The digital revolution: eight technologies that will change health and care

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Before the emergence of the novel coronavirus and the subsequent pandemic, the health and care system had a poor track record in adopting digital technologies at scale. However, in response to the pandemic the health care system rapidly implemented new tools, many technology-based, to allow health care to be delivered when physical contact is not possible. The approach to using digital tools in health care provision is undergoing a substantial and rapid shift. Many of the technologies adopted during the first phase of the pandemic were already well established but not widely implemented; the maturity of the technology enabled the provision of health care through remote consultation to be much more prevalent much more quickly.

Despite this recent rapid adoption of digital technologies, the health and care system remains at the early stages of digital health, with many tools replicating physical approaches and processes rather than taking advantage of what makes digital different. In this explainer, we examine the technologies most likely to change health and care over the next few years. Some of the technologies we discuss are on the horizon; others are already in people’s pockets, their local surgeries, hospitals, homes and communities. But few are systematically deployed in the health and care system and none have reached their full potential. Each could represent an opportunity to achieve better outcomes or more efficient care and improve patient experience.

1. Smartphones and wearables

Smartphone

It’s been more than a decade since the launch of the pocket-sized devices we recognise as smartphones. While they may have originally been perceived as a luxury item, they soon became essential companions. The technologies within these devices have improved iteratively and it is now possible to have access to computing power that could steer a spacecraft, GPS, a high-speed internet connection and high-quality imaging capabilities in the palm of our hands, alongside a host of sensors for health-relevant data (eg, movement and location tracking), plus a touch-screen interface.

Almost four in five of the UK population own a smartphone, yet the use of smartphones in health and care still falls short of the potential to create and monitor personalised digital biomarkers that combine with new data sources to improve prevention, treatment and help people make sustained behaviour change.

Wearable devices are in a newer category of technologies encompassing smartwatches (eg, an Apple Watch), activity trackers (eg, a Fitbit) and connected patches (eg, a smart bandage or smart plaster). These are generally in direct contact with the wearer for long durations, generating large quantities of data on specific biometrics or behaviours. Many large technology companies are positioning these devices as health or wellness devices not medical devices – currently side-stepping regulatory requirements. However, there is potential for these devices to be widely used in health and care, as well as by individuals to improve their health and care. For example, a wearable sensor measuring heart rate can give a truer indication of a person’s heart-rate at various stress levels (sitting, standing, walking, etc) over time instead of a single one-off measure in a surgery which could be erroneous due to patient anxiety or stress.

Apps

App stores already feature thousands of health and wellbeing apps, encompassing everything from diet diaries and mindfulness guidance to period trackers and musculoskeletal rehabilitation support. However, the uptake by the health and care system has been patchy due to a range of issues including quality, evidence, clinician knowledge, confidence and skills, and integration into pathways. Efforts to curate the best quality apps, for example, in the NHS App Library, have had little success in making the use of apps for health mainstream. A growing number of apps now focus on a direct to consumer approach largely focusing on health information, self care or monitoring. Apps have also been developed to provide digitally enabled interventions (these are known as digital therapeutics).

The NHS has developed its own NHS App to enable citizens to have easy digital solutions to simple health care needs, such as booking appointments, checking medical records and ordering repeat prescriptions. This could be the first step in creating an app-enabled health care system with the NHS App acting as a front door. Online consultation providers (such as eConsult) are being integrated with the NHS App, supporting triaging and allowing text messaging with health care professionals to be more easily available. Personal health record (PHR) services, such as Patients Know Best, are now also integrating with the NHS App. PHRs can bring together the fragmented health and care of an individual into one record held by the individual themselves. Combining services and PHRs with the NHS App supports the move to person-centred care and multidisciplinary care provision. As more services are able to integrate into the NHS App, the functionality will become richer and more personalised to the individual’s health and care needs as well as their capabilities.

Hubs

Smartphones combined with the cloud can serve as the hub for wearables, connected devices, data and sophisticated new diagnostic and treatment technologies. For example, people with type 1 diabetes are driving the development of an ‘artificial pancreas’ which links continuous glucose monitoring and insulin-delivery systems that are all controlled by the smartphone. It will adapt its algorithms for insulin delivery to a person’s physiology.

