Your health in your hands

Wearables linked to online systems could put designers at the heart of a revolution in healthcare. Patrick Burgoyne asks where this ‘self-care’ movement is taking us

We’ve all seen the doom-laden predictions: in the future, the NHS will not be able to cope with the demands being placed upon it. The UK has an ageing population. Some 70% of hospital beds today are occupied by the over-65s. Demand on the NHS will only rise as we live longer, the numbers suffering from chronic conditions such as diabetes and hypertension increase and our healthcare needs become more complex.

Speaking to The Guardian in January, Prof Sir Bruce Keogh, medical director of the NHS in England, warned that “if the NHS continues to function as it does now, it’s going to really struggle to cope because the model of delivery and service that we have at the moment is not fit for the future”.

Many healthcare professionals are stressing the need for us to take responsibility for monitoring and managing our healthcare as a means of alleviating the stress on the NHS. At the forefront of this ‘self-care’ revolution are digital devices and services. Already we have seen the rise of consumer ‘wearables’ such as Fitbit and the Nike FuelBand aimed at incentivising us to get fitter or healthier. In 2014, Apple launched its HealthKit platform for developers. At the time of writing, it has just launched the Apple Watch along with ResearchKit, described as “an open source software framework designed for medical and health research, helping doctors and scientists gather data more frequently and more accurately” from Apple users. But Apple is not the only tech giant betting that healthcare will become a key part of its offering. The likes of Samsung (with its S Health app and Gear Fit wristband), Facebook (with its Moves app) and Google have all been active in the personal health and wellbeing sector.

Alongside these developments by brands, sit a whole range of clinical devices aimed at managing serious conditions such as diabetes, heart problems and drug regimes. And insurance companies are already linking to devices and apps: the Prudential’s Vitality scheme, for example, links its rewards points programme to its members’ use of Moves to monitor how active they are.

In an attempt to put the health technology revolution into a wider context for the benefit of patients and consumers and to bring together some of the most significant developments in this area, health insurance provider AXA PPP healthcare, think-tank 2020Health and the Design Museum have come together to create the AXA PPP Health Tech & You initiative. An exhibition at the Design Museum features 24 shortlisted entries to the AXA PPP Health Tech & You Awards 2015 (all of which can be seen in a supplement accompanying this issue of CR for subscribers).

Maria Blyzinsky is the curator and project manager on behalf of the Design Museum of the AXA PPP Health Tech & You exhibition. She explains that innovation in this sphere is being driven both by large organisations such as insurance firms and healthcare providers as well as by individuals with a great idea and, now, the means to develop it. Blyzinsky cites the example of Brush DJ, which features in the Keep Me Healthy category and which has been developed by dentist Ben Underwood. The app motivates toothbrushing for an effective length of time by playing two minutes of music taken at random from a playlist on the user’s device. Brush DJ also allows users to set reminders to brush twice a day, floss, use a mouth-rinse and when next to see their dentist or hygienist. In the same category is a project from a much bigger player – Nuffield’s HealthScore app, which tracks exercise, eating behaviours, body measurements and emotional wellbeing to provide a holistic picture of users’ general health.

Blyzinsky notes two trends in terms of designers’ approaches to health tech that are evident in the work chosen for the show. The first, she says, is about “taking an old idea and thinking about how we can make it more useful, more attractive, more prevalent”. The otoscope, for example, is a tool for shining a light inside a patient’s ear and can be found in most GP surgeries. Chosen for the Signs & Symptoms category, Cupris Health have developed an otoscope that connects to a smartphone allowing a patient to send an image of their inner ear to a doctor remotely. “The fact that it’s using standard smartphone tech to do this is a huge leap forward in design terms,” Blyzinsky says. “The potential impact of that on communities that are isolated is enormous. Your GP may not even be in the same country anymore.”

Other designers are approaching issues from the opposite direction, taking a new technology and asking how it can be applied for health and wellbeing. BleepBleeps, for example, takes the principles behind the internet of things and applies them to create ‘tools, technology and content that help everyone become a great parent’.

As the adoption of both consumer and clinical health tech services and devices becomes more widespread, our relationship with the medical profession will change fundamentally. “Traditionally, our relationship with our GP has been patriarchal,” notes Blyzinsky. “We go along to the surgery, say ‘it hurts here’ and wait for them to wave a magic wand and make us better. Health tech changes that relationship and some GPs will be more adaptable to that than others.”

