Vision Paper by Collette JohnsonDirector of Medical and Healthcare, Plextek

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Part One: The Patient of Today

Part Three: Virtual Reality

Part Two: The Patient of the Future

Lacking Empowerment

Changing the Perception

What Should We Expect by 2020?

The High Street Health System

Sensor Technology: Coming to a Store Near You

The Future of Sensors: 2020 Vision

Saving the NHS Time and Money

Supporting and Replacing Healthcare Services

Regulation and Legislation: The Key to Success

Hydration MonitoringObesityDementia

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The Military Vision

Rehabilitation and Virtual Reality

Using VR for Collaborative Understanding

Personalised Rehabilitation

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Conclusion

About Plextek

About Collette Johnson

Collette Johnson, Director of Medical and Healthcare. PlextekBy the year 2020, med-tech innovation will have transformed the UK healthcare landscape. The medical industry will see significant progress in the way that patients are monitored, diagnosed and treated by exploring improved methods of self-monitoring and innovative care models that are less reliant on a budget-constrained, government-funded health system.

The medical technologies shaping our future will change the way in which everyday healthcare is delivered to us. Not only will we be able to confidently understand

and explore our options for medical treatment, we will also be able to use accessible, everyday applications that will be available in the home and on the high street.

By drawing on more than a decade’s knowledge and experience of the NHS and working with breakthrough medical start-ups, this paper focuses on how emerging and pioneering technologies such as sensor applications and virtual reality systems will enhance healthcare delivery within the next five years.

This vision paper was first published in 2014, all information and statistics were correct at that time.

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The medical landscape in the UK is facing a somewhat uncertain time as the increasing economic stress on the health service continues. Recent reports highlight that NHS budget restraints have resulted in cutbacks and a serious rethink around the way in which medical treatment is delivered. Although money is now trickling back into the healthcare system, for example Chancellor George Osborne confirmed an £2bn in extra funding for NHS frontline services in his 2014 Autumn Statement, there is a strong debate as to whether the additional money is really making an impact on the modernisation of the health service and contributing to improved patient care.

“We have had a significant amount of money pumped into the NHS in the past, but patients are still receiving substandard care.”

Katherine Murphy, Chief Executive of the Patients Association (2014)

Understanding the consequences of this substandard care becomes further prevalent when it is put in the context of the ageing UK population. The Office for National Statistics states that on average we are living to around 83 years old, which is contributing to the rise in long-term conditions such as diabetes, often with multiple co-morbidities. This patient type subsequently incurs an increased cost of treatment. These problems are likely to manifest if not treated adequately and to make some progress in overcoming the issues, the UK healthcare system is considering further ‘secondary’ care options with the GP, community pharmacist or regional nurse stepping up to help fulfil this requirement. But there are even bigger opportunities to tackle these issues with accurate and reliable self-monitoring and diagnosis.

The NHS is losing money and quality

is suffering as a result

We’re living longer which creates

associated health problems and puts further strain on

the NHS

There is an opportunity to move

toward self-monitoring and self-diagnosis - but how does this become

reality?

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Patient of Today: Lacking Empowerment At the moment the ‘Patient of Today’ is not empowered enough to fully participate in their own healthcare development and therefore patients fail to feel a meaningful sense of responsibility. Typically patients will struggle to monitor their health adequately as they fail to understand their symptoms and turn to online forums as a method of self-prescription, often feeling embarrassed to ‘inconvenience’ their GP or hospital with a potentially ‘minor’ problem. But for the one in six of us who do feel comfortable heading to their doctors for a consultation, many are forced to wait up to a week to get an appointment according to recent NHS figures.

To address these issues there are a growing number of unique medical

technology products coming on to the market designed to aid self-diagnosis and offer both better control to individuals and less pressure on doctors. However, so far the education and subsequent adoption of such solutions are failing to keep pace with demand.

