Welcome - 1 January 2018
Happy New Year to all our friends and collaborators.
2017 proved to be a year of progress for RemoteHealth Tech with the development of our prototype remote heart rhythm monitoring platform, the signing of our first commercial agreement with a strategic partner and the growth of our digital health memberships and new bases at Health Foundry in London and MediCity in Nottingham.
2018 promises to a landmark year with plans to launch a commercial version of our platform and the imminent beginning of an exciting collaboration with a leading university department.
The latest addition to our blog is a description of an event we participated in thanks to our membership of UCL Digital Health Institute Industry Club at UCL Institute of Healthcare Engineering - a three day workshop on frugal innovation run by the brilliant Dr Prashant Jha, Fellowship Director at the School of International Bio-Design (SIB) in the All India Medical Sciences Institute (AIIMS) in Delhi.
In particular Dr Jha's frugal innovation provides a systematic 'Discover, Define, Design, Develop' approach to developing priority healthcare innovations. Our multi-disciplinary team Demut - German for humility - of talented collaborators presented on the final day on our smart belt mechanical system to help prevent falls in people suffering from dementia.The workshop provided much learning to apply to RemoteHealth Tech's development plans.
Our other blog posts are available to read including details on the origins of RemoteHealth Tech, the inspiration provided by Nic Jackson, a talented young photographer, whose brilliant Red Dawn is the banner picture on this page and our observations on digital health and the value of self-tracking, and the potential role of community pharmacies as gateways to personalised medicine.
RenoteHealth Tech welcomes guest blogs covering our areas of interest in remote monitoring, person-centric medicine and digital health. Please contact us with suggestions at email@example.com.
Reversing India's approach to Frugal Innovation - 16 November 2017
UCL Healthcare Engineering Department: Saving the NHS Costs - The Frugal Way
Last week we were delighted to welcome our international collaborator Dr Prashant Jha, Fellowship Director at the School of International Bio-Design (SIB) in the All India Medical Sciences Institute (AIIMS), to run a three-day workshop on frugal innovation at UCL.
Day 1 - Listening to Dr Jha's engaging introductory lecture on frugal innovation
Reversing the concept of Frugal Innovation
The simple and appealing concept of frugal innovation - that more can be done with less in a faster, cheaper and more efficient manner - is a necessity in the healthcare landscape of emerging economies like India as medical doctors and nurses have to deliver services where infrastructure is limited. In India a significant proportion of its 1.4 billion citizens live near or below the poverty line and medical care is paid for out of their own pockets, meaning product development must be inexpensive in order for it to be adopted.
What is significant however, is that this low-cost constraint has not compromised the quality of the healthcare innovations coming out of India. Affordable, effective and accessible alternative solutions are being created for patients with regularity. This concept is so prominent in India's outlook that they even have a Hindi word for it; jugaad, an improvised solution borne out of ingenuity in adversity.
Conventional wisdom has framed frugal innovation as something only really needed for low-income countries. However, there has increasingly been recognition that developed economies could do well to adopt a similar, bottom-up approach.
As the NHS faces its own resource constraints, the question of whether the UK should be looking to learn more from India's expertise in affordable innovation has become particularly pertinent. It is our opinion that global learning should no longer be assumed to flow from high-income to low-income countries, but in all directions and in partnership.
Changing mindsets and practices the 'Frugal Way'
As the Fellowship Director of SIB programme and a life-long frugal innovator himself, Dr Jha was well placed to lead the three-day workshop. The workshop followed a four system process: 'Discover, Define, Design, Develop', devised and delivered in a similar format to the SIB's Fellowship programme, albeit in a shorter timeframe.
The week began with an open 'Frugal Innovation Mindset' lecture from Dr Jha before the workshop participants were split into small teams to develop, prototype and eventually present their idea based on an identified scenario.
Day 3 - Team Demut's intense prototyping ahead of our dementia anti-fall system presentation
Teams were encouraged to take the Global Affordable Need Driven Health Innovation (GANDHI) perspective and to apply this to real clinical needs within the NHS. Frugality was key to the whole process, with workshop participants constructing their own prototypes out of paper, felt, straw and other basic materials. This again echoed the SIB programme, where students typically only have an average $50 budget to make their prototypes.
