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mHealth

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mHealth

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mHealth

  1. 1. How mHealth is improving health and social care | April 2017 How mHealth is improving health and social care With five billion smartphone users worldwide, what are the opportunities for mobile health ?
  2. 2. How mHealth is improving health and social care | April 2017 Copyright © Genetic Digital www.geneticdigital.co.uk 2 Contents Introduction .....................................................................................................................4 A smartphone society ..................................................................................................4 Healthcare professional use ........................................................................................4 Uptake and use of mHealth apps ................................................................................4 Current healthcare challenges.........................................................................................6 Population ageing.........................................................................................................6 Chronic illnesses...........................................................................................................6 Mental health...............................................................................................................7 Medication adherence.................................................................................................7 Staff shortages..............................................................................................................7 Budget cuts...................................................................................................................7 Supporting evidence for mHealth apps...........................................................................9 The potential of mHealth.............................................................................................9 Case studies of success stories ....................................................................................9 Mental health apps ....................................................................................................14 Gamification ...............................................................................................................15 Wearables...................................................................................................................16 Connectivity................................................................................................................16 Barriers to mainstream adoption..................................................................................18 Private vs. public sector technology gap ...................................................................18 Security and data protection 
 ................................................................................18 Lack of interoperability 
 .........................................................................................18 Sorting the good from the bad ..................................................................................19 Looking to the future – beyond the pill.........................................................................21 Big data.......................................................................................................................21 Smarter technology....................................................................................................21 Augmented and virtual reality...................................................................................22 Implants & the bionic man.........................................................................................22 The take-home message................................................................................................23 References......................................................................................................................24 About Genetic Digital.....................................................................................................26
  3. 3. How mHealth is improving health and social care | April 2017 Copyright © Genetic Digital www.geneticdigital.co.uk 3
  4. 4. How mHealth is improving health and social care | April 2017 Copyright © Genetic Digital www.geneticdigital.co.uk 4 Introduction With approximately five billion smartphone users worldwide, there are huge opportunities for mobile health (mHealth) apps and other technology to revolutionise healthcare and patient outcomes and experience. This is reflected in economic forecasts and a report by the market research firm Mordor Intelligence suggests that the global mHealth market will reach $62.84 billion by 2021.1 Among the key drivers of this rapid growth are ever-increasing smartphone penetration rates. A smartphone society According to Deloitte’s latest Global Mobile Consumer Survey (GMCS),2 81% of the UK population eitherownorhavereadyaccessto a smartphone. Sporting the highest adoption rate of 91%, corresponding to 21 million people, are the 18 to 44 year olds – which includemillennials. The 35to 54yearoldsand the over-55 age group follow with adoption rates of 84 and 60%, respectively. An interesting finding of the GMCS survey is that smartphones have increased quite rapidly over a relatively short time. In 2012, only about 50% of UK adults owned one. And, although the year-on-year growth appears to be gradually slowing down, smartphones are, and are expectedto remain, the electronic device with the highest penetration rate, compared with laptops (76%), tablets (63%) desktop computers (48%) and smart watches (4%). Healthcare professional use There is evidence to suggest that smartphones are the most successful electronic devices also among healthcare professionals. In 2015, a team from Imperial College, London, conducted a study of over 6,000 hospital doctors and nurses from five NHS hospitals. The results, published in the British Medical Journal, show that 73.5% of surveyed doctors and 64.7% of surveyed nurses owned atablet, but 98.9% and 95.1%, respectively, were smartphone owners.3 Notably, the latter figures are higher than those found in a survey of healthcare professionals worldwide (91%),4 suggesting that the UK might be a more fertile ground for digital innovations as means to improving health and social care. Uptake and use of mHealth apps The Imperial College London study provides another interesting insight: 90% of surveyed doctors and 67% of surveyed nurses said they use mHealth apps in everyday clinical practice, to enhance task efficiency and facilitate communication, data sharing and diagnostics. According to a 2015 report by the IMS Institute for Healthcare Informatics, there are now over 165,000 health apps available from the Apple iOS and Google app platforms.5 They can gather, share and analyse streamsof biometric data such as heart rate, blood pressure, body temperature and physical activity. And, drawing on evidence from medicine and behavioural research, they can facilitate disease prevention by promoting healthy lifestyle behaviours, and assist with the diagnosis, management and monitoring of specific medical conditions. The IMS estimates that the number of iOS apps with these capacities has increased by over 100% since 2013.
