In the first part of a new major series on wellbeing technology in the workplace, Stephen Haynes outlines the range of platforms and devices available.
Technology related to health and wellbeing, or wellness, has long played a role in workplace health, but it has become more prevalent in recent decades with the move towards more proactive health management programmes, and even more so in the past decade with the growth in technological advances and greater ease of connectivity.
When we think about technology in the context of health and wellbeing, we might think about wearable devices or smartphone applications, but there are a wide range of solutions. Recent decades have seen a number of advances, such as improvements to occupational health systems, attendance management software, health risk assessment tools and wearable devices.
Artificial intelligence in healthcare
Artificial intelligence (AI), or as Daniel Kraft, chairman for Medicine at Singularity, prefers to call it “augmented intelligence'” because it is about using technology to add and enhance healthcare, not replace the human aspect, is playing a huge role in the delivery of healthcare today and will do so in the future.
IBM Watson is supporting physicians using cognitive computing AI technology to recommend cancer treatments in remote areas.
Meanwhile, robotics are being used by doctors in delivering treatment, and Google Brain is using machine learning, working with hospitals to predict health outcomes from medical data so it can ultimately train computers to predict when people may get ill.
The evidence base is also growing; for example, a study last year by Stanford University found that AI could identify skin cancer in photographs with the same accuracy as trained doctors, which could potentially enable a smartphone to act as a cancer scanner.
It is important to distinguish AI from machine learning, a form of AI that enables computers to learn without being specifically programmed.
Machine learning is part of everyday life and can be found in things like spoken commands to a smart phone, which relies on tech supported by machine learning, or virtual personal assistants (for example, Siri, Cortana and Google Assistant).
A 2016 study by Harvard Medical School sought to understand whether digital platforms could be more accurate in diagnosing conditions compared to actual doctors. It showed that doctors made a correct diagnosis more than twice as often (72%) as online symptom checkers (34%). However, this study was recently criticised for including some known overly-poor performing symptom checkers.
A study in 2016 of Babylon Health’s automated triage system (Middleton et al, 2016) showed an accurate outcome in 88.2% of cases compared to 75.5% of cases for doctors, providing “a clinically safe outcome in 100% of cases, and performed an accurate triage in up to 90.2% of cases”.
It was also quicker at diagnosing and triaging in almost 90% of cases, halving the time to triage for the average case assessed.
In July 2016, Babylon released its first AI-enabled symptom checker and in January 2017, partnered with the NHS to use this technology to power an NHS 111 app available to over a million north London residents.
Workplace health surveys and trends point to a key role for technology over the next couple of years, including: effective adoption of meditative practices into the workplace; financial education; support for the employee as a carer; improvements to the communication and integration of benefit and support services (including apps and platforms); and taking a more joined-up, strategic approach to the alignment of employee wellbeing with company mission, vision and values.
Defining health and wellbeing technology
Workplace health interventions are generally considered to fall into one of three categories: preventive, supportive or rehabilitative. Workplace health-related technology can be broadly categorised as:
- workforce monitoring;
- coaching and consultation; and
- occupational health and safety.
Platforms, trackers and workforce monitoring tools are mainly focused on prevention and support, while coaching and consultation and OH and safety are typically more supportive and rehabilitative in their nature. The latter, more familiar workplace health-related technology includes absence management platforms, OH-based technologies and tools adopted in health and safety.
Platforms, trackers and workforce monitoring
Platforms, or wellbeing portals, have been around for years, particularly in the US, and simpler versions of health and wellbeing programmes have also been found in employee benefit platforms.
The role of the platform is to integrate an organisation’s programme, educating, capturing data, communicating and engaging all the relevant stakeholders across the business. There is much cross-over between platforms, trackers and workforce monitoring tools. Most platforms are able to capture data from wearable or app-based activity tracking devices. While some platform providers used to offer their own wearable device, this has become less prevalent as they recognise that most people that track use their own.
Platforms capture information from employees, either input by themselves or automatically through an automated tracker (mainly using personal devices and/or smartphone “mHealth”, but also some employer-provided tracking devices).
These devices deliver tailored plans, coaching and support to staff, with aggregated data to the employer to feed into programme design. Some platforms enable integration of wider benefits (for example, financial and pension information), some offer more sophisticated data analysis, while others allow employers to schedule and track wellbeing-related activities, such as wellbeing challenges.
Currently, platforms tend to come from three main channels:
- Providers in the health and protection benefits space (insurers such as AXA PPP’s Health Gateway, Vitality’s Active Rewards, and Bupa Boost; and employee assistance programme providers such as Optum’s LiveWell platform).
