As promised in our last newsletter I have sumarised my summer of webinars. However as it is still long I have put it at the end of this newsletter, to ensure that readers don’t miss some of the important items included.

A REAL intelligent toilet seat?

Intelligent toilets have been spoken about ever since I can remember – the favourite being one that uses you bodily waste to diagnose and monitor a wide range of diseases that the sitter might have. Although there have been claims, no-one has yet convinced me of a fully working version. However it looks like there may now be an additional use for a toilet, specifically its seat, that works: cardiovascular monitoring.

The Heart SeatTM “measures heart rate, blood pressure, cardiac output, ECG, blood oxygen, and much more!” The developer, Hearthealthintelligence, claims to be “Integrating traditional sensors into non-traditional platforms to enable capture of clinical data in an inconspicuous way.” It is still in development although there are some appropriate pictures of early versions.

Important Lessons for app developers from a CBT trial

The current Lancet Digital Health carries an interesting short comment on a recent very successful RCT of a CBT insomnia app (called Sleep Healthy Using the Internet (SHUTi)). That in itself is not the news though because I understand that Sleepio for example has done 12 RCTs to prove its efficacy (although when last I looked NICE’s advice is still a tad equivocal). What interested me were the associated observations. These included:

  • There was a strong association between accessibility and educational level “Although digital interventions are claimed to be easily accessible, people with a higher socioeconomic status are reached more easily while people with a lower socioeconomic status are under-represented.”
  • Adherence to completion without any human support was comparatively low (46%) with a strong suggestion that occasional face:face engagement with a professional would greatly increase this “The addition of some form of (minimal) human support can increase adherence rates considerably, but means that the intervention is less scalable. Whether the benefits of this increased adherence outweigh the loss of health benefits resulting from reduced scalability remains under debate.”
  • Finally there is a slightly more arcane argument about whether such interventions should be offered as a stepped care model or – as was used here – a stratified care model, with the author preferring the former.

(There is also comment about efficacy of full face:face vs digital health, with face:face being marginally better, though as that is so manifestly unscalable especially for mental health interventions, I am not highlighting it here.)

The full RCT paper referred to is here.

Clearly both the first two points are really important for digital health developers to act on – I regularly comment publicly on how digital health improves health equality yet it looks here if anything that the reverse may be happening. Likewise there does seem to be an important issue identified with adherence for autonomous interventions that needs urgent attention. The use of stepped care in delivery of digital health interventions also possibly merits greater consideration too.

IMPORTANT Draft for comment: ISO 13131 Health informatics — Telehealth services — Quality planning guidelines

This important standard is currently up for comments until 9th September. Its purpose is to provide processes that can be used to analyse the risks to the quality and safety of healthcare and continuity of care when telehealth services are used to support healthcare activities.The relevant BSI page including links to the draft, how to comment etc. is here.

Some short items:

  • In a post that looks like it ought to have arrived on April 1st, researchers in Houston have developed a way of drawing sensors directly onto skin, thereby eliminating problems with sensor/skin adherence. “The electronics are able to track muscle signals, heart rate, temperature and skin hydration, among other physical data, he said.” In addition “The researchers also reported that the drawn-on-skin electronics have demonstrated the ability to accelerate healing of wounds.”
  • ADI under whose auspices DHACA was established in 2013 has vacancies for both a Head of Business Development and a Software Manager because of substantial expansion of their leading Digital Health platform, “MyPathway”. This guides and supports patients remotely through healthcare assessment, treatment, rehabilitation, and prevention pathways. MyPathway improves healthcare, reduces costs, and empowers patients. More information from john.eaglesham@adi-uk.com. Although ADI is based in Saltaire (very close to the station), Bradford, geographical proximity is less important than ability, drive and determination to win.
  • Innovate UK currently has 25 competitions running to provide funding for SMEs. The most recent SBRI competition is Using digital technology to support psychological therapies. There’s a recording of a recent webinar on the Biomedical Catalyst Call (now open) here.
  • European Digital Week is 21st to 26th September 2020 and of course virtual.
  • Wired Health is on 22nd September. DHACA members get 10% off the (considerably lower than original) price of £40//£75 (with a further discount for two) if you book via https://wiredhealthtech.eventbrite.co.uk?discount=DHACA10 as a number of you already have.
  • The RSM/DHACA/AHSN webinar today 5th August 2020 is The Tipping Point of Virtual Care and Rise of Personal Health Data with Drew Schiller, CEO and co-founder of Validic. It’s on at 13:00 – 14:00. The discount code for DHACA members (only, please) is DHACATEN63

Reflections on a webinar summer

Pride of place in a DHACA summary must of course be the nine webinars we ran with the support of the AHSN Network, all the recordings of which, plus in most cases other relevant material, remain available on the links that follow.