Large-scale research

Smartphones and wearables are highly effective data collection devices, and they can record a lot of detail about people’s lives. As well as tracking their own health status, people can also help researchers gather large amounts of real-world data on health problems and their determinants using their smartphones or wearables.

Apps are now being created specifically for medical research, thanks to open-source frameworks (such as Apple’s ResearchKit, and ResearchStack for Android devices) that have made it possible to more easily transfer apps from one platform to another. These apps are able to survey users and enable them to opt-in to research through consent forms, as well as supporting the sharing of data automatically gathered on their devices such as step counts, heart rate, etc. These platforms have sparked a new approach to disease study, with a number of long-term and large-scale opt-in studies completed since 2015. For example, more than 4,000 people enrolled for a Parkinson’s disease study in 2016, more than 400,000 people enrolled for a atrial fibrillation study in 2018, more than 8,000 people in a asthma study in 2017, and 250 people are being identified in 2020 for enrolment as ‘citizen scientists’ for a study on adolescent arthritis.

The sheer numbers recruited over a short period of several months wouldn’t be possible without a digital app-based approach. These studies have the potential to create understanding of how disease varies over time and the associated lived experience of individuals, and have improved the use of smartphones and wearables as digital endpoints for medical research. In future researchers will be able to create personal baselines using this data, quantify an individual’s lived experience, track the digital biomarkers that can improve diagnosis and accurately monitor disease progression and treatment efficacy. These features remain tantalisingly out of reach for the time being.

Virtual machines

Most, if not all, digital tools and technologies are dependent on infrastructure (devices, connectivity, sensors, etc) to function. Infrastructure, in the form of the hardware running the software tools, and connectivity to the internet are absolutely essential for modern digital tools. But health and care systems are often held back by cheaper or older hardware with limited functionality and poor connectivity.

Virtual machines offer an alternative approach that works in a similar way to screen sharing in video calls. The difference with virtual machines is the screen sharing occurs with a computer in the cloud, which the user can control. This means the internet connection only needs to transfer the screen image and some control information (eg, if the user taps on an onscreen button) requiring lower internet speed and data. It also means that the user hardware needs to do less processing so can be less prone to crashing, stalling, etc. Using virtual machines offers a way of overcoming the issues associated with older or lower capability hardware. In health and care systems where resources are tight and infrastructure can be generations behind consumer technology, virtual machines could enable digital to leap forward and meet patient and consumer demands.

2. At-home or portable diagnostics

Telemedicine

The response to the Covid-19 pandemic has seen a massive shift towards telemedicine replacing face-to-face contact. Current solutions mostly focus on enabling communication virtually. However, there is potential to further improve and differentiate telemedicine by adding functionality in the digital realm that isn’t possible in the physical consultation room. For example, live image tracking could easily quantify a patient’s mobility, which isn’t possible in face-to-face consultations. In the future functionality could also enable colleagues to drop in to virtual consultations providing coaching, mentoring and peer support.

Connected devices

Connectivity has become almost ubiquitous, now that devices such as e-stethoscopes, connected blood pressure monitors and connected pulse oximeters are readily available. They are cheap enough to be affordable for many patients or are readily available for clinics and surgeries to provide to patients for short-term use at home.

Portable x-ray machine

Hospital-level diagnostics in the home and community

Diagnostic tools once found in hospitals, can now be used in the home and the community. These include portable x-ray machines, ultrasound equipment, blood-testing kits and other technology that can provide more and more of the diagnostics required to support health care, with profound consequences for the way the health care system is configured.

Butterfly IQ is a point-of-care ultrasound system which has a specialised ultrasound probe that leverages a smartphone (or tablet) to provide the computational processing, connectivity and display – in combination creating a highly portable point-of-care ultrasound system. The smartphone (or tablet) also enables new functionality such as virtual support from a clinical expert.

Smart technology

Many people with disabilities or long-term conditions use assistive devices to help them perform tasks or activities made harder for them by their disability or condition. These are often available as part of NHS and social care packages. The prospect of using these to gather information in addition to achieving a specific task is motivating several new developments.