The SIB programme is renowned for its phenomenal success in training the next generation of frugal health-tech leaders. It has produced innovations ranging from an affordable fetal monitoring device that aims to reduce stillbirths to a splint made of low-cost cardboard that allows the temporary protection of injured limbs.
SIB innovations frequently adapt ideas from other areas, such as a powered needle to access bone that borrows the same motion technique as an Indian carpenter's tool or a device that helps bed-ridden, non-ambulatory patients to pass stool by using a similar method as a catheter for urine. These products can be manufactured for the low-cost of under $2 and under $5 respectively.
Our workshop's emphasis was on replicating and nurturing this frugal mindset, which could subsequently influence workshop participants' ongoing research and day-to-day work. Dr Jha highlighted how adopting this new, agile way of thinking has the potential to save the NHS significant resources, which could then be directed towards patient care instead.
Strategic Collaboration with Indian Research Institutions
Dr Prashant Jha and Prof Sebastien Ourselin
UCL is developing a strategic relationship with SIB and AIIMS which will enrich our research base and activities in an equitable and bidirectional manner.
Prof Sebastien Ourselin, Director of the newly founded WEISS (Wellcome / EPSRC Centre for Surgical and Interventional Sciences) and Vice-Dean Health at the Faculty of Engineering Sciences, is leading this activity in conjunction with UCL Global Engagement Office.
If you would like to learn more about the workshop and UCL's activities in South Asia, including India, please contact Dr Rahima Begum (firstname.lastname@example.org) and Dr Amit Khandelwal (amit.Khandelwal@ucl.ac.uk) respectively.
Thank you to our partners
Day 3: Group picture after the prototype presentations
The workshop was led by UCL Institute of Healthcare Engineering in collaboration with the NIHR UCLH Biomedical Research Centre and supported by the UCL Global Engagement Office.
The SIB programme, which the workshop was modelled from, is funded by the Indian government's Department of Biotechnology and is a joint collaboration between Stanford University, All India Institute of Medical Sciences (AIIMS) and Indian Institute of Technology (IIT-D).
We would like to thank Dr Prashant Jha and all attendees for their participation in such a rewarding and fruitful workshop.
See article on UCL Institute of Healthcare Engineering website:
The Future of Pharmacies: leading new models of community-based care - 27 June 2017
On the 1st June, Lambeth, Southwark and Lewisham Local Pharmaceutical Committee and Community First Services Pharmacy Federation hosted an event in collaboration with Health Foundry on the opportunities that pharmacy has to take a lead role in developing innovative new models of community-based care with a range of partners from the digital and voluntary and community sectors.
Amit Patel, Chief Officer of Community First Services Pharmacy Federation and Chief Executive Officer of Pharmacy London, kicked off proceedings introducing us to pharmacy and asking the question "how can pharmacy play a lead role in bringing people together to transform community-based care?".
The vision is to ensure it becomes a true key player in primary care utilising all its key features. He mentioned the ability of pharmacy to promote self-care through easily accessible services, flexible opening hours, real understanding of local patient populations and the potential for a more cost-effective, efficient operating model. Amit also discussed the ability to work with a diverse set of partners and being able to truly employ family based care.
James Roach, NHS Transformation Lead at the National Pharmacy Association then set out the vision and strategy for pharmacy in the future and the importance of elevating the role of the community pharmacist in a changing NHS. He talked about the need for change and the benefits of redirecting non-essential workload out of general practice. He highlighted how our professionals must be enabled to lead that change and how positioning community pharmacy as a regional system solution could add value. James then discussed community pharmacy interventions and the importance of taking the continuous care brand forward.
We then looked at the innovative work already being done by pharmacy in all sorts of different settings and with different partners across the system. First to the stage were Lelly Oboh, Kat Le Bosquet, Gopal Ladva from Guy's and St Thomas' Integrated Care Pharmacy Team and Lambeth CCG Community Med Plus team discussing how focusing community support on those with frailty rather than those with highest risk of hospital admission can improve patient care and reduce hospital bed usage. This was a great example of pharmacy working in conjunction with secondary and community care to improve patient outcomes.
