IoT could cure NHS A&E costs by Chris Wheal

Posted on 1st November

"Health is about to get a medicinal dose of IoT to enable better treatment of patients in their home and to cut emergency admissions to hospitals." - Chris Wheal

Health is about to get a medicinal dose of IoT to enable better treatment of patients in their home and to cut emergency admissions to hospitals.

NHS England announced a series of “test bed” technology initiatives in January, two of which are specifically IoT projects. One of those – the diabetes digital coach – kicked off in May and has already established the tools it is to trial over the coming two years. It about to start selecting several thousands of users who will include patients, their next of kin, carers, nurses and GPs. Its project lead is Dr Elizabeth Dymond, deputy director of enterprise at West of England Academic Health Science Network.

Dymond’s outline of the project aims tallies with efforts throughout the NHS. “We have five digital tools for patients with type 1 or type 2 diabetes. We want to enable better self-management of patients’ conditions. We havetools to make it easier to self-manage and tools that educate patients so they can better self-manage. And we’re looking at better integration of the treatment and care process,” she explains.

Data storage and sharing

Another major issue data-protection and sharing. “We are testing out a new model of citizen-owned data and how that integrates with NHS data systems and approaches. Plus we are testing how that works within the rules and regulations governing how data systems can talk to each other,” says Dymond. Each patient gets to choose how their data is shared – it could be with their family, friends, carers, medical staff, their GP, the hospital, a social group or a network (the project is backed by Diabetes UK which has local support groups) as well as the project researchers over all. The aim is that each patient gets to see relevant trends faster and can adapt their self-management accordingly.

Technology partners

  • Hewlett Packard Enterprise
  • Ki Performance
  • LeLan / SocialDiabetes
  • Mapmyhealth
  • Oviva
  • Rescon
  • R-outcomes
  • Soupdragon Resources
  • HEOR
  • These include education tools to help patients predict insulin levels. Although operating as phone apps, some have been approved as medical devices for regulatory purposes, as they take readings from machines measuring weight, blood pressure and blood glucose levels. The data transfers to the app automatically but can also be entered manually.

    There are also NICE-approved wearable activity monitors that measure activity and encourage patients to increase that over time, plus educational tools to show that even housework is non-sedentary behaviour – it does not have to mean joining a gym.

    Dymond is currently evaluating monitors where blood glucose readings are taken by plugging into the patient’s phone, holding the phone near the monitor and even wearable continuous blood glucose monitoring technology.

    The varying nature of diabetes has dictated the array of technologies. But the aim is that more patients feel confident to self-manage their condition and they, and medical staff, get earlier warning of problems are deal with them more efficiently at an earlier stage.

    Reductions in hospital admissions

    The aim is fewer GP visits and hospital admission but also that the hospital admissions become more elective, with fewer emergency admissions or, worse still, via already overrun Accident and Emergency departments brought in by overstretched ambulance services.

    “The combined data will enable healthcare professional to set up alarms and plan treatments and see trends and drill down to see if services need to be delivered in a different way,” says Dymond.

    She sums up the programme succinctly: “It’s a great opportunity to use technology that is already out there in a different way in a healthcare setting. It is giving people the choice about which tools suit them best. It’s about using digital technologies to reach a large number of people and show them what could be possible – both the people with diabetes and healthcare professionals.”

    Case study

    East London pioneers

    East London NHS Foundation Trust in the capital’s most deprived borough, Newham, has been pioneering IoT in patients’ homes. It uses Philips Health’s Motiva system for the top 5% of its severe long-term, heart and hypertension (stroke) patients.

    Motiva is either installed as a tablet or as a set-top box on the patient’s TV, depending what the patient prefers. It takes weight, blood pressure and pulse, readings from Bluetooth connected measurement device. Oxygen saturation and blood sugar can be entered manually by the patient.

    The Motiva is either connected via the patient’s broadband or uses 3G to send the data to UK servers, enabling healthcare professional to track, monitor and be alerted if patients’ conditions deteriorate.

    For diabetes patients and those with less serious heart and hypertension conditions, the trust uses a system called Florence, or Flo, which is a web-based tool – a phone app was avoided because not all patients in the area have smartphones. Patients are prompted to take readings and enter them manually.

    Better planning

    The data enables health professionals from GPs to the ambulance service, to plan treatments and interventions and to react rapidly. Patients or their carers can be called with urgent instructions and the trust has established rapid response units as an alternative to calling the ambulance service wherever possible.Bureaucracy and internal NHS accountancy rules get in the way. Blood glucose level readings are still entered manually, partly because the funding stream is via GPs, who have to issue prescriptions to their patients for the monitoring strips used. If the trust provides electronic ones – currently awaiting regulatory approval, the trust would pay but the funding would stay in the GP’s budget, making the GPs richer and the trust poorer. The trust will need to get GPs to agree to pay for the monitoring kit.

    One objection patients have is the fear they will receive less face-to-face treatment, but telehealth team lead Ram Padmanabhan, says patients get more interaction.

    Life changing treatment

    Patient Terry Munro claims the system stopped him becoming house bound. “In 2008, I was worried about falling into a coma with no one around to raise the alarm. Now, because I take daily readings and upload these to the central telehealth system, it means that I know how I am, and the health professionals know how I am, and we can take action if needed.

    “I often do a reading before I go out so now I know how what my blood sugar level is. It has given me so much confidence. I don’t have the worries about my health that I used to have. That little machine has taken my worries away.”

    Expansion plans

    The trust has already expanded remote monitoring to patients at risk of bed sores and is looking to expand to mental health services. It is also about to introduce a multi-lingual version so more of Newham’s diverse community can use the technology without needing an English speaking person to help. They will receive and send messages in their own language but these will be auto-translated into English for the central admin and healthcare professionals.

    Philips also has plans to extend its system. Rupert Hipwell, director of population health management, said: “Philips’ Motiva system has been designed principally to support people living with long-term physical health conditions to better self-manage. We are currently evaluating the use of Motiva with people living with Dementia and their carers.”

    Want to learn more about the impact IoT will have on today's industries? IoT World takes place in Dublin this November – Europe's most comprehensive IoT-focused event. Paid Places and Free Expo passes are still available.

    Health Innovation Week 2016