Smart inhalers like those in development by Propeller Health work by passively detecting each use, its location and the surrounding air quality, allowing insights into what triggers asthma attacks. Seeing AI is another example of smart technology, which describes nearby people, text and objects to support the visually impaired.

3. Smart or implantable drug delivery mechanisms

Drug delivery

Between a third and a half of all medication prescribed to people with long-term conditions is not taken as recommended. Several technologies in development could enable patients and care professionals to monitor and improve adherence to a prescribed drug regime either through automation (see implantable drug delivery) or providing better information about medication usage (using smartphone reminders and location information).

Implantable drug delivery

Drug delivery

Several new drugs and biologics have poor solubility, which makes administering them difficult – it can be time consuming, uncomfortable and highly variable. Technological developments have prompted renewed focus on new approaches to delivering these drugs at the point of need. Implantable drug delivery approaches provide the drug locally, minimising side effects that can occur when medication is taken orally or injected. Existing technological methods for delivering drugs include drug eluting stents, balloons and sinus implants, but new automated drug delivery technology is under development. Researchers and companies are developing implantable devices with hundreds of tiny, sealable reservoirs that open when a small electric current, controlled by an embedded microchip, is applied. The vision is that such devices could provide a way to automatically release doses for more than 10 years from a single chip.

The next stage of development will be to make these devices using new materials that are bioresorbable – that is, the material essentially dissolves once drug delivery is complete, negating the need to retrieve the device. Microchips are also driving the development of more sophisticated closed-loop systems to connect with smartphones and improve dosing.

4. Digital therapeutics and immersive technologies

Digital therapeutics

Digital therapeutics

Digital therapeutics are evidence-based health or social care interventions delivered either entirely or mostly through a device (a smartphone, tablet, virtual-reality or augmented-reality system, or a laptop). They effectively embed clinical practice and therapy into a digital form. At a minimum, these interventions combine provision of clinically curated information on a health condition with advice and techniques for dealing with that condition. For example, a clinician could prescribe a person with a history of depression or anxiety an app that incorporates, for example, breathing exercises, meditation or cognitive behavioural therapy (CBT). Such an app could give regular support alongside self-care to help the person overcome episodes of depression without needing to seek in-person help and wait for an appointment.

Whether fully automated or blend automation with supervision (or coaching), the therapy offered can be tailored to the needs of the specific user. Digital therapeutics are often cited as a solution to help manage long-term conditions that call for behaviour changes or to prevent diseases in the long run.

Computerised cognitive behavioural therapy

The use of computerised CBT) in the NHS has a relatively long history. A recent independent study looking at early computerised CBT has suggested that the approach was limited in its effectiveness because young people failed to complete the course.

Recently, however, a new generation of automated digital therapies based on CBT has been developed, which aims to deliver CBT at scale with better engagement. Sleepio is one example: a six-week tailored programme delivered online that is designed to treat insomnia and, in doing so, help alleviate anxiety and depression. There have been positive results in randomised controlled trials. The therapy is personalised in response to data provided by the patient, and by using the latest practice in design and delivering the therapy via an animated avatar, the course is made more engaging. Design and personalisation are key elements likely to improve engagement, and therefore outcomes, in digital therapies of all types

Immersive technologies

Virtual-reality and augmented-reality technologies have been on the cusp of widespread consumer adoption for many years but have yet to be realised despite significant advances in the technology. Virtual and augmented reality have the potential to build further on digital therapeutics to improve accessibility, features and outcomes. These tools will provide immersive and personalised health care access using more sophisticated digital therapeutics than today all in the comfort and convenience of an individual’s home.

Virtual reality has potential to be applied to several areas such as pain management, eating disorders and rehabilitation. Virtual reality is fully immersive – it blocks off sound and sight instead providing the patient with computer-generated imagery and noise. This means a patient can be immersed in a virtual world that can help to manage pain, provide scenarios to change behaviours or games to improve mobility.

