A lady running on a running machine with a heart monitor

Healthcare and wearable technology: monitoring the connected body

As the power of the Internet continues to transform lives, could consumer wearable technology revolutionise the healthcare industry?

The major political parties in the UK election campaign are all keen to stress how much they want to maintain spending on the National Health Service (NHS). But over the long term, it's a promise that's going to be increasingly difficult to keep.

Fifty years ago, according to an analysis put together in 2013 by The King's Fund, paying for the NHS took 3.4 per cent of gross domestic product (GDP). Today, it is close to 8 per cent and figures from the Office for Budget Responsibility suggest it could easily double again to more than 16 per cent in another 50 years. In the US, the situation is even worse. The country spent 16 per cent of its considerable GDP on healthcare in 2006. By 2040, it could soar to 29 per cent, according to the US National Bureau of Economic Research.

"That's unsustainable," says Chris van Hoof, programme director for wearable healthcare at Belgian research institute IMEC. "Solutions are needed to curb that increase."

A significant part of the rise will come from lifestyle-related diseases such as diabetes, heart conditions and cancers that are more likely to afflict the obese. The UK could see a million more cases of diabetes by 2030 because of the population's growing weight. As a result, healthcare experts are looking to the lifestyle rather than the treatment to arrest the problem.

The bold claim for wearable technology is that it could lead to 'a revolution in self-care' by improving the monitoring of patients with a host of long-term conditions as well as encouraging people to live more healthily. Patients with conditions such as diabetes, liver disease and asthma could benefit from wearing devices that can detect deterioration and alert the patient or anyone else they choose via a smart device. Wearable technology can also benefit clinicians from a training and development perspective, while improved geo-position technology will increase the safety of lone workers.

Medical devices enable patients to monitor themselves remotely, for conditions such as asthma, diabetes and high blood pressure, and yet still be able to communicate directly with medical professionals; other wearables are aimed at monitoring wellness and fitness levels. Gadgets such as the Apple Watch - plus Garmin's Forerunner 15, Samsung's Gear 2 and the FitBit Flex - tout long-term fitness monitoring as key features.

"With the public fitness habit intensifying and the technology growing more intelligent, we are likely to see wearables playing a pivotal role in medical diagnostics, information sharing and general health in the not-too-distant future," says NHS England's medical director Professor Sir Bruce Keogh. "These devices will put patients in the driving seat of their own care and allow us in the NHS to predict things, act early and keep people safe and healthy in their homes for as long as possible."

Van Hoof claims: "half of what determines our health is due to our behaviour. Eighty per cent of heart disease, stroke and type-2 diabetes could be prevented if the behaviour factors could be eliminated."

What's the difference?

The change in healthcare needed is not just about wearables. In general, e-health, the use of telecommunications and IT to provide and improve clinical healthcare, aims to link patients and treatments over the Internet to save time, cost and resources and potentially save lives. The idea around e-health comes in varied forms: it could mean digital healthcare, such as electronic health records, assisted healthcare, telecare, telemedicine and the latest being wearable technologies.

Research by IDC Insights indicates that by 2018, 70 per cent of healthcare organisations worldwide will invest in consumer-facing technology, including apps, wearables, remote monitoring and virtual care. Analysts PriceWaterHouseCoopers also say 80 per cent of consumers believe wearable technology has the potential to make healthcare more convenient, while Soreon Research predicts the wearable healthcare market will grow from $2bn in 2014 to $41bn in 2020. It appears the predictions and statistics are in line with NHS's medical director Keogh's view, but will this just be all hype?

"The answer here is clearly we do not know yet," says Tony Cornford, associate professor in information systems at the London School of Economics. "Wearable technologies so far have a very small place in healthcare, not surprisingly, as they are quite new and all the support infrastructures to use them are not in place.

"There is potential of course, and industry backing could lead to surprising levels of take-up. But I believe that, as with m-health in general, the impact on actual healthcare outcomes will be slow to emerge. Benefits will probably be modest and occur mostly when wearables are incorporated into wider healthcare initiatives."