  5. 5. How mHealth is improving health and social care | April 2017
  6. 6. How mHealth is improving health and social care | April 2017 Copyright © Genetic Digital www.geneticdigital.co.uk 6 Current healthcare challenges In many important areas, health and care systems in Europe and the UK face a growing number of significant challenges. Organisations such as our National Health Service (NHS) are under unprecedented pressure to deliver high-quality services in spite of increasing demand and shrinking budgets. If newwaysof addressingtheseproblemsarenotfound,therecouldbeimportant consequences for patients and service users. In this regard, the main challenges facing health systems and society fall into six main categories: • Population ageing • Chronic illnesses • Mental health • Medication adherence • Staff shortages • Budget cuts Population ageing Population ageing is defined as the rising average age of a community, and is a global phenomenon. By 2050, the number of people worldwide aged 60 years or older will more than double to two billion, according to the World Health Organization (WHO).6 By about the same time, the proportion of the UK’s population over 65 years of age will increase to 24.6%, from 17.8% in 2015, corresponding to an extra 10.8 million baby boomers than in 1975.7 The Office for National Statistics (ONS), which released the figures in 2017, reports that population ageing will be a key driver of the overall growth of our country, which, within three decades, will have the largest population in Europe.7 Increased life expectancy is, with declining fertility rates, the reason why populations age. Indeed, we live longer today than ever before. For example, in 1901 people in England had a life expectancy of 45 to 49 years. This has risen to about 79 to 83 years in 2012, and is projected to further rise to about 83 to 86 years by 2032.8 Increased longevity is certainly one of the greatest achievements of the twentieth century. Nevertheless, from a health resources standpoint, it creates significant challenges. These are mainly in terms of the ability to cope with increasing demand for health and social care, given that, as life expectancy expands, so does the period of time prior to death in which people may experience disease. Chronic illnesses Notably, life expectancy is increasing partly because the leading cause of death within older populations has shifted from acute illnesses to chronic conditions. Over 15 million people in England have at least one chronic disease, such as arthritis, cancer and diabetes.9 Although diverse, these conditions share one common feature. They have profound, long-term effects on all aspects of life – psychological,
  7. 7. How mHealth is improving health and social care | April 2017 Copyright © Genetic Digital www.geneticdigital.co.uk 7 social and economic – creating unprecedented challenges for patients and health providers alike, in Britain and worldwide. For example, people with chronic conditions are the most frequent users of health services. In England alone they account for more than 50% of all GP visits and 70% of all hospital bed days.9 Mental health An important fact about physical chronic conditions is that they are commonly associated with mental health problems such as depression, anxiety and, in older adults, dementia. The latest available figures suggest that every year a 25% of the UK population experience mental health problems, but only about 15% receive adequate care. Yet, mental disorders cost the economy £105 billion annually.10 Since two million more people are expected to experience mental issues by 2030, it is clear that the NHS faces huge present and future challenges in this area.11 Unsurprisingly, experts recommend that creating integrated models of care that enablesto address both physical andmental health needs in individuals,should be a main priority for clinical commissioning groups. Medication adherence Adding to the challenges facing health systems is the large proportion of patients who don’t take their medications. A 2015 survey by Omnicell revealed this occurs in 21% of cases, mainly among individualswith chronic conditions.12 For patients, the health consequences range from poor qualityof lifeduetouncontrolled symptoms to increased risk of complications, hospitalisations and mortality. For the NHS, medication non-adherence means wasting £300 million of medicines every year, according to Government estimates.13 Staff shortages A report bytheNationalAudit Office(NAO) shows that in 2014 the NHS had around 50,000 fewer clinical staff than it needed.14 Another report, by the Health & Social Care Information Centre (HSCIC), found that in September 2015the NHS had 69,317 fewer