Augmented reality is being explored as an approach to improving quality of surgical interventions through two means: training and live guidance. Augmented reality overlays computer-generated features such as arrows or text over what can already be seen around us. It can be applied to training to improve how surgeons perceive and interpret anatomy during interventions. Augmented reality can also help by identifying what a clinician is seeing to guide an intervention. This could be through software that automatically recognises specific parts of the anatomy to highlight specific features of interest or alternatively could involve a more experienced peer joining remotely and annotating the live shared video to support and coach colleagues.

5. Genome sequencing

Genome sequencing

Advances in genome sequencing and the associated field of genomics will give us better understanding of how diseases and medications affect different individuals. With the genetic profile of a person’s disease and knowledge of their response to treatment, it should be possible to find out more about the likely effectiveness of medical interventions, such as prescribing drugs to treat a disease (pharmacogenomics).

The first complete genome sequence of a living organism was produced in 1995, with the first human genome sequenced in 2003, costing approximately $2.7 billion over a decade. Since then, the economics of genome sequencing has changed significantly. In 2003 it was commonly believed that a $1,000 genome sequencing cost would unlock personalised medicine. With the cost now trending towards a few hundred of dollars this aim has been surpassed. However, we are yet to see the dramatic impact of genome sequencing because the upfront costs for equipment and training for interpreting the complex genome are still high and likely to remain so for a long time.

The cost of sequencing could fall further thanks to new sequencing techniques.

Population-level studies

Major projects are under way internationally to gather large databases of genomes and analyse them to find relationships between genetic make-up, people’s disease risk and experience, their physical characteristics and their behaviour.

In the United Kingdom, the 100,000 Genome Project, announced by then Prime Minister David Cameron in 2012, achieved its ambition of sequencing 100,000 genomes in 2018. The NHS in England has since established the Genomic Medical Service, comprising laboratory services, directories, sequencing provision and informatics infrastructure to apply the advances to improving the care of the nation. In 2020, the government published Genome UK: the future of healthcare, a vision to build on the 100,000 Genome Project with focus on diagnosis, screening and research.

In the United States, Project Baseline (a research collaboration between Verily Life Sciences and Stanford and Duke medical schools) is analysing large amounts of volunteers’ linked genome, lifestyle and physical data. The initiative will develop a better understanding of how all that data looks when a person is healthy and identify the changes that indicate disease at an earlier stage than currently identified.

Genomics provides insight but it is one part of a bigger picture, often family history, socio-economic and environmental factors can have as important if not more important influence towards an individual’s health. New tools and approaches need to be developed and implemented at scale to bring these different datasets together. The Accelerating Detection of Disease initiative sets out to do just this. Partially funded by UK Research and Innovation the initiative will link datasets for five million individuals to detect and prevent the development of diseases. This huge interlinked dataset will completely change how we view and treat disease risk, prevention and prediction.

6. Artificial Intelligence

Artificial intelligence (AI) is an umbrella term encompassing a number of different approaches where software replicates functions that have until recently been synonymous with human intelligence. This includes a wide spectrum of abilities such as visually identifying and classifying objects, converting speech to text and text to speech, etc. The NHS AI Lab launched in 2019, with the aim of supporting AI development in the NHS and addressing challenges in implementation with AI tools in health care.

Machine learning

Machine learning

Until recently, computers weren’t especially good at recognising patterns in messy data. Or rather, the way people programmed them meant they weren’t very good. New techniques have now been developed in the applied mathematics and computer science fields that have allowed more effective use of computers for tasks like this. In combination with the development of graphical processing units, artificial intelligence has benefited from a renewed focus and increasing funding, unlocking insights in large and complex datasets. Machine learning is one such field. It is a type of artificial intelligence that enables computers to learn without being explicitly programmed, meaning they can teach themselves to change when exposed to new data.

New insights into big datasets

Several new businesses hope to use machine learning techniques to provide diagnostic support to improve care delivery. For example, Deepmind has published research evaluating AI applied to breast cancer screening showing improved efficacy, and startups, such as Ultromics, are applying machine learning to improve speed and reduce variability in the diagnosis of cardiovascular disease from ultrasound images. In the future, machine learning tools will be able to quantitatively interpret images to create digital biomarkers that predict onset of disease. The EVAREST study is a multi-centre trial aiming to validate blood and imaging biomarkers, the first step to achieving diagnosis based on machine learning-powered digital biomarkers.

