit of usable data, we would have already made great progress.

However, it would be awkward for me to say that the hospital IT departments are not doing their best to ensure that these tools work properly. In their defense, the maintenance of this software would perhaps require a few days per year and per software. For a hospital, this is a big organizational problem.

E-health is therefore still a virgin territory despite all the players already in place. This article should be interpreted as an ode to innovation, because there is still much to do!If you like this article, we will write a next on the different tracks that are currently developing on precision medicine, which is truly the Holy Grail of medical technology.

As a small overview of this evolution, I share with you the projects we are currently working on in Bress Healthcare, a company created as part of a desire to combine medical skills with those of " Tech Engineer ". The goal is to be able to meet the daily expectations of doctors using new technologies. Bress Healthcare focuses on the synergy between new technologies and doctors in order to significantly improve the quality of patient care.

Our different projects follow the same vision dictated by the observation that the interaction between doctors and new technologies can only be beneficial for the healthcare system as a whole.

Our first application is Stare Lab: the first French-speaking digital application for orthoptic vergence rehabilitation. It was developed in collaboration with orthoptist, Marc Fauveau, who notably wrote an article of about twenty chapters to explain the interest of vergence reeducation and the Stare Lab tool.

Our next project is a smart medical remote app called Igakoo (medicine in Japanese), which will allow different doctors to request an opinion from the national reference centers on several diseases in a secure, practical and ergonomic way. The creation of this platform will give us a know-how in relation to obtaining and analyzing medical data. We can then further develop this know-how in a much larger medical algorithm project. This project will constitute a global, intelligent and evolving system of aid to care by following the latest French recommendations on patient monitoring.

It is nevertheless important to remember a concept, the goal is not to hacker medical knowledge, which is illusory at the moment, but to work in synergy with it. It will nevertheless remain essential not to submit to the rigidity of the system.

About the authors:

Juan

General medicine intern at the Paris Descartes Faculty of Medicine. Currently in preparation for his medical thesis which deals with the realization of an online decision algorithm. Very interested in new technologies, Juan developed a search engine for general medicine consultation called Tools & Docs which he has already presented at three Medicine Congresses. Juan and the Bress team met in March 2015, following a thunderbolt in terms of their visions and strategies, Juan joined the team as co-founder.

Lou Husson

Lou is a co-founder of Bress Healthcare as well as Evangeliste Europe for “The French Tech Alumni Network: While42.E?

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