Around 80% of UK healthcare spending is accounted for by long-term health conditions such as diabetes, heart disease, lung disease, mental illness, and obesity. In connected healthcare, this is driving the focus towards drugs adherence as providers strive to manage the progress of these debilitating conditions.
The focus on adherence is partly being fuelled by drugs company research funding. They are interested in the area following a changing payment model in the US, which determines that drugs companies get their money only when the patient is better, rather than when the prescription is picked up.
This model is likely to be replicated globally, says Frazer Bennett, healthcare technology expert, PA Consulting Group.
There is also an increasing movement towards finding more efficient and therefore cheaper methods of managing public health. With this in mind, a growing number of mobile apps and platforms are aimed at encouraging users to take their prescriptions.
Bennett cites the example of a social platform for drugs adherence similar to Facebook: ‘When you take the drug, a post is put onto your “wall” so friends can see. If you forget, this also appears on the wall.’
At the same time, technology is emerging that is able to monitor the progression of diseases and make sure drugs are administered at the right time. For example, one way of monitoring the progression of dementia is to measure gait.
Bennett explains: ‘The way you walk changes as you go through the stages of dementia. We can put sensors on you – which is similar to technology used by the film industry – to measure gait over time.’
Another key trend in connected healthcare is a move away from bespoke devices to commercial off-the-shelf based systems with multiple integrated sensors. According to Collette Johnson, director, medical and healthcare at Plextek, this reduces the system’s development time and helps to move products into the market far more quickly.
Meanwhile, devices are becoming smaller as mobility takes over the sector. One company, miDIAGNOSTICS, is developing diagnostic tests integrated into silicon chips. These act as miniaturised labs, able to detect cells, proteins, nucleic acids, or small molecules using a tiny volume of body fluid. The results and data from the tests are connected to patients’ and caregivers’ mobile devices for diagnostics on the move.
Another small form factor device is the health patch developed by imec, the Holst Centre and TNO. Optimised for low power consumption, the patch is the first of its kind to track physical and cardiac activity, while monitoring bioelectrical impedance.
For first-response situations where paramedics are needed, the First Response Monitor is a very compact, low-cost product that can measure and provide respiration and heart rate.
An ageing population means there is increasing focus on the elderly, too. There are lots of products for disease groups but the big problem yet to be solved is multi-morbidity – when a patient has lots of things wrong, says Jonathan Burr, founder and CEO of Intelesant.
He explains: ‘When the problem is about multi-morbidity, solutions become more about daily living and management; more about the care aspect than the physiology and vital signs.’
With this in mind, Burr’s company, Intelesant is part of an NHS Test Bed project with Surrey & Borders NHS Trust called Technology Integrated Health Management (TIHM) for dementia patients. ‘Many people with dementia will also have other diseases; for example hypertension,’ says Burr.
‘But dementia by its very nature creates challenges in the management of the other diseases. In this project we are looking at vital signs and also at patterns of daily activity – such as the use of electrical appliances – to give an all-round view of a patient’s health.’
Barriers to adoption
But there are still barriers preventing connected health from reaching its full potential. The business case for introducing new technology into existing care pathways remains a big hurdle.
According to Bennett: ‘It’s all well and good coming up with new technology but we have to demonstrate it’s better, and sufficiently so that it’s worth the extra cost. One of the reasons it takes a very long time to get these in place is because of our centralised NHS model of funding.’
There is also a sensitivity about information-sharing across different health platforms due to patient data confidentiality issues. According to Robert Breedon, partner, head of health and care sector at Gowling WLG, there is also concern over the secondary use of data for research, and around consent from patients.
This is seeing data security being taken more seriously, says his colleague, Jocelyn Paulley, a director at Gowling WLG. It is resulting in CIOs being appointed so there is accountability at board level, she says.
But the biggest challenge faced by the connected health industry is reducing the unnecessary complexity of its systems and interfaces, says Plextek’s Johnson. For example, she says, if a system is used for diabetes it should only measure blood glucose and not take in physiological data ‘just because it can’.
The industry also needs more innovative form factors, adds Johnson. ‘Simple systems with user-centred form factors are the way forward in this space.’
An AI Future
Artificial intelligence (AI) techniques have great potential to transform connected healthcare. In the UK, this is already starting to take shape. In an NHS first, Liverpool’s Alder Hey Children’s Hospital is using IBM’s Watson AI super computer to diagnose patients, using medical data and patients’ notes to offer treatment advice.
More widely, machine learning is being used to analyse sensor data, says Karthik Ranjan, director healthcare and emerging technologies, at ARM. ‘We will start to see AI deployed among GPs. We already have telemedicine where you can have a video conference with your doctor. In the future you may be able to test issues such as a sore throat with sensors that can assess you remotely.’
Further down the line, a patient might be able to feed his or her symptoms into an AI machine which, combined with sensor data, would be able to choose a prescription without the need for a GP.
Photo: IBM Watson - Alder Hey Children's Hospital