A future of mobile-centric healthcare could save lives

Picture the scene: an elderly woman with bronchitis is overcome by breathlessness while out for an afternoon shop. Instead of ignoring the problem, she immediately turns to her mobile phone, which is measuring her breathing rate and integrating that reading with other personal health data. The program decides that she needs a GP consultation within two hours, books it at a local walk-in centre and even tells her which bus to catch.

Far from being science fiction, this kind of scenario represents the kind of reality the NHS must work towards, says Sir Bruce Keogh, NHS England’s medical director. With spiralling costs, demand increases and staffing issues squeezing existing resources, a future of mobile-centric healthcare would increase efficiency – and maybe save lives.

Deborah El-Sayed, director of digital and multi channel at NHS England, says that the focus comes from a realisation that mobile phones are now central to our lives: “The NHS has often been 10 years behind other businesses in terms of technology, but this time we are trying to bring healthcare to people to fit in with the way they live their lives.”

Salford Royal hospital’s chief information officer Rachel Dunscombe is excited at the possibilities that the mobile phone offers, but she is worried about data security and the breakneck rush at which technological innovations are being introduced. She says: “A few well-thought-out and correctly aimed interventions will do far more than a scattergun introduction of funky toys.”

At the recent public health conference in Manchester, Keogh highlighted three areas where healthcare is already progressing with the aid of technology.

Monitoring individual healthOne big innovation is the move towards monitoring lifestyle data instead of clinical data so that the effect of diet and exercise can be assessed as well as the efficacy of drugs. This is where wearables come in.

A good example is Diabetes Digital Coach – a project led by the west of England academic health science network in partnership with Diabetes UK and technology companies including Hewlett Packard Enterprise. It uses software that communicates with wearable sensors to enable people with type 1 or type 2 diabetes to self-manage their condition.

A number of hospital trusts throughout England are trying out a product called AliveCor, which uses two pads in a phone case to take medical-grade electrocardiograms, sending it to a cardiologist and instantly embedding the information into a patient’s records. Arrhythmias can cause sudden cardiac death, which kills 100,000 in the UK annually – according to the Arrhythmia Alliance, 80% are avoidable.

Using clinical and lifestyle data to achieve personalised healthcare depends on the successful use of massive databases. The Department of Health is using expertise from the aerospace industry to set these up.

Creating a trusted channel for informationThose who have searched for health information online will know how many sources there are and how difficult it is to find one you can trust. Diabetes is a case in point. According to El-Sayed, patients do better if they self-manage their condition. However, many still don’t – 100 diabetics every week undergo avoidable limb amputations.

Work is underway to upgrade NHS Choices, ensuring the 1.7 million individuals who use it every day are given the best possible information wherever they are. Meanwhile, newly-diagnosed diabetics are trialling a version of the NHS.uk site that sends information to their phones. Mobiles are also being used in an NHS telemedicine project at Airedale nursing home in which 10,000 care home residents receive video consultations from their rooms, with the team able to access the full patient records. This has resulted in a large reduction in hospital-bed deaths and £117,872 in savings due to reduced visits to hospital A&E.

Devices that communicate with each other – Internet of Things – can be used to keep track of elderly and unwell people in care homes. A simple socket that plugs into household devices can now be used to monitor elderly and unwell people. If plugged into a kettle, it could send a message directly to a carer’s mobile phone if an older person has failed to make their morning cup of tea by a certain time.

Creating personalised care using electronic patient records

Historically, the greatest obstacle to technological progress in the NHS has been getting multiple systems to work together. Fhir (pronounced “fire”), which stands for Fast Healthcare Interoperability Resources, allows computers to exchange electronic health records by using an application programming interface.

Salford clinical commissioning group is leading the country in Fhir’s implementation and has a testbed working in partnership with NHS organisations in Greater Manchester, Cumbria and Lancashire.

Fhir – which is being developed in the US for introduction in the UK in 2017 – enables computers to send parcels of patient information such as body temperature or blood pressure in a format that other computers can understand and use. This makes accessing personalised medicine through mobile phones more than just a dream.

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