Health tracking computer chip

Patient heal thyself

Governments and electronics companies are thinking the same thing, reports E&T: electronics should be deployed to track the health of the population.

Having become a dominant force in the consumer market, the electronics industry is set for a foray into public health. It is not just about treatment of medical conditions. Companies in the electronics sector are seizing on concerns about the rising cost of healthcare, and a focus-shift to from 'sickness' to 'wellness'.

The logic behind attacking healthcare as a market for wearable technology is that it is a huge and potentially vital requirement - and wellness presents an even bigger target. If there are plenty of sick people, there are even more who are nominally healthy.

Governments are keen on the idea of promoting wellness. The Pharmacy White Paper published by the UK government in Spring 2008 proposed that pharmacies could play a big role in encouraging people to adopt healthier lifestyles. Some primary care trusts (PCTs) have already gone down this road. In Knowsley, the PCT has started running lifestyle checks for men nearing retirement age at local pharmacies.

Men going to the local pharmacy can receive checks on their blood pressure, blood glucose levels and an assessment of their body-mass index. A survey carried out immediately after the health check found that the vast majority made changes to their lifestyles, such as taking more exercise. Almost all participants said they would return for a follow-up health check.

The principal behind lifestyle checks is the consideration that preventive medicine is cheaper than remedial. During her presidential campaign in the US elections, Hillary Clinton's slogan was "focus on prevention: wellness not sickness". Barack Obama took up the theme for his recent healthcare reform initiative.

Preventive versus remedial costs

These claims can easily be overstated. In a paper for the New England Journal of Medicine, Joshua Cohen and colleagues at the Tufts-New England Medical Centre in Boston analysed work on the cost-effectiveness of preventive medicine versus treatment, and found a wide disparity. Some measures reduced overall costs significantly. Others, which often relied on expensive screening techniques showed a much lower or even negative benefit because of the number of people who need to tested, potentially on a regular basis.

The key to cheaper medicine through preventive measures and early testing lies in reducing the cost of the tests. One good way of doing that is to have people do much of the legwork themselves.

"The NHS is looking to the public for ways to monitor their health," says Ged O'Shea, head of product development at pharmacy giant Alliance Boots. "This is a way that pharmacies can go."

The European Commission estimates that, by 2030, Europe will be home to 34.7 million people over 80, compared to 18.8 million today. That will put even greater pressure on the healthcare system.

Steve Mollenkopf, president of Qualcomm CDMA Technologies, says: "With the ageing of the population, the efficiency with which we deliver healthcare will become increasingly important. We need tools to allow us to do it properly."

O'Shea says one aim of the Boots initiative is "to support positive ageing through products and devices for mind and body. They could monitor chronic disease and help people age positively. Monitoring, say. blood glucose levels without having to give blood is very important."

Ageing is not the only factor. In the UK, some 15 million people of all ages have long-term conditions that need some kind of personalised care plan, according to the Department of Health.

Although analysing a mammogram is probably going to be out of the question for most people, simpler mass-produced devices can potentially help in the push for more preventive healthcare. This is where Mollenkopf sees companies such as Qualcomm stepping in: "We are pushing wireless technologies into the healthcare industry. If you look at the healthcare industry we are still stuck in the processes of the 1950s. The quality-of-life improvement that is available by improving the IT systems that allow doctors to have information at their fingertips is important for humankind," he claims.

Qualcomm is far from alone. Companies such as NXP Semiconductor and its former parent Philips are engaged in a number of EU-funded projects that explore techniques such as telemedicine and near-continual monitoring (see p62) that range from heart-rate measurement to an analysis of sleep problems using 'smart beds'.

Jörg Habetha, director of medical signal processing at Philips Research, calls the trend the "consumerisation of healthcare". Consumers can wear body monitors long-term that update a remote database somewhere on the Internet with their current conditions, and software can use the data to determine whether the patient's health is about to take a turn for the worse. The main focus at Philips is on heart conditions because it is the major cause of adults death. Non-invasive devices to measure the electrical pulses generated by the heart as well as other factors such as breathing are also comparatively straightforward to make, although their acceptability may be an obstacle (see p32).

Home comforts

One major advantage of long-term monitoring for clinicians is that they get a more representative view of how a patient's condition is developing. Often, the stress of visiting a surgery or hospital will make things look worse than they really are.

The situation is similar for people with sleep problems. A sleep centre is full of instruments that probably will not help with insomnia. But, by putting sensors into a regular bed, it becomes possible to take measurements that are almost as good, and which are probably more representative of a condition.

Working with the University of Swansea, Boots now has its Centre for Innovation in South Wales with the hope of attracting a range of startups keen to develop over-the-counter treatments and gadgets. One area for development - beside devices that work at a cosmetic level, perhaps improving skin tone - is gadgets that deal with the effects of ageing.

The UK's Technology Strategy Board identified healthcare devices as potential recipients for grants from its £100m Small Business Research Initiative (SBRI) announced in April this year. The head of the SBRI, Mark Glover said at its launch: "There are lots of novel and exciting ideas out there and SBRI enables the public sector to seek out these innovative ideas and then support turning them into commercial, viable products and services."

A trial of the scheme was run by the Department of Health in 2008. Companies were invited to develop technologies and systems to improve hand hygiene, in order to reduce the number of infections contracted in hospitals and doctors' surgeries.

Following the SBRI launch, the East of England Strategic Health Authority made the focus of one of its SBRI competitions technologies to help manage patients with long-term conditions as well as systems that enable better patient monitoring or encourage children to take more exercise.

Electronically assisted wellness is not a reality yet, but the combination of government policy and corporate action makes it one of the biggest technology trends for the next ten years.

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