Healthcare In The Digital Age

Introducing the iMoko! eHealthcare at your fingertips!

This was the topic Dr. Lance O’Sullivan, New Zealander of the year 2014 talked about to a room of aspiring doctors. Dr. Lance is a GP in a small rural city in the far north of NZ. He is also the inventor behind a new app known as iMoko. The app was developed to reduce the number of preventable hospital admissions by infectious diseases. Particularly skin conditions such as impetigo, infected eczema, etc.

The app is used in schools by volunteers-and this point was stressed quite clearly and repeatedly by Dr Lance- who are NOT medically trained. They are from different backgrounds eg. IT, accounting, teacher aids, etc. He told us that these volunteers receive a maximum of 30 minutes training on how to use the app, along with small clinical devices such as a thermometer, pulse oximeter. They then visit students at school that teachers are concerned about, to perform a ‘clinical assessment’. They proceed to take pictures of any skin lesions and a supporting video if necessary.

This information is then uploaded to a cloud where other volunteers assess the information, make a diagnosis, suggest a treatment and submit the case for approval. At the end of the line, a doctor either approves or disapproves the case. If it is approved, a referral is sent or a prescription is to be processed.

Dr. Lance moved on to say that many kids have been treated through this app and the consultation time for him was a mere 15-30 seconds as opposed to the 15 minutes you get with your general physician. He also added that the volunteers were practically at the level of ED triage nurses after a 30 minute training on how to use this app. Finally, he concluded with the statement that this is the future of healthcare. And that in a country of 15,000 doctors, we only really need 5000. And soon we won’t need any.

……..well I’m sure you’ve realised that I have some thoughts on this.

First off, Dr. Lance seemed like quite the salesman. He was very persuasive that his idea was revolutionary. Okay that’s a bit catty. But it’s true to a certain extent.

Secondly, I like the idea. No really, I do. The intent of the app was to reach children in places with difficult access to healthcare and easily curable (but potentially fatal) diseases. That, by all accounts is a good thing.

Where I have issues is this whole “volunteers who are not medically trained” business. Not because I think trained doctors are superior to others or anything like that. But come on. Dr. Lance was essentially suggesting that a 30 minute app tutorial > 6 year medical degree. I’m sure I am not the only one who has issues with this. Would you be happy with someone with an IT background taking your temperature, looking at your skin lesion, taking photos of it to put on a web app and have other people with nor medical background diagnosing and suggesting medication for you? I wouldn’t.

And that’s another thing. Where does patient confidentiality fit into this app? Essentially, the volunteer doing the assessment and all the volunteers on the app have access to patient information. Including their NHI number (the index number that provides access to their entire medical record), name, etc. Patient confidentiality is an endlessly stressed topic at med school. You would get into all sorts of trouble if it is breached and if any confidential patient information is revealed. Who’s to say these volunteers have had training in confidentiality? How can we monitor that they are not showing this information to others (who are not volunteers) as part of their assessment?

Then there’s respect. Photos on this app can be of anything. Regardless of which part of the body the lesion is on. How comfortable would you be about having a bunch of pictures of different parts of your body (including your face, as there is generally an attached video of the patient) on a web app for many people to see. And you wouldn’t necessarily know who was viewing this info?

Another thing I was really iffy about was Dr. Lance’s nonchalance regarding these risks. During the talk, one of the other doctors present expressed her concerns about the possible risks of this app. To which, Dr. Lance smiled, said “good question”, and then turned to the rest of the audience and asked “How many of you believe our current health system is 100% risk free?”. That was a complete salesman response, in my opinion. Turn a question into another question to divert away attention from the fact that the person was unable to answer the question (or was reluctant to). Whether or not our current health system carries risks is in no way a justification for the risks posed by this new app. Because we should all be striving for a 100% risk free system. To say that yes we have flaws but atleast we’re better than, say, West Africa’s health system is really not a good comparison and is really nothing to boast about. I think it was pretty clear to everyone that Dr. Lance was not interested in addressing the risks of his app even though he may be aware of their existence. He seemed to be more interested in selling the idea that this is the future of healthcare and face-to-face consultations will become obsolete and we won’t need as many doctors anymore.

This is something that I really struggle with. You hear a lot about robots taking over human jobs and doing them better. But in a field such as healthcare I really fail to see how humans can become obsolete.

Yes you can have a machine dispense medication. But you can’t beat the important role of the pharmacist in recognising pitfalls and contraindications in the prescription based on the patient’s history.

Yes you can have a robot in the emergency room bringing water/food, checking temperature and asking patients their current level of pain out of 10. But you can’t substitute the nurse’s ability to recognise when a patient is in distress and provide the appropriate support and action.

Similarly, yes you could probably devise an algorithm to diagnose disease (I assume this is how the volunteers suggest diagnoses and treatment, as Dr. Lance failed to elaborate on this). But there’s no way you can beat a doctor’s ability to see a patient and rule out several possible diagnoses that carry the same symptoms for the correct one in that particular patient. As well as provide support, respect and that human touch in the doctor’s role that goes so much beyond just simply diagnosing and treating.

Does anyone out there have any views on this? Would like to know how others feel about this app.


  1. thehaystackonthehill · June 24, 2017

    “To say that yes we have flaws but at least we’re better than, say, West Africa’s health system is really not a good comparison and is really nothing to boast about.” Where did I read this?


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