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30 September 2015

Power to the patients

Patients are about to gain unprecedented control over their health and data, which will have a profound impact on them, their well-being and the professionals who care for them.

By New Scientist

THE SURGEON’S epiphany came out of the blue one Monday morning. Matt Jameson Evans, an orthopaedics specialist in a National Health Service hospital in Chelmsford, UK, found that more than 30 patients had been booked into his back clinic. That meant he had only 7 minutes to assess and treat each of them. “It was just impossible to do any kind of effective analysis or treatment of chronic back conditions in that amount of time,” he says.

“On top of this, many patients had travelled a long way and waited months for their consultation, yet all I could do was provide a semblance of care,” Jameson Evans says. “It was not what I spent years training to do.”

Pincer movement

This workload prompted Jameson Evans to launch his own tech-mediated healthcare service. His approach is showing how technology can overcome the all-too-familiar problems facing healthcare systems like the NHS. Indeed, the service’s problems were recently concisely summed up by Bruce Keogh, medical director for the NHS in England, speaking about healthcare innovation in Manchester. “We are caught,” he said, “in a quadruple pincer of increasing demand, escalating costs, rising expectations and a constrained financial environment.”

If nothing is done to control demand and costs, the NHS will be spending £30 billion more than its projected budget by 2021. Add to that the pressures of an ageing population, and the problems become profound.

There is hope, however. Keogh and his colleagues have established the NHS Innovation Accelerator, a collective of healthcare entrepreneurs – including Jameson Evans – who believe a raft of emerging digital and mobile technologies could put people in charge of their own healthcare. This “patient power” is a key plank of the NHS’s five-year plan, announced in October 2014, to refocus healthcare towards the prevention of illness – and so keep people out of hospital.

The NHS plan includes giving patients online and mobile access to their own medical records by 2018, allowing them to correct errors or check their medical histories, prescriptions and surgeries. “It’s a vast change from focusing on diagnostics and treatment. People should be able to manage their healthcare in a more proactive way,” says Neil Mesher, Managing Director with Philips Healthcare UK & I, a medical technology firm headquartered in Amsterdam, the Netherlands.

And people are already carrying around some of the technology that will allow this: the smartphone. Containing sensors that know more about us than our friends do – when we move, how we move, whether we are hot or cold, indoors or outdoors – phones will carry a new generation of medical apps plugged into body-worn sensors that will allow patients to beam data to doctors, and sound the alarm if predictive software spots trouble. 

“The mobile phone is going to be one of the major disruptors in the way we develop healthcare,” says Keogh.

Making the transformation to a prevention-led health service, one that encourages people to live healthier lives, is vital, because dealing with the preventable illness load is becoming nonviable. Fully 50 per cent of NHS health-related spending now goes on treating just 5 per cent of patients – the very sickest, many of whom owe their pulmonary, cardiac or renal conditions to preventable factors like smoking, obesity and alcohol abuse.

Here, digital mobile healthcare opens up a new frontier. Digital cloud-based platforms such as the Philips HealthSuite have already seen the first clinical applications for lifestyle-related illness such as chronic obstructive pulmonary disease (COPD). Clinicians are provided with greater access and analysis around patient data whilst patients are empowered to manage their own health at home, supported with proactive reminders to take medication. This is particularly important given that in the UK over £150 million is lost due to people deviating from drug regimes each year.  If technology can help keep at least some people out of hospital, more resources will be available for those who really need them.

Hospital at home

Those technologies are proliferating. For instance, Jameson Evans’s start-up,, is a social network that lets people with similar medical conditions get support from each other in dedicated communities – from people with obesity seeking weight-loss help, to those with cancer understanding their chemotherapy. It’s working: the site has 350,000 people regularly blogging and 3 million visitors per month. Philips, too, has recently unveiled a smartphone app that helps people with type 1 diabetes to better monitor and control their condition. The prototype enables patients to send private messages to healthcare providers as well as share posts about their health with other patients, clinicians and caregivers.

But it’s telehealth – the supporting of patients living at home by medical professionals via smart devices – that has some of the greatest potential for empowering patients and resource savings. At Philips Healthcare UK & I, Alan Davies runs “Hospital to Home”, a remote telemonitoring  service for people with COPD, chronic heart failure, epilepsy, diabetes and hypertension. “People who are in and out of hospital the most tend to have a combination of these conditions,” Davies says, so by adopting supported self-care programmes, patients can safely manage their health and retain at-home independence. This improves patient experience and relieves pressures on the healthcare system.

Mobile tech is also making its presence felt. To use such a system, a patient has a smartphone or tablet running apps designed to connect via Bluetooth to a raft of different wireless sensor types ranging from weight/body-fat scales to pulse oximeters for measuring blood oxygen. At intervals, the person takes a measurement prompted by an alert from an app, and data is sent over landline, broadband, or the mobile phone network, to a hospital server that can alert medical professionals to any data deviating from the norm. This type of technology is now rapidly entering the home and helping to prevent, not just manage, the onset of chronic diseases.

For Jameson Evans, this revolution is unstoppable. “The technology is waiting to be used,” he says. “Patients will provide the momentum for this change to happen.” 

This article was first published by the New Scientist on 22 October and is re-published here with permission.

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