- Employee benefit advisers/platforms (Mercer Harmonise or Reward Gateway’s Yomp platform).
- Wellbeing companies.
Wellbeing companies include Virgin Pulse (which acquired the Global Corporate Challenge recently); SAAS provider Welltok (which recently acquired Keas); Limeade; Provant; Ceridian Lifeworks; Dadacoo; Umanlife; Wellness Checkpoint (from InfoTech – principally a health risk assessment vendor); Sonic Boom Wellness; Ritualize; WellBe Solutions; CoreHealth Corporate Wellness; CHC Wellness; Wellness Corporate Solutions; and RedBrick Health.
We are beginning to see the introduction of artificial intelligence (AI) “chatbot” technology into eHealth – programmes that communicate through text or audio, simulating how a human would behave in conversation.
More advanced technology means much of this passes what is referred to as the “Turing test’”, referring to the machine’s ability to behave equivalent to, or indistinguishable from, a person, which can create greater trust and reliance on the output of information.
Babylon Health, the on-demand remote healthcare support provider, known for its remote GP services, is enhancing its existing AI-driven technology, which already uses texts from users to triage patients, whether connecting to a virtual GP or advising them to visit A&E, combined with providing test results and supporting health information.
A growing number of platforms and workforce monitoring technologies capture employee feedback in real-time. This addresses the traditional annual survey, which only captures a particular point in time, or an employee’s original intent.
Soma Analytics and Psychological Technologies provides bespoke interventions to support employees based on their inputs, while providing employers with aggregate wellbeing data of employees. Of course, real-time capture is only as good as the quality and quantity of the input, as well as how you interpret the data and respond.
Some providers go beyond simply offering the technology to capture the data, to offering metrics and even action plans based on the combined outputs, with real-time recommendations, advice and guidance back to line managers and HR. Some companies, such as Glint, use AI and natural language processing, which can capture and analyse qualitative data from multiple sources.
Wellbeing expert Professor Cary Cooper sees real-time monitoring technologies playing a key role in the future of workplace health. He says: “Smartphone and wearable tech can already enable staff and employers to capture and manage data on how people perceive their working environment and let them give feedback in real time – without the employee having to do anything.”
Cooper adds that Network Rail has already developed technology that enables it to monitor its people in real time.
Nancy Hey, director of the What Works Centre for Wellbeing, says: “There are work-related aspects that we have not properly investigated from a wellbeing or performance angle yet. For example, the way workers take breaks is different today compared with 15 years ago; and what effect have home working and hot desking had? In many cases, the data is probably already there in terms of people survey information.”
Hey adds: “There are a small number of employers that really look under the skin of their workforce to understand both the engagement and wellbeing drivers – for example, the Civil Service People Survey provides a wealth of information over a five-year period so it can monitor the impact of workplace trends such as redundancies and organisational change on worker wellbeing – measuring mood, purpose and job and life satisfaction.”
Terminology and health and wellbeing technology
There is much debate about how to categorise different types of health and wellbeing technology, from consumer and wider healthcare perspectives.
The World Health Organisation (WHO) defines eHealth as “the use of information and communication technologies [ICT] for health”, while mHealth is seen as a component of eHealth which the Global Observatory for eHealth (GOe) defines as “medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants (PDAs), and other wireless devices”. More specifically, mHealth taps into smartphone capabilities such as SMS, GPRS, GPS and Bluetooth, as well as accelerometers – sensors that measure the tilting of a mobile phone.
In the September 2015 report “Patient adoption of mHealth”, Murray Aitken, from the IMS Institute for Healthcare Informatics, noted that the number of mHealth apps available to consumers exceeds 165,000, with the number of iOS apps increasing by more than 100% between 2013 and 2015.
The report adds that most apps concentrate on wellbeing, diet and exercise, with about a quarter focusing on disease and treatment management. However, the report notes that more than half of mHealth apps have limited functionality and most simply provide information.
The study found these apps are increasing capability to connect to other devices or sensors (defined by Wikipedia as an electronic component, module, or subsystem whose purpose is to detect events or changes in its environment and send the information to other electronics), as well as social media connectivity and connectivity and communication with provider healthcare systems (albeit only 2%).
In addition to smartphones, watches and wearables, some of the more relevant sensor categories that experts believe will be most applicable for mHealth app solutions in the next five years include implantable sensors (for example, glucose detection for diabetes control), and ingestible sensors, which are those that are swallowed.
There are about 260,000 mHealth smartphone apps currently available, and more than half are targeted at people with chronic conditions, such as hypertension, heart disease, cancer, depression and diabetes, according to Research2Guidance published in 2016.
