The future of digital healthcare could be a two-metre USB cable

I've probably walked through my front door and past my hall table 10,000 times. But one April evening my foot caught the table, a toe blazed in pain, and a subsequent x-ray confirmed a proximal phalanx fracture. I thought I knew what would come next. Various adventures with skateboards, trampolines, and bicycles have all ended …

[ChoHag]

> The experience left me thinking this virtual medicine thing has legs – pardon the pun – at least for injuries like broken toes that don't obviously benefit from closer inspection.

That's a lot of expense and effort to say "why are you here? It's a god damn toe."

Having said that it might improve waiting room times by getting rid of the 90% of people who don't need to be there, and doctors get a tool nobody trusts to blame bad diagnoses and other problems on.

[jmch]

"improve waiting room times by getting rid of the 90% of people who don't need to be there"

mostly this

[John Brown (no body)]

Most of them are there because the waiting time for doctors appointment in some areas is a week or so if you can even get through on the phone to book one. By then, whatever ails you has either gone away, got much more serious or killed you.

[Fruit and Nutcase]

got much more serious or killed you.

Preferably the latter, from the point of view of the government/health service bean counters - that way they get to keep the contributions you paid for health care and you are no longer a burden

[LybsterRoy]

My experience differs. Taking my wife to A&E on occasions, when her heart throws a wobbly, a lot of the other "patients" are there because they don't know how to treat a scratch/scrape or think their runny nose needs immediate attention.

[Francis Boyle]

There will always be people

like this just as there will always be ones who could give the Back Knight a run for his money (well, a hop at least). The trick is discouraging the one lot while not scaring away the other and that's not easy.

[low_resolution_foxxes]

Precisely.

My NHS GP clinic is useless. It is a moderate sized practice with 5+ Doctors. The waiting time is currently 3 weeks.

Sure, when they have given me service, it was acceptable, but largely felt like a sausage factory churning me through the system.

I recently watched my partner register for a mobile NHS GP app available on a mobile app. She was registered within 24 hours, an appointment was available "within minutes" or at 20+ appointments available through the day until 8pm. The person she was talking to specialised in the exact unusual thing she was calling about (OK it did feel slightly "call centrey" as there were 40+ staff available to talk to).

The traditional GP practice will die from this technology.

[JohnTill123]

Considering other applications...

You have to wonder how this use of a home webcam would work in a consult with a proctologist.

[PRR]

Re: Considering other applications...

> You have to wonder how this use of a home webcam would work in a consult with a proctologist.

We came close. My dog was very sick in the eye, the pee-pipe, and basically all his boy-parts. (Lymphoma.) That needed a skilled knife. Which needs a 1-week follow-up to see if it heals OK. With pandemic and all-day drive, the surgeon consented to a verbal report and good (but gross) photos. It helped that both the humans here have healed from heavy surgery (and have a clue what goes wrong); also there was a 2-week follow-up when a local general vet took the stitches out. (I could do that but it is a Union job.)

I also have a Bore-Scope for looking inside engines or walls, 10 foot long. And an ear-scope, $20 at WalMart. The technology is there, but not adapted to body parts. For proctology or urology, you want a camera that can be steered, also right-sized.

And yeah!! Get Well, Simon!

[tinman]

Re: Considering other applications...

well USB endoscopes are very cheap now, you can even get them in the centre aisle of LIDL. Just saying...

[Alan Brown]

When I broke my toes my GP looked and said "yup, they're broken. What do you expect me to do about it?"

Advice was to avoid repeating the event and not stress them for a few weeks

[Sampler]

IP Webcam

I came across IP Webcam during lockdown, our weekly board game group couldn't meet in person, but, with enough cameras hooked up to OBS, I could still run a game remotely.

All the old phones and tablets came out the drawer and I could tell the wife "told you so" that there indeed was a use for a 2013 Sony Xperia that needs to be permanently wired in to a power source...