staff than previously thought.15 The situation is expected to further deteriorate as Britain prepares to leave the European Union (EU) following the Brexit vote. Currently 135,000 EU nationals work within the NHS and the adult social care sector.16,17 New regulations may affect the ability of European citizens to work in the UK, and prompt part of the EU workforce that is already in the country to move elsewhere. Budget cuts Currently, over 40% of the NHS budget is spent on people over 65 years of age.18 An 85-year-old person costs the NHS an average of £7,000 per year – seven times more than the spending for someone in their 30s. Since the population is ageing, these expenditures are expected to increase by up to 1.12% annually.19 In spite of this, the Government has announced that in the financial year 2018-19 the NHS budget per person will be cut. As the spending per person goes down, the consequences for patients could be serious, as a recent study in the Journal of the Royal Society of Medicine suggests. It found that underfunding in the NHS could be implicated in nearly 30,000 excess deaths that occurred in England and Wales in 2015.20
  8. 8. How mHealth is improving health and social care | April 2017 Copyright © Genetic Digital www.geneticdigital.co.uk 8
  9. 9. How mHealth is improving health and social care | April 2017 Copyright © Genetic Digital www.geneticdigital.co.uk 9 Supporting evidence for mHealth apps Although mobile health apps are not intended to replace patient-doctor interactions, it is now widely acknowledged that they have a significant role to play in helping address the multitude of challenges facing health and social care providers, in the UK and globally. The potential of mHealth In health and social care, mobile health is driving change in many innovative ways. For example, apps can assist in shifting the focus from expensive, reactive and mainly hospital-based care to care that is less costly, more proactive, and delivered closer to the patient. They can help healthcare professionals work collaboratively with patients and providers for the more effective day-to-day management of chronic physical and mental illnesses. Overall, mHealth apps have the potential to facilitate the delivery of high-quality care and services to an increased number of patients, within available staff and budget resources. In a recent interview to the Financial Times, NHS Chief Clinical Information Officer, Keith McNeil, said: “In five years’ time, smartphones … will take the burden away from the limited number of human specialists we have. People will get … triage that’s personalized to them from their phones, or be empowered to look after their own chronic conditions, like diabetes, via home monitoring.” Case studies of success stories Collaboration between care providers and the mobile health industry has already started, and the benefits of app usage to healthcare professionals, patients and the public are becoming apparent. The following case studies are just a few examples. CANTAB MOBILE CANTAB MOBILE memory impairment detection app. Developed by Cambridge Cognition Holdings, CANTAB Mobile is a simple, 10- minute, self-guided iPad test that can help identify the first signs of clinically- relevant memory impairment. It is essentially the mobile version of a test that has been used for over 30 years in clinical trials of Alzheimer’s disease. The idea behind the app is that it can assist healthcare professionals inmaking moreaccurate diagnosis of dementia illnesses at a larger scale and at the point of care, so that more patients can receive timely treatment. Clinicians who used the app have seen their rates of diagnosis improve from 39% to 46%. Economic models have estimated that routinely using CANTAB Mobile in GP practices could cut diagnostic costs in dementia by 40% and save the NHS £33 million over the next seven years.21
  10. 10. How mHealth is improving health and social care | April 2017 CORDIO CORDIO voice monitoring app for heart failure. This smartphone app can accurately detect from the tone of the user’s voice whether their congestive heart failure (CHF) is deteriorating. The patient’s voice is captured by the app and sent for analysis to determine the presence of fluid in the lungs – a characteristic symptom of worsening CHF. If fluid build-up is detected, alerts are triggered, so that the patient can receive the necessary treatment, and avoid hospitalisation. For example, they may be recommended to take an additional dose of a heart medicine. In clinical trials, CORDIO has accurately predicted admission to hospital one week before patients’ CHF exacerbated. The voice-monitoring app is now being considered for use among NHS patients.
