As the pandemic has left patients unable to visit GP surgeries or anxious at leaving their home, a raft of new digital and AI-enabled tools has emerged to plug the gap. What role might they play in future healthcare and where do the limits of this technology lie?
In the coming years, Dr Chris Morris estimates 70 per cent of care at the NHS GP surgery where he works will be delivered to patients remotely.
Already any patient wanting advice will first be asked to answer questions on their symptoms via telephone, email or text, he explains. They may be asked to snap pictures of “lumps, bumps and rashes” via their smartphone, with images automatically added to their notes. Or asked to join a video consultation to go into further depth, with Morris able to send follow-up advice via SMS. “We don’t want to go back to how things were,” he says.
In fact, this integration of technology into how healthcare is delivered looks set to be a legacy of the pandemic. The risk around in-person care has prompted a wave in adoption of digitally enabled alternatives in the last 12 months, from digital check-ups, to remote monitoring tools and even stethoscopes using artificial intelligence (AI). Such is the speed and scale with which the healthtech market has grown that investment reached record levels of $5.4 billion in the first six months of 2020, according to McKinsey.
On the one hand, many clinicians on the front line, such as Morris, believe these technologies can “help raise the level of patient care” while allowing providers, like GP surgeries, to operate far more efficiently. On the other, there is caution we shouldn’t forget the value of in-person care or underestimate the expertise that needs to accompany even the smartest of digital tools.
“This is not a panacea,” says Morris. “But it is another way of delivering healthcare.” It’s one with plenty of potential.
At Numan, a digital check-up service targeted at men – the team has now conducted 1.4 million digital consultations in less than two years – is one of a number of digital consultation services seeing a rapid uptick in interest since the pandemic. Numan first launched in 2018. Its users are asked to fill in an online questionnaire and within 24 hours treatment will either be approved or patients will chat with a clinician via email to obtain further details.
“It brings healthcare up to speed with how we interact digitally with our lives anyway,” says Luke Pratsides, lead GP at Numan and also a practising GP in East London. It allows clinicians greater control of the time and length of consultations, and gives patients greater convenience, he says. “Plus, because it’s happening across the board, both in the private sector and the NHS, people are getting used to it and realising it can offer high-quality, safe and convenient care.”
At myGP, an app which allows users to book GP appointments, order prescriptions and check medical records online, transaction volumes increased by 80 per cent in 2020, the company says, while there was a 96 per cent increase in people accessing their records and a 62 per cent rise in prescriptions ordered.
Digital consultations will never be for everyone or for every situation though, cautions Morris: “Some patients don’t like them and they’ll want to see their doctor face to face.” In addition, you can “lose the nuances of body language and non-verbal communication”.
“At my practice, we walk into the waiting room, see the patient get out their chair, walk down the corridor and sit down. That tells you an awful lot about the patient even before you talk to them. And you lose all that in a remote consultation,” he says.
Remote symptom monitors
Paul Landau launched remote monitoring platform Careology after his wife was diagnosed with cancer at 34 weeks pregnant. Watching her endure treatment, including spells at home in between cycles of care, “I saw so many opportunities for how technology could be better used to support someone going through what is a complex and daunting diagnosis”, he says.
Brought to market in July 2020, Careology now enables patients to log symptoms digitally, connect to Bluetooth devices to track heart rate or activity, receive medication reminders, download health summaries of their status and contact carers and clinicians at the click of a button.
As of February 2021, the technology has been used by Lloyds Pharmacy Clinical Homecare and has already proved a huge help, says its deputy head of nursing Jo Upton. “From our perspective it’s all around the visibility of the patient,” she says. “Our nurses go into a patient’s home to take blood or give treatment as part of that patient’s cancer pathway. With COVID though, every contact with the patient has been changed or has been limited.”
Alternative ways of checking in, such as ringing patients frequently can be intrusive. “But the Careology app allows the nurse to view the status of the patient without invading their time or their privacy,” says Uprton.
Remote monitoring platforms go beyond cancer care. CliniTouch Vie, for example, enables patients to take regular readings of their vital signs using a Bluetooth device. The readings are then shared directly with clinical staff who provide remote advice.
AI-enabled clinical tools
In April 2020, healthtech startup StethoMe announced the rollout of its smart wireless stethoscope, an AI tool the company says is “capable of detecting, classifying and analysing pathological sounds within the lungs using medical-grade precision”. The small circular device, which can be pressed to the body to pick up a reading, works alongside a smartphone app that guides patients through each examination and then shares results with their doctor.
It’s one of a number of such devices gaining popularity since the pandemic, allowing patients to collect simple readings at home. KardiaMobile, for example, is now being used by more than 92 NHS trusts to collect ECG readings from patients remotely. Two fingers from each hand are simply placed on the digital monitor and the results are transmitted to an app using high-frequency sound waves, ready for sharing with clinical teams.
And at NuroKor, a wearable technology that uses bioelectric nerve, muscle and microcurrent stimulation to help patients manage pain, sales grew by 156 per cent during lockdown, according to the company.
It’s crucial though that behind these AI tools and connected devices “there’s a system set up to deal with all the information”, says Pratsides. It can be unhelpful as a patient, “if you’re bombarded with information you don’t understand” and just as unhelpful for clinicians if they’re being constantly sent data. “So it’s about trying to sift out information and use home monitoring in the right way,” he says.
At-home testing kits
Wouldn’t it be easier for patients to test themselves for a condition or abnormality prior to seeking clinical advice? That’s the idea behind the plethora of at-home testing kits now available, enabling patients to check for everything from hormone and nutrient levels to fertility and sexually transmitted infections. For diagnostics platforms such as Thriva, which says it has 54,000 subscribers, carrying out half a million tests, the potential is huge.
“To take just one example area, there are 3.9 million people living with diabetes in the UK; roughly they each need a blood test every three months,” says co-founder and chief executive Hamish Grierson. “You can add to that the millions of people who are on powerful drug treatments and require blood tests to monitor their liver function or those who require regular check-ups while they’re on cancer treatments.”
But if COVID has fuelled usage of these at-home tests, it’s also served to highlight the potential risks. A swathe of at-home COVID-19 testing kits launched last year were met with concerns around how accurately they were being used by patients and how reliable the results were. As one expert at the New York University School of Medicine says: “There’s a lot of bunk, junk and crank stuff out there. Some tests are coming from reputable places and some are not, and that’s hard for the average consumer to tell.”