Health Tech: An Occupational Therapist’s Perspective

Medicine evolves. Treatment and clinical practice change based on evidence and feedback. The pursuit of effective healthcare continues.

In the last 10 years, computational technology has exponentially increased the potential for healthcare’s reach and application. As an industry, it now relies heavily on technology — but this is just the beginning. Digitising healthcare could mean a paradigm shift in how we relate to our bodies and maintain their health state. As a professional with a background in public healthcare and web development, I love exploring the relationship between and the possibilities of how one can inform the other. This article looks at a few of the current offerings from the health tech industry and their potential for increasing quality of life through improving (and sometimes disrupting) contemporary healthcare.

I’m fascinated by the intersection of health and technology. We only get one shot at this rollercoaster ride of life and one body, so the concept of digitally managing healthcare, or automating portions of it, really excites me if it means improving management of and access to records, patients having increased autonomy in their own care, and clinicians being freed from administrative tasks which take up a disproportionate amount of time. In short, to me health technology represents the opportunity to improve quality of life.

What is digital health?

It’s a massive field incorporating lots of different aspects and approaches.

Digital health is the convergence of digital technologies with health, healthcare, living, and society to enhance the efficiency of healthcare delivery and make medicines more personalised and precise. The discipline involves the use of information and communication technologies to help address the health problems and challenges faced by patients. These technologies include both hardware and software solutions and services, including telemedicine, web-based analysis, email, mobile phones and applications, text messages, wearable devices, and clinic or remote monitoring sensors.

Generally, digital health is concerned about the development of interconnected health systems to improve the use of computational technologies, smart devices, computational analysis techniques and communication media to aid healthcare professionals and patients manage illnesses and health risks, as well as promote health and wellbeing.

Digital health is a multi-disciplinary domain and a booming industry sector, and has more stakeholders than just patients. On a core level it brings together these patients (as service users) with clinicians, researchers and scientists across public health, engineering, social science, economics and development.

What is occupational therapy? Why is this relevant?

Ah, how my heart rejoices when I don’t have to explain what occupational therapy is to someone. Why is it difficult? Because it’s nebulous. You can be an OT in a hospital, in the community, for children, for the elderly, for war vets, for people with serious mental health conditions — and every single job description would be very different. The unifying thread would be:

OTs promote and help people work towards achieving independence.

or, as the NHS puts it:

They look at activities you find difficult and see if there’s another way you can do it.

Let’s get this out of the way now. “Occupation” in this context is nothing to do with an employer. It refers to any human occupation or ‘activity’. Broadly, OT rubric tends to classify all human activities into categories of leisure, self care, or productivity (though there are other approaches).

Think about it this way: if you get sick (short term or ‘acute’) or you’re affected by illness for a long time/a lifetime (a chronic condition), it will have significant impacts on your ability to function. Broken arm? Tying your hair up = difficult. Broken ankle? Driving your car suddenly not possible. Moderate to severe anxiety? Potentially no more going to the supermarket for you. Elderly and frail? High likelihood of spilling boiling water on yourself when lifting up kettle to make tea, or slipping when climbing out of the bath. Arthritis? Even doing up the buttons on your shirt, or dialling a phone number can be a trial. An OT can help with ANY AND ALL of these things. They are the NHS’s secret weapon and benefit patients’ lives hugely.

If I could find ways to help patients help themselves where it was appropriate to do so (be their own OTs, to a degree), I would really feel like I had achieved something. Teach a man to fish, and you feed him for the days he wants to eat fish. Teach someone to manage their own health, and you have helped them improve their quality of life for as long as they live.

What is the point of this article?

An article covering all the different ways in which technology currently contributes to healthcare would end up gargantuan and unwieldy. Many articles already exist citing that month’s most exciting fitness or calorie tracker app. As an occupational therapist, I am a professional uniquely concerned with individual engagement in meaningful activities, and how I can help people overcome barriers. As a developer, it really excites me to see how people are coming up with interesting and innovative apps to further encourage this engagement. Business and profit aside, a lot of the time, it just warms my heart to see how tech can contribute to improving quality of life. Writing this article could help me find ways in which I can contribute, too.

