Not everyone may have noticed, but we are living in a period of revolution — and it eclipses the industrial one of the 18th century by a factor of about ten. Technology is evolving at breakneck speed and what is happening right now is likely to be obsolete by the next decade. Think back 20 years and you can see what I mean — I was carrying a radio telephone on home visits that was the size of a car battery and writing all my notes on paper in longhand in 1996. Today all my work is web-based and health technology has finally caught up with the explosion in processing power available on a microchip.
Digital technology in healthcare is the new buzzword. But what does this actually mean in practice? Well, there are a handful of examples which show the brave new world that medicine is being steered into.
The smartphone. Perhaps the most obvious example. The computing power in our pockets could put man back on the moon. Two thirds of us use smartphones to access the internet, and thousands of health apps are downloaded every day. However, their potential has still not really been tapped, and in the coming years we will see them being increasingly used as patients demand easier access to medical care services via their smartphones. This will typically be in arranging appointments, ordering prescriptions or talking to their GP via video consultations. With the current political drive towards a full-time, seven-day, routine NHS availability, remote appointments will become increasingly common via phones, tablets and computers (for instance, here).
Networked medical devices. There are currently four main categories in use, all relying on quality wireless networks to function effectively. These include wearable external medical devices (such as portable insulin pumps) that communicate wirelessly with central hubs; consumer health-based products such as Fitbits that use Bluetooth to communicate with personal devices; internally embedded devices (such as pacemakers) that ‘speak’ wirelessly to doctors, and stationary medical devices such as home-care cardiac monitoring for bed-bound patients. Their usage remains in its infancy but is likely to expand dramatically.
Smart pills. With up to half of all medication prescribed to people with long-term conditions not being taken as recommended, technology is now available to help promote better compliance and treatment adherence. ‘Sensor pills’ are a good example. Micro-technology now means that sensors can be swallowed in pill form, which — when dissolved in the stomach — are activated. Data is then transmitted to a wearable patch on the outside of the body and on to a smartphone app, enabling both clinician and patient to see how good compliance is.
One drug delivery system currently under development (which sounds like it is off the set of Star Trek but in reality is almost ready for use) aims to use an implantable device containing tiny, sealable drug reservoirs that open when triggered by a small electric current controlled by an embedded microchip. Doses of drugs could be released automatically for a decade from a single chip — think contraception or psychiatric drugs and you can see the potential here.
Genome sequencing. This is the motherlode. As we further advance genome (DNA) sequencing we bring a better understanding of not only how disease affects different individuals, but also how that individual may respond to certain drug treatments (pharmacogenomics). On the back of this, potentially curative treatment for illnesses such as cancer or inherited conditions becomes a possibility and, although this is probably at least a decade away, we can reasonably look forward to our children having access to individualised treatments linked to their genome in the future. The cost of sequencing a single person’s genome continues to rapidly fall to a point where cost is not the major factor in its use.
In theory, all would seem lovely and shiny in the digital health world, where doctors can improve the accuracy and usefulness of information gathered on a patient’s health, where new ways of predicting and treating illness are appearing and where we can change both where and how healthcare is delivered.
However, the NHS is notoriously slow to adapt to technology (hospital letters are still sent to me by fax rather than email). Unless the benefits are dispensed universally, then access to digital healthcare services will be subject to a postcode lottery, with all the frustration and unfairness that this brings with it.
The NHS also shows little evidence of being able to deal with the huge volume of health information that new technologies generate, and until it does so, the prospect of using available real-world technology to improve the health of my patients remains frustratingly just out of reach. And it’s there, waiting for us.