Tech 100: ‘We have to have systems in which the patient becomes the initial manager of their own condition’

Written by Brian McKinstry on 13 March 2017 in Comment

Brian McKinstry, professor of primary care e-health at the University of Edinburgh and co-director of Edinburgh Clinical Trials Unit, on a new approach to chronic conditions

Professor Brian McKinstry, Professor of Primary Care eHealth, University of Edinburgh - Image credit: NHS Scotland

There are going to be a lot more ill people over the next few years and the number of people with chronic diseases is going to double.

However, the number of full-time equivalent doctors and nurses in Scotland is probably going to fall. Technology will have to fill this gap.

Telehealth, where patients self-monitor conditions and send results for analysis by doctors and nurses, has shown promise, particularly in the fields of hypertension and diabetes.

However, this reliance on clinicians will be unsustainable as the population ages.


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We have got to have intelligent systems running carefully crafted and validated algorithms that can advise patients at a basic level referring to clinicians only when this initial approach is unsuccessful.

In the past, of course, we have done something very similar with a paper-based approach.

For instance, people have used asthma or COPD management plans to advise them what to do if symptoms changed or if their readings deteriorated, for example, to double up their inhalers if they got a cold.

What we are talking about here are electronic versions, probably more intelligent versions, that take data from symptoms, physiological measures like oxygen saturation or pulse rate and based on the individual patient’s characteristics and what has learned about that individual’s responses over time so they know, for example, they always become very ill if they get a cold and intervention with increased medication may be required.

We have found in the past with our previous research that patients really like to take control of their condition as long as their decisions are supported.

For example, with chronic obstructive pulmonary disease we have given them a pulse oximeters and symptom diaries which allowed them to make decisions on their management. .

This was an observational study but it certainly seemed to reduce the amount of contact with doctors and nurses with no detriment.

Indeed patients were very happy with it and preferred it to the traditional telehealth system in which data was sent centrally and someone phoned them back, because they felt they were more in control of their condition.

Future artificially intelligent systems would be a development of this approach.

However, the biggest resistance is likely to come from industry and developers of these kinds of apps, given they will be concerned about litigation if things go wrong, particularly with an app which could be sold anywhere in the world.

Devices such as these, once they have been rigorously tested and approved, will likely have to be adopted health boards or HMOs, who will shoulder responsibility for their maintenance and underwrite them.

The use of these devices will always come with a caveat – if you are really sick do not go by what this things says, contact your doctor in the way you normally would.

Our current management strategies and even those based on traditional telehealth, which alerts the doctor or nurse at a low threshold of concern are not sustainable – they will increase workload, they won’t reduce it. We have to change what we do.

Brian McKinstry is professor of primary care e-health at the University of Edinburgh and co-director of Edinburgh Clinical Trials Unit 

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