Figure this could equally be useful, given OBS's virtual webcam output, you could simply switch from your webcam to the ipcam running on your phone and point it at the necessary body part. No cables required, we are, quite, living in the future..

Get well soon Simon!

[Pete 2]

The smart solution

> waving a laptop's lid

Surely it would be even easier to use the camera on your phone.

You never know, it might even fit in places your laptop couldn't

[Korev]

Re: The smart solution

I was about to make the same point!

[Richard 12]

Re: The smart solution

We're trying to reduce the need for hospital visits, Pete!

[Arthur the cat]

The next frontier …

Proctology.

[Korev]

Re: The next frontier …

Surely

The next frontier: Proctology.

As there's a colon involved...

[Sampler]

Re: The next frontier …

I don't know, seems a bit of a bum joke..

Coat icon 'cos I can't spend all day arsing around here..

[ChoHag]

Re: The next frontier …

> The next frontier ... proctology.

Ah I see you're new to the internet.

[Arthur the cat]

Re: The next frontier …

Ah I see you're new to the internet.

Very old (started on ARPANET pre TCP/IP) so I have mental filters honed over many years exposure. My visual cortex automatically elides goatse from the scene.

[Fruit and Nutcase]

Re: The next frontier …

Proctology.

Exactly the same thing that came to my mind

[LybsterRoy]

Re: The next frontier …

Is that the latest digital currency?

[martinusher]

Re: The next frontier …

Oh, you mean a small diameter camera on the end of a cable that's sold for fishing inside things?

Got one, They're really cheap, very useful and could probably be used for fishing around inside people if you were desperate or stupid enough. The only problem with it is that there's increasingly desperate efforts to monetize the software that works on my Android phone that you use as a viewer. You actually don't need the software -- if you plug the camera into a PC for example 'it just works' -- but mobile software is fraught with value add which don't add value and generally doesn't work (and might dish out the odd bit of malware as a bonus).

(FWIW -- Music players used to be simple, straightforward and functional. Not so much these days.)

[ThatOne]

Webcam consultation?

I might be an old skeptic, but besides checking if the toe is still attached I don't really see what the point of a webcam examination might be. I'm no MD, but I would assume a more thorough examination might require some tactile feedback, to check if there is something "not-as-usual" inside, out of view, especially of a shaky low-res picture taken from moderately afar...

_{I guess the point is to show the patient they actually do some examination, as opposed to simply assuming that "toe fracture = not lethal, ergo the patient will probably be okay".}

[Phil O'Sophical]

Re: Webcam consultation?

I'd guess that discolouration and shape could tell a doctor a lot, before they have to get you down from the ceiling after the "does this hurt" tactile exam. Then again, IANAD.

[Richard 12]

Re: Webcam consultation?

Figuring out colour from a webcam is basically impossible. The auto-exposure, auto white balance and auto red/green tint adjustment makes it so.

That's assuming the doctor has a reasonably calibrated screen, which is a fairly big ask to begin with.

[Anonymous Coward]

Re: Webcam consultation?

I think the difference between normal pink and you've broken it black would be clear even on the worst webcam.

[ThatOne]

Re: Webcam consultation?

Yes but then the broken/not broken issue was already settled, since he got a x-ray before that session. Also, the emergency room would had spotted anything too obviously bad, so the only thing left to do would be (I think, I'm not a medical doctor as I said) to assess if the toe can be left to heal over time, or if it will need some assistance to properly do so. The x-ray pictures would indeed give the bulk of the required information, but a more extensive inspection is still necessary, thus the referral to the fracture hospital.

[Alan Brown]

Re: Webcam consultation?

ditto sepsis. The red spiderwebs tend to be a giveaway

[Francis Boyle]

Re: Webcam consultation?

Well we'll just have to give everyone Pantone books then.

[NATTtrash]

Re: Webcam consultation?

I might be an old skeptic... No, you are not.

I'm no MD... Well, I am.