Although some advanced medical technology has begun to infiltrate homes, it is being met with a somewhat mixed response. In-home applications that can communicate directly to a medic, such as using Skype, can cleverly optimise time and provide quick solutions and treatment to an individual’s health care. However the perceived ‘invasion’ into a patient’s home creates a barrier to adoption, which is something that the future patient will need sufficient education in to overcome

Patients need more empowerment and

self-control to become less reliant on health

professionalsTechnology

solutions are appearing in

the market but education is not

keeping pace Some patients are concerned

about the privacy of their

medical data

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What Should we Expect by 2020? Upcoming technological advances within the medical industry are likely to cause the most active and rapid progression that the UK health system has ever seen. The market will become increasingly more open to portable, easy-to-use and low-cost systems and we will see the patient of 2020 rely heavily on sensor technology as the main solution to self-monitor, prescribe and resolve medical problems.

Currently, diagnosis at the point of care is not fast enough and is too indirect. In the recent past, GPs have been encouraged not to send patients to specialist doctors and were being incentivised to avoid sending patients for further secondary care treatment. In stark contrast, by 2020 the industry should have moved towards a large majority of medical screening taking place at the point a patient goes into the GP surgery and it must become commonplace to triage people immediately.

There will be a move toward portable and low-cost medical

systems for the home

It should be commonplace for screening to take place at first

port of call - the GP surgery

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The High Street Health SystemThis secondary care does not always need to be found at the doctors’ surgery and by 2020 we’ll see this becoming commonplace in the local high street. The ability to self-care and self-monitor at home using technology will aid this transition, with ‘community’ pharmacies opening up further opportunities to take the pressure off healthcare professionals and incorporate medical services into retail channels and the high street.

Stores such as Boots are already enabling off-the-shelf technology devices to become integrated into everyday use and providing technology applications, such as HIV tests, over the counter. This will

continue to become even more prevalent and thus reduce the initial screening involvement. The industry is therefore turning its attention to looking at ‘off-the-shelf’ medical technologies such as Cambridge Temperature Concepts’ wireless temperature monitoring device for fertility that can be easily picked up by a consumer and used within the home.

As a result the pharmacy - including those within large retailers and supermarkets - will become a first port of call for medical diagnosis, followed by the GP. A health MOT at a large chain such as Tesco could very well be the near future!

Health solutions will become much

more accessible on the high street

Over-the-counter technology and

community pharmacies will

push the high street healthcare system

Patients will be less reliant on medics and professionals

as a result

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Sensor technology: coming to a store near you Sensor technology will become part of the move away from the reliance on secondary care as it has the potential to be easily integrated into the home for self-monitoring. Sensor technology devices can detect and record real data after an input from the physical environment such as motion, pressure or heat. Such devices provide patients with the freedom to carry out independent monitoring and facilitate the ability to take their own individual test samples. There is currently a large focus on protecting the health of our hearts using sensor devices that can monitor aspects such as blood pressure. Alive Cor was the first FDA-approved trial fibrillation application and device allowing a consumer to take their own ECG recording, using just a finger tip to gather the data. Devices such as Alive Cor are easily attainable to the everyday consumer and it is this accessibility that will help drive the rapid infiltration of sensors into our homes.

Heart monitoring is just the start for sensors and it has huge potential for our patient of 2020. For example, parents of young children can use sensor-based technology devices and telehealth to more accurately monitor the temperature of their sick child, reducing the time spent at the hospital or GP surgery.

However the adoption of sensors can only occur after significant patient education and very clear regulation regarding the interpretation of individual results. Device manufacturers, retailers and health professionals must provide plenty of guidance to ensure self-misdiagnosis does not occur. For example, solutions that just offer a ‘symptom’ (e.g. increased heart rate or low hydration levels) but provide no further resolution or explanation are likely to cause panic and unrest for patients, and deter user adoption.

Medical technology for the home

purchased “off-the-shelf” should become

commonplace

However significant patient education will need to occur

before it can become a reality

Sensors will enable less reliance and a

move away from secondary care

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The Future of Sensors: 2020 Vision Sensor technologies will provide doctors and healthcare professionals with far more visibility of the environment in which treatment is being taken, indicating whether the patient is adhering to the programme prescribed and how certain conditions or frequencies affect particular treatments. Utilising sensor technology, doctors and medical experts can focus

their stretched time on more serious cases.