  11. 11. How mHealth is improving health and social care | April 2017 Copyright © Genetic Digital www.geneticdigital.co.uk 11 EPI FLU EPI flu outbreak tracking app. In 2015, England and Wales recorded the largest increase in number of deaths from seasonal flu since 1968. An extra 28,189 people died compared with the year before.22 Globally, flu outbreaks cause 250,000 to 500,000 deaths annually.23 A US team of researchers from Duke University and the University of North Carolina at Chapel Hill has developed a smartphoneappthat can predict howthe disease will spread within a community. The app works by collecting real-time data – such as heart rate, blood pressure, social interactions, and physical activity levels – which allow to estimate a person’s risk of developing flu. The information can be used to implement preventive or other measures (e.g., vaccination, throat swabs, improved hand washing) to contain the outbreak and potentially reduce mortality. The team successfully tested the app within a study of university students, the results of which were presented at the 2015 International Conference on Knowledge Discovery and Data Mining, in Sydney, Australia.24
  12. 12. How mHealth is improving health and social care | April 2017 Copyright © Genetic Digital www.geneticdigital.co.uk 12 MY MRI at KING’S MY MRI at KING’S app. Physicists at King’s CollegeHospital, London,createda virtual reality (VR) app that helps reduce the anxiety children often experience before and during a magnetic resonance imaging (MRI) scan. The medical app uses 360 degree videos that can be viewed on a VR headset, smartphone or tablet. Incorporating sound effects and supported by the explanations of a radiographer, the videos allow children to experience an MRI scan before of the actual procedure, both at hospital and home. The app has been successfully trialled by a 10-year-old patient with brain tumour, who needs regular MRI scans. “Even though my dad explained I couldn’t imagine what it would be like … the app is really helpful as it shows you what to expect … it reallyfeels like you are inside the machine,” he said. OVUSENSE OVUSENSE fertility sensor and app. For couples trying to conceive, the ability to accurately identify the time of ovulation increases significantly the probability of pregnancy. Fertility Focus and Genetic Digital partnered in the development of OvuSense, a combined sensor and fertility app, which can predict the date of ovulation up to 24 hours in advance, with an accuracy of 99%. The device consists of a vaginal sensor that collects temperature readings during a woman’s cycle. Using the
  13. 13. How mHealth is improving health and social care | April 2017 Copyright © Genetic Digital www.geneticdigital.co.uk 13 same technology of contactless payments, the readings are downloaded to an app and displayed on a smartphone or tablet. Unlike other fertility kits, OvuSense is a regulated, CE marked medical device, and is clinically proven. It has enabled couples to conceive, even when pregnancy was deemed unlikely due to the presence of medical conditions such as polycystic ovarian syndrome (PCOS). ROSEMONT ROSEMONT pocket reference guide dosage calculator. Rosemont Pharmaceuticals Limited and Genetic Digital have created the first pharmaceutical app to carry the CE Mark and be certified by the Medicines and Healthcare Products Regulatory Agency (MHRA). The app allows healthcare professionals to access information on all Rosemont liquid medicines and easily calculate the accurate dose titration for any adult or paediatric patient. Downloadable on both tablets and smartphones, the app is playing an important role in helping Rosemont Pharmaceuticals successfully engage with customers and, at the same time, contribute to the health and wellbeing of patients by enabling healthcare professionals to prescribe more suitable forms of medication to patients with swallowing difficulties.
  14. 14. How mHealth is improving health and social care | April 2017 Copyright © Genetic Digital www.geneticdigital.co.uk 14 Mental health apps The Five Year Forward Review, published in 2016 by the Mental Health Task Force, predicts that mobile health solutions will play a pivotal role in driving positive changes in mental health services. Such transformation is already under way, and clearly encouraged. The NHS offered £400,000 for digital innovations that can help better manage mental disorders and improve access to relevant care and services.25 Mobile apps have significant potential in this regard. Those that enable the self- management of mentalhealth issuessuch as anxiety, depression and stress are especially sought-after, given that the majority of affected people avoid seeking face-to-face professional help, largely due to the stigma associated with mental disorders. Mental health apps can help providers increase access to recognised psychological therapies, so that patients don’t miss out on the benefits. For example, certain smartphone apps offer self-guided versions of cognitive behavioural therapy (CBT) – one of the most effective treatments for a wide range of disorders, including depression, post-traumatic stress disorder and phobias. The effectiveness of these tools is increased if supported by email or SMS reminders, to ensure engagement with therapies. Not surprisingly, patient demand for mental health apps that facilitate self-
