Since the early nineties the increase in digital capability has grown exponentially in our society, we now expect to interact with all manner of services digitally. Indeed the government instructs public services to be ‘digital by default’ . We are without doubt out the other side of the Information Revolution and well into the Information Age, including in health and care.
Those of us who remember the early episodes of Star Trek, celebrating its 50th anniversary this year, recall how the crew communicated via wearable technology in the form of the badges on their tunics and how ‘Bones’ the medic, used a handheld device to assess the health status of patients in the field or in the Enterprise sick bay. That imagining of the future 50 years ago is now increasingly commonplace reality – digital communication between patient and healthcare professional: smartphones giving access to a wealth of health apps and even clinical interventions and services; wearables such as Apple watch, the Microsoft Band and the Fitbit encouraging healthier lifestyles; digital portable ECG machines, heart rate and other vital sign monitors enabling better management of chronic conditions.
We explored in our previous article how the continuing growth in digital technology is affecting the arena of personal health and wellbeing, impacting people’s behaviours across all age groups . We have also considered how the older generation is increasingly digitally capable, how they are using technology to help improve their health, wellbeing and continued independence, and how their appetite to use it is increasing year on year.
Now, looking back over the last 10 years, it is interesting to consider the question: where has the most progress been made in applying digital technology to personal health? There are certainly many more easily accessible channels to access information, advice and services, in both the public and private health sectors available today than ten years ago. Online and telephone services such as NHS 111 provide a comprehensive and increasingly reliable 24/7 route to NHS services, directing people to the most appropriate services, information and support. The growth in private online services is now well established and growing apace. Development and delivery of interventions and treatment through digital channels has been particularly helpful to people living with mental health conditions where examples include the Big White Wall, and AXA PPP HT&Y winner, PsyOmics, which support clinical trials for psychiatric treatment. The rise of the smartphone giving instant access to such services and innumerable other health and wellness apps is arguably the biggest contributor to opening up these instant access channels to the population at large.
As digital channels have expanded people have increasingly taken the opportunity to join together in online communities, sharing knowledge and information and providing peer support. There are online communities for every aspect of health and wellbeing as well as for common and rare conditions such as the international community, Patients Like Me, which links people and families facing similar health challenges all over the world. Other examples abound: from key life stages, such as new mums getting support and advice from Mumsnet or apps such as AXA PPP HT&Y finalist Babybuddy; apps that link people and their personal data together to share experience and even compete in physical challenges, such as the cycling app Strava; and geographically focused ‘digital localities’ providing online support systems for vulnerable groups, such as Sheffield Flourish, which coordinates and communicates support for people managing mental health conditions in that city’s community.
This progress has underpinned an ever more knowledgeable population. People are becoming more informed about their health conditions, chronic and acute, and about how to stay healthy in the first place. There are clear signs of a shift in the relationship between individuals and their healthcare professionals. Patients now increasingly attend consultations having accessed their own records, using online services such as 2016 AXA PPP HT&Y Champion Award winner, Patients’ Know Best, researched online beforehand and prepared questions and considered treatment options available to an extent unseen even 10 years ago. When considering where and by whom to be treated, people now have instant access to information about the care providers available via both government sponsored information services such as NHS Choices and myriad independent sources. The consumer generation who demand ever more choice and flexibility from their services are increasingly seeking it from their health services, as illustrated by the politicians pressing for a ‘truly 7 day service’ despite the culturally embedded reverence for the NHS that sometimes inhibits change, even for the better.
As we look back over the past 10 years or so, we can also see that there are some things have not progressed as anticipated and consider why that is. Back in the 1990s the government and the NHS were actively supporting the development of digitally enabled ‘telehealth’ and ‘telecare’ as a key factor in delivering more efficient and consistent services to patients and to shift health record keeping from paper to digital. The reality has been slow and patchy adoption by our health service providers, both public and private, and the evidence of value and benefits has been mixed at best .
More recently health tech policies have focused on the drive for greater participation and transparency through digital channels, driving the move to online service delivery, such as the Patient Online programme to promote the shift of GP services online; and numerous initiatives making health service performance information more readily available to inform people’s choices and support greater accountability. The current policy focus has shifted back towards digital and information technology as the enabler of more efficient services that are increasingly personalised. The NHS CEO Simon Stevens and the Health Secretary Jeremy Hunt have both spoken consistently on this topic, including recently at the NHS Expo in Manchester, where AXA PPP HT&Y launched its third year Award categories .
