The process that started with people searching online for the causes of their symptoms will end with consumer technology taking over the way in which patients organise their health and wellbeing, from prevention to diagnosis and treatment to recovery
Visiting your doctor is an incredibly inefficient way of addressing a minor health problem. It costs you the time it takes to organise and attend the appointment, as well as the hassle and expense of getting a remedy from the chemist.
It costs employers for the time when you’re not working and it costs the UK’s National Health Service (NHS) billions of pounds each and every year. Yet people see their GP practice as a service that they have paid for, and they want to extract full value from it.
The upshot, according to a 2014 report by the British Medical Association (BMA), is a massive 340 million GP consultations each year, an increase of 40 million since 2008. Between 1998 and 2012 the number of visits increased by 24%, which represents an unsustainable jump in medical traffic.
Despite an ongoing programme of reform, the NHS is buckling under the strain of a growing, ageing population, and budgets simply can’t keep up.
According to the BMA, the number of Brits aged 65 or over reached 10.5 million in 2011. It expects this figure to soar 50% to 15,778,000 by 2031. With the growing and ageing population will come increased instances of complex and resource-sapping medical conditions such as dementia, cancer and diabetes.
Research commissioned by Grant Thornton reveals that hospitalisation of 65 to 84-year-olds and those above 85 has increased by more than 100% in both groups over the past two decades (1989-2009/10) and the number of elderly needing care is expected to increase by 61% during the next 20 years (2010-2030).
Policymakers are already wondering how to pay for short-term costs such as an extra £5 billion needed by 2018 to provide social care for the elderly.
Drilling down to the disease level, the Grant Thornton research reveals that once the economic, health and unpaid care costs are accounted for, the UK is paying £15.8 billion a year to treat cancer patients.
Tackling diabetes currently accounts for 10% of the NHS budget, 80% of which is spent on preventable complications. With the research predicting that the number of diabetes sufferers will increase from 3.2 million in 2015 to more than 4 million in 2025, the slice of NHS funding going to diabetes patients could rise.
Something’s got to change. Throwing more money at the problem will not make it go away.
Luckily for a government with a patchy track record in selling healthcare reform to the public, technology entrepreneurs, not politicians, are leading the race to create a healthcare system that is appropriate and affordable to both patients and the Treasury.
Diagnosis by smartphone
Patients used to rely entirely on doctors for a diagnosis, but now most people will do a basic web search to learn about what could be wrong before they visit a professional.
This presents advantages and challenges to doctors, who see the benefit of better-educated patients while also appreciating the risks of false leads. But the willingness to resort to consumer-grade digital channels is a sign of things to come – and it could be our best hope for a healthier future.
One British businessman offering a connected solution to our ailments is Lee Denith, founder of Dr Now, a smartphone app that offers video consultations with UK doctors and medicine deliveries in London within four hours, as well as drop-offs outside the capital with longer lead times.
Central to the business is Denith’s belief that the majority of health problems do not require a physical examination for diagnosis and treatment. This is especially true for non-medical visits, such as to pick up a ‘return to work’ certificate.
“Doctors have told us that the vast majority of visits do not require a physical check-up and some 86% of diagnoses are based on patient history,” he says. “People are much more aware of their bodies and four in five will self-diagnose before they go to their doctor.”
According to Denith, doctors are on-board with the idea of ‘diagnosis over IP’, especially the younger generation of GPs under the age of 50. Many that use the Dr Now service are private doctors working towards their Continuous Professional Development certificate, which requires a set number of hours toiling in the National Health Service.
He thinks the idea could have huge cost-saving implications for the health sector and illustrates the point with the example of elderly care home residents who have limited mobility.
“We have a new platform the size of an iPad which will go into nursing homes,” he says. “It has three buttons: to call carehome people, a doctor or an ambulance. At the moment they need to call an ambulance to take them to a GP appointment. That’s £700 just to see a doctor.” It’s a fine example of how something as prosaic as phone apps, more associated with Angry Birds than healthcare provision, could serve as channels for diagnosis and treatment hat relieve pressure on something as big, complex and real-world as the NHS.
The unstoppable rise of wearables
But it doesn’t stop at apps. Wearables have an even greater potential to influence the way people look after their health. Research firm Gartner says worldwide sales of wearables – a range of connected devices that are worn, as opposed to held – will grow from 232 million in 2015 to 323 million next year.
Much of their sales growth will be driven by consumers interested in monitoring biometric data, activity levels and diet plans. Sales of smartwatches, the cornerstone of the wearables sector, are projected to double during the same timeframe.
The relevance of this is twofold. Most obviously, the symbiotic relationship between wearables and the health of their owners will keep people’s minds on their wellbeing, encouraging them to eat properly, exercise, and sleep long and often.
Fall below the recommended tolerances in any of these areas and your watch or band will give you a nudge: ‘get up, put down the doughnut, run around and then go to sleep’, it will suggest with a passive-aggressive buzz or bleep.
But it is in the capturing of all this data where the benefit really lies. We all know that treating any illness early shortens its duration; well, what if your device could inform you of an anomaly in your readings before you even start to feel peaky?
Better yet, if these readings are fed directly to your GP surgery and your doctor gets the buzz as well as you, then diagnosis could begin before you even wake up in the morning. Calculating how much money this form of early intervention could save the health sector is pure conjecture, but you’d guess it could be an awful lot.
As the technology improves, so will the opportunities, says Collette Johnson, Medical Director at electronics company Plextek: “The biggest development in 10 years will be remote treatment in the home and diagnostics will come in the next five years. The more remote we can make things the better for the patient and for the healthcare system as a whole.
“The advent of 5G will bring more opportunities for remote treatment, while different form factors of wearables will enable a multitude of new innovative approaches to healthcare.
“In years to come it could get seriously sophisticated, with street lamps picking up on a suspected heart attack reading and calling a 999 response to a patient in a city centre. Connected health means linking health into our daily lives which should be the reason for transforming the healthcare system as it currently stands.”
How data is getting bigger and better
Oxford BioDynamics is one organisation using data-fuelled science to improve outcomes in cases of serious illness.
It implements big data and machine learning to recognise patterns in illnesses and identify the best course of treatment for each patient.
“Diagnosis of serious diseases such as cancer and amyotrophic lateral sclerosis are currently very complex and require a lot of time from healthcare professionals for conducting biopsies, as well as extensive physical tests and assessments over a long period of time,” says Dr Alexandre Akoulitchev, Chief Scientific Officer at Oxford BioDynamics.
“Our technology enables doctors to identify a disease in its early stage, indicate how it could progress, confirm which drug would be best for the patient and offer residual disease monitoring after treatment for patients with a high risk of relapse.”
The technology, called EpiSwitch, also helps to reveal which patients will respond best to certain medicines, enabling better treatment targeting and improving on current ‘trial and error’ approaches to drug courses, says Dr Akoulitchev.
“Knowing that not all patients with a particular disease respond equally to a given drug, the technology identifies patients with an epigenetic state that is not conducive to a highly effective drug response, and allows clinicians to separate them from the rest of the patients and offer them alternative therapy,” he explains.
It’s one of a million uses of data that could make treatment more efficient and practical for all. Technology and medicine have always been close relations, but as technology becomes cheaper, easier to use and essentially ubiquitous, more people are having a say in when and how they get better after falling ill. Searching Google and wearing a heart monitor is just the start. In 10 short years the entire system could be flipped on its head, potentially saving money, as well as thousands of lives.
Illustration: Harry Haysom