Many of these tools use machine learning but not adaptive algorithms, which continuously learn and change with use. If the regulatory, safety and cultural issues can be overcome in future there will be software that changes and improves dynamically with each use.

 

Natural language processing

Verbal and textual sharing of information is complex, with nuance in sentence structure and choice of words – there are an almost infinite number of ways of saying a sentence. This makes it very difficult for a machine to understand written or spoken sentences. Natural language processing is a sub-category of AI that focuses on how to programme software able to process, analyse and respond to the spoken or written word. It is still a nascent field, but one with huge potential for health care. For example, Microsoft is looking at how natural language processing can automatically capture consultation information for electronic health records and IBM is developing chatbots to improve information awareness for frontline staff at the Royal Marsden Hospital. In the future, computers that can interpret, store and show relevant information will improve efficiency and reduce burden in the health care system. Tools like this can also help to engage a person in their own health by overcoming health literacy and literacy barriers.

7. Robotics and automation

Robotics

The ongoing miniaturisation of electronics and motors over several decades has enabled the creation of more complex and capable robotic systems. When combined with sophisticated sensing technologies, medical imaging data and safety mechanism they have the potential to be used in health and care settings. Robots have multiple unique benefits such as no fatigue, the ability to lift heavy loads smoothly, not being damaged by x-ray radiation, the ability to replicate tasks with high degrees of precision, and can be many different shapes and sizes. With these benefits and flexibility, there’s potential for robots to be used to improve diagnosis, interventions and care provision in health and care settings. This could span simple tasks, such as helping porters move patients, to advanced applications involving surgical interventions.

Robot-assisted diagnosis

Robots can be developed with more dexterity and degrees of motion than people and, more importantly, more arms. In the near future, hospitals could be using a multi-arm robot to hold several ultrasound probes at once to carry out multiple foetal ultrasound images, enabling more accurate and higher quantities of foetal images. Improved image quality and quantity will enable improved image processing and interpretation, with the potential for identifying problems that might currently be missed. The iFIND project is aiming to do just this. With £10 million funding from the Wellcome Trust and the Engineering and Physical Sciences Research Council, the project aims to enable a high-quality scanning service that does not require expert sonographers during routine scans, with ultimately fewer babies with major problems missed.

Robot-assisted surgery

Robots are potentially well suited to carrying out minimally invasive surgery due to a high degree of precision. ‘CE’-marked robotic systems conforming to European standards for health, safety and environmental protection are readily available but could need further development to improve outcomes beyond traditional (non-robotic) surgery to justify the high cost of the system. Robotic systems have the potential to improve the consistency and quality of surgery and may enable surgeons to use their clinical judgement and expertise to carry out interventions that are currently not possible.

Some types of heart surgery require the use of ultrasound imaging during live x-ray interventions. This means a nurse or other highly qualified member of staff needs to hold the ultrasound probe while wearing lead apron to protect them. Lead aprons are heavy and cumbersome, and as they are not entirely effective the member of staff still receives some x-ray exposure. Holding the probe for the duration of the intervention can be tiring and motion can result in delays or even errors during surgery. In the future robotic devices could be used by nurses to control hold and position the ultrasound probe while keeping the nurse safe from unnecessary radiation exposure.

8. The connected community

Connected commmunity

Behind all technologies, there are people. The internet and the devices and technology it has enabled have facilitated the development of many communities, bringing together people around a common interest, shared identity, social movement, or even just a hashtag.

Peer-to-peer support networks

Connected communities for health are growing in their membership and their diversity. Several platforms bring together people with interests in health and care within countries and across the world to support each other, share learning and even provide a platform for tracking their health data or helping them manage their condition.

