Over the next couple of months the DHI will begin to narrow its efforts, addressing a number of more strategic topics – four to begin with. This blog will outline some of the draft themes with a view to getting feedback from the Scottish digital health & care community. The first of these themes is ‘Alternative Digital Wellness Services’. So what do we mean by this?
At the moment there is a mixture of primary care services, NHS Inform guidelines and NHS 24 advice lines that form the ‘public sector service’ for people who have a query about their general wellness. The use of these services are reinforced by public campaigns and public health measures that aim to educate people in how to proactively manage their health and how to approach public services if they feel they have an issue. However, the NHS is not constructed to fully manage this ‘proactive wellness’ space. Instead, they are geared more towards supporting people once they already have a diagnosed condition.
The public sector has long had an issue with getting people to proactively uptake preventative health measures and to change behaviours in order to avoid early diagnosis of a variety of lifestyle oriented conditions. Meanwhile the global consumer health marketplace has progressed quickly to meet needs in this area.
A recent YouGov survey showed that wearable uptake is accelerating with a jump in use from 6% to 13% of the UK population. This puts wearables broadly in line with the adoption curve for tablets earlier in the decade. Therefore it is worth remembering that while there is both hype and scepticism around wearables, they are following a well-trodden adoption curve. Gartner’s own ‘Hype Cycle’ places wearables past the “peak of inflated expectations” towards the start of the “trough of disillusionment”.
The wearables industry already reports that consumers discard wearables after an initial flurry of interest. We are likely to enter a Gartner Hype Cycle ‘trough’ phase for two reasons:
- The devices in question are still crude. While they may look and feel reasonably slick, in tech generation terms the wearable marketplace is still in its infancy. Devices will continue to become more sophisticated, melding many health monitoring capabilities and intertwining these health elements with more generally useful functions. Smartwatches, as they currently exist, are a step on this journey. So too is the iPhone’s ‘default’ step counting – we will see more of our mobile and environmental technology passively monitoring us without any direct interaction required from the wearer.
- Consumers realise that most wearables cannot meaningfully move beyond their cosmetic or fitness focus. This is in a large part due to a lack of both understanding and infrastructure on the part of health and care services. This means they cannot capitalise on this new capability. However, there is a clear interest in connecting these technologies to meaningful care service interactions. For example, 60% of people surveyed recently by KPMG said that they are against the idea of tech companies holding health data generated by their wearables. Yet 74% of the same group said that they would willingly share that same data with their GP. An industry study from the UK Government Office for Life Sciences highlighted another interesting trend: 90% of patients reported they would accept a mobile app prescription from their doctor, while only two-thirds of patients reported willingness to accept a medicine prescription in the first place.
It appears that consumer health has something public service needs, and vice versa. The consumer digital health movement has appeal and is offering empowerment to consumers/citizens in a fashionable format. It will also be able to flex as consumer demands change. The public service layer, on the other hand, is trusted, has credibility and meaning. It has the capability to reinforce the long term value of self-monitoring, if people see that they can maintain a degree of control and also meaningfully inform discussions with carers in order to improve their outcomes.
The DHI will explore how these two worlds merge, under the banner of ‘Alternative Digital Wellness Services’. This might be as simple as the wider use of smart scales to help ‘at risk’ groups feed data into a model that reaches back out to those showing negative trends. This could help some people relax and remain at a healthy weight by just knowing that someone is keeping an eye on their progress (even if that someone is an algorithm that can escalate risky cases to clinicians). For others, Alternative Digital Wellness Services could flag them to the care system for earlier, digitally supported intervention. Similarly, other non-clinical measures and support services could be initiated in response to automated trend alerts.
Now picture this concept applied using a vast array of metrics that can be gathered in automated, passive ways:
- Step count
- Active daily minutes
- Sleep duration and quality
- Blood pressure
- Other vital signs e.g. heart rate trend
Add to this some more involved measures that an ‘activated’ citizen may choose to collect:
- Medicines management
And then a number of emergent capabilities:
- Sweat analysis
- Cough analysis
- Skin lesion / mole checking
With this type of citizen generated data becoming more easily captured, what might be possible both in terms of improving self-management and overall wellbeing, as well as reducing demand for face to face primary care (and other) services?
At the moment the existing public sector health and care service model cannot take advantage of these new forms of data at the required pace. The DHI aims to help health & care service providers make sense of this emerging opportunity by demonstrating how that might work in practice (both technically and in terms of alternative service delivery approaches).
DHI proposes to materially demonstrate answers to a number of questions, including how we:
- Tie together a number of consumer-facing monitoring capabilities and understand how integrating these with care provision may increase long term commitment to self-management and the proactive pursuit of wellbeing.
- Increase and ensure the quality of the data generated by citizens.
- Qualify different types and tiers of data and determine what data, in what form, is allowed to influence care giver decision making.
- Establish how the use of novel data management and analytics capabilities can make sense of vast quantities of citizen generated data, feeding only actionable information to care-givers, when deemed necessary by risk assessment models and evolving clinical / service delivery governance.
To this end, the DHI is forming a consortium of academia and industry to look at how we might demonstrate a working model. This consortium would undertake a small amount of exploratory work, hosted by the DHI. We then intend to facilitate bids to secure funding for the consortium to build one or more alternative digital wellness services. This in turn may help mainstream public services procure and use a number of technologies already on the market.
If you have developed a technology that gathers similar metrics to those listed above, and if you have the technical development capability (and the will) to hook that product into some open APIs on a generic ‘access’ platform for data flow demonstration purposes, then we would be interested to hear from you with a view to adding new partners to our consortium. Get in touch with our team.
Thanks for reading