Next up was Clare Thomson from Lambeth and Southwark Integrated Heart Failure Service. She started by highlighting the shocking statistics around heart failure in the UK, showing that 900,000 people are estimated to be living with heart failure in the UK and 30-40% of patients diagnosed with heart failure die within a year. Clare suggested that with early and accurate diagnosis, access to heart failure specialists, prescription of evidence-based therapies and coordinated care can significantly improve prognosis, and quality of life. She highlighted the important role community and practice-based pharmacists can play in helping reduce unplanned admissions by helping identify and educate patients with heart failure, signpost patients to help, promote self-management and support medicine adherence.
Following Clare was Melanie Dalby, a Darzi Fellow discussing how by integrating the role of community pharmacy with secondary care it can lead to better support and outcomes for patients on oral anticancer medication.
Next on the agenda was a Q&A on becoming an independent prescriber and the experience of using this and working in General Practice with Atul Patel, Mohammed Mia and Fatai Papoola. Each pharmacist was asked about why they became an independent prescriber and the benefits that it has brought to them as pharmacists as well as to patients and the GPs that they work with. They all shared the message that, whilst it isn't an easy course to pass requiring a lot of commitment and effort, independent prescribing represents a real opportunity to change the culture of general practice and have GPs and commissioners see the strengths and assets that pharmacy can bring to the table.
The next part of the event focused on the question: "what pharmacy can do with other partners?"
First we welcomed Rosa Friend from South London Cares and Karman Chung from Hills Pharmacy in Lambeth to discuss their fantastic partnership. Rosa now does outreach work one day a month at Hills Pharmacy talking to older patients about their social needs while they are waiting for their prescription and how South London Cares can support them with their advice and wonderful inter-generational befriending model.
Rosa described how a community pharmacy is a safe place to meet vulnerable older people and there are real practical benefits as her organisation now has a base in North Lambeth with a room and wi-fi she can use to work remotely. Karman then explained from a pharmacist's perspective that this was a very simple and effective way of supporting his patients to access care they needed that he couldn't otherwise provide and at no cost to him or his pharmacy. Karman described how this was also extremely rewarding on a personal level to make a difference in this way.
This partnership is a great example of how community groups working in conjunction with community pharmacy is easy to do, doesn't cost anything and provides fantastic care and outcomes for patients.
Rich Harris, Health Foundry's Community Manager, then gave an introduction to Health Foundry. Rich highlighted its role in connecting digital health solutions within community based pharmacy interventions. He discussed its vision in creating a more effective health service and how enabling the healthcare system itself to innovate and adapt new technologies can be beneficial to the system. Rich talked through examples of the inspiring work its members contribute at the co-working space and introduced two members Adam Oakman (NVOLVE) and Baron Armah-Kwantreng (RemoteHealth Tech) to showcase their work and discuss specifically how it can benefit pharmacy in Lambeth, Southwark and Lewisham.
NVOLVE is a medication adherence helping hand. Adam highlighted how important it is to empower patients to take control and in turn their medication on a regular basis and also provide the necessary support if and when they need it. He discussed how loved ones and caregivers can work together and help increase adherence rates with polypharmacy patients. NVOLVE have several products including a simple SMS reminder and self reporting system which attaches through to a device that monitors how much and when the medication is taken. Adam highlighted how he sees pharmacists as key in helping with adherence rates and is excited to build on the connections with the Lambeth, Southwark and Lewisham Local Pharmaceutical Committee.
RemoteHealth Tech (RHT) is a digital health software company focused on developing remote data services using wearable technology that can improve the clinical outcomes of people suffering from abnormal heart rhythms. Baron shared their current activities which involve developing a working model of a software platform that can gather clinical grade heart rhythm data from wearables, and share information with health professionals through a secure log in system. They are also working with manufacturers of a wrist band ECG device that can be used gather clinical grade data in medical surgeries and remote locations to integrate data with patient record systems.