When I lived in South London, I would ride past a building now requisitioned as a sexual health clinic. Every day, I would see this wonderful plaque:

It made a huge impact on me, and has stayed with me ever since, as it put into words how I feel about healthcare. If you have ever been seriously unwell or known someone who has been, you know how much other aspects in your life suddenly play second fiddle to your health. There truly is nothing more important than your mental and physical health in this life. Improving global healthcare (both access to, and delivery of) is of paramount importance.

Having worked in the National Health Service, I can immediately see the benefit of improved technology for clinicians alone. I could write a gobsmackingly long article on the inadequacies of the current IT system; how utterly unusable and contrary to efficient clinical service provision it is, but also how it renders the system virtually inaccessible to patients/service users. Imagine trying to provide care for patients when the information is spread out over at least 6 databases, none of which talk to each other. I am heartened by the fact that the work undertaken in the past by the heroic and trailblazing Human Genome Project, which took 13 years and over £2 billion to complete, can now be accomplished in under 24 hours for not much more than a thousand pounds. I live in hope for public healthcare in the UK.

Still - this highlights something interesting about contemporary conversations surrounding health tech. There are actually two issues here:

• unifying the different IT systems/structural framework of the current NHS
• embracing new technologies which would revolutionise current practice

Both of them involve incorporating a pro-tech outlook on health and a total paradigm shift in how we look at healthcare; a focus on prevention rather than cure, of self-management and patient autonomy rather than clinician power, gatekeeping access to services. If service users are more engaged with monitoring their own health and acting early to prevent deterioration, access to treatment would end up not being so heavily oversubscribed. I will be focussing more on the second point, and hopefully able to write more clearly on the first following further research.

Apps

The NHS currently has a beta list of apps which it endorses and which promote a healthy lifestyle.

There are also lots of private companies doing the same. Some, like Strava, Sleepcycle, and Headspace (for cycling, sleep cycle monitoring, and meditation respectively) have been around for some time with a high take-up rate from the public. Though I haven’t been able to find a more up to date statistic, Business Insider reported in 2014 that

approximately 85% of health apps in the market […] are for wellness, designed to be used primarily by the consumer, and the remaining 15% are medical, designed to be used by physicians.

There are amazing technologies being designed and trialled now, and many ventures being supported by things like the Digital Health London Accelerator Scheme. I wanted to get a better overview of what’s happening and available on the market (or just about to be) so I picked a few for the following themed list; in no way exhaustive or in any order, we have:

Preventative medicine and digital self-monitoring:

One of the most fundamental aspects of the exciting new world of digital health is, to me, the possibility that patients can have more control through a preventative approach to healthcare. In short, this is the embodiment of the phrase “prevention is better than cure”. It’s better for your health to try and lead a healthy and balanced life, and keep an eye on things as you go, rather than live obliviously then end up seriously unwell and getting emergency treatment.

As Helen Parrot points out, the NHS has long advocated for people (especially those living with chronic conditions) to take more responsibility for monitoring their health, but has consistently failed to provide people with the tools to do so. Wearables like the Fitbit and Apple Watch now enable the lay person to have access to capturing personalised health data like their heart rate, and more. Apple is reportedly working on a new product to monitor blood glucose levels without piercing the skin, for people with diabetes to have more autonomy in their essential daily monitoring — but there are other companies and initiatives working on the same.

Apps in particular, thanks to the ubiquity and accessibility of smartphones, can encourage users to stay more engaged with symptom tracking and management, linking them more with feedback from their idiosyncratic health situation, ranging from diabetes to hypertension, atherosclerosis, and chronic obstructive pulmonary disease(COPD).