MedHelp, PatientsLikeMe and HealthUnlocked are just three of these social networks for health. Alongside these dedicated networks, platforms such as Twitter and Facebook that dominate the social network market in many countries have also become key places for disseminating and discussing health and care information and best practice. Closed Facebook groups for clinical conditions have been established by patients, hospital clinics and GP surgeries to improve health literacy and support patients to make informed decisions on their own wellbeing. Closed groups can result in the sharing of misinformation, however groups set up and managed by trusted organisations such as health care providers and charities can counter this by providing trusted information at patients’ fingertips and enabling group support.

Communities contributing to research

Some online communities are contributing to research about their health conditions, offering people the chance to be ‘data donors’ and providing a simple way to share their data with researchers. Data from PatientsLikeMe has contributed to published studies, in multiple clinical areas including depression, amyotrophic lateral sclerosis (ALS), and multiple sclerosis (MS).

HealthBank offers a different model and is described as ‘the world’s first citizen-owned health data transaction platform’. Members pay a one-off fee to store health data securely and control who it is shared with. The organisation is a co-operative, so profits made using the patient data are paid out in dividends to its members.

Conclusion

Advances in technology provide the opportunity to reconsider what good-quality, effective health and care looks like. Technology can improve access to information to enable better decisions about what will work for an individual and can enable individuals to have more control and knowledge about their health.

But along with these opportunities come challenges. Technology works for some but not everyone, and is affordable to many but not all, so it is important to ensure that embracing technology does not exacerbate inequalities or create new ones. The most precious resource in the health and care system is its staff, and technology needs to work for them and for the individuals receiving care. Technology is enabled by infrastructure and the skills and expertise of the users, which will require investment if the benefit of these tools is to be realised.

The technologies highlighted here are not an exhaustive set. Many of them could transform health and care but more evidence is needed on their costs and benefits to deliver on their promise. Asking too much or giving too few opportunities for real-world testing could protect an outdated status quo. Asking too little could risk spending public money on something ineffective.

Above all the health and care system must not lose sight of the human need driving use of technology to improve outcomes, quality of life and the care it provides with the limited resources available.

Related content

Comments

Michael Branag…

Position
CEO,
Organisation
Device Access UK Ltd
Comment date
02 January 2016
Great report on Digital Heath Innovation at a time when the NHS needs to try and relieve the growing demands with 900 more admissions per day in 2015 over 2014 - digital Heath and wearables are a great idea to monitor people at home. Trouble is they are not drugs and therefore don't come with an easy reimbursement route. Some of these technologies were showcased as far back as the 2011 NHS Innovation showcase demonstrating the millions saved by adoption but uptake has been terrible. Is it really easier for the NHS to build 22 new 800 bed hospitals in the next 6 years to meet current demands than finding a way in the system for non pharma MedIcal Technologies to be paid for in the system?

Pearl Baker

Position
Independent Mental Health Advocate & Advisor/Carer,
Organisation
Independent
Comment date
02 January 2016
The 'SMART PILL'
Parts of this idea is 'frightening' it is almost to difficult to comprehend what could be in 'stall' for those individuals suffering from a Mental Illness (LTC) Many patients do not have their medication reviewed for years, often walking around in a 'Zombie' like appearance, denied any offer of New Drugs that could help their condition, and quality of life.


'Implantable drug delivery'?
Not on my 'patch' it is all about 'promoting their product, which saves 'MONEY' by having less Professionals around to do their 'JOB'.


Who is responsible for ensuring the 'Health & Social Care' of the patient now? and who will be in the future if this MAD 'money making' Company have their way? by virtue of a 'Rubber Stamp' by this Government, who are unable to deliver quality 'Health & Social Care' now due to 'Funding'.


'Genome Sequencing' is so far in the distant future as 'every individuals is different. This idea is 'back to front' first find out each person's 'Genome Sequencing', then It is down to the Professionals qualified in their patients illness to decide what is best for their patient.


'Compulsory Treatment Orders' is something I will always be against. I was invited with two other organisations by the DOH to give verbal evidence in LONDON, and still support this today.


I have no idea how they operate CTO when we have 'incapacity' legislation?


'Innovation' is still out there! how can we make it work better?


All those requiring 'Health & Social Care' can be improved, by all those responsible, including Carer's having a 'single' system of communication.