From the 3,677 respondents to the 2014 National Cancer Institute’s Health Information National Trends Survey (a cross-section of US citizens’ use and access of health information), Carroll et al identified that the main users of health apps are younger, with high levels of education, health and income.
The survey also showed that app use is associated with, but not necessarily validated by, intentions to change diet and physical activity.
Despite advances in the nature and volume of health apps, there are still limitations – in particular, the limited evidence of clinical effectiveness and a lack of integration with healthcare systems.
Apps don’t just focus on wellness, diet, exercise or disease and treatment management. Some of the popular work/productivity-related apps (not necessarily evidenced based) include Headspace, which helps improve focus and concentration, and Focus Booster, which breaks down work into intervals separated by short breaks.
There are numerous stress management apps, including Worry Watch, which lets you write down what is bothering you, track whether or not the outcome was as bad as you originally thought and then assess the trends and patterns in your anxiety visually.
Telemedicine: Broadly defined as remote diagnosis and treatment of patients via information and communication technologies. The WHO considers it an evolving science because it is constantly incorporating new advances while adapting to changing societal health needs and contexts.
The WHO has a broad, all-encompassing definition of telemedicine, which is: “The delivery of healthcare services, where distance is a critical factor, by all healthcare professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of healthcare providers, all in the interests of advancing the health of individuals and their communities”.
Telehealth: Often the terms telemedicine and telehealth are synonymous and used interchangeably, although there is much debate as to whether or not they mean the same thing. The Telecare Services Association defines telehealth as: “the remote exchange of data between a patient at home and their clinician(s) to assist in diagnosis and monitoring”.
Telehealth is commonly used to support patients with long-term/chronic conditions such as chronic obstructive pulmonary disease; diabetes; and epilepsy. Telehealth solutions give patients greater control over their health by monitoring and transmitting information about their condition in real-time to a central point where it can be assessed against baselines set by their doctor.
When measurements fall outside these parameters, the telehealth provider can instigate an appropriate response. It also enables doctors to monitor a patient’s condition and intervene remotely. It is widely proven to reduce emergency and hospital admissions as well as mortality rates.
Telecoaching: While no clear definition of telecoaching exists, it is a subset of telemedicine that uses communication and technology devices such as phone, computer or tablet to provide remote treatment and advice. Generally speaking, the remote patient monitoring elements of telemedicine and telehealth would be considered too invasive for the employer/employee relationship, but we do see elements of these types of technology in workplace health settings. These are commonly found in the form of remote GP/specialist services, counselling services and online medical record services.
Pre-primary care: While not in itself technology specific, the concept coined by Your.MD in its 2016 report “Pre-primary care: an untapped global health opportunity” (Carr-Brown J, Berlucchi M, 2016) is worthy of mention as it seeks to encompass any form of initiative or service intended to help people understand what’s wrong with them and connect them to relevant healthcare services.
As Professor Sir Muir Gray says: “The term ‘primary care’ is a misnomer. The first thing citizens and patients do is think what they can do for themselves, the second is to seek advice from friends and family, and in the past 20 years, the internet. Then they seek professional help.”
Convergence of wellbeing technology
All of the platforms vary in scope and focus, and are getting smarter. It would appear we are converging to the portal in the near future that uses AI combined with machine learning to assess multiple employee engagement, motivation, health and wellbeing factors.
This can be used to target specific and tailored interventions, coaching and support using chatbot technology (which supports conversations through voice or text) to individual employees, across diverse and spread-out workforces.
If the industry can work together effectively, then arguably technology could enable data to be captured and interpreted, from attendance data to stress risk assessments to engagement and health insurance expenditure. Devices will be broadly compatible between health benefit providers, OH and attendance management platforms, as well as personal tracking devices and apps.
Of course, all this should be wrapped up in a simple-to-use and easy-to-administer tool for staff and programme managers. The technology exists to make it happen already – and in many cases, the demand is being driven by a small number of forward-thinking employers and technology solutions providers, as well as the payers and insurers.
Stephen Haynes is a workplace health specialist, and currently the programme lead for Mates in Mind, which provides the UK construction industry with a framework to improve mental health by raising awareness and addressing the stigma of poor mental health.
Carr-Brown J and Berlucchi M (2016). Pre-primary care: an untapped global health opportunity.
mHealth New horizons for health through mobile technologies (2011). Global Observatory for eHealth series, vol.3. World Health Organisation.
Middleton K, Butt M, Hammerla N, Hamblin S, Mehta K, and Parsa A (2016). “Sorting out symptoms: design and evaluation of the ‘Babylon check’ automated triage system”. Nursing Education Perspectives March/April 2017, vol.38(2), pp.108-109.