2020Health’s director of operations Gail Beer agrees. “The way we practice medicine now is very much that the clinician is in control,” she says. “[The rise of health tech] will fundamentally change that relationship because the individual will have much more information at their fingertips about their health and will be able to have a much more objective dialogue with their clinician, rather than just taking the information or advice offered. It makes it more of a joint decision and that represents a real challenge to clinicians who are not used to working in that way.”

Already, many of us Google our symptoms before we set foot in the GP’s surgery but health tech offers much more than that. “This is about a much deeper understanding about your health,” Beer says. “It’s about you having hard data about yourself – your signs, symptoms and responses to how you feel.” Armed with that knowledge, we can have a proactive rather than a reactive relationship to our health, becoming partners with our clinicians rather than expecting them to do everything for us.

“It’s about monitoring what you need to monitor [rather than overwhelming yourself with too much data],” Beer says. “Are you eating the right diet? Taking the right number of steps each day? If you’ve got a long-term condition, you will probably already have been monitoring that on paper: health tech devices make life much easier and give you instant feedback. If you are a diabetic, for instance, it’s less invasive, instant advice.”

But can we trust that advice? Beer points out that many clinical devices are already approved under the Kite-marking and CE quality assurance regimes. Additionally, the Health Technology Assessment programme examines the appropriateness and viability of devices for use in the NHS.

In the near future, we may see health and wellbeing devices being prescribed to us by our doctors. Keogh told the Guardian that “I see a time where someone who’s got heart failure because they’ve had a previous heart attack is sitting at home and wearing some unobtrusive sensors, and his phone goes, and it’s a health professional saying: ‘Mr Smith, we’ve been monitoring you and we think you’re starting to go back into heart failure. Someone’s going to be with you in half an hour to give you some diuretics’.”

But is our health service ready for what this will mean? Is the NHS going to develop its own devices? Logic, and its track record when it comes to IT, suggests not. Which means enabling the health service to work with the data being collected by an individual’s own devices from private providers. Again, keeping in mind the fact that hospitals can’t even access your GP record at present, the idea that the NHS will be able to collect, collate and interpret such data seems remote in the extreme.

Just how far we currently are from this future was revealed when, last November, the health minister Jeremy Hunt set out the Government’s first steps toward a personalised, digital future for the NHS. From April, individuals will be able to book GP appointments online and order repeat prescriptions without having to go to their local surgery. By 2020, with a patient’s consent, their ‘electronic care record’ will be accessible by clinicians across the entire health and care system.

In NHS terms, that’s real progress, but it is a world away from digitally-enabled self-care. “[The widespread adoption of self-care] requires a shift in the way the NHS delivers care,” Beer says. “At the moment, I don’t think the NHS is prepared for that change. Perhaps in a hundred years’ time, we might look back and see this as the start of democratising the NHS and care but a lot needs to happen before we get to that point.”

Perhaps a more fundamental question is ‘do we want to get to that point’? This tech-led, ‘self-care’ revolution has exciting potential but, as with everything to do with the NHS, there will be suspicions that it will be accompanied by, or be a mechanism for, cost-cutting and creeping privatisation. The overall winner of the Health Tech & You awards is babylon, a digital, private healthcare system: is that the future? And what if the model turns from incentivising and encouraging to using our data for penalising and punishing us? Insurance companies may currently be using health apps to reward members, but what if they start using them to push up premiums for those who haven’t completed their mandatory 10,000 steps a day?

Shiny health tech apps are all very well for the young and affluent, but what many people want out of their health service first and foremost is to be able to see their GP without waiting three weeks.

Self-care’s proponents would argue that the widespread adoption of health tech will free up resources to allow better access to GPs and better care for the vulnerable (including those unlikely to take up wellbeing apps). The UK government has declared that, “Technology will play a vital role in helping contribute to the £22 billion in efficiency savings needed to sustain the NHS”.

That ‘we can’t carry on as we are’ seems inarguable and the arguments for being more involved and informed about our healthcare are compelling. Health Tech & You is a valuable starting point for the debate about how much health tech (and the creative community) will contribute to a sustainable future for the NHS.

The AXA PPP Health Tech & You exhibition (healthtechandyou.com) is at the Design Museum, London SE1 until April 26, designmuseum.org. A supplement featuring the awards is published with subscriber copies of CR this month

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