  15. 15. How mHealth is improving health and social care | April 2017 Copyright © Genetic Digital www.geneticdigital.co.uk 15 management is strong. A survey appeared in the Journal of Medical Internet Research found, for example, that over three- quarters of respondents would use mobile apps for managing mental problems, if the tools were available for free.26 For mental disorders such as dementia, there are opportunities for mHealth apps to assist care providers in optimising interventions that support independent living and wellbeing. Among various examples is a smartwatch developed by researchersfrom Gjøvik UniversityCollege, Norway. The device collects biometrical data such as blood flow and body acceleration and temperature, from which healthcare professionals can extract useful information about the person’s daily activities (e.g. walking, sleeping) and health status. For example, it may be possible to recognisean increaseinthenumberof visits to the bathroom, which may indicate the presence of a urinary infection.27 Gamification A potential downside of self-management is that patients may lose the motivation to engage with their apps. Gamification provides a means to overcome this potential problem. It involves the use of elements typical of game playing, such as setting goals and scoring points, to enhance the user’s motivation. For example, Public Health England’s Active 10 tallies minutes spent walking and awards badges for reaching daily walking goals established by the user. In Canada, Vancouver-based Aygo has developed a gamified health app, called Empower, for chronic conditions such as diabetes. Through a game-based approach, patients can set goals for desired changes in behaviour,trackmedication useandreceive reminders for activities. In addition, they are awarded points and badges for any completed task. The research on the effectiveness of gamified health apps is still limited but promising. For example, a review of 10 clinical trials concluded that game-based app for depression can have a moderate positive effect on symptoms.28
  16. 16. How mHealth is improving health and social care | April 2017 Copyright © Genetic Digital www.geneticdigital.co.uk 16 Wearables Wearables are considered major drivers of mHealth penetration. Although the majority are designed for the wrists, chest and arms, they also include devices that can be embedded in clothing and shoes. An emerging new trend is wearables for the ear. Like most smart technology devices, they can monitor heart rate and steps taken. In addition, they can provide information about respiratory rate, oxygen saturation and blood pressure in a completelynon-invasiveway. Somecan also calculate caloric intake and provide dietary suggestions. Since wearables like these collect data in a passive manner, they can be particularly usefulforolderadults, who may not be technology savvy. More generally, for people with chronic conditions, wearables can monitor symptoms and other parameters in the background, andalertthemif changesoccur that require medical intervention. An example is the Health and Environmental Tracker (HET) system, developed by researchers of North Carolina State University for people with asthma. It consists of a wristband and a chest patch, which monitor environmental factors such as pollutants and humidity as well as physiological parameters. Complementing the system is a smart spirometer that measures lung function. The gathered data are transmitted wirelessly to a computer, and allow to predict the occurrence of asthma attacks. Connectivity Importantly, connectivity among mHealth devices has improved significantly in recent years. For example, wearables can now communicate with health apps on smartphones or tablets. In addition to increasing accuracy and convenience, this opens up a wealth of new opportunities, including the ability to forward health data from wearables to hospital and doctor office systems, so they can be accessed in real-time by healthcare teams for the benefit of their patients.
  17. 17. How mHealth is improving health and social care | April 2017 Copyright © Genetic Digital www.geneticdigital.co.uk 17
  18. 18. How mHealth is improving health and social care | April 2017 Copyright © Genetic Digital www.geneticdigital.co.uk 18 Barriers to mainstream adoption While there is no doubt about the potential of digital technology as a facilitator of transformation in health and social care, it has its own challenges in terms of mainstream adoption. Private vs. public sector technology gap A global Economist Intelligence Unit (EIU) survey of doctors and payers, commissioned by PwC, suggests that a major barrier to a greater deployment of mHealth is the technology divide between private and public sector.29 For example, the survey shows that 33% of public-sector doctors don’t have mobile internet at work, compared with just 14% of those in the private sector. As the survey authors point out, to accelerate the mainstream adoption of mHealth, the public sector must work towardclosingthis gap,by investingmore in technological innovation Security and data protection 