...but I would assume a more thorough examination might require some tactile feedback, to check if there is something "not-as-usual" inside, out of view, especially of a shaky low-res picture taken from moderately afar... Are you sure you're not an MD sir, because that is pretty spot on.

Professionally, I do understand the need to streamline/ higher throughput and make more cost effective, the 2 major forces in healthcare nowadays (Ah, you thought it was all about you, the patient and your ailment? Well, may I introduce a modern thing called reality?) Then again, we/ I still learn medics it is all "about the person" and "that personal connection and contact". I too see what author described creeping in more and more, next to other "modern" developments (e.g. centralisation and closures of points of care, devolution of treatment responsibilities, budget driven care, globalised telemedicine "CT/ MRI here, diagnose in India")). Happy to retire soon, it will not be my concern anymore. Although looking at my students, I do worry, if quality/ ability decreases due to such overarching decisions, why don't the responsibilities of the treating physician? If, as happens now, financial/ administrative decisions are made (forced) upon physicians and their patients, why don't the people forcing those decisions than also are e.g. liable?

As for the story here from a tech perspective: I know that Zoom (seems to) offer a "healthcare option". But what about for example patient data confidentiality? First of all I doubt whether an US company, which speaks only about "US hospitals" can serve the considerably different (more) European situation for example. I understand it might be convenient to quickly set up a Zoom consultation service, but what about all the conditions that are normally required from consultations and the resulting data (standard, location)? Is Zoom guaranteeing it will all be all compliant? Or is the hospital/ care facility that is offering the Zoom service? Or can we address the mentioned physio*** for that? Curious what you tech gifted think of that one...

*** Although responsibilities around the world do vary, physios normally DO NOT have independent curative privileges, but can only treat based on diagnosis of treating physician, thus end responsible MD. It's indeed true that in some less efficient territories, to "address patient waiting times", para-medical personnel works more freely under the general responsibility of an "overseeing physician". But, if push comes to shove, it's an MD where it lands. Hence the account by author is "confusing" to begin with, since physios generally do not diagnose independently, nor initiate treatment.

[martinusher]

Re: Webcam consultation?

My healthcare provider (I'm in the US) is an HMO and they provide this service using their own software which I'd guess is HIPAAA compliant. The downside of this is that it doesn't work with my PC (I run Linux primarily on this but it doesn't like my Windows for some reason). However, it does work with a Mac and therein lies a tale.

After returning from an overseas visit a month or so back I felt 'off' for several days.....its the usual "its Friday, I'll wait till after the weekend" thing that often does a fair bit of damage. Come Tuesday I was still not well so faced with having to go to the Urgent Care clinic, take a number, hang about and so on I thought I'd try the video visit (I was looking up the clinic schedule when I noticed this). After answering a few questions I was seen promptly and after a short discussion a couple of tests were ordered -- long flight, suspected DVT sort of thing. I turn up promptly, tests are tested and I wait a bit for the result. At this point there's obviously some suspicion of a problem because lines were cut (i.e. "queues went away"), doors opened and things happened very quickly. So much so that I was next instructed to "Go directly to the ER". Again, lines disappeared, doors opened and so on.

So I'd guess that if you need that toe seen promptly then also exhibit symptoms of a stroke or heart attack or something like that. The thing is, telemedicine does work and its a handy tool but its not a substitute for F2F, its just a way of triaging. (The ER I visited had at least 40 people waiting in it BTW). Most urgent care doesn't need the resources of a fully staffed hospital and all you do by turning up there is clag the system up and end up waiting a lot because you're going to get bumped by serious cases that need immediate attention. The alternative is to bring a book (Kindle in my case) and be prepared for a bit of a wait on less than comfortable chairs.

[yetanotheraoc]

Re: Webcam consultation?

`I guess the point is to show the patient they actually do some examination`

More likely show the insurance company.

`assuming that "toe fracture = not lethal, ergo the patient will probably be okay"`

This. I had three of them in the span of a few years (the basic problem is I try to move around as if I were still young) and didn't even bother to see the doctor. After the third one I switched from barefoot in the house to always wearing flip-flops, I have a pair that is just for indoors. A couple of weeks ago I smashed a flip-flop into some pointy furniture, my toe was very thankful for the buffer.