An important factor in slow take-up has consistently been acknowledged as insufficient time and focus on the end users of the technology, both health care professionals and their patients. This has affected both the design of technology healthcare solutions and the approach to implementing technology. Even well designed technology can be badly implemented and poorly used. Failure to really put the person or patient at centre of design remains a significant issue. Although almost all health IT solutions and personal health apps contain personal records, they are not easily joined up. Hospital and GP records remain bounded within the organisations that create them and, whilst personal data in apps might upload to your laptop or smartphone, as yet it is not easy to integrate all the data to create a holistic picture useful to individuals themselves or their healthcare professionals and community healthcare planners and commissioners. A third key factor is the variability of progress in gaining people’s confidence in government and tech suppliers’ ability to maintain the confidentiality and security of personal information and ensuring an acceptable balance between surveillance and support.
Looking ahead, what is important is that we learn from our mistakes as well as build on success. In line with personal wellbeing goals, prompted by my own Fitbit, my summer holiday this year included getting up early to walk in the cool of the day, before the obligatory loafing by the pool. The effort was rewarded with classically beautiful views across Tuscan hills and valleys sprinkled with picturesque medieval towns. It also highlighted that for every climb achieved, and dish of pasta justified, another higher peak was revealed. As Newton understood, to advance human knowledge we need to look beyond the current horizon and acknowledge the development of those who went before, as he remarked about his own achievements he was “standing on the shoulders of giants” .
The AXA PPP HT&Y Awards are built on the premise that success and progress rely on continuous innovation and this is reflected in the development of the award ethos and the categories. The importance of developing personal health tech in a human context and the central role that good design has on usability and take up is acknowledged by the AXA PPP HT&Y partnership with the Design Museum. Last year’s winners of the Innovator Award, Helen Hamlyn Centre for Design, provide an exemplar of people-centred design, using technology to improve lives .
In Year 1 the Awards, Forum and Showcase took a snapshot of recent health tech developments and examined what these changes could mean for designers, healthcare professionals and users of new technologies. In Year 2 the 2016 Awards celebrated the best in personal health technology innovation across seven categories from individuals, designers, developers, entrepreneurs and healthcare professionals from the UK and around the world. Recognising that this is a rapidly developing environment the aims and objectives for Year 3 the focus is again on sharing, promoting and supporting the best in consumer digital health innovation and development .
The Awards also recognise that, to succeed in pushing the boundaries of health tech innovation forward, you need tenacity and staying power as well as vision. Every award winner will have overcome many challenges to achieve success. Indeed they have pushed the boundaries and been prepared to fail, trying things out and learning from each attempt, working with users to ensure a usable design. Our award categories not only reward and applaud success but aim to support those who have that combination of vision and determination to keep at it when the going gets tough.
At our Year 3 launch this year at NHS Expo in Manchester, we were delighted that three of our past winners were able to join us. Winning entry in the Health & Care category was Food Maestro, developed in response to the innovator’s own family’s challenges with extreme allergies to certain foods. Independent Living Award winners, Walk with Path showcased their ‘Pathfinder’ walking aid for people with conditions such as Parkinson’s disease. We also heard from the designers of Ostom-I , winner of the Breakout Award, a sensor that links via Bluetooth to a user’s phone, alerting them in good time when they need to attend to their colostomy bag. Although these achievements are at the forefront of personal health technology, it took years of hard work and development to arrive at the award winning solutions that we celebrated earlier this year.
So, following the launch of Year 3 of the Awards, let’s look forward over the next 10 years and beyond and consider the anticipated areas of progress in personal health tech. The indications are that the increasing personalisation of health and wellbeing enabled by the growth in data analytics will be a central theme. This will impact at both at an individual level, with people being able to manipulate and review their own data as part of an holistic personal record , and at a population health data level, with the rise of ever more sophisticated ‘big data’ analytics, derived from the inexorable shift of our daily lives into the digital arena. Data about our genetic makeup and state of health and wellbeing will be core components in the tailoring of our increasingly personalised digital identity, enabling personalised healthcare designed ever more precisely and effectively for our individual needs and preferences. Our younger generation clearly expect and seem comfortable with this direction of travel, as evidenced by the HT&Y 2015 State of the Nation Report.
Alongside these developments is the convergence of the hardware devices. It seems our personal technology devices are becoming interchangeable, their capabilities and functions merging into increasingly well designed and intuitive personal portals, bringing together all the facilities of smartphones, Fitbits, and other life enhancing wearable devices. So the next generation of personal devices will not be single function, whether we wear or carry them or even have them implanted or woven into the fabric of our clothes. They will be our secure, individually tailored personal portals enabling our digital selves to participate in an ever more sophisticated digital universe.
As these technologies become more widespread and easily accessible to all, this will support and enable people to take greater ownership and control of their own health and wellbeing. The AXA PPP HT&Y Awards will continue to support this future vision and build on the success to date in identifying, showcasing and supporting an exciting and inspirational group of developers, designers and businesses that are – or soon will be - helping people become true ‘Participatients’ in clinical settings, in the workplace and at home.