 Although smartphones and apps are great enablers of the healthcare revolution, they are vulnerable to a number of security threats. These include malicious software that can alter sensitive information or send it to untrusted entities, and third party attacks with theft of private information. Leakage of personal information may also occur, for example as a result of poorly designed apps. In 2016, the NHS Choices Health Apps Library was suspended following concerns that some of the apps were leaking data. The previous year, a study in BMC Medicine, led by Kit Huckvale of Imperial College, London, had found that 23 of the 35 health apps in the NHS library that were assessed for six months were sending unencrypted identifying information over the internet.30 Lack of interoperability 
 Ideally mobile health devices should be able to seamlessly connect to provider systems, enablingdatasharingbetween,forexample, consumer apps and electronic health records (EHR). However, this level of interoperability is presently hard to achieve, largely because of the many disparate platforms and operating systems, which are difficult to integrate with each other. The fact that these evolve at a much faster pace, compared with medicaldevices, also add to the challenge of speeding up
  19. 19. How mHealth is improving health and social care | April 2017 Copyright © Genetic Digital www.geneticdigital.co.uk 19 mHealth adoption. Sorting the good from the bad A surprising finding of the surveyof hospital doctors and nurses mentioned earlier is that, although the majority used health and medical apps in clinical practice, only a few recommended them to their patients. A frequently reported reason for this is the inability to assess the quality of the large number of mHealth apps presently available to patients, or the scientific evidence supporting their use. Indeed, the rapid proliferation of mHealth apps seen in recent years, combined with a current lack of agreed quality standards, are making it difficult to distinguish the good from the bad among the multitude of products available. Additionally, a lack of clear regulatory requirements for prescribing health apps could be further contributing to doctors’ reluctance to recommend these products to their patients. Regulatoryinitiativesarebeingundertaken, at both national and international level to bring some clarity. In the UK, the National Information Board (NBI) outlined, in their Personalised Health and Care 2010 policy paper, a new endorsement models for consumer oriented health apps. 31 The initiative, which involves Public Health England(PHE) andtheNational Institutefor Health and Care Excellence (NICE), among others, aims to ensure that these products meet certain evidence-based criteria in order to be accredited for use. In addition, last year the Medicines and Healthcare products Regulatory Agency (MHRA) published updated guidance for software developers on health apps as medical devices.32 Similar initiatives are being undertaken across Europe, with the publication by the European Commission, in 2016, of draft guidelines to assist with the development of mHealth apps that meet high standards of effectiveness, quality, reliability and safety.33
  20. 20. How mHealth is improving health and social care | April 2017 Copyright © Genetic Digital www.geneticdigital.co.uk 20
  21. 21. How mHealth is improving health and social care | April 2017 Copyright © Genetic Digital www.geneticdigital.co.uk 21 Looking to the future – beyond the pill A characteristic feature of mHealth technology is that it is constantly evolving. Following are the top trends that, according to experts in the field, will shape its future. Big data In healthcare, as in other industries, digital technologies are generating a huge amount of information, or Big Data, and will continue to do so in the future. These are extremely varied, ranging from clinical data and sensor-generated data to personal health information and electronic medical records. Systems that can support such large volumes of data are expected to increase, and to play a major role in the improvement of health and social care. For instance, big data health platforms may enable healthcare providers to analyse and compare biometric information or patient behaviour patterns from mHealth apps with the aim of identifying interventions that can help improve care and services, lower costs and make disease prevention more effective. Smarter technology Emerging smarter technologies of particular interest are those aimed at supporting disease management and adherence to treatment. A key area in this regard is diabetes. The global devices market for this condition is projected to reach $35.5 billion by 2024.34 And smarter technologies are increasingly contributing to the market’s growth. An example is the smartphone app Sugar.IQ. It monitors blood glucose levels in real time, and makes food and other recommendations, helping patients keep their diabetes under control. In the area of medication adherence, coming to the digital health market are smart pills that aim to revolutionise patient compliance with prescribed treatments. For instance,Proteus Digital Health and Otsuka Pharmaceuticals have developed a device consisting of an ingestible sensor linked to a wearable patch that is applied to the chest. Used in combination with a medication, the sensor communicates the intake time to the patch, and the information is then displayed on a mobile app.