[alexeistepanov]

if the session is in the zoom (i think other video calling tools can also offer this option) you can join the same session from the third device, let's say from your phone, and you will see how your foot looks like in the webcam of the laptop located on the ground.

[Doctor Syntax]

"other video calling tools"

For medical consultations I think confidentiality might be a major consideration. My preference would be for Signal.

[Anonymous Coward]

"My preference would be for Signal."

In the UK, you can use Teams or (if you really must) Skype as it will happily talk to Teams.

Why? Because that is what the suit wearers decided.

MS gave the entire NHS free Teams for the duration and we swallowed it. Now that duration is officially over, we are stuck with it!

[winchester_disk]

Luddite tech

Your laptop/2m usb/webcam combo sounds nice but people now do those virtual appointments with a gadget called “phone”.

Btw , after she fell down the cellar stairs this weekend - I took my mum 84 to south london hospital at 5.30pm and we had our ankle X-ray by midnight, surviving skunk scented lavatories and teams of police visiting the waiting room.

[Steve Button]

Re: Luddite tech

"5.30pm and we had our ankle X-ray by midnight"

Yeah, that's really not great though is it? Perhaps acceptable in the 1970s but aren't we in the 21st Century now? It should not be like this. Not great for anyone to be sitting around for 6 1/2 hours, but even worse for an 84 year old. Unfortunately this is exactly what you'd expect, and why I generally stay away from A&E unless something is hanging off.

[winchester_disk]

Re: Luddite tech

"Yeah, that's really not great though is it?" ...oops the intended irony was not stressed enough :-)

JTLYK we used to blow through that same hospital in the 70s like prince Phillip inspecting nurses coifs ; in and out in one hour , that includes developing the negatives from x-ray room!

[Terje]

Re: Luddite tech

I would say this is indicative of the general development around at least our so called western civilization that a larger population suffering the same number of injuries / illnesses per capita is treated by fewer and fewer people.

[Richard 12]

Re: Luddite tech

The rate of injury and illness per capita has also greatly increased, because people have been living rather a lot longer.

Except in the North, where life expectancy has started to drop despite (or more accurately, due to) the "levelling up" policies of the last decade and a bit.

[LybsterRoy]

Re: Luddite tech

Don't forget that people will now go to their GP/A&E for minor things that would have been ignored/home treated when I was young. In Scotland its also complicated by the fact that prescriptions are free (to the "patient" if not the tax payer) and if you have to go to the chemist to buy a bottle of cough medicine it costs you.

[Eclectic Man]

Re: Luddite tech

For some reason this reminded me of the Ogden Nash poem:

An ancient termite knocked on wood,

And tasted it, and found it good.

And that is why your Aunty May

Fell through the parlour floor today.

Sorry, I've just found that fraudsters have 'liberated' about £20k of my savings from a company that should have known a great deal better as they've been scammed before, and I am in need of some levity.

OI do hope your mum makes a full recovery.

[Robert Carnegie]

Yes

I got some confused messages from a Scottish hospital consultant for both an outpatient day appointment, and a "virtual clinic". I proceeded with the physical appointment and I didn't hear about the other except for the time I spent looking up what they meant by a "virtual clinic" and finding out that from my point of view, I would receive a telephone call.

[J.G.Harston]

I had my final ENT post-surgery consulatation via video conferencing, using a 1/4-inch USB camera I happened to have taped to a wooden splint so I could guide it around the back of my mouth.

[Mr D Spenser]

Return of house calls?

Portable ultrasound devices exist that use phones or tablets to display and capture the images. It would be possible to send a trained tech to the patient for diagnostic or follow up imaging rather than making them come in.

[jmch]

Re: Return of house calls?