Baron highlighted the importance of startups working with pharmacies to help understand what each group can contribute to improving health outcomes in local communities and then working with them to understand how to best to collaborate effectively together. He also highlighted how community pharmacies have a vital role to play as community gateways in person-centric medicine where the health service needs to pivot around the needs of people in their localities. RHT is keen to explore opportunities with community pharmacies such as developing Atrial Fibrillation (AF) screening services integrated with personal health records using existing and future devices in the pharmacy setting.
The evening ended with a summary from Will Nicholson, Health Foundry Community Connector, who thanked everyone who participated in the group discussion and suggested a follow-up session to build on the energy, great ideas and conversations. Will looked forward to addressing the possible challenges and opportunities that had arisen throughout the evening and welcoming anyone to get in touch to help build on this success and to get practical in finding ways to work together.
The follow up event is going to be on 28 June 2017 at Health Foundry between 7-9.30pm. If you are interested in attending or would like more information please email Will Nicholson email@example.com.
The Future of Pharmacies: leading new models of community-based care
Quantifying My Self - 17 April 2017
Last night I slept 8 hours and 9 minutes of which 1 hour and 23 minutes were deep sleep. Today, I've walked 4,060 steps, 5,940 short of the minimum recommended.
So says my Xiaomi Mi Band an entry-level sleep and step wristband tracker I've been wearing for a week.
The impetus was realising my attempt to set up a start up at sprint pace was impacting on my sleep and energy levels. Time to rebalance.
If digital health, as set out in the last blog, can be an aide to increased quality and length of life then this was a good chance to test the theory. I was also conscious of the question Unity Stokes asks each digital health entrepreneur at the end of the excellent Start Up Health Now interviews: And finally what are you doing to improve your own health?
Shamefully my own answer would be a series of good but unfulfilled intentions: A better balance between work and rest, more time walking in the woods, meditate mindfully, good sleep, a more healthy weight.
In Self Tracking, Gina Neff and Dawn Nafus consider how self-tracking can fill gaps in the healthcare system. Whereas in The Quantified Self, a Ted Talk, Gary Wolf suggests self-quantifying could be the gateway to enhanced self-knowledge. Weighty promises, and tempting.
The biggest advantage of the Xiaomi is its physical form. The rubber band and silver tracker sit lightly on the wrist so I can wear it 24/7 without irritation. The band is waterproof for 30 minutes so it can be used during light washing.
The numbers? I knew I hadn't been sleeping well nor doing much exercise but I didn't know how poorly. At first the tracker recorded around 4 hours sleep, with as low as 35 minutes deep sleep and only 3,000 steps during the day.
The National Sleep Foundation, a US organisation with a mission to act as "the global voice for sleep health" says adults need between 7 and 9 hours sleep each night to feel their best. On deep sleep, the American Sleep Apnea Association states: "The phases of deep non-REM sleep, when blood pressure drops, the heart rate slows, and body temperature is lowest, are believed to be the most refreshing and restorative periods of sleep."
So far, so bad. How about my activity levels? The Walking Site suggests 10,000 steps a day, almost 5 miles, as a good goal for someone just getting started. "You simply start tracking your steps and gradually increase over a period of time."
The site adds: "A sedentary person may only average 1,000 to 3,000 steps a day. For these people adding steps has many health benefits." My starting stats were less than flattering. Jolted, a week later my sleep was within recommended levels and I was averaging 8,000 steps a day.
An improvement, but only a start.
What is the point of Digital Health? - 14 April 2017
What is the point of digital health? A strange question perhaps, for the CEO of a digital health start up. But one worth asking I think.
Let's start by looking at global health trends. Global Health and Aging, a joint report by the World Health Organisation (WHO) and US agencies, the National Institute on Aging (NIA) and the National Institute of Health (NIH), highlights the theme of Living Longer. The report cites the "dramatic increase in life expectancy" in the 20th century as one of "society's greatest achievements".
Most babies born in 1900 did not live past 50 years, whereas life expectancy in Japan the global leader now exceeds 83 years and rising. Thanks to vaccinations, the leading causes of death and illness have shifted in the last century from infectious and parasitic diseases to non-communicable diseases and chronic conditions like heart disease.
In modern societies, most people live past middle age, and deaths are highly concentrated at older ages. With ever increasing longevity, a study published in The Lancet suggests women in South Korea will average 90 years by 2030.