He adds: "It's not really a revolution but slow incremental changes. But if there is a revolution it will be led by a mix of some technologies, some patient engagement and empowerment, and quite a lot of more traditional health improvement activity."

Changing attitudes

With any advance in technology, there is a chance that acceptance and adoption will take time. Though governments and companies are racing to promote new technologies and applications and though these have shown signs of successfully breaking through, reality shows there is a major battle with e-health ignorance. The Delivering Assisted Living Lifestyle at Scale programme, funded by the government, surveyed 2000 people of whom 90 per cent did not know what telehealth and telecare technologies were and 70 per cent were not aware of health and care apps available on their smartphones and tablets.

While the benefits are clear, the reality shows the NHS is not quite up to speed yet. According to the results of Freedom of Information requests made by software firm Ipswitch, 83 per cent of NHS trusts are unprepared for the impact of wearable technology and furthermore, only 38 per cent of trusts were able to differentiate between wired and wireless devices on their networks.

Compared with other industries, where technology has transformed the market and the way consumers interact with their service providers, the experience of transforming the healthcare industry has hardly changed at all, reckons Inhealthcare.

"E-health has really taken off with the public - wearable devices, health apps and access to clinical information has become huge business. However, the challenge is that the public's use of e-health is massively outpacing the rate at which the UK health system is realising technology," says Simon Jones, commercial director at Inhealthcare.

What is more, the technology does not need to be incredibly advanced, as a mobile phone or landline could be used to monitor the care of a patient. Not only can these platforms help the healthcare system reach a vast proportion of the population remotely, but they can also free up resources, both financial and time of the healthcare professionals.

"Members of society now run their lives via digital means, and the increasing use of wearables and apps shows that the appetite for digital-enabled lifestyles includes health and wellbeing. The challenge this pace mismatch creates is that lots of data sets are being created but the connection between the data and clinical decision-making is weak, and therefore the benefits of e-health have not been maximised," says Jones.

LSE's Professor Cornford comments: "there is hype today around wearable devices, but the core issues, I believe, remain in the established institutions of healthcare and revolve around digital patient records, sharing of information and better resources.Giving patients the ability to hold a more appropriate role in their own care is also a very important development to consider. But there is no one magic bullet solution. There are lots of areas that we can, and should, improve upon."

PA Consulting Group is doing just this as it is helping roll out telecare services across Hampshire County Council to find innovative ways to manage the demands of an ageing population. The Argenti Telehealthcare partnership comprises Tunstall Healthcare, O2, CareCalls, Medvivo and Magna Careline to deliver mainstream telecare services. The outcome of this partnership could expect financial benefits of £3.4 million over a three-year span.

Breaking the barriers

"The main impediments to wider adoption are not cost, ease of use or privacy, but the attitudes of care practitioners and a hesitancy to incorporate technology," says Steve Carefull, healthcare expert at PA Consulting Group. "We often encounter care professionals who are reluctant to use technology unless there is unequivocal evidence of benefits. However the evidence can't be generated unless the technology is integrated fully into redesigned pathway. There is a 'chicken and egg' situation here that requires courageous commissioners to adopt a more ambitious approach."

There are some benefits to caution, says David Rees, public sector specialist at PA: "Firstly, there is an importance to avoid being seduced by the latest technology. There is constant work to improve the quality of imaging, reduce weight and extend battery life, as can be seen in the latest Apple Watch launch and Google's decision to pause and refocus its Glass for the next iteration.

"It is also just as important to recognise that the device itself is just one part of the solution and on its own will not bring benefits," adds Rees. "To fully exploit its advantages the NHS needs to include not only the device, but also additional items such as location software, specific applications and the use of cloud solutions, but crucially integration into the end-to-end patient experience."

Despite the slow uptake to transform the traditional healthcare system, reality shows the hype around wearables and health are actually happening and only shows signs to improve.

PA Consulting's health expert Carefull adds: "The future for e-health and wellness looks positive. Technology is now becoming smarter, smaller and cheaper. Furthermore, there is a growing level of comfort with technology, as we are now used to the idea of always being connected."

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