" send a trained tech to the patient"

Trained techs are in just as limited supply as doctors and nurses. Sending them around would mean they spend at least half their time travelling rather than actually working.

[Eclectic Man]

Re: Return of house calls?

House calls??? My local GP stopped doing those years ago. Even when I was literally coughing up blood, I had to attend for an examination one very cold day. I was NOT AMUSED. I got my second lot of antibiotics and a Chest X-ray. I did eventually recover, but lost about 15lbs weight in two weeks.

[Yet Another Anonymous coward]

Re: Return of house calls?

>Sending them around would mean they spend at least half their time travelling rather than actually working.

You aren't doing out-of-the-box MBA style business optimisation.

It's only wasteful if you see only a single patient per visit.

If instead you lined up multiple patients, along the route, you could see a large number of patients as you drove past.

You would just need some sort of icecream van style jungle and then as you passed each person they could cough or display whatever bit ailed them.

what's more you could increase efficiency by simply using a faster vehicle

[ThatOne]

Re: Return of house calls?

> what's more you could increase efficiency by simply using a faster vehicle

...so patients can't catch up: Less time wasted, profit.

[Yet Another Anonymous coward]

Re: Return of house calls?

The patients wouldn't need to move.

They would line up outside their houses and as they heard the NHS van drive past they would just wiggle/wave/twerk the afflicted limb at the medic - picture a Mexican wave of affected limbs

[ThatOne]

Re: Return of house calls?

And the medic would just bless them while driving by?

Won't work, they've already tried this in a slightly different context.

[tinman]

Re: Return of house calls?

and then two years after the MBA consultant suggests that it would be even more efficient to have a centralised unit that the patients would come to, to make maximum use of the professional's time. But that's probably just a crazy notion

[big col]

Can be a crap idea to diagnose this way

Unfortunately both my wife and I have had terrible experience of diagnosis by video.

My wife developed a sore finger after gardening. Looked a bit red but nothing visually of interest. First video call she was told to bathe in warm water. The second call a week later antibiotics were given. It got worse and very painful. A&E visit 2 weeks after the antibiotics was informed she should have been sent to A& E by the GP sooner as she had a nasty abscess.

In my case I had a video call with a PT.. problem was diagnosed as muscle weekness. Lots of PT later no improvement. Problem finally diagnosed as nerve damage caused by being in a coma for 9 weeks and subsequent recovery due to sepsis. Now on a 70 week waiting list to see a neurologist. But the video call and PT did more harm than good

[jmch]

close inspection

"that don't obviously benefit from closer inspection."

I'm struggling to think of many medical situations where the doctor / nurse / physio could get by with a simple visual inspection without the aid of being able to touch the affected area, or to more closely look at the back of the throat, inside of the ear etc which requires particular instruments. Mostly it would be to simply rule out the most obvious "nothing to see here" cases.

Get well soon, Simon!!

[Yet Another Anonymous coward]

Re: close inspection

Broken toes are very difficult to diagnose, even with x-rays

Fortunately the treatment for a broken toe is normally 'tape it up, ice, pain killers and try not to stub it on anything' while the treatment for a diagnosis of merely severely bruised is 'tape it up, ice, pain killers and try not to stub it on anything'

[John Brown (no body)]

Emergeny Room? Free to use?

At first I thought was a US based story due to the use of "Emergency Room". Then I read that it was free to use so wondered where in the world hospitals have free to use "emergency rooms". Eventually I realised it was a UK based story using US terminology. Confusing since we don't have "ERs" in the UK, we have A&E.

[Doctor Syntax]

Re: Emergeny Room? Free to use?

Australia? IIRC that's where Simon is based.

[Anonymous Coward]

Re: Emergeny Room? Free to use?

> in the shared office space The Register occupies down under,

[John Brown (no body)]

Re: Emergeny Room? Free to use?

Yeah? OK, I'm always willing to learn. Although a quick Google search tells me that in Oz it's called the Emergency Department or ED for short, so I'm still confused :-)

[Yet Another Anonymous coward]

Re: Emergeny Room? Free to use?

