How could healthtech transform patient care?

In the com­ing years, Dr Chris Mor­ris esti­mates 70 per cent of care at the NHS GP surgery where he works will be deliv­ered to patients remote­ly. 

Already any patient want­i­ng advice will first be asked to answer ques­tions on their symp­toms via tele­phone, email or text, he explains. They may be asked to snap pic­tures of “lumps, bumps and rash­es” via their smart­phone, with images auto­mat­i­cal­ly added to their notes. Or asked to join a video con­sul­ta­tion to go into fur­ther depth, with Mor­ris able to send fol­low-up advice via SMS. “We don’t want to go back to how things were,” he says.

In fact, this inte­gra­tion of tech­nol­o­gy into how health­care is deliv­ered looks set to be a lega­cy of the pan­dem­ic. The risk around in-per­son care has prompt­ed a wave in adop­tion of dig­i­tal­ly enabled alter­na­tives in the last 12 months, from dig­i­tal check-ups, to remote mon­i­tor­ing tools and even stetho­scopes using arti­fi­cial intel­li­gence (AI). Such is the speed and scale with which the healthtech mar­ket has grown that invest­ment reached record lev­els of $5.4 bil­lion in the first six months of 2020, accord­ing to McK­in­sey. 

On the one hand, many clin­i­cians on the front line, such as Mor­ris, believe these tech­nolo­gies can “help raise the lev­el of patient care” while allow­ing providers, like GP surg­eries, to oper­ate far more effi­cient­ly. On the oth­er, there is cau­tion we shouldn’t for­get the val­ue of in-per­son care or under­es­ti­mate the exper­tise that needs to accom­pa­ny even the smartest of dig­i­tal tools.  

“This is not a panacea,” says Mor­ris. “But it is anoth­er way of deliv­er­ing health­care.” It’s one with plen­ty of poten­tial. 

Digital check-up

At Numan, a dig­i­tal check-up ser­vice tar­get­ed at men – the team has now con­duct­ed 1.4 mil­lion dig­i­tal con­sul­ta­tions in less than two years – is one of a num­ber of dig­i­tal con­sul­ta­tion ser­vices see­ing a rapid uptick in inter­est since the pan­dem­ic. Numan first launched in 2018. Its users are asked to fill in an online ques­tion­naire and with­in 24 hours treat­ment will either be approved or patients will chat with a clin­i­cian via email to obtain fur­ther details. 

“It brings health­care up to speed with how we inter­act dig­i­tal­ly with our lives any­way,” says Luke Prat­sides, lead GP at Numan and also a prac­tis­ing GP in East Lon­don. It allows clin­i­cians greater con­trol of the time and length of con­sul­ta­tions, and gives patients greater con­ve­nience, he says. “Plus, because it’s hap­pen­ing across the board, both in the pri­vate sec­tor and the NHS, peo­ple are get­ting used to it and real­is­ing it can offer high-qual­i­ty, safe and con­ve­nient care.”

At myGP, an app which allows users to book GP appoint­ments, order pre­scrip­tions and check med­ical records online, trans­ac­tion vol­umes increased by 80 per cent in 2020, the com­pa­ny says, while there was a 96 per cent increase in peo­ple access­ing their records and a 62 per cent rise in pre­scrip­tions ordered. 

Dig­i­tal con­sul­ta­tions will nev­er be for every­one or for every sit­u­a­tion though, cau­tions Mor­ris: “Some patients don’t like them and they’ll want to see their doc­tor face to face.” In addi­tion, you can “lose the nuances of body lan­guage and non-ver­bal com­mu­ni­ca­tion”. 

“At my prac­tice, we walk into the wait­ing room, see the patient get out their chair, walk down the cor­ri­dor and sit down. That tells you an awful lot about the patient even before you talk to them. And you lose all that in a remote con­sul­ta­tion,” he says. 

Remote symptom monitors  

Paul Lan­dau launched remote mon­i­tor­ing plat­form Care­ol­o­gy after his wife was diag­nosed with can­cer at 34 weeks preg­nant. Watch­ing her endure treat­ment, includ­ing spells at home in between cycles of care, “I saw so many oppor­tu­ni­ties for how tech­nol­o­gy could be bet­ter used to sup­port some­one going through what is a com­plex and daunt­ing diag­no­sis”, he says. 

Brought to mar­ket in July 2020, Care­ol­o­gy now enables patients to log symp­toms dig­i­tal­ly, con­nect to Blue­tooth devices to track heart rate or activ­i­ty, receive med­ica­tion reminders, down­load health sum­maries of their sta­tus and con­tact car­ers and clin­i­cians at the click of a but­ton. 

