Healthcare in the age of apps and clouds

Posted on Fri 28 July 2017 in Articles • 4 min read

For the last year or so I've had a shoulder injury. Thinking back, I did it in the weeks leading up to the birth of my daughter in August of last year. As well as writing, I love weightlifting but alas I'm not getting any younger and injuries don't just heal like they once did.

When my daughter was born I realised three kids was the tipping point and I had to choose between the domains in my life: family, work, writing and exercise. Family and work are non-negotiable and since I was injured and I wanted to rewrite my book, I decided to take time off exercise.

Anyway, a year goes by and I decide to hit the weights again but lo and behold the problem with my shoulder hasn't magically disappeared. So I checked myself into my local sports physio and got the diagnosis: I'd torn my serratus posterior muscle. This particular muscle helps to support the scapula and with mine dropping an inch, it affected my shoulder's mobility which under load is causing all the complex network of tendons and muscles in the shoulder to catch and inflame.

I'd torn my serratus posterior muscle

As you'd expect, the physio prescribed me a series of isolation exercise (which I hate because I prefer compound movements) designed to strengthen the surrounding muscles.

As she rattled off the list of exercises, sets, reps and recommended weight limits, I asked her to note them down for me on a piece of paper. But as in all avenues of life, she patiently told me there's an app for that.

Using a browser, she constructed the programme and told me to download Physiapp from the App Store. I remarked the name sounded like a a soft drink brand, and she had good grace to smile at my joke. She gave me a code to access the programme and so the regime began.

This is where treatments diverge and new technology starts to encroach on old ways of doing things.

I can't fault the app, at least functionally (design is another matter, though not relevant for the discussion). It lays out the exercises I need to complete including the sets and reps and, where relevant, the weight to use and/or the length by which to hold the movement. The exercises are each demonstrated with a video, complete with voice-over description. Videos can be downloaded for offline viewing, which is nice. Finally the app tracks your progress and nags you with push notifications and badges (which I set up and had quite a bit of control over).

In summary, it's a very useful way to manage your treatment away from the clinic.

Wider issues

Medical and healthcare is rapidly being transformed and my recent encounter is just the tip of a growing iceberg. There's big ethical and technological issues at play, not least around privacy and security.

Physiapp is a two way mirror. In addition to what I see, my data is also being pushed back to my physiotherapist. She can track my progress, we can message each other and by the time my next appointment comes around, she'll be able to use that information to refine the treatment.

That's awesome, but the nerd in me is wondering who else has access to that information and what is potentially being done with it.

The question is valid, not least because Australia is in the process of migrating to an online medical record system managed by the Commonwealth Government. Considering how inept the Australian Government is at big IT projects and security, and the our current prime minister doesn't understand mathematics you can forgive me when I say I'm sceptical.

What I'd like to see

I have no conceptual problem with digitising health and medical data but I prefer a decentralised approach. Medical data should not be stored in a honey-pot data centre (especially one controlled by the Australian Government). That data should not be available to anyone unless by my explicit consent and then only for a limited time. I do not want companies (research bodies, insurers etc) accessing it for the purpose of big data mining and analysis.

Medical data should be stored by individuals using the encryption method of their choice. When you visit a healthcare professional, you should be able to share data with them visually (i.e. they can eye ball your device once you unlock). If data exchange between devices is required, then it should be key-based and temporary with data self-destructing after a specified time.

Why it won't happen

Yeah, I'm smoking medical cannabis if I think that will work. Basically, my preferred choice is a pipe dream and the fault rests with us, the populace, rather than government.

For the great unwashed, a government controlled public store of medical data is more practical because:

  • Most people don't know how to encrypt data properly.
  • Not everyone has a smartphone (or computer) with which to store, encrypt and retrieve data.
  • Health care professionals don't want to deal with dozens of different encryption systems and/or apps.
  • You can't easily decrypt your data if you are incapacitated in the case of emergency or illness.
  • Scammers, phishers and hackers are smarter than the average Joe/Jane.
  • Government and corporations love big data.

Oh well, I guess it will be amusing when the first hack or leak happens.

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