Most people think nothing of using their mobile phone or tablet PC to look up information or to play interactive games. But can the technology most of us now take for granted be used to improve our general health and wellbeing? A recent doctors.net.uk survey revealed that UK medics are divided over the benefits of mobile phone apps to help patients manage their health, and there are fears they could even put lives at risk. To explore how apps can be utilised in the future, Jo Makosinski spoke to GUY SMALLMAN, commercial development director at Coventry University's Health Design and Technology Institute, which provides a healthcare app design and evaluation service.
"Innovation and technology can revolutionise the health service and patients can truly be in the driving seat." Health Secretary, Andrew Lansley, made these comments earlier this year as he revealed plans to promote and encourage the creation of innovative healthcare apps that could be used by GPs and other medical staff to improve the health and wellbeing of patients.
"So many people use apps every day to keep up with their friends, with the news, to find out when the next bus will turn up, or which train to catch," Lansley said. "I want to make using apps to track blood pressure, to find the nearest source of support when you need it, and to get practical help in staying healthy the norm."
This is an approach supported by Martha Lane-Fox, the UK’s ‘digital champion’ and a dot.com entrepreneur. She said: "We live in a world where digital technology is an essential part of people’s lives – whether it’s at work or simply getting around town. Using apps that locate local health services, or apps that help you to get fit, can dramatically improve your daily life."
The issue formed a large part of the Government’s recently-published NHS Information Strategy. But this has led to concerns that computers and smartphones could begin to replace the family GP, with potentially disastrous consequences.
Speaking to BBH this week, Guy Smallman, commercial development director at Coventry University's Health Design and Technology Institute (HDTI) said: "Apps can be controversial when they are used as a diagnostic tool. This is especially so if they are made available through app stores without having to go through any form of regulatory approval or accreditation. Also there are certain things only a doctor can and should do and apps do not replace this expertise, but we can use this technology to improve health and wellbeing."
This potential is certainly evident in the marketplace, where up to 40% of all new apps coming onto the market are related to health and wellbeing.
Smallman said: "There is a range of healthcare apps available, from learning and development technology for training midwives, for example, through to apps for care workers and community nurses and relatives and friends of people who are vulnerable or have a health condition."
Examples of these apps include tools that help people to keep track of relatives with dementia. These can trace the whereabouts of the person and their behavioural patterns using the GPS technology contained in modern smartphones.
Smallman explained: "Apps have enormous potential in the telecare market using the technology already built into the phones we use on a daily basis, including 3G, wireless, GPS, Bluetooth, accelerometers, cameras, microphones and speakers. All these things can provide the basis for assistive technology devices, which historically tend to be expensive and quite bulky. In addition, some telehealth and telecare equipment simply doesn’t get used because there is often a stigma attached to it. Smartphones and tablets, on the other hand, are perceived as being quite cool by most people. They are comfortable with them and want to use them."
Apps have enormous potential in the telecare market using the technology already built into the phones we use on a daily basis, including 3G, wireless, GPS, Bluetooth, accelerometers, cameras, microphones and speakers
As the Government launches its 3millionlives programme, which aims to roll out telehealth devices to people across the UK, Smallman said the relatively low cost of apps could make this easier to achieve.
"Because the hardware and software platforms already exist, putting together an app to work with them is easier and cheaper than developing something from scratch," he added.
Another positive is that apps can help to get over the problem with interoperability, where devices from different manufacturers, suppliers and network providers often fail to work together as seamlessly as users would want them to.
"On iPads and smartphones we have a much better chance of using common communications," said Smallman. "Also, if 3G fails, you still have wi-fi, so they are potentially more reliable."
Having launched its new app development service in February, HDTI is already working with a number of clients designing new products. The institute also provides in-house product design and prototyping together with a usability testing service which evaluates new healthcare innovations with groups of end users.
Examples of technologies include a partnership with Staffordshire County Council to produce an app that will improve the way social care needs are assessed and met.
Smallman said: "The health and social care landscape is changing and support provision is becoming increasingly personalised. Up until recently if you needed some form of support you would be seen by someone, they would assess you and you would be given what you were deemed to need, whether that be a zimmer frame, hot meals or fall detector. If you didn’t like what you were given it was tough.
"However, using a new app called Me, Myself & I, users can play a game answering questions about their concerns and needs. At the end of the game, a personalised care profile is generated that can then be passed onto the person’s GP or a social worker. As a result, the individual has a greater chance of getting what he or she really needs. Moreover, there is less chance of limited resources being wasted on products that remain unused.
"As a population, as a result of living longer, we are having to live with more long-term conditions for a greater number of years and the NHS cannot afford to treat us all in hospital. Where new products such as healthcare apps can be of the most use is in helping people to live more independently at home.
"We need to develop tools that can help with decision-making and tools that can support people to live more independently. For example, helping someone to care more effectively for a relative with dementia is a wonderful thing to be able to do."
The doctors.net.uk survey found that, of the 550 GPs and secondary care doctors questioned, just 54% agreed that mobile phone apps could be beneficial in helping patients to monitor their health. A total of 46% completely disagreed. The results also showed doctors who graduated after 2000 were more likely to see the benefits of technology being used in this way.
One doctor opposed to the idea claimed smartphones and iPads were mostly used by people who were ‘young and fit’ and not those who would be most likely to need the support; while another claimed the technology was too expensive compared to basic advice given out in the form of a leaflet.
However, one GP said a pregnancy app was achieving positive results among antenatal patients and that smoking cessation apps had helped people to quit cigarettes.
Growing in popularity, mobile phone and tablet computer apps could be a more cost effective way of providing modern health and social care services in the future
Commenting on the findings, Dr Tim Ringrose, chief executive of the website, which has a membership of more than 190,000 clinicians, said: "Our poll highlights a significant difference of opinion among doctors about the value of mobile phone apps to help patients monitor and improve their health.
"While some doctors have already experienced at first hand the value apps can bring to their patients, as well as themselves, others clearly need to be convinced that they will add value.
"It will therefore be interesting to see how this government initiative to increase the popularity and availability of health apps unfolds and whether smartphones will indeed play a critical role in saving millions of pounds through unnecessary visits to the surgery or hospital."
Another key consideration if healthcare apps are to be rolled out in great numbers is the regulatory aspect. Currently, medical devices such as blood pressure monitors have to go through the European regulatory process and be awarded a CE Mark. Providers selling healthcare apps do not offer the same reassurance.
Smallman said: "Whether it’s an app providing the complete works of Shakespeare, or one to tell you the weather in your area, these could have been developed by anyone, anywhere. People are comfortable with purchasing medical devices because they know they go through an approval process. They do not have the same reassurance with apps.
>"While some doctors have already experienced at first hand the value apps can bring to their patients, as well as themselves, others clearly need to be convinced that they will add value
"GPs do have a right to be concerned about this and we will have to be careful about who is selling them and who is ultimately responsible for their performance, efficacy and safety."
Whatever happens, industry is responding to the increasing popularity of smartphones and tablets and it is now a balancing act between modernising health services to fit in with a more technology-savvy population and ensuring they are used in conjunction with, and not instead of, medical expertise.