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mHealth in the NHS – Everywhere and Nowhere

If you follow the mHealth blogs and groups on LinkedIn you’ll see a constant debate about where mHealth is in out existing health services. I’ve been looking at some of the applications which are already in use within the NHS. As yet, there’s no central policy for mHealth, and it’s debatable whether much of the good practice using mHealth is even acknowledged, but that doesn’t mean it’s not providing benefit.

Much of mHealth is invisible. It’s not the high tech monitoring that we find in glossy medical device brochures, but far simpler, everyday applications. Many of these use SMS, but mHealth extends through voice and video, and we’re already seeing local use of applications on iPhones and Android. However, there is little coordination of deployment, and almost all that is happening is as a result of local initiatives.

Let’s look at some of the examples.

The need for Patient Accessible Medical Records

I came across an excellent report on homecare and chronic disease management this week, produced by Pam Garside of the University of Cambridge for Healthcare at Home. Entitled “Lessons from the US” it looks at homecare practice in the two countries. Healthcare at Home are a commercial organisation with an interest in promoting home care (which you probably guessed from their name), but the report seems to be refreshingly clear independent.

It compares and contrasts the use of remote monitoring technology in the US and UK to support patients at home, both in terms of release from hospital and to manage long term chronic conditions. Its main conclusion is that the UK is far better positioned to benefit from this than the US. But there’s one proviso – that the UK needs to put in place a system that allows patient records to be shared between those involved in care, including the patients themselves.

The report acknowledges that this is currently lacking in the UK, but predicts that this will be remedied during the course of 2010 by the introduction on Summary Care Records (SCRs).

Pam’s obviously not spoken to the British GP’s Council. This week their chairman – Laurence Buckmann, made a presentation to the Local Medical Committee’s Conference calling for SCRs to be scrapped, ostensibly because they require a patient to opt out, rather than opting in. It’s part of an ongoing campaign against SCRs by the British Medical Association (BMA) that makes Luddites look progressive. And which seriously threatens innovation within the NHS.

Smart Energy, mHealth and the Chocolate Factory

Although they may seem strange bedfellows, both the mHealth industry the smart metering industries (both favourite children of the technology world), are facing the same problem. Both are moving from a world of almost no data to data overload of a level they never imagined, even in their worst nightmares. Whether it’s from an annual health check or a visit from the meter reader, both are used to getting one data point per customer per year. The advent of connected sensors means that is changing to anything up to one reading per second.

It’s a bit like the case of a child who has hitherto only been allowed chocolate on Christmas Day. Now they’re being led into a chocolate factory and told they can eat as much as they want. The inevitable result is a very happy child for a few hours, until they’re violently sick. At which point they either vow never to eat another chocolate, or learn to treat it in a more sensible manner.

Today the medical industry and energy utilities are being shown the doors of the chocolate factory. We have yet to see how they behave once they enter it. Some may emerge as triumphant Charlies, but others risk becoming the commercial equivalent of Augustus Gloop and Veruca Salt.

FDA and Regulation. The dangers of crying Wolf.

Everyone seems to think that mHealth is about to take off. mobihealthnews.com’s recent roundup of analyst predictions estimated sales of around $4 billion per year by 2014, and my own more fanciful review of potential savings ran into tens of billions of dollars. Network Operators are setting up mHealth divisions faster than you can say “long term chronic condition” and the outpouring of mHealth apps for smartphones continues to grow exponentially.

It has all of the characteristics of the next technical bubble, but with the added benefit that, if we can make it work, it might actually save our healthcare systems from terminal meltdown. We need the disruption that mHealth will bring. As Clayton Christensen points out in his seminal book – The Innovator’s Prescription, the only way we are going to effect a major change in healthcare is through the introduction of new, parallel business models to challenge those that our current healthcare structure is built on. That will need new technologies that provide more effective diagnosis of symptoms, as well as devices that encourage personal participation in healthcare by putting monitoring and health records into the hands of patients. Which are exactly the areas being targeted by the mHealth community.

However, there’s an invisible gorilla in the mHealth room that could consign the whole enterprise to history. It’s called the FDA. The FDA has the ability to apply regulations that would choke the development of mHealth. Like all regulators, the FDA moves slowly – far more slowly than the emerging mHealth technology. It is important for the industry to engage with it to reset the levels of regulation for mHealth. What is worrying is that most of the noise around regulation is not about that resetting of expectations, but scare-mongering about the possible reaction of the FDA to an expansion of connected healthcare and new delivery methods. It’s important that manufacturers understand the barriers that regulation might bring, but we’re at risk of crying “Wolf” to the extent that mHealth may never happen, or else only evolve outside the U.S.

Can mHealth save the NHS?

There’s an election looming in the UK, which is causing problems for the political parties. Everyone knows that we need major public spending cuts, but no politician is going to risk votes by committing to anything too great. So everyone is carefully skirting the issue, particularly where the NHS is concerned. The British public have a love-hate relationship with the NHS. They love to deride its inefficiencies and problems, but as soon as anyone attempts to take an axe to it, it transmutes into the most valuable aspect of being British.

Of course, those of us involved with healthcare know that this is more than just an election issue. The changing demographics mean that the NHS, and every other health system in the world is heading for financial meltdown. Rather than acknowledge it, our politicians (even those who have been pushing through the U.S. Health reform bill) are doing little more than being fitted for their lemming suits and asking for directions to the edge of the cliff. We cannot afford healthcare in its present form and we’re running out of time to address that inconvenient truth.

One straw that is invariable grasped and brandished is the potential of mHealth (or eHealth, telecare or eCare) to sweep away the costs. So in the spirit of helping our flailing politicians, I thought it might be an opportune time to review how it’s doing.

Electronic Health Records, Data Integrity, Consumer Apps and Continua.

A few weeks ago I was talking to someone who mentioned the Talisman SOS bracelet that she and her family wore and suggested that people should be encouraged to add basic medical information into their phone. In the UK there have been a number of campaigns to persuade people to add an ICE (In Case of Emergency) number into their list of contacts. Her suggestion was that this could be expanded to include key medical details. Plenty of such phone apps like this already exist, such as My Life Record, Smart-ICE, Hermes and Allscripts Remote. The problem they bring is how much they can be trusted, particularly in an emergency. It’s something that is causing considerable anguish not only within the medical profession, but also within industry groups who are trying to move medical monitoring into the home. It was a hot topic at this week’s Wireless Communications in Healthcare Conference in London.

At the heart of the problem is the integrity of data that goes into a clinical record. Until recently, data was only ever entered by members of the medical profession. The advent of accessible electronic health records means that patients can begin to enter their own data or modify their records. Whilst I believe that’s the way the world has got to move, it raises important issues.

Take the case of Julia…