Doctor Tim Ringrose is a nephrologist. Which means he’s an expert in the workings of the human kidney. But he also has a front-seat view of the debilitated state of the NHS – especially in the wake of Covid-19. He’s not alone. “One consultant friend told me that it’s like the car’s engine has been taken to bits, but we’ve lost the manual so we can’t put it back together,” he says.
According to Dr Ringrose’s own diagnosis, it’s not worth wasting time hunting for that manual. Because healthcare was already in need of a new engine anyway.
If there’s one thing that has traditionally kept the pistons of healthcare moving, it’s personal contact. From Florence Nightingale’s revolutionary Crimean War nursing, to the modern local GP, health professionals have always dished out doses of reassurance or reality directly to their patients, in person. But with the arrival of Covid-19, the most caring thing anyone could do was keep their distance. So governments and healthcare services were forced to rapidly rethink what viable care looks like.
Dr Ringrose is CEO at Cognitant Group, the tech company behind healthinote, a digital platform that uses gaming technology and virtual reality to share interactive health information with patients via their smartphones and computers, or even VR headsets. Cognitant is one example of how digital innovation, previously making slow inroads into the healthcare space, has been propelled forward in the wake of the pandemic to take the pressure off over-stretched health services.
“Prior to Covid, everyone knew that the NHS, for example, was under strain,” says Dr Ringrose. “Clinicians were burned out from overload, waiting lists were getting longer, and demands were going up. But services were paralysed, not knowing how to change, and the experience of patients was maybe getting worse. Covid forced change. It forced clinicians to try new things, and has been a turning point for us. I know lots of GPs who, a year ago, would say that online consultations aren’t worth doing because they take just as long and you need face-to-face to evaluate patients properly. They’re now thanking god for virtual.”
Mobile tech has long been an integral part of many day-to-day lives – driving everything from friendships and takeaway orders, to banking and tax affairs. Healthcare is finally catching up. But it’s not just for the sake of a trendy gadget. According to Cognitant, 43% of people lack the literacy skills to understand typical health information, while non-adherence to medication is as high as 50%. In Europe, this contributes to 200,000 deaths, costing £125 billion, per year. Cognitant’s healthinote platform enables healthcare professionals to provide essential, trusted health information – training how to store and prepare their medication, for example – in a form people will actually take in and remember. This takes pressure off nurses’ face-to-face visits, and prevents people resorting to Google for information as consultations get shorter and less comprehensive.
But the digital health picture is a complex jigsaw, and Cognitant is not working alone. Cognitant is, for example, partnering with eConsult, a digital triage tool that allows patients to send GPs their symptoms in written form along with pictures. Cognitant was able to cure a critical issue for eConsult – it had a ready-made visualisation tool that could plug into the latter’s platform. Meanwhile eConsult had the reach: 40% of the UK’s 7,000 GPs are already using eConsult, giving Cognitant what Dr Ringrose calls “a turbo-charged engagement with clinicians”.
This collaboration is just one of countless partnerships currently transforming the provision of healthcare around the world. Google Health, for example, is partnering with London’s Moorfields Eye Hospital to pioneer the use of artificial intelligence in eye scans. Using images of the back of the eye, the system can detect health issues as well as any ophthalmologist. It can even use that data to discern the patient’s gender – something no human can do.
Another emerging trend is the use of ‘digiceuticals’, therapies that rely on software to help manage diseases. In one key partnership, Apple and Johnson & Johnson are running a clinical trial exploring whether the Apple Watch can be used to detect atrial fibrillation, a condition that causes an irregular heartbeat.
And things quickly turn even more sci-fi with digital pills. In 2017, Proteus (the US) and Otsuka (Japan) won FDA approval to launch Abilify Mycite, a sensor-laden schizophrenia drug that allows doctors to monitor whether patients are taking their medication as prescribed. The pill’s ‘ingestible event marker’ sensor sends a message to a wearable patch, which transmits the information to an app, so patients and caregivers can track what medication has been taken.
Dr Michelle Tempset is a partner at Candesic, a 30-strong mix of academics, frontline health and business people that advises investors and operators of digital health companies on strategy and operational change. She believes that these partnerships, between the tech world, medical world and other partners, are key to making healthcare more patient-centric and ultimately more effective.
“You need the techies, those with medical knowledge and the end user to come together to actually make it useful,” says Dr Tempest. “That’s the secret sauce. We’ve come a long way in a short period, but this work is iterative, and it is going to take time. To speed it up, you need investment.”
It’s certainly a worthy cause. According to the World Health Organisation, one of the greatest challenges facing health systems globally in the twenty-first century is the increasing burden of chronic diseases. Already one in three people around the world have at least one long-term condition.
When it comes to the long-term vitality of our health services, the digital pill has already been swallowed – it’s a case now of waiting to see the impact as it enters the arteries of global health provision.