The following core areas are predicted to experience the biggest take-off within the industry by 2020 and offer a large opportunity for personal monitoring and treatment:

Hydration monitoring:Devices such as Fitbit and Apple iWatch have made headway during 2014 by encouraging people to monitor their personal fitness, focusing on conquering goals for exercise, weight, food and sleep patterns. These existing health sensor applications concentrate on providing targets for achievements and strive to ensure the user meets them. However, these devices can’t monitor the effect that the particular lifestyle decisions encouraged by the applications - such as running and additional fitness - have

on health overall. As a result, expect sophisticated and discreet hydration and nutrition monitoring to be a large part of the sensor future for 2020. Hydration monitoring could potentially occur with the use of ‘plaster technology’, an adhesive plaster-type monitoring device placed on the chest to monitor the hydration levels using heart acceleration, humidity, pressure and temperature from the built-in sensor to accurately measure water levels in the body.

Hydration monitoring, obesity and dementia will be market areas

that will have the biggest impact in the

health industry

Sensors improve the monitoring of patient’s

self-treatment and give them more independence

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Obesity:

Dementia:

Medical technology to combat obesity will migrate further towards mHealth and mobile apps, using sensors for recording emotional health and psychology, rather than providing control measures and a ‘meal plan’. 88% of obese patients already admit their problems with food is related to emotional problems, so mental health

applications will be a vital technology to help combat obesity. Ingestible sensors could also track what a patient has eaten, compared to their mood diaries recorded on a mobile application, enabling the NHS to clearly monitor the comparison.

The integration of sensor technology within ‘every day life’ will help dementia patients by facilitating safe monitoring of the patient’s wellbeing without causing distress or panic. Behaviour and health problems of a dementia patient can be monitored at home to treat people early and ensure they do not go back into hospital, giving patients that fundamental independence they can lose with their condition. The integration of sensors within everyday objects, such as kettles or even a TV, will ensure dementia patients

are relaxed while recording valuable trend data. The same concept will apply for home monitoring for both the ageing and those on life support.

By better utilising existing consumer devices and making the medical monitoring - such as food intake and nutrition - part of everyday life, it will be possible to remove the often ‘confusing clinical barrier’ for patients with these conditions.

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Saving the NHS time and money The evolution of sensor technology for the healthcare system will empower the patient to take control of their health by providing freedom of self-monitoring and better understanding of their potential treatment and secondary care.

Sensor technology will enable a reduced burden on the healthcare service which will improve service delivery and the

patient experience. This will also save clinic time and money in the short term, but in the long term, it enables innovative service delivery and the reduction of on-site clinic visits.

As a result we will see significant changes with the money and hours spent on healthcare.

By allowing patients to be discharged earlier to recover at the home, alongside treatment monitoring from data recorded

from the sensors

A seven-minute appointment with a GP costs the NHS £45

15 million hospital admissions per year costs the NHS £6 BILLION p.a.

A day in hospital costs the NHS £400

SENSORS WILL SAVE NHS AROUND 20%

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Supporting and replacing healthcare services The NHS loses money when patients are sent back to hospital as the government charges a penalty fee for all those readmitted within 30 days. By 2020, sensors could provide the ideal solution to ensure this does not need to happen. After being discharged, a patient can be continually ‘monitored’ in the comfort of their own home, saving additional ad hoc charges to the healthcare system when the patient has to be readmitted due to issues related to secondary complications.

This ‘monitoring’ can occur within a mobile device, which is anchored with an app. Apps such as uMotif that aims to control Parkinson’s disease, offer cognitive ability tests and monitoring of the patient’s movement, recording their data over a period of time. This enables

not just budget accuracy for the NHS but a more stable treatment and education programme. Subsequently, data taken from mHealth applications will also empower hospitals and patients to take control.

Aside from apps, wearable technology with built-in sensor technology such as knee braces for home physio exercises will also enable greater visibility of whether the treatment is being carried out correctly, enabling the NHS to work out its expected budgets more accurately, dependent on how much aftercare patients will need.

With sensors within the home, it’s with no doubt that the patient of the future will be able to successfully work with doctors to enable a shared intelligence approach.

