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FEATURE: E-health and empowering the patient

29 November 2011

Healthcare in developed countries is going through a major transformation. Pressures on healthcare systems from ageing populations and rising costs are driving technological change, evident in the large number of medical devices and smartphone apps being launched. Different perspectives on where e-health is heading came out at the recent TechWorld 2011 event in London, writes David Eldridge.

At TechWorld, hosted by UK Trade & Investment, George MacGinnis of PA Consulting chaired the conference session on “Healthcare going online - How healthcare delivery is changing our lives.”

MacGinnis sees three effects of the transition happening in UK healthcare:

- Acute care is moving from hospitals into specialist centres;
- Other types of care are being delivered in the community and the home, with online health services being just one aspect of that growing trend;
- Patients are becoming active participants in their own care.

Remote monitoring and support of chronically ill patients in their home has spawned internet-based services and devices from companies such as Docobo, based in the UK. Docobo’s doc@HOME service is via secure web access, in which the healthcare professional can check the data and medication compliance of a patient remotely, with a clinical visit only triggered if necessary. The patient accesses the service through Docobo’s handheld device called HealthHUB (pictured above) or via a PC.

Speaking at the conference, John Tarrant of Docobo said that monitoring their own health data creates “expert patients”. He showed a video of a patient who said he felt he had more control if he could monitor his own health data and use that in discussions with the clinical professional.

Empowering the patient with information is the premise upon which the PatientsLikeMe website (screen grab below) is built. PatientsLikeMe is a network of patients on a secure website in which subscribers can find other people with the same condition and which also provides data aggregation about aspects of the condition.

The website currently has 120,000 users and more than 1,300 conditions. Most of the users are in the US, but Paul Wicks is heading up PatientsLikeMe’s move into the European healthcare space. At the TechWorld conference, Wicks said a subscriber must fill in a detailed questionnaire about their health, and this information is viewable by other subscribers.

The willingness of subscribers to share all their data is what makes PatientsLikeMe function. Wicks showed infographics from this data and other easy-to-use tools that give patients information they cannot access from a doctor.

He criticised the paternalistic approach of doctors who guard information from the patient, often with the motive of being protective towards them.

“I don’t think that approach is good enough any more,” said Wicks.

Doctors can’t always help patients with the anxiety they feel about their condition. But, Wicks said, other patients can help by sharing their experience, in data form and by online contact.

“We believe context is therapeutic. The most important part of a map is ‘You are here’,” he said.

Healthcare providers' perspectives

But if healthcare is going online, how do those people working in healthcare feel about the move?

Eddie Ritson, a manager in the North Ireland healthcare system and a director at the European Centre for Connected Health, said: “Adoption of new technology [by those working in the healthcare system] is slow. We do it, but it takes time to happen.”

Carmel Dickinson, who is the infomatics programme manager at the University of Manchester, made a distinction between e-health and m-health – the latter taking in all aspects of providing a mobile health service.

“So far, m-health hasn’t reached tipping point,” she said. “There have been successful trials, but poor adoption.”

Dickinson said the European m-Health Alliance is trying to achieve the step change that is needed. In its work, it is focusing on twin, synergistic goals: the economic development of m-health and the empowerment of patients.

Will smartphone apps or bespoke devices like Docobo’s HealthHub become the preferred tools as e-health develops?

John Tarrant said bespoke devices (or “fit for purpose products”, as he called them) have the advantage of enhancing user experience through new design features. For example, patients with tremors say they need buttons on a device as they find touchscreens difficult to use.

“There will always be a market for fit for purpose products,” he said.

Paul Wicks claimed only one in four of people with health apps on their smartphone actually open them. Those who do use them do so only a few times, he said.

“The amount of data generated is slim,” said Wicks. But he added: “The challenge is not how to develop a gizmo [device], it’s how to integrate it in a patient’s daily life.”

Carmel Dickinson said the key to the development of useful devices and apps is interoperability. Dickinson and Eddie Ritson said it would be good if a standards system was introduced so that when devices and apps are developed they could adopt those standards and work seamlessly together.

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