>in Oz it's called the Emergency Department or ED for short

An unfortunate medical acronym.

So if you took too many of the little blue pills to cure your ED you would go to the ED to have your E dealt with ?

[Emir Al Weeq]

Re: Emergeny Room? Free to use?

I too assumed it was US from the use of a "two-meter USB cable".

In the UK that would be a cable used to connect two measuring devices.

[Yet Another Anonymous coward]

Re: Emergeny Room? Free to use?

>I too assumed it was US from the use of a "two-meter USB cable".

The US would use freedom units that would be a 0.022 football field cable

[Norman Nescio]

Triage

My experience of video consultations was the speedy use of an iPhone to connect with video to the local equivalent of NHS 111. It saved a trip to, and long wait in the local walk-in/small injuries clinic, and while I'm glad it saved me time, the point of the exercise is probably to reduce pressure on said clinic with non-urgent stuff.

I quite agree that full diagnosis probably requires hands-on (literally), but medicine is a game of playing the odds, and whoever does these calculations has probably worked out that its better to miss the occasional thing than have a clinic permanently backed up with ailments that could be better treated at home without professional involvement. I don't envy those who make those calculations. As it is, things missed have nearly killed a close relative three times, so I'm not speaking as one who thinks this is the best thing since sliced bread.

Lowering the barrier to swift access to expert medical opinion/care is probably a good thing, so long as demand can be managed. Video calls are probably a net benefit.

NN

[ThatOne]

Re: Triage

> Video calls are probably a net benefit.

You can also arbitrarily decide every 5th patient arriving will be refused entry. It's even more efficient, since it takes even less time for a similar result.

[petef]

When I was recuperating in a hospital bed after surgery I was glad that I'd the forethought to buy a longer USB charging cable for my phone.

[Anonymous Coward]

Plus in the US they charge just as much as if you physically went to the office...

[LybsterRoy]

Yup - definitely become to US oriented

[hugo tyson]

Doctor Duncan's Video Symptom Show!

"Just press your buttocks up against the screen...." :-)

[7teven 4ect]

I dialled 999 with my nose

both my hands fell off after a huge moebuntu session and both my hands fell off so I dialled 999 with my nose and got a webcam appointment so now I have to undo the thumbscrews with my teeth and tip and hit the pc to get the side off so I can use my mouth to hold a screwdriver to jumper the pc to start because the start button broke because I tried to use my toe to press it.

the moral of the story? disinfect your screwdriver you dirty basement dweller

[Norman Nescio]

Re: I dialled 999 with my nose

I'm impressed you had the foresight to register the tip of your nose with TouchID^* so you could unlock it to make the call^**.

*This is a thing. Related to this is using the phone when it is 'rather' cold. Most gloves make the touchscreens finger-detection mechanism fail, and rather than ripping your gloves off to answer calls or use the phone, it's useful to remember you can use the tip of your nose.

**Yes, yes, I know. You can make emergency calls (999, 112, 911, and others - sometimes other numbers are programmed in as well) without unlocking the phone first. It's part of GSM standards - see table D.2 in the attached (rather interesting) document on 'Advanced Mobile Location' for some examples: GSMA: Emergency Communication: Version 1.1: 07 June 2022

The source on AML is the European Emergency Number Associations documents - the 'Report Card' is interesting: EENA: AML Report Card: 2023 Update

[Francis Boyle]

I must

try this!

[Francis Boyle]

I had

my first remote consultation last week. Or rather I didn't. The doctor was using a private number and my provider blocks private numbers for obvious reasons. Doctors and technology – not quite there yet.

[Neil 44]

We get texts with links from our medical centre to join video consults.... Call it back from the phone and use the phone's cameras

I've also used #LiveDroid on my phone to be a handy wireless IP camera...

[Anonymous Coward]

I once had a similar problem with a swelling on my elbow.

I live on my own, you try taking a photo of your own elbow! Got there in the end though.