The Computer 'password' entry allows Carers with concerns, GPs Consultant's SW CPN anybody responsible for that person's 'Health & Social Care' 'emergency' 'out of hours'. All Meetings will be recorded in the Computer.


My idea saves the time and energy spent by everybody contacting each Professional individually. Its called 'INSTANT ACCESS'.


Why I favour my idea of Computer access to those responsible for 'Health & Social Care' and their Carers, and my previous idea for Pharmacy access is simple. The Majority of people have a Computer, for those unable to 'operate a smart phone or even own one is even more remote.


The Patient is number ONE, the preferred access is down to them and their ability to 'cope' with a system in their own home is essential, they could be encouraged to input a daily 'diary' in how they are feeling.


A Care Manager Co-ordinator is assigned to a client, daily access to the patients notes.



There is 'innovation' and 'innovation' that allows Companies interested in making money as their number one priority as second to the patient's Health & social Care'.

It is important not to lose sight of the role of the CQC, the 'Protector' from NEGLECT for some!!

Losing sight of ACCOUNTABILITY!




Dave Ashton

Comment date
03 January 2016
This preoccupation with (or addiction to?) microwave-emitting wireless technologies in the NHS is really extraordinary and irresponsible.

Presumably, the pre-eminent reason for the existence of a National Health Service is to promote health and treat illness, and yet the ubiquitous provision of wifi, smart devices, and other wireless technologies will inevitably achieve the opposite outcome.

Before succumbing to the superficial allure and "convenience" of these technologies, it may be worth remembering (or learning of) a few things.

1) Wi-fi, mobile phones, DECT cordless phones, wireless laptops and tablets, smart meters, smart wearables, even wireless baby monitors, all emit pulsed, modulated, microwave-frequency radiation, which is officially classified by the World Health Organisation / International Agency for Research on Cancer as a possible carcinogen, on the basis that it increases the risk of developing a glioma (see IARC Monograph 102).

2) This non-ionising radiation has been linked to many other health conditions, including autism, ADHD, Alzheimer's, SADS, auditory dysfunction (eg. tinnitus), cognitive dysfunction, dermatological issues, gastrointestinal issues, musculoskeletal issues, respiratory issues, sensitisation, and so on. There are decades of scientific research to back this up.

3) The insurance industry refuses to accept liability for claims related to this radiation. SwissRe categorised it as High Risk in it's 2013 SONAR report, saying: "The ubiquity of electromagnetic fields (EMF) raises concerns about potential implications for human health, in particular with regard to the use of mobile phones, power lines or antennas for broadcasting"

4) There is a long-running legal case, Murray v. Motorola, bought by a number of brain tumour victims, and their surviving relatives, against the telecoms industry for brain tumours which they say were linked to mobile phone use.

5) Two US government departments, the Department of the Interior and the Environmental Protection Agency, have released internal documents in which they note that the exposure standards for this radiation are set on the mistaken assumption that because non-ionising radiation cannot heat bodily tissues by an appreciable degree, then it is therefore "safe".

6) The Parliamentary Assembly of the Council of Europe issued Resolution 1815 in 2011, in which they say: "While electrical and electromagnetic fields in certain frequency bands have wholly beneficial effects which are applied in medicine, other non-ionising frequencies, whether from extremely low frequencies, power lines or certain high frequency waves used in the fields of radar, telecommunications and mobile telephony, appear to have more or less potentially harmful, non-thermal, biological effects on plants, insects and animals as well as the human body, even when exposed to levels that are below the official threshold values".

7) France has outlawed children under three from being exposed to wifi radiation in nurseries and public places, and restricts the exposure of older children.

8) 217 international experts in the study of the biological effects of this radiation have warned the UN, all UN member states, and the World Health Organisation, of an "emerging public health crisis related to cell phones, wireless devices, wireless utility meters and wireless infrastructure in neighborhoods" (see the International EMF Scientist Appeal).

And so on...

Wireless technologies have absolutely NO place in the NHS, and to think otherwise is to ignore the many thousands of scientific papers showing the harmful biological effects, and to throw away any pretence of implementing a Precautionary Principle aimed at protecting everyone - but especially children, pregnant women, the elderly, and those already vulnerable to illness.