Understandably, perhaps, daily health headlines in countries like the UK focus on the consequences of financial constraints. However, global health systems are now arguably managing the problems of success with the question arising: Is there a natural limit on life expectancy?
We can see these trends in the strategy documents of leading non-communicable disease charities. Cancer Research UK states its strategy is to help increase cancer survival rates from less than a quarter in the 1970s, and half today, up to three-quarters in the next 20 years. Success would represent an achievement close to the impact of vaccines on infectious diseases in the 20th century.
Similarly, The British Heart Foundation's 2015-2020 strategy notes that since its founding in 1960 UK death rates from cardiovascular disease have more than halved and most babies born with congenital heart disease now survive to adulthood.
Underlining an increasingly common theme for modern middle aged adults, caring for chronically ill ageing parents, a friend said recently when reflecting on his parents living into their late 80s/early 90s with debilitating degenerative conditions: People are living too long now, its as simple as that.
So, I asked Dr. Cécile Monteil, a Paris-based paediatric physician and start up entrepreneur: Is eradicating all disease and exponentially increased life expectancy the aim of modern doctors? Dr Monteil says she does not believe she and her colleagues are focused blindly on increased longevity for its own sake. The emphasis instead is on helping patients to reach a high quality of life throughout a full natural length of life.
This sentiment is echoed in the British Heart Foundation's forward aims: "... coronary heart disease remains the single largest cause of death in the UK, quality of life is diminished for millions living with cardiovascular disease and each day seemingly healthy young people die suddenly from a heart rhythm disturbance. Only when we fully understand the molecular processes underlying these events will we be able to neutralise their threat."
At RHT, we believe that by contributing usefully to the increased quality of life and understanding of the causes of sudden loss of life of people suffering from abnormal heart rhythm conditions and other non-communicable diseases digital health will be of useful relevance to society.
What does the advance of MedTech mean for medical students? - 7 April 2017
By Huzaifah Jearally
The exponential advance of technology has reached all corners of the globe, and it's no surprise that its potential has been tapped in the field of medicine. MedTech is a booming industry with more ideas, networks and startups than ever before. Let's take a closer look at what this means for medical students and how it could revolutionise our careers.
The making of a well-trained doctor relies on a comprehensive and relevant foundation of knowledge. Technology allows this learning process to be more efficient and accessible regardless of location. There are now interactive versions of medical books, platforms to share medical cases and revision aids that harness the power of AI.
At a London medical school, the Barts X Medicine scheme will soon pilot a course that teaches students about the intricacies of digital health - along with, importantly, how it can improve health outcomes. I anticipate (and hope) that more medical schools will integrate this new technology approach into the curriculum, as well as trialling more novel solutions. For example, the use of immersive technologies to improve anatomy learning (see HoloLens & Pearson).
We are also seeing the slow reimagining of everyday diagnostic methods and tools to leverage the power of technology. Working as a doctor in the future may be drastically different with the advent of predictive systems like IBM's Watson. However, they serve not to replace doctors but to augment their clinical knowledge as a valuable second opinion. Companies like Eko are also rethinking traditional tools like a stethoscope, allowing the sounds to be stored/analysed digitally while maintaining the same form factor.
As entrepreneurs lead the charge in developing or adopting MedTech, it's important that medical students are engaged and prepared for the impact it could have. As a first year student, I have been pleasantly surprised by the number of MedTech events on offer. For example, the 2017 MedTech Conference (25th February 2017) introduced me to several qualified doctors who are fulfilling their vision through a startup. Schemes like the NHS Clinical Entrepreneurship Programme are paving the way for medical students and qualified doctors to become clinical innovators of the future.
Collaboration with industry is also more prominent than ever. For example, Royal Free London Hospital is working with Google DeepMind to use AI to help diagnose kidney failure early-on. Google DeepMind is also working with Proximie to give UCL students and surgeons access to live surgery streams.
To conclude, we are about to witness some big changes in the MedTech industry and it'll have big consequences for healthcare and medical education. The industry needs more innovators and entrepreneurs from all areas, however, to power this change.
