At the start of eHealth week it is hard not to be impressed by how much the peddling of dreams as much as selling of technology has entered the healthspace. The promise is that technology will solve the challenges of delivering healthcare, and that this will be achieved through devices that monitor our bodies and lifestyle, and that they will be able to predict and prevent future illness. This surrounding ourselves with intelligent connected devices is only outstripped by the sheer variety of ways in which we can wear digital devices to track every nuance of our being, and share that with...well there is a question.
If we pursue an endless generation of personalised data without consideration of what we can meaningfully do with the data - and this does go way beyond privacy concerns - we could well increase costs and inappropriate treatments within health services. We are yet to learn how to interpret the data effectively and accurately and therefore risk diagnosing normal variation as disorder. For example, a Dutch neurosurgeon has suggested that an indiscriminate use of MRI scans for those with non-specific low back pain often highlights anomalies in the spine that may actually be within normal limits. The worry that such an anomaly may not be part of a normal variation of the spine's anatomy leads to an impulse to surgically intervene, which does not substantially improve the situation, and is a significant risk of its own.
Casual collection of data for its own sake is potentially damaging and a lazy and poor research method. Many of us are already haunted by results from health trackers, and Google Search, when we cannot make sense of the results, and possibly, neither can our doctor. Yet the lure of generating more data remains despite the fact that we cannot see that in certain, critical areas of life, the facts do not just speak for themselves. Our homes are at risk of becoming a womb-like retreat, reporting upon us and nudging us to act, through our smart fridges and smart meters so that all thinking and planning will be guided for us, creating passive dependence, and not well-being.
If you detect at this point the feint odour of 'conflict of interest' of the doctor who 'of course would say that', you may indeed be on to something. Like many of my peers, I learnt from many great doctors whose observation, examination and diagnostic skills seemed worthy of Conan Doyle's writings. The reliance upon technology alone in health is scarcely different from the concerns of university lecturers deploring the student's reliance on search engines and Wikipedia. Intelligence and work in the form of scholarship foster the growth of the thinking mind, and those creative leaps of imagination that I do not believe yet form a part of the Turing test.
Generating data to help us understand the onset of a health problem and spot the early signs of an impending a coming health crisis can only be a positive benefit. This is just as true in the wider natural world; predicting earthquakes may save lives and then enhance well-being. But allowing data from the myriad connected devices in the home to inform healthcare seems to me naïve, confused and concerning, as is a widespread, unthinking use of symptom trackers. The data smog that emerges is hard to interpret, and the internet of things, sadly, becomes nothing much, and for those used to practising evidence-based medicine a great step backwards. Economic, intelligent deployment of connected devices may be a rather different matter.
Even so, the use of wearables in healthcare may involve other challenges for ourselves in the UK that are less problematic to our distant neighbours in Silicon Valley. Trust in and use of technology, in every sector, has many systemic aspects, including cultural attitudes, and this can be most easily demonstrated through measuring the use of automatic cars in different countries. Depending on the study, research suggests only 25% of us in the UK drive a car with an automatic gearbox, but in the US 93% drive automatic cars. Not all of us will use what might be regarded as the more advanced technology, especially if there is a perceived loss of control in using it. Roads, reliability, and cost will play their part, but the difference is striking, and perhaps a little concerning for anyone wanting to bring driverless cars to the UK.
So where does this leave us in the still promising future of eHealth? Digital pragmatism must be a key part of any future, where devices, apps and the data from them sits within effective care pathways, and they are meaningful to health practitioner and service user alike. And it is the latter group who must have greatest influence on these developing services, if they are to truly improve, perhaps even transform healthcare, through their sharing of the lived-experience of health problems.
There are already some excellent examples with us from the UK that have been developed over many years to reflect the needs of those using them, and the wider Health Service. In alphabetical order, in the e-mental health space, Big White Wall, Buddy App, Pow Health, and the splendid Doc Ready App (an app for helping young people get the most out of time with their GP) are all focussed, sensitive and intelligent services more than worthy of use. They inspire those practitioners recommending them, as well as those that use them, though like automatic cars they will not be for everyone. And if they collecting data, it is already with a defined purpose, so that no-one ends up with random data noise in their heads that makes it harder to think and decide; we learn from the data, but do not get lost within it.