21 April 2016
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Smartphones are ubiquitous –for many of us they have become an essential part of our lives. What do you check that you have with you when you leave home – for me it is wallet, keys and phone. The wallet and keys have always been a necessity but the smartphone is the relative newcomer- we obviously use it for staying in touch – but we also use it to check where we are going, to access that item of information we need ‘right now’ and for catching up on the news. But are smartphones now poised to take on an equally essential role in healthcare?
Treatment and care of those with chronic conditions accounts for 70% of healthcare budgets in England. Smartphone apps have the potential to revolutionise management of diseases such as diabetes, asthma, cardiovascular disease and even chronic back pain. Telemedicine, where mobile and other digital tools are used to deliver care remotely, could become the predominant means of delivering healthcare. In the future, GP surgeries and hospitals may only be required for healthcare that cannot be delivered without ‘hands on’ intervention by clinicians such as surgical procedures or management of acute illnesses.
In principle, our healthcare could be improved significantly by the availability of rich (i.e. continuous and multidimensional) data supplied by wearable monitoring devices, especially for chronic conditions. Imagine if your doctor could receive and analyse images and other health data transmitted via your smartphone from devices measuring blood pressure, blood glucose or pulse oximetry, enabling them to personalise your care without any need for a face to face consultation. This is not an outlandish view of the future, a number of health apps are already doing just this.
Many types of data obtained from smartphones could be used to improve health, not just those collected from physiological sensors. Smartphone geolocation functionality, linked with physiological data, can be used to help asthma sufferers identify exposures to environmental factors such as pollution levels or allergen that trigger attacks. They can then minimise exposure to such triggers where possible and aggregated data from individual users could also inform public health initiatives. Again, studies on asthma control app users are already showing improvements in how well controlled the asthma is. According to Goldman Sachs more than half of the $34 billion spent on asthma and COPD in the US could be saved by using such apps.
Another great challenge we face is meeting the health and social care needs of an ageing population. Independent living smartphone apps could enable elderly people to live at home longer, with sensors detecting movements and tracking eating or drinking behaviour. But technological barriers such as battery life as well as usability will need addressing for these applications to become realities.
Linking smartphone data to electronic health records will be key to maximising the value of the data both for individuals and the health system, but this will require significant interoperability issues to be overcome. Such rich data could also be of enormous value to health research. But probably the greatest value of smartphone mediated healthcare is its potential to empower us to respond more proactively to changes in our health status and take control of our care. The smartphone really does hold the key to effective personalised prevention.
We must recognise that obstacles remain to achieving this smartphone enabled healthy future. Evidence of effectiveness and a system for certifying health apps are both still lacking. This makes it hard for healthcare providers to recommend their use. Safeguards are also needed to ensure that the privacy of personal data is protected as it is transmitted between the user and healthcare provider. Will other interested bodies such as insurance companies or employers attempt to access the information?
Perhaps of most concern is whether already wide inequities in access to healthcare will be increased? Will those who experience the worst health – the elderly, those who cannot afford a smartphone or without internet access, minority groups such as travellers or those from certain ethnic groups end up with even less access to healthcare and information if these become dependent on smartphones? These groups have the worst rates of those very chronic conditions upon which the smart health care revolution could have the most impact but unless we are careful they could be the groups that benefit least.
Cost pressures are likely to be the driver behind the mobile health revolution. A report highlighted that in 2017 mobile health could save a total of €99 billion in healthcare costs in the EU. While the exact figure is speculative, it is clear that smartphones could enable a paradigm shift in health care and politicians and policy makers should focus on enabling the smartphone revolution while ensuring that the pitfalls are robustly addressed.
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