Dementia:

We are living in a time both of population growth and of increasing life expectancy; managing multiple comorbidities in an ageing population. Someone in the world develops dementia every three seconds. Dementia detection has historically relied on pen and paper tests administered by GPs, and referral to a memory clinic if memory is affected (which suggests significant disease progression). But progress has been made by AI and big data in the field of dementia detection. This could mean not just earlier detection, but more personalised and effective care to complement the advice on assistive technology and lifestyle for those with dementia (especially Alzheimers), and those who care for them. We can’t yet treat dementia fully, but if given earlier warning, perhaps lifestyle changes and treatment could be more easily incorporated. Every little helps.

For older adults who may or may not live with dementia as well as other health conditions, the likelihood of staying well and staying put in your own home dwindles. As an OT, my heart rejoices to see companies like Birdie looking into and promoting ways to keep people in their own homes, and still meet their care needs.

Gamifiying physical rehab:

One of my most beloved rotations in OT was hand therapy. Highly specialist, it aims for full return to function for those who have had a hand or wrist injury of any type (as a developer, I’ve given more than my fair share of advice to devs struggling with carpal tunnel!). It covers the full spectrum, from chronic, early onset and lifelong arthritis — of which there exists multiple types — to avocado hand, severed tendons, knife and gun injuries, amputations, circular saw injuries, and tendonitis. One of the most crucial aspects of my job was to introduce assistive and adaptive tools, and maintain their essential engagement with a personalised rehab program, because they simply will not recover if they don’t do the exercises. Physiotherapists have a very similar struggle — and now they are starting to approach it as something to collaborate with patients on as a game, and enjoy it, rather than take the traditional didactic approach. There are also the beginnings of physio apps for people to take more control and logging of their rehab data — I would love for these to become the norm in clinical settings and have patients be able to take their progress home with them.

Reduced vision:

An inability to visualise the world and your immediate surroundings can drastically curtail involvement. Aira offers a service where people with reduced vision can access the world around them safely and informedly via a pair of smart glasses and phone call connection to an ‘agent’ who can verbally feed information back to them.

Primary Care:

There are many caveats to primary care/GP access. The issue of getting an appointment within the next 3 weeks notwithstanding, if (like me) you are one of the 10,000 people in London who live on a boat and must travel 20+ miles over the course of a year, even getting to the practice itself can be problematic to say the least. All this has been revolutionised by the app GP At Hand. Powered by Babylon Health and partnered with the NHS, the app gives you the option to connect via voice- or phone-call with a GP in minutes, and electronic prescription services sent to your local pharmacy. Digital appointment summaries are available immediately following an appointment and the app links up with your calendar and phonebook if you want, to ensure success is maximised.

Despite the huge failure so far of updating the NHS system and its records, the positive impact of GP At Hand for those who struggle with traditional GP services makes me feel hopeful about the NHS app which is apparently to be publicly released at the end of 2018.

What else is there to consider, though?

A lot of health technology rests upon the Internet of Medical Things (IoMT),

the collection of medical devices and applications that connect to healthcare IT systems through online computer networks.

As of January 2018, there were 3.7 million medical devices in use to monitor different parts of the body and inform healthcare decisions. The benefits are huge — objective, precise and potentially remote reporting of individual data. However, the use of tech like fitness or calorie counting apps have also been linked to “eating disorder behaviours”, and have the potential to create harm or detract from health. Even “well-intentioned” apps can have unintended consequences and exacerbate unhealthy behaviours to meet the app’s goals. Similarly, there are few apps which have been through any scientific rigour or standardised testing prior to being available publicly.

It is prudent not to succumb to what has been termed ‘apptimisim’ and (as with anything that is a product of the internet, or the Internet of Things) treat it with as much caution as celebration. They’re just tools. “You can’t blame the hammer for what the carpenter does with it”.

Lastly, though there are innovative things being designed with great potential to do good and improve healthcare, it doesn’t necessarily mean the market will support them, or services will take them on. I am excited to see what comes next, and keep thinking of ways I can add value to this global conversation.