Huzaifah Jearally is a first year medical student at UCL and author of themedic.blog - the result of his passions in medicine and web/graphic design. He enjoys being immersed in technology and photography.
Six Things A Project Manager Can Do For Your StartUp - 2 March 2017
Co-founders of StartUps are, by definition, strategists. There's much thinking to be done: how your industry is being transformed by digital; what the possibilities are for change; how your product will fit in; discussions with collaborators and investors; etc.
But while you're generating and developing new ideas, how can you also be doing the detail: defining your product; applying for and securing investment; creating a prototype; preparing for launch; increasing users; collating feedback; refining the product; getting second round investment; recruiting new help; and on and on the To Do list grows.
To free up your time, to continue to focus on strategy, may I suggest outsourcing the management and completion of your To Do list to a professional project manager?
Six things project managers do as their bread and butter:
1. Complete a business plan and slide deck
2. Produce a project plan showing the smallest steps needed to deliver all your initiatives
3. Oversee the development of a prototype product through Agile methods
4. Co-ordinate tech, marketing and customer service activities for a product launch
5. Draw up a detailed budget forecast with validated cost estimates
6. Track project status including identifying and resolving issues via frequent quick meetings.
You could engage a project manager on a daily rate (at typically not less than £200 per day), but for a seed stage StartUp this is not realistic. A better model of engagement is to agree a fixed cost per deliverable within a fixed timescale.
So, "I want a business plan and a high level project plan within two weeks plus two weeks of daily project tracking for delivery of a prototype after that for £1,500". You will be astonished at what a professional project manager can achieve in a short space of time.
That's minimal spend for an incredible number of To Dos crossed off the list and significant progress achieved. Professional project management need not be expensive. If your To Do list is overwhelming, a freelance PM will bring structure quickly and cost effectively.
Jackie Tilston has managed projects for a diverse range of corporate and public sector organisations. She believes in bringing structure to projects with the simplest and smallest set of tools possible.
Nic's Pics - 18 February 2017
Until six years ago, when a family member survived a cardiac arrest, I knew little to nothing about heart rhythm problems.
Since then I regularly stumble across everyday heart rhythm stories in the least likely places.
During picture research for this, RHT's first website, I found Little Visuals.
Little Visuals was the sixth of fourteen free picture sites I'd found. I was long past peak pictures so I quickly scanned each new site for the images I wanted.
But LV was different. Before the pictures was this message:
"Those of you who look at Little Visuals and any new visitors will be aware there have been no further uploads for over a year now. Sadly the young man who created this site died suddenly in Nov 2013. His name is Nic he is 26 and we are his family. Nic is one of far too many young adults whose death comes under the heading of S.A.D.S (Sudden Adult death Syndrome).
We are now fundraising in the hope to provide a number of schools or sports areas with portable defibrillators in Nic's memory. With this in mind we would like to ask if any of you that view his site and download the images would consider a small donation towards the Hand on Heart Charity. We hope to update this site in the near future with previously unpublished photos.
With thanks, Nic's family."
Nic's portfolio is a group of striking landscapes, close ups, interiors and exteriors. My favourite is Red Dawn, a morning country scene with a fire-flame cloudscape (see banner pic at top).
Looking at the photographs it is hard not to wonder what Nic was thinking as he took each picture. Or what he might have gone on to achieve personally and professionally.
It's Good to Check if you have AF - 13 February 2017
Most people have never heard of Atrial Fibrillation. Or know if they have it.
AF is a leading cause of stroke and is the most common irregular heart rhythm condition. Over one million people in the UK alone are known to have AF. Currently one in four people over 50 have AF. By 2050 due to lifestyle changes and increased longevity that figure will be one in two.
People with suspected AF are typically referred to their GP for a heart rhythm check and may then be referred to a specialist. There is a relatively standard treatment program usually involving "blood thinning" drugs like Warfarin to reduce the risk of blood clots in the brain, and of stroke.
The real challenge is identifying the up to 500,000 undiagnosed people in the UK, and equivalents elsewhere, who don't know their heart is a ticking time bomb.
You probably know someone who doesn't know they have AF. Or you may be that someone.
A friend of mine recently went for his annual health MOT and his GP noticed his pulse was irregular. Turns out he has AF and will be on Warfarin for the rest of his life. But at least he now knows.
