Consumer healthcare

The changing demographics and associated costs of healthcare argue for a move towards patient responsibility and personal monitoring. Not only does that reduce dependency on invasive treatments, it also has the potential to generate large amounts of personal health data. That means it performs the double whammy of decreasing health spending whilst helping to make it more effective by furthering the cause of evidence based medicine.  
At Medica last year, the medical industry appeared to have a different agenda, showing no desire to move from the status quo of supplying the clinician with products that ratchet up the cost of healthcare.  
I was at Medica to talk about the need to develop simple products for Assisted Living and the related aspect of Good Design for Consumer Health Devices, trying to promote the fairly obvious concept that these products should be made simple and compelling enough for patients to use. If we can achieve that we should be able not only to reduce treatment costs but also accumulate a lot more data on what works, which will help the cause of evidence based medicine.
Assisted Living is the simplest variant of telecare – if we’re going to successfully deploy any form of telecare it should be this. It consists of low cost devices, such as door alarms, bed occupancy sensors and fall alarms, which can be used to let the elderly, frail and vulnerable stay in their homes. It suffers from the fact that it’s not a glamorous area of medicine, either in terms of deployment or technical design. Yet it’s an area that a growing number of people need and will continue to need.
One of the bigger elements of healthcare budgets is the cost of treating us out of our home, particularly if that requires us to stay in residential care or hospital. Installing assisted living devices is a proven way of extending the time that we can live safely at home.
It needs very basic, wirelessly connected devices and monitoring services. We have a few today, but most product designs have changed little in the last two decades, nor are there more than a few million of them deployed around the world, most of which still require professional installation.
Despite the need for these products, they were noticeable by their absence. We desperately need to address this market by incorporating the appropriate technologies to make them cheap and useable. If the world could deploy tens or hundreds of millions of these systems to the households that need them, we could probably halve the need for the more complex technology on display around Medica.  

Designing for the market

Technology has already advanced to the point where it can deliver these products. It’s not technology that is holding the field back, but the reticence of the medical profession to be involved. The medical industry has a major issue in developing products that appeal to the patient as direct consumer rather than the traditional equipment purchaser – the medic.  
The main reason behind this is probably the obvious one that the consumer is not a member of the medical profession. In other words, if they’re not going to make the purchase, why take their views into account?
It seems to be very difficult to break the current mindset of designing products that appeal to the cash earning potential of general practitioners, surgeons, specialists and hospital administrators. However, if we are going to be successful in getting people to take charge of their own health we need to empower them. That means designing products that are simple and compelling.

Barriers to new design

There are two fundamental issues that are important to understand when talking about this shift in design focus.
The first is the acceptance of the fact that we’re not necessarily going to provide cures with these devices. Instead we need to do is concentrate on the simpler goal of managing long term disease, so that patients can continue to experience a good quality of life.
The second is that products, and particularly services to enable them, may not need to involve medical personnel. That possibility is heresy to the medical profession. However, very few of us need critical medical monitoring devices for more than a few days of our lives.
What most people would benefit from is a level of simple daily monitoring that helps us prevent disease and manage our health. The feedback for these types of application requires very little medical input. In fact, they may well work better and be more relevant with user input from support groups that have personal experience of the disease and living with it.
Needless to say, neither of these points help to persuade the medical industry to progress along the line of designing such products.

Consumer technology
How do we migrate from healthcare as medical technology to healthcare as consumer technology?
The skill needed is the ability to design products that are so simple to install and operate that they can be shipped to the patient in a jiffy bag. They need wireless connectivity that works and they need software that can analyse the patient’s data and provide convincing feedback.
It’s interesting to note that the companies that know how best to mine and manipulate data generally work outside healthcare. One of the prime examples is Tesco. Their database knows more about our personal diet than most of us do ourselves. It’s not the only information that we willingly, albeit often unconsciously give away.

The route to evidence
The King’s Fund, one of the world’s most respected medical think tanks, recently argued that the NHS needs to look to the world of everyday technologies like these to make the healthcare system more responsive, serving the patient better and reducing the cost of that service.
Let’s take an example; When we log onto an online commerce site that we’ve used before we get given recommendations of something we might like to buy. That’s based on an analysis of the buying trends of other customers who have bought similar products.
So, when we log onto our personal health record, wherever that may be, shouldn’t we expect it to say: “You recently contracted Asthma. You might be interested in being tested for Sinusitis?”
Such a proactive approach is a long way away from where most people’s healthcare experience is today. The medical profession treats our medical records with a Fort Knox approach to security. That dates back to the days of paper records and a real fear of data. Until that fear changes to enthusiasm, evidence based medicine is going to struggle.
Our health is complicated. It’s intimately linked with our behaviour and our past history. Companies like eBay, Google, Tesco and Amazon are good examples of commercial enterprises that have learnt how to profit from information like this. What the King’s Fund is asking seems obvious – apply the experience that we now expect to see in our everyday use of the internet and other services to improve the way that healthcare is delivered by the NHS.
There’s an implicit assumption in the report that innovation in service delivery is going to have to come from outside the medical profession. As consumers become more used to these services, they will, by comparison, perceive any healthcare system as increasingly backwards if it does not embrace these developments. If our perception of healthcare services is even to stand still, let alone improve, change must come.

Filling the gap
Medica exhibited little understanding of putting the consumer first. Outside the array of Taiwanese blood pressure cuffs in every conceivable shade of plastic, the product that the big boys at Medica were pushing that came closest to the ideals of consumer health monitoring was probably intelligent clothing – garments designed to include a variety of sensors that can monitor us as we get on with our daily lives.
The most popular of these is the heart rate monitor vest. It provided a good example of the gap between patient understanding and medical equipment promotion.
These vests serve two markets: they can be used for sports enthusiasts to monitor their level of fitness, but also have enormous potential for monitoring patients at risk of cardiac disease. The average age of prospective patients for these vests is around 75, with the greater risk factor being male.  
Now for the reality check. Wherever you looked, the average age of the mannequins and models displaying them was closer to 25, with a definite preponderance of well-endowed females. It was an excellent and often repeated example of image triumphing over any understanding of the everyday user, or the issues that he or she might have with this new technology. The comparison may be trite, but if you’re going to change a market, you have to believe in it, which means believing in and understanding its actual consumers.
It suggests that the way forward is not with the companies that were filling up 19 halls in Düsseldorf, but for more consumer aware companies, either working by themselves, or with smaller companies and designers that understand the possibilities. It needs people ready and eager to make the disruptive advances that will bring forward major changes in the way that individuals and society address healthcare.

Evidence or ignorance based?
Telecare has more to offer than just reducing our healthcare costs. Along with the advantages of dispensing with the status quo and developing compelling products for people to monitor their own health, remote monitoring has the ability to determine what of existing practice works and what does not.  
Making it simple and accessible to the consumer not only lowers cost and improves quality of life – it provides a major source of data that can be analysed and used to improve traditional medicine. If we can deploy large quantities of simple, connected home health devices, the quantity of data that will accumulate from them will be many orders of magnitude greater than that which currently exists. Moreover, it will cover a much greater range of the population, including people who are not critically ill.
If we find ways to share and analyse this, it’s the first real chance to discover what works and what doesn’t. That alone could save billions from the healthcare budgets of the world and reduce the amount of useless and wasted treatment.
Unlike most existing trials, it gives us the chance to judge the outcome of all of those times when we take something or go to the doctor, but never follow it up because we get better. Medical science and practice has no real idea of how much of this is due to pharmaceuticals and how much is just Mother Nature. For the first time, we might be able to answer that question.

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