Denise Silber

Position
CEO,
Organisation
Basil Strategies / Doctors 2.0
Comment date
04 January 2016
Always a challenge to draw borders between the technologies. I think it is most interesting to look at what brings the greatest impact in terms of scalability, versus pilot projects. After online search via Google, online communities are undoubtedly the tool that has had the greatest favorable impact to-date on people with medical conditions, primarily communities of patients/caregivers and secondly professional communities. The next greatest scalable change and which is imminent will be the combination of online appointment fixing, access to online providers via Skype-type platforms, and connected objects in the home (quantified self, EKG, stethoscope, otoscope), generating massive telehealth. It doesn't matter whether these contacts occur on home computer or mobile device.

Rech, RL. MD, …

Position
Physician and Clinical Researcher,
Organisation
Private Clinic
Comment date
05 January 2016
It is very clear for professionals in the health of large Medical Centers, which required a discussion we implement new technologies in order to increase the safety of patients also the distance.
Many outpatients lose an entire work shift to display tests to their doctors and have the dose of your medication adjusted. A large percentage of these contacts could be virtual. In fact many of these contacts are already made by WhatsApp, Facebook Messanger, E-mail, SMS or even a phone call.
Patients travel for long periods interrupt their psychotherapeutic treatments because they can not do for Skype, Face Time or other ... That's better than having your virtually session?
Urge that regulate such practices ... It is necessary to discuss with an open mind for this new time. Determine which calls can be made in virtual form, how the calls must be recorded, how the professionals can be paid, how to establish cybersecurity.
We can not ignore the benefits to patient healthcare and better physician results with regulated forms and situations in which the virtual contacts and virtual guidance can or should happen

Esther O'Sullivan

Position
Head of Digital Strategy,
Organisation
BMJ
Comment date
05 January 2016
Really pleased to read this as these eight technologies can and should be transformative to health care, and should therefore create a really exciting time for the health service as it adopts and adapts them to become more efficient. One of the challenges I would add is the cultural changes required to engender acceptance of these digital revolutions as useful tools for us all, and not to be blocked because of fears around technology and change.

Adam Hoare

Position
Managing Director,
Organisation
Red Embedded Systems Ltd.
Comment date
05 January 2016
Absolutely agree. We demonstrated some years ago a 45% reduction in A&E attendances for people with long-term conditions by supporting them remotely at home using video. We have connected dialysis machines back to the hospital and connected remote blood pressure and weight measurement devices to support people at home. We are currently developing technology specifically aimed at supporting people with learning disabilities to live in the community and get better access to healthcare. In all cases there is no reimbursement mechanism. Prevention and remote support for people does not fit into the reactive, "wait till it is a crisis" way that health and care is funded. If we had drugs that could deliver the outcomes we provide there would be a route to market. If the system wants to move away from crisis management it will need to fund the things that stop crises happening.

Ileana Welte

Position
President/Managing Director,
Organisation
BIg White Wall
Comment date
06 January 2016
Excellent review although disappointing to see a lack of focus on UK scaled evidence based interventions such as Big White Wall, IESO, Silvercloud, and Headspace to name a few. Scaling digital in integrated pathways is real innovation.

Richard Pope

Position
Clinical Director,
Organisation
Dynamic Health Systems
Comment date
06 January 2016
A timely reminder that we already have many of the tools we need to improve productivity within health and social care - and we HAVE to improve productivity to deal with the tidal wave of long term condition related ill health - 'creating' additional healthcare professionals is neither a long term solution or even a realistic prospect. We have shown that contacts with primary care can reduce by 55% at the same time that biomedical measures of condition control improve when individuals engage with digital health services. Personalization, leveraging a person's care network and using I.T. to create new, more productive and much more citizen focused response systems within the healthcare sector have to be key to sustainability - so this list ticks the box for us.

owen david

Position
medical consultant,
Organisation
DGH
Comment date
06 January 2016
Love some of these cool ideas - and i suspect many older people will accepted them in significant numbers, but many currently needing health and care have complex problems which will continue to need an individualised multifacited complex health and care approach. O

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