The quantified patient - the future of healthcare?

Sarah Cook

14 November 2017

Today is World Diabetes Day. For patients with this chronic disease, self-monitoring is not new - at home blood glucose (BG) testing has been available since the 1970s. In 2010 over 63% of patients with diabetes were self-monitoring, and now with developments in less invasive technologies – from skin patches to smart contact lenses - it’s expected that even more will. Diabetes self-monitoring is a powerful example of how technology can help place individuals at the centre of their own care.

Beyond diabetes, advances in technology including portable bioassays, wearable or implantable sensors, and mHealth are widening the possibilities for patients to manage their conditions away from their healthcare team. For example there are a growing number of mHealth apps either NHS approved or being tested within the NHS for patients on the, recently reinstated, NHS digital Apps library. The wide range of apps include those intended for patients with COPD, diabetes, mental health issues and  undergoing cancer treatment. 

Claus Nielsen (Data for Good Foundation/Personal Connected Health Alliance Europe) will present his vision for diabetes care which reflects on the rise of personal connected health technologies at  Healthy Futures - Genomics and Beyond on 28 November

The data generated by patients self-monitoring at home is (or should be)  included in patient records.  But healthy citizens – and patients - generate a considerable amount of health related information outside the health system is it time to consider how we can also make the most of this ‘citizen generated data’?

Beyond the patient – what about the (apparently) healthy?

It’s not just patients already embedded in the healthcare system (i.e. those managing a chronic disease) that are producing data potentially useful for healthcare decisions. Most of us are constantly producing measureable data, either intentionally (e.g. fitness and lifestyle trackers) or more passively (e.g. Google searches and environmental sensors) that could be relevant to our health.

Advances in sensor technology and our burgeoning use of smartphones and the internet have made quantifying aspects of our lives easier. The plethora of wearables, handheld devices and apps available in the consumer space with a health focus has exploded in recent years. However the question remains -  how  useful is this data for health services and for individuals seeking to optimise their health? Some consumer-facing health apps and devices that claim to measure vital signs such as blood pressure and blood oxygen saturation have come under heavy criticism for their uncertain accuracy and scientific validity. Some have even been labelled as dangerous because if the app or devices’ disclaimers are overlooked then consumers might be misled into using the tools for medical advice.  

Connecting the data dots

Even as the quality of tools improves, another challenge to overcome is finding ways to integrate all the useful data produced by individuals outside the healthcare system with other health related information, such as electronic health records and data from other health-related devices. This is because the data on any one health indicator is likely to be more insightful if viewed in the context of the individuals’ wider health data and medical records in order to gain holistic insights.

The Internet of Things -  is one way to link self-monitoring device with healthcare systems. Many self-monitoring devices are linked via the IoT to an app on a user’s smartphone and to a mobile or internet based platform that a healthcare team can access.

Last year, NHS England Chief Executive, Simon Stevens, declared the launch of several Test Bed collaborations between the NHS and innovators of such technology. The ambition is that by using a variety of ways to monitor the elderly and those with chronic disease, predictions can be made about the likelihood of complications, requirements for emergency care and to improve the lives of patients and their caregivers.

Some current examples

In light of NHS England estimating that self-care could result in £584m in savings by 2021, an app by Reliq Health Technology is being trialled at Imperial College Hospital, London. The app compiles data from disparate sources such as implantable devices, wearables and sensors within the phone and stores it in NHS secure cloud-based software enabling patients and their loved ones to proactively manage their chronic conditions at home.

In the US, data from Apple’s health app framework Healthkit, which includes personal wearables can be integrated with patients’ medical records in some hospitals. Plans to feed data produced by NHS approved apps and devices directly into patient records are promised in the UK;  Health Secretary, Jeremy Hunt, has alluded to incorporating personal tracker data into medical records. Despite the interest, currently attempts to link this data with the healthcare system are primitive and slow, especially as electronic health records (EHRs) have yet to be implemented across the board.

What next for the quantified patient and citizen?

The eruption of personal monitoring technologies is exciting, but it’s clear that there are issues to be considered before the wider potential for enabling health benefits is realised. These range from questions around data linkage and potential integration with EHRs, data quality and reliability, and citizen appetite for personal monitoring. In the upcoming months the PHG Foundation will be exploring the opportunities, challenges and barriers regarding citizen generated data.