Soapbox: Further thoughts on CarelineUK, O2 & WSD

The many, excellent, comments on O2’s withdrawal of their current telecare & telehealth offerings in the UK market, most notably from my fellow editor Alasdair Morrison, have prompted further thoughts on the post about CarelineUK’s 25th anniversary earlier today: what will CarelineUK,  and other organisations like it, look like in 25 years’ time?

Perhaps the most significant change that appears to be coming in the area of telemonitoring is  that it will no longer be dominated by equipment considerations.  The Royal Society of Medicine held two one-day events, in April and June, respectively on apps and on the disruptive influence of mHealth, from which it became very clear that apps downloaded onto people’s own smartphones are likely to be able to do most of the health and social care monitoring required.  And where you need to go out of the house with your smartphone, a SIM card slipped into a smoke detector or other alerting device will look after the house in your absence.  (I understand that the important features of O2’s telecare product can be replicated on an ordinary smartphone, for example, which makes it much more affordable if you already have a smartphone.)

Anyone doubting this need only look at how successful Simple Telehealth has been, which has very little reliance on additional hardware, as my former Newham colleague Richard Stubbs points out in his comment on Monday’s Farewell to the WSD post.

One of the issues is of course peripherals.  For telecare, the one that is really hard to get people to wear – the falls detector – disappears into the smartphone, using its accelerometer and other sensors; even medication adherence is becoming smartphone-friendly.  For telehealth, there has been a more gradual absorption of sensing into the smartphone beginning with pulse and blood oxygen saturation.  However when the compact vital signs module becomes commonplace in smartphones – predicted at a recent Royal Academy of Engineering event as less than two years away – all the commonly required vital signs, apart from weight, will be easily measurable, and weight Bluetoothed or Zygbee’d from your bathroom scales.

There are still problems to overcome with apps too  – as the post on Tuesday pointed out, there are some 20k medical apps on the Apple Store, and just under half that on Google Play.  The process is at an early stage to ensure their safety and efficacy, to give end-users the confidence to entrust their health and wellbeing to them.  However many, including in the UK dallas’s i3i, are working the issue.

So, with your smartphone able to monitor your health and activities of daily living, and raise alerts for example if you fall or slump, or don’t take your medicine, what you need is a great service, tailored to your individual requirements.  I believe therefore that to answer my earlier question, the future for the likes of CarelineUK looks pretty bright if they provide the service that users want.  At the low end, that might be merely ensuring alerts get through to the appropriate carer or professional responder, emergency or otherwise.  At the high end that might include a full response service  complete with telecoaching to encourage self-care.  In order to bring down costs, service organisations will need to embrace automation, and big data, heavily, exploring the difficult issue of moving from systems that offer decision support to systems that take decisions, which of course immediately increases medical device sensitivities.  Telehealth suppliers tend to react in horror at this suggestion, however there are plenty of examples elsewhere of machine learning being applied to health decisions, so why should telehealth be different?

Who will pay for this of course is the key question, as posed by Alasdair and others.  With the cost of a telehealth installation reduced from £1000 or so to software-only, and the need for  telecare sensors and dispersed alarm units linked by proprietary systems eliminated, the hardware costs of telemonitoring will be vastly reduced, and if the service suppliers embrace automation, then their costs might fall a tad too.  The question will then come down to what is the cheaper way of supporting people’s social care and healthcare needs.  As the post this week on how telehealth & telemedicine can improve hospital revenues showed, hospitals can treat many more people using such technology, and when it is much cheaper, will it still be more attractive to treat so many people in a hospital bed rather than in the community, when other considerations such as the disorienting effect of hospital stays on older people with early stage dementia, or hospital acquired infections are included?  (This incidentally is a view shared by others, including Dr Eric Topol, author of Creative Destruction of Medicine, who believes hospitals should be used only for intensive care, making his point with a recent tweet of his design for a hospital room of the future.)  Perhaps the same finding will apply to the GP service too – once the impact of remote treatment of their patients, in terms of lower costs from smaller waiting rooms, fewer consulting rooms, more homeworking etc., at the same time as higher revenues from the ability to handle more patients, work through the system, perhaps telehealth will prove to be cheaper and more effective in many cases than face:face primary care too.

Who will pay for the smartphones is also a legitimate question – however with Android phones starting at £10/month now, I suspect that won’t be too much of a problem for most people.

There are other questions too, like how long it will be before this can become a reality, and how this fits with the GP vision highlighted in the Farewell to WSD post, but I’ll stop here and seek your reactions, please!

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