Starting initially as a way of spreading out presentations planned for the cancelled DHACA Day in March, these quickly took a supportive role to assist the NHS’s transformation. Our first identified silver linings that our fourth and fifth then developed further, the write-up of the latter particularly bringing out the benefits that users – both as GPs and patients – saw from implementing “total triage”. These all flowed from reframing patients’ needs from “I want an appointment” to “I have a health issue I want dealing with”.

In between we squeezed in webinars on medical device regulation and on healthy ageing/what Covid-19 could teach us. The former was really key as at the time the MDR was expected to be implemented fully on May 26th so there was work to be done urgently by some of our members. Deferral now to 2021 in the EU raises the issue of whether HMG will ratify the MDR or replace it with something else, so watch this space.

For our sixth webinar we changed tack slightly with a focus on tech for vulnerable people. Here we learned about the importance of community assets, and of always asking “who isn’t in the room?” when discussing community matters.

Many of the Techforce ’19 winners presented in the following webinar. On that theme our final (ninth) webinar was on how to get carers to invest in technology. We have subsequently taken up the call for greater publicity for technology which is being answered both by NHSX and, we hope, PHE.

In between (again!) we had a fascinating webinar on home testing which opened my eyes to the amazing opportunities there. A particular takeaway for me was the importance of such tests being in a pathway – testing, as well-meaning patients sometime pay to have done that is not part of a pathway is largely wasted. Another was being told that SkinVision should not be treated as an app – it is a validated clinical service!

A particular theme in that last webinar was that we already have too much innovation – there is a desperate need to put more effort into implementing what we have rather than spend on more innovation, a comment reiterated by many over the summer, most recently Chris Marshall of the NIHR Innovation Observatory.

Gems from other webinars I listened to over the summer included:

  • “Downloads are not clinical outcomes” (James Woollard)
  • “Save money with automation, not on automation”
  • “A delay of greater than three seconds in initiating an app download results in 57% dropout” (not specific to health apps, though a cautionary finding)
  • “One of the advantages of using mobile devices for health monitoring is that they enable longitudinal diagnostics” – eg weight, pulse, blood sugar monitoring over times.
  • “In an unstable complex system, small islands of coherence have the potential to change the whole system” Ilya Prigogine, Chemistry Nobel prize winner, quoted by Dr Martin Curley
  • “We did what mattered, not what we were told to do”
  • Improving health care is all about converting a non-deterministic system to a deterministic system – Keith McNeil
  • “Health care workers are trained to achieve a sense of mastery”
  • “Dear God, can you please reinstall 2020: it has a virus”
  • “The telephone has come to the rescue, after 150 years” James Read
  • Behaviour change will only happen if people have all three of: opportunity, capability, motivation – Prof Susan Michie

The word I heard most often was resilience – particularly in the context of mental health during the lockdown, though it was applied often to heath & care delivery supply chains and even to health & care staff. Sustainability came a close second. The experience of listening to speakers from five continents was exhilarating – to get that experience in person would involve many thousands of airmiles. The one thing I missed was the networking – I haven’t yet got the hang of these online networking systems, sadly. I found looking at one screeen was enough so Tweeting at the same time seemed much harder. Overall a great experience though.

The two webinars that inspired me most were Keith McNeil’s on “Chaos, COVID & Catastophe” during the Digital Health Summer School, from which I have shown one quote above, and Debbie Wake, founder and CEO of My Diabetes My Way who gave a truly brilliant and humble summary of how she and her colleagues had developed such a superb app, and how it had changed her.

Thank you for those who have read through to the end and especially to Malcolm Clarke for pointing me to the ISO 13131 review, all the way from Turkey.