The good news is it can be simple to identify AF. If you do a simple pulse test on your wrist and get German Techno instead of Melody FM it might be worth checking out.
Thankfully, technology is also making AF identification simple-for-all. A range of hand-held recorders and wristbands such as MiCor's A100 Cardiac Recorder can be used by anyone.
A recent study showed that daily snapshot ECG monitoring using such devices with people known to be at high risk of AF over 365 days detects half of the patients who later develop AF.
If you're not sure get checked.
Information on AF
MiCor's A100 Cardiac Recorder
21st Century Medicine - Treating the Whole Person - 3 February 2017
Being told you have a life-threatening condition is life changing. It's a mental and spiritual challenge like no other.
You can choose how to respond. As Morpheus says to Nemo in the Matrix film:
"Take the blue pill, the story ends. You wake up in your bed and believe whatever you want. Take the red pill, you stay in Wonderland, and I show you how deep the rabbit hole goes."
My London teaching hospital heart rhythm consultant told me he has two sets of patients. About 40% don't want to know about their condition other than turning up to appointments and following their prescribed treatment.
The rest will read up on their condition, ask searching questions at their clinical appointments, attend support groups and generally engage with their health.
However, both sets of patients could do with more help.
Patients groups report a lack of medical support in coping with the emotional impact of receiving a life-threatening diagnosis.
For me this highlights the limitations of consultant-centric 20th century medicine where the patient was treated as a bag of physics problems rather than as a whole person whose emotional well-being is integral to their physical well-being.
A study on Psychological Distress and Arrhythmia concludes:
"As cardiologists have learned from prior experience (CAST), reducing the burden of disease from cardiac arrhythmia requires a comprehensive approach that involves the patient, not just the ECG.
In a similar fashion, the recognition is spreading that reduction of arrhythmia risk in patients with psychological distress needs to incorporate the heart as well as the mind."
Clearly there is some way to go for the much-trumpeted fruits of 21st century person-centric medicine.
Practical advice: 9 Tips to Manage Emotions and Irregular Heartbeat
Psychological Distress and Arrhythmia: Risk Prediction and Potential Modifiers
Life after taking the Red Pill - 31 January 2017
Receiving my 'Healthcare Enterprise Programme' graduation certificate
As I say in the next blog: we all have a choice between Morpheus' blue or red pill.
I was tested for LongQT Syndrome, a relatively rare heart rhythm condition where the time taken for the heart to spark into action can be dangerously long, following my younger sister surviving a cardiac arrest.
LongQT is a genetic condition so when my sister showed symptoms in intensive care all her close relatives were advised to get checked.
I went to a London teaching hospital to take a standard 12-Lead ECG exercise test. The test checks your heart's electrical system via 12 electrodes stuck to your torso while you ride a cycle machine for as long and as hard as you can.
It was a shock when the consultant said my heart's recovery time was too long and it was unusual for someone with my symptoms to be alive in middle age.
A few years later, a heart rhythm outpatient on stress reducing beta blocker tablets for life, I had my first fainting episode on a commute home. Fainting or blackouts can be early warnings for more serious episodes.
My red/blue pill moment. I was conscious one sister had been found dead in unexplained circumstances in her flat and another nearly had her cardiac arrest alone in her flat. Not being the type to Wait for Godot I devised an emergency heart alert service using standard consumer heart rate monitors and a mobile application.
This led the team to an emergency alert proof of concept, a continuous remote heart monitoring prototype and the founding of RemoteHealth Tech Limited. To gen up on founding a med tech start up I read Guy Kawasaki's The Art of the Start 2.0 and Eric Sebban's
Santé Connectée - a manifesto for the re-humanising of medicine through the thoughtful use of technology and data analysis.
I also graduated from SETSquared's Healthcare Enterprise Programme for NHS Innovators at the Surrey Technology Centre, Guildford.
In the process my relationship with my health has changed from passive consumer to health innovation team member. A rollercoaster ride with a wonderfully talented can do team and a growing cast of collaborators opening up across the brave new world of digital health.
So to answer Cypher: I'm glad I took the red pill!