Sensor technology can cut costs by ensuring patients are not

readmitted back into hospital

NHS budgets will go further thanks to greater accuracy when defining

treatment and rehabilitation

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Regulation and legislation - the key to success Although sensors and mHealth applications have enormous scope to change the medical industry for the better, this kind of change causes potential issues with regulation that must first be addressed to ensure successful adoption. Boundaries must be enforced with clearer structures of accountability to avoid liability disputes between the device makers and the communications infrastructure provider the devices use. Importantly, medical device regulations for mHealth will need to offer guidelines for the doctor, the manufacturer, the software developer and the consumer. Consistent approaches to privacy and security across business models and technologies will also be necessary and implemented sooner rather than later. Advisory guidelines regarding the collection and accumulation of mHealth

data will be vital to help the adoption of sensors, and regulators need to look at how companies accumulate data and use it. Ultimately, regulation would enable consumers to feel safer and the use of mHealth applications to become normalised.

Unfortunately devices such as FitBit or Garmin Heart Rate Monitors are in huge demand but are still manufactured with little or no medical regulation or specifications behind them. This lack of standardisation increases the risk for doctors or insurers when consumers adopt them. However for the patient of 2020, it is necessary for professionals to determine what constitutes a medical device and the difference between that and something designed with the consumer in mind.

Sensor integration causes issues with

liability as there are no clear boundaries of who is left accountable if misdiagnoses occur

Med-tech ‘gadgets’ on the market have no clear regulation causing a barrier to wider professional

adoption

Industry will need more consistency

on privacy and security, including guidelines for the

doctor, manufacturer, software developer

and consumer

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Changing the perception Virtual reality (VR) has been associated with gaming since it came to public attention in the 1980s and 90s. More recently devices like Oculus Rift, due to its entertainment heritage and $2 billion investment from high-profile organisations such as Facebook, have elevated VR to a technology hot topic. But outside of gaming these systems still run the risk of not being viewed as a ‘serious’ solution capable of solving genuine issues.

Yet we’re already seeing a small shift in perception with VR in the medical

industry as a technology to help rehabilitate and train patients and industry professionals. Outside of health, this has also been of interest within energy organisations for training on sustainability. Actual training scenarios such as fires on oilrigs or pipe management are also leading the way for virtual reality to break free of the confines of gaming.

VR systems are both cheap and easy to install and set up, pushing the technology forward for widespread adoption in the very near future.

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The military vision The armed forces in particular have a vision to incorporate a virtual reality solution within their training developments, utilising training simulators that can accurately replicate a real-life trauma on the battlefield. Government-funded technology developed by Plextek already exists and by 2020 we will see the full uptake of this technology on a grand scale.

Medical VR training systems for the military allow users to practise tending to a wounded colleague in a very realistic battlefield setting, with environmental

factors including gun fire, extreme weather conditions and heavy smoke occurring within the scene. Military personnel are required to treat their colleague using a controller to ‘touch’ them and the headset as their 360-degree vision.

VR systems such as these are an effective tool to both mentally and physically prepare armed forces personel for emergencies on the front line and can be easily replicated for additional training scenarios within the military.

Systems can improve mental and physical

preparation for trauma on the

battlefield

Virtual reality is moving away from

gaming into the military

UK armed forces are looking to adopt

medical virtual reality training systems by

2020

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Rehabilitation and virtual reality

Using VR for collaborative understanding

The patient of 2020 will fully utilise VR systems to overcome traumatic situations or rehabilitate their body. For patients that can no longer walk and are fearful of what their life is going to be like, a simulation is the ideal tool to reduce the fear of the unknown and provide a full understanding of how their life will be without physical motion in their legs.

Oculus Rift recently provided a terminally ill patient in Italy with an Oculus Rift after

she was left confined to a chair due to her health. With the virtual reality simulator she could ‘walk’ through a virtual Tuscan villa, try to catch butterflies and admire the sunshine.

Soon this will not just be a one-off donation from headset brands but a commonplace commercial application of the technology, enabling all sorts of amazing virtual experiences to those suffering physically or mentally.

VR is not just for the future patient but also for the family around them. By placing another person within their world, clinicians will unite the family by providing a greater understanding of how loved ones are being affected by their particular health issue. For instance, parents of children that have schizophrenia or mental health problems, such as paranoia or disturbing images, can be put in the mind frame of their child and realistically understand the trauma and perception they are experiencing.

It has previously been said that parents feel as though they have ‘lost’ their child to schizophrenia with one woman reporting in a medical study that she had “lost her son through his illness”, explaining that “it is like something in another world” and that she couldn’t understand what it was. VR solutions will have the potential to turn this perception on its head and help both the family and patient understand and cope with mental and physical conditions.

