Increasing patient expectations, chronic disease prevalence and budget constraints are placing unprecedented pressure on the NHS. This is paving the way for technology to transform radically care pathways in the UK. Giving people greater control over their health and wellbeing through digital innovations is a crucial part of this process.
At the Nuffield Trust Health Policy Summit, Health Secretary Jeremy Hunt said: “Patients are ready to take on the challenge. We need to give them the chance to sit in the driving seat.” He added that, although technology is key, it is also important “to change the cultural relationship between doctors and patients, from master and servant, to partners”.
A review of the research conducted globally on the digital self-management of asthma concluded that this can improve self-care, life quality and medication use. In a US budget impact model for diabetes, self-management technology delayed complications and generated savings to the health system. Remote monitoring of blood glucose, alone, saved $326 million over ten years.
Telemedicine, wearable technology and online resources are all crucial in creating efficient services, potentially saving the NHS money that could be spent elsewhere. But mobile phones are considered the key driver.
Between December 2013 and June 2014, daily use of health apps increased by 62 per cent, compared with a 33 per cent rise for mobile apps in general
“Mobile-phone subscriptions exceed the world’s population of over seven billion. It is no surprise that this is helping shape some of the innovations we are seeing in healthcare,” says Dr Mutaz Aldawoud, a GP in Bradford, West Yorkshire, and digital clinical champion at NHS England. We are beginning to realise the benefits of using mobile phones and apps for medication reminders and communication of vital-sign readings, which helps reduce unnecessary visits to the GP.
There are some 40,000 health-related apps available today. Flurry Analytics reports that, between December 2013 and June 2014, daily use of health apps increased by 62 per cent, compared with a 33 per cent rise for mobile apps in general.
The NHS Choices Health Apps Library has many clinically safe products for managing health on the go. They include apps for booking GP appointments and understanding laboratory tests, and cover conditions such as autism, diabetes, stroke and cancer.
Professor Kevin Fenton, national director of health and wellbeing at Public Health England, says: “We recognise that digital technology is revolutionising the way people get personalised information and interact with their health. In particular, mobile phones are helping people lead healthier lifestyles with immediate and relevant personal support through new apps and websites. They have the potential to be the single most important channel through which we can help improve the nation’s health, address health inequalities and alleviate pressure on the NHS.
“Public Health England already has a range of apps available for free from the NHS Choices website, many being among the most downloaded apps in the country. We are keen to develop this whole area and, through our Health X initiative, we are working with leading tech startups to bring the most innovative digital thinking to health improvement.”
The Health X initiative, which was launched last year, has already produced groundbreaking ideas for products that will help consumers conduct healthier lives.
“Whether helping people follow a simple programme to get them off the couch and in a few weeks running 5km, knowing how many calories are in foods or aiding smokers to quit for good within 28 days, we are looking for mobile phones to play a significant role in improving the health of the nation over the coming years,” says Professor Fenton.
Marple Cottage Surgery, Stockport, Cheshire, has been using interactive self-management plans for asthma and diabetes for years. “Together with advice from our nurses, they help patients control the condition without having to come to the practice,” says GP Dr Andrew Johnson. “We are now about to embark on new areas, including live video appointments.”
Dr Arvind Madan is a GP and chief executive at the Hurley Group, a network of NHS practices in London. With colleagues, he created webGP software enabling patients to self-care, check symptoms and consult with their doctor online. “Patients can educate themselves, take control over their health and choose the most appropriate service,” he says.
They can expect improved outcomes, thanks to comprehensive history-taking and early-symptom detection and treatment initiation. Practices use their resources more efficiently, and commissioners save money as a result of reduced complications from delayed treatment and attendance at urgent-care centres.
In a pilot funded by the NHS Tower Hamlets Clinical Commissioning Group, webGP had 36,000 visits in six months. Some 60 per cent of the patients who visited were managed remotely and 18 per cent did not need the doctor. This saved 400 GP hours.
Dr Stuart Bingham, lead GP at the Barkantine Practice in London, highlights the importance of online self-help information and consultations. He says: “Technology needs to advance alongside services, to enable primary care to develop and meet demand. However, IT governance and patient confidentiality issues could delay the process.”
Crucially, practitioners must be willing to engage with technology and advocate its use among patients. Bradford GP Dr Aldawoud concludes: “We need to get the technology to those who need it most, embed it into care pathways, and convince healthcare professionals and decision-makers that, if such innovations are allowed to flourish in a supportive environment, care can be delivered closer to home, saving time, avoiding waste and ultimately improving health outcomes.”
Asthma and chronic obstructive pulmonary disease (COPD) are among the most prevalent long-term conditions globally, imposing a heavy burden on patients and health systems.
The UK has the highest number of asthma cases in the world, costing the NHS £1 billion a year. Of the three million people living with COPD, fewer than a third receive adequate treatment. The associated mortality is almost double the European average, while that from asthma is 1.5 times higher. Yet, it is estimated that 30 and 90 per cent of deaths from COPD and asthma, respectively, could be prevented with better care.
At Portsmouth Hospitals NHS Trust, a team of clinicians, led by Professor Anoop Chauhan, has taken on the challenge to help improve health outcomes and quality of life for patients, while reducing visits to the GP, hospitalisations and, consequently, some of the strain on the NHS.
Patients’ lung function, blood pressure, heart rate, temperature, weight and physical activity are measured using a wrist-worn tracker
Using wearable technology by Aseptika, they enable patients to monitor and manage their condition at home. The project is funded through the Small Business Research Initiative, an NHS scheme to help small enterprises develop innovative solutions to major healthcare challenges.
Patients’ lung function, blood pressure, heart rate, temperature, weight and physical activity are measured using a wrist-worn tracker (pictured above). The information is sent via a computer tablet to a secure web-based system called Activ8rlives. This enables monitoring by the patient and the care team, who can provide advice and support remotely, before problems become serious.
Portsmouth Hospitals and Aseptika are also trialling a home-use test that can detect signs of infection flare-ups or exacerbations caused by the bacterium Pseudomonas aeruginosa, which are associated with increased mortality, up to 15 days before they become so severe to require hospitalisation.
Joyce Stouse is one of the 30 patients using the technology. She joined the project while being treated for double pneumonia and she hasn’t looked back. “It has opened my eyes up to how my chest is day to day,” she says. “It has had a really positive impact, making it much easier to get on with my life.”
Patients are reporting improved confidence to seek help earlier through using the system, as well as increased physical-activity levels, which research shows reduce symptoms’ severity, enhancing quality of life. None of this was achieved by accident. Patient education and training, easy-to-use software and support from the clinical-care team all contribute to success.
Elizabeth Waldock has COPD and runs a self-help charity for other respiratory conditions. She says: “As things stand at present, the patient has little or no say in their treatment. Technology not only has the potential to give patients a level of self-empowerment, but also to benefit both people and the health service.”