  22. 22. How mHealth is improving health and social care | April 2017 Copyright © Genetic Digital www.geneticdigital.co.uk 22 Augmented and virtual reality In augmented reality (AR), the real-view from a smartphone or tablet device is supplemented with computer-generated elements, such as graphics and sound effects. It is essentially an evolution of virtual reality (VR). Together, these technologies offer fascinating opportunities for the advancement of mHealth. Some breakthrough platforms are already on the market. Take Medical Realities’ Virtual Surgeon, for instance. Using 360 degree videos and 3D, it enables consultantsto practice operations via head- mounted systems such as Oculus Rift, without actually being in the operating theatre. Another example is Bravemind, which uses VR technology to treat people with post-traumatic disorder (PTSD), by having them relive the traumatic events that triggered their PSTD – an approach known as exposure therapy. A similar VR solution has been developed by health tech firm, Pious, for the treatment of people with phobias. And Switzerland-based Mindmaze has created a virtual reality-based intervention for the early motor rehabilitation of stroke survivors. It is estimated that the VR market alone will be worth around $30 billion by 2020.35 A number of medical VR tools have also already been tested for efficacy, in clinical trials. A recent example is the virtual reality intervention for managing pain in hospitals, developed by researchers at Cedar-Sinai Medical Center, in Los Angeles, California. Using a Gear Oculus headset fitted with a Samsung Galaxy phone, hospitalised patients with pain can engage in a 15- minute, 360-degree, fantasy-world game called Pain RelieVR, which involves shooting balls at various targets. In a six- month study, published in the Journal of Medical Internet Research Mental Health, RelieVR reduced pain scores by 24% – almost two times the decrease observed in a control group of patients with pain who watched a relaxing nature video on a TV screen.3 Implants & the bionic man Today, implantable devices are limited to such things as pacemakers or defibrillators. But the future of mHealth includes sensors that will be implanted under the skin and, similarly to what wearable devices do, will gather biometric andother data. Among the
  23. 23. How mHealth is improving health and social care | April 2017 Copyright © Genetic Digital www.geneticdigital.co.uk 23 various possible applications of these sensors is to assist with wellness, medication adherence and disease management. Researchers at Texas A&M University are developing an implantable sensor that can provide continuous blood glucose measuring, improving the way diabetic patients can control their condition and reducing their risk of complications. Meanwhile, the National Institute of Biomedical Imaging and Bioengineering (NIBIB) launched the Bionic Man – an interactive tool that details 14 sensor- based and other technologies that may, one day, help prevent, cure or manage injuries and disease. Among these are blood glucose sensing contact lenses, a microneedle patch that delivers vaccines, robotic leg prosthesis, implantable sensors for prosthesis control, and a wireless brain- computer interface that could help people with paralysis move robotic limbs with their thoughts. The take-home message In recent years, mHealth has evolved significantly. Users increasingly rely on a multitude of technologies to better manage physical and mental conditions, prevent disease and share information. There is an increased opportunity for care providers to improve health and social care, by empowering patients, healthcare professionals and the public, and by investing more in technology innovations.
  24. 24. How mHealth is improving health and social care | April 2017 Copyright © Genetic Digital www.geneticdigital.co.uk 24 References 1. Mordor Intelligence (MI), global mobile health (mHealth) market – growth, trends & forecasts (2016 - 2021), 2016. 2. Deloitte, Global Mobile Consumer Survey 2016: UK Cut, 2016. 3. Mobasheri M, King D, Johnston M et al. The ownership and clinical use of smartphones by doctors and nurses in the UK: a multicentre survey study. BMJ Innov 2015; doi:10.1136/ bmjinnov-2015-000062. 4. The Economist Intelligence Unit (EIU), Mobility, performance and engagement, 2016. 5. IMS Institute for Healthcare Informatics, Patient adoption of mHealth, 2015. 6. World health Organization (WHO), Aging and health, 2015. 7. Office for National Statistics (ONS), Overview of the UK population: March 2017, 2017 8. The King’s Fund, Life expectancy. 9. Department of Health, Improving the health and well-being of people with long term conditions: World class services for people with long term conditions, 2010. 10. Mental Health Task Force, The five year forward view for mental health, February 2016 11. Mental Health Foundation, Starting today – the future of mental health services, September 2013 12. Hagan P. The true cost of medication non-adherence, 2015. 