Oculus Rift is already making headway

providing its headset to terminally ill

patients, but there is room for a larger scale

adoption

VR will be used to unite and educate families by placing loved ones in the same situation as

the patient

VR will be used for rehabilitation by 2020, allowing those confined by health issues to have

the freedom and better mindset to self-treat

Patients do not have to feel as isolated as before, with families having an enhanced

understanding of what they are going through

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Personalised rehabilitationBy 2020, patients will also be utilising VR as an effective distraction technique. Excessive pain can be subdued by creating an immersive environment that ‘distracts’ the patient, taking them away to a nice calming environment that enables ‘normality’ to resume and associated anxiety to be reduced.

Escapism is a great part of virtual reality and changes the way patients psychologically view the world and their (and others) health issues. It offers a much more personalised rehabilitation approach that can be tailored to the specific needs, wants and levels of degree required by each patient.

However for this type of VR therapy to really take off for our patient of the future it must be managed in a very precise manner. Virtual reality systems come with potential safety warnings, as do many technology products, and there must be appropriate systems in place in order to take people in and out of the immersive world gradually. The user must be psychologically prepared for what is about to happen and not spend too long in the system to avoid losing the concept of reality and perception.

“SEPT provides mental health and learning disability services to a population of 2.5 million people throughout Bedfordshire, Essex, Luton and Suffolk so its exciting to see that VR can offer potentially groundbreaking treatment within the area. The work being carried out in post-traumatic stress disorder shows real potential and provides the opportunity of improved recovery for the patient group. However for VR to be taken up as a widespread treatment, we must understand the secondary effects of patients undertaking such treatment to enable us to provide this responsibly, including the ability to screen those who are and aren’t suitable for such treatment.” Dr Vishal Agrawal, Consultant at South Essex Partnership University NHS Foundation Trust (SEPT)

But patients must be mentally

prepared to go into the system and clear guidelines

should be enforced

VR can provide therapeutic

escapism to take a patient to a

different, unique environment that is suited to them

The ease of personalisation of

VR systems provides a more tailored

virtual experience for each patient

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Sensors will show real value in the medical industry, particularly with the exciting opportunity to screen patients in the community, enabling post-operative patients to return home just 48 hours after major surgery. However this mass introduction of sensors will need a push from the consumer to enable fast movement of the market, as without this, it will be a slow and cumbersome journey that shows little value in the near term.

Such technology will revolutionise the future of our health for the better, and with the correct

education of users of the system and intelligent interpretation of the data collected, it could change the way we deliver healthcare. Consumers must embrace this technology, start using it and be in control of their health.

To make the patient of the future vision a technical and commercial reality, emerging start-ups, manufacturers, retailers and healthcare professionals must all work together to ensure innovative devices and revolutionary medical systems make the step from concept to reality.

TRENDY STARTUP

TRENDY STARTUP

Medical Supplies

GP Surgery

Coffee

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About Plextek

About Collette Johnson

Based near Cambridge, UK, Plextek specialise in providing solutions for complex engineering challenges.

By efficiently using a broad range of skills, Plextek deliver innovative solutions that meet the highest standards for robustness, reliability and ease of manufacture.

Key markets include; Defence, Medical & Healthcare, and Security, as well as a presence in IoT technology, and the design and manufacture of volume products.

In business for over 25 years, Plextek’s market-focussed expertise ranges from innovation and concept development to product and system design and equipment manufacture and supply. Trusted by organisations worldwide, our teams deliver maximum value from our clients’ investments in technology.

For more information visit www.plextek.com

Collette’s focus at Plextek is solely on medical business development and helping companies with their strategic positioning relating to product development.

Prior to working at Plextek she worked at NHS Innovations with a lead role in bringing together industry and clinical organisations for product adoption and also was the programme lead for the national SBRI healthcare programme. Whilst in this role she focused on the mhealth and telehealth space and developed a network bringing together, industry, clinical and academic stakeholders.

She also worked in a strategic role in healthcare at Cambridge Consultants for world-leading corporate organisations and highly innovative start-ups.

This vision paper was first published in 2014, all information and statistics were correct at that time.