As of Feb­ru­ary 2021, the tech­nol­o­gy has been used by Lloyds Phar­ma­cy Clin­i­cal Home­care and has already proved a huge help, says its deputy head of nurs­ing Jo Upton. “From our per­spec­tive it’s all around the vis­i­bil­i­ty of the patient,” she says. “Our nurs­es go into a patient’s home to take blood or give treat­ment as part of that patien­t’s can­cer path­way. With COVID though, every con­tact with the patient has been changed or has been lim­it­ed.” 

Alter­na­tive ways of check­ing in, such as ring­ing patients fre­quent­ly can be intru­sive. “But the Care­ol­o­gy app allows the nurse to view the sta­tus of the patient with­out invad­ing their time or their pri­va­cy,” says Uprton.

Remote mon­i­tor­ing plat­forms go beyond can­cer care. Clin­i­Touch Vie, for exam­ple, enables patients to take reg­u­lar read­ings of their vital signs using a Blue­tooth device. The read­ings are then shared direct­ly with clin­i­cal staff who pro­vide remote advice. 

AI-enabled clinical tools

In April 2020, healthtech start­up StethoMe announced the roll­out of its smart wire­less stetho­scope, an AI tool the com­pa­ny says is “capa­ble of detect­ing, clas­si­fy­ing and analysing patho­log­i­cal sounds with­in the lungs using med­ical-grade pre­ci­sion”. The small cir­cu­lar device, which can be pressed to the body to pick up a read­ing, works along­side a smart­phone app that guides patients through each exam­i­na­tion and then shares results with their doc­tor.  

It’s one of a num­ber of such devices gain­ing pop­u­lar­i­ty since the pan­dem­ic, allow­ing patients to col­lect sim­ple read­ings at home. Kar­diaMo­bile, for exam­ple, is now being used by more than 92 NHS trusts to col­lect ECG read­ings from patients remote­ly. Two fin­gers from each hand are sim­ply placed on the dig­i­tal mon­i­tor and the results are trans­mit­ted to an app using high-fre­quen­cy sound waves, ready for shar­ing with clin­i­cal teams. 

And at NuroKor, a wear­able tech­nol­o­gy that uses bio­elec­tric nerve, mus­cle and microcur­rent stim­u­la­tion to help patients man­age pain, sales grew by 156 per cent dur­ing lock­down, accord­ing to the com­pa­ny. 

It’s cru­cial though that behind these AI tools and con­nect­ed devices “there’s a sys­tem set up to deal with all the infor­ma­tion”, says Prat­sides. It can be unhelp­ful as a patient, “if you’re bom­bard­ed with infor­ma­tion you don’t under­stand” and just as unhelp­ful for clin­i­cians if they’re being con­stant­ly sent data. “So it’s about try­ing to sift out infor­ma­tion and use home mon­i­tor­ing in the right way,” he says.

At-home testing kits

Wouldn’t it be eas­i­er for patients to test them­selves for a con­di­tion or abnor­mal­i­ty pri­or to seek­ing clin­i­cal advice? That’s the idea behind the pletho­ra of at-home test­ing kits now avail­able, enabling patients to check for every­thing from hor­mone and nutri­ent lev­els to fer­til­i­ty and sex­u­al­ly trans­mit­ted infec­tions. For diag­nos­tics plat­forms such as Thri­va, which says it has 54,000 sub­scribers, car­ry­ing out half a mil­lion tests, the poten­tial is huge. 

“To take just one exam­ple area, there are 3.9 mil­lion peo­ple liv­ing with dia­betes in the UK; rough­ly they each need a blood test every three months,” says co-founder and chief exec­u­tive Hamish Gri­er­son. “You can add to that the mil­lions of peo­ple who are on pow­er­ful drug treat­ments and require blood tests to mon­i­tor their liv­er func­tion or those who require reg­u­lar check-ups while they’re on can­cer treat­ments.”

But if COVID has fuelled usage of these at-home tests, it’s also served to high­light the poten­tial risks. A swathe of at-home COVID-19 test­ing kits launched last year were met with con­cerns around how accu­rate­ly they were being used by patients and how reli­able the results were. As one expert at the New York Uni­ver­si­ty School of Med­i­cine says: “There’s a lot of bunk, junk and crank stuff out there. Some tests are com­ing from rep­utable places and some are not, and that’s hard for the aver­age con­sumer to tell.”