13. Jeremy Hunt, Personal responsibility, 2015. 14. National Audit Office (NAO), Managing the supply of NHS clinical staff in England, 2016 15. Health & Social Care Information Centre (HSCIC), NHS Workforce Statistics, 2016 16. Health & Social Care Information Centre (HSCIC) a, Staff by nationality grouping and customer selected specialties, 2016 17. Skills for Care, Nationality of the adult social care workforce, 2016 18. Robineau D. Ageing Britain: two-fifths of NHS budget is spent on over-65s, The Guardian, 2016 19. Caley M, Sidhu K. Estimating the future healthcare costs of an aging population in the UK: expansion of morbidity and the need for preventative care, J Public Health 2011;33(1):117-22 20. Hiam L, Dorling D, Harrison D, et al. What caused the spike in mortality in England and Wales in January 2015? J R Soc Med 2017 21. Housden C, Rous R, Lewis L et al. Modelling the economic impact of Cantab Mobile use in UK primary care in the dementia diagnosis pathway, 2014 22. Office of National Statistics (ONS), Provisional analysis of death registrations, 2015 23. World Health Organization (WHO), Influenza (seasonal), 2016 24. Fan K, Aiello A, Eisemberg M, et al. Hierarchical graph-coupled HMMs for feterogeneous, Personalized health data, Proceedings of the 21th ACM SIGKDD International Conference on Knowledge Discovery and Data Mining, Sydney, Australia, 2015;239-48 25. NHS England, Mental health digital innovators to apply for new £400k fund, 2016 26. Proudfoot J, parker G, Hadzi D, et al. Community attitudes to the appropriation of mobile phones for monitoring and managing depression, anxiety, and stress, J Med Internet Res 2010;12(5):e64 27. Boletsis C, McCallum S, Landmark F, et al. The use of smartwatches for health monitoring in home-based dementia care. Lecture Notes in Computer Science 2015;9194:15-26
  25. 25. How mHealth is improving health and social care | April 2017 Copyright © Genetic Digital www.geneticdigital.co.uk 25 28. Li J, Theng Y, Foo S. Game-Based Digital Interventions for Depression Therapy: A Systematic Review and Meta-Analysis. Cyberpsychol Behav Soc Netw 204;17(8):519- 27 29. Economist Intelligence Unit, Emerging mHealth: paths for growth, 2014 30. Huckvale K, Prieto JT, Tilney M, et al. Unaddressed privacy risks in accredited health and wellness apps: a cross-sectional systematic assessment. BMC Med 2015;13:214 31. National Information Board (NIB), Personalised health and care 2020, 2014 32. Medicines and Healthcare products Regulatory Agency (MHRA), Medical device stand- alone software including apps, 2016 33. European Commission, Second draft of guidelines, EU guidelines on assessment of the reliability of mobile health applications, 2016 34. Grand View Research, Diabetes devices market to reach $35.5 billion by 2024, 2016 35. Statista, Statistics and facts about virtual reality. 36. Tashjian VC, Mosadeghi S, Howard AR, et al. Virtual Reality for Management of Pain in Hospitalized Patients: Results of a Controlled Trial. JMIR Ment Health 2017;4(1):e9
  26. 26. How mHealth is improving health and social care | April 2017 Copyright © Genetic Digital www.geneticdigital.co.uk 26 About Genetic Digital We help healthcare, pharma & medical device organisations use web and mobile technologies to effectively connect patients and healthcare professionals. With 10+ years of digital healthcare experience, we combine a talent for designing intuitive user experiences with a thorough knowledge of your key audiences and medical compliance. We’ve developed mobile apps that interface with hardware & medical devices; taken apps through CE Marking and built sophisticated web based patient management systems. We've developed digital & mobile solutions for:  Smiths Medical  Fertility Focus  Rosemont Pharmaceuticals  Martindale Pharma  Britannia Pharmaceuticals  Astellas  Alliance Healthcare  University of East Anglia  InHealth Group  University Hospital Southampton NHS Trust  Oxleas NHS Trust  Grampian NHS Trust As a team, we bring strategic, technical, design, marketing & medical compliance expertise to ensure that your digital and app investment delivers tangible healthcare outcomes. We also run Genetic Apps our dedicated health and medical app development division. Learn more at: www.GeneticDigital.co.uk www.GeneticApps.co.uk Email us: evolve@geneticdigital.co.uk Twitter: @geneticdigital LinkedIn: www.linkedin.com/company/genetic-digital
  27. 27. How mHealth is improving health and social care | April 2017 Copyright © Genetic Digital www.geneticdigital.co.uk 27 We’re a small digital agency focused on helping healthcare organisations use web and mobile technologies more effectively so they can improve health and social care outcomes. To discuss a digital health project: Email us: evolve@geneticdigital.co.uk Call us on: 01494 858 054 www.geneticdigital.co.uk

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