With the digital age now having a firm grip on society, OH practitioners are well placed to tailor the use of the latest technology systems to their advantage, says Dr Peter Mills.
We now carry around more processing power in our pockets than was available on the Apollo spacecraft mission to the moon. Whether this is actually true or not, it certainly is amazing to ponder just how technological innovations over the last couple of decades have become integral to our every day lives. Having said that, with the exception of medical diagnostics and treatment, healthcare professionals have generally been rather slow at adopting technology as a way of improving service delivery and clinical outcomes – I remember trying to persuade some colleagues of mine to use email as recently as the early 2000s. This is particularly the case in occupational health, with many practitioners still using paper records or tracking cases in a static spreadsheet.
So how is technology going to shape the healthcare space in the next few years and what does this mean for the practice of occupational health? Is it going to be more of the same late adoption of innovation or are we going to see some “game-changing” applications reach the front line in the near future?
Introduction of the electronic and personal health record
One thing we have to get right sooner rather than later is the digitisation of health records. Sitting in my hospital out-patient clinic on a Friday morning I continue to be amazed that, despite all of the advances that have been made in transcription, storage and access of information, I am still presented with an unruly pile of paper as an excuse for a patient record.
Not only is this potentially dangerous, in that important pieces of information can be mislaid or, worse still, lost, but rummaging through them during a consultation is distracting and does nothing to optimise the short period of time that I have with a patient.
There are several electronic health record systems on the market; some would say there are in fact too many. But with core standards in place, it shouldn’t be too difficult to connect all aspects of an individual’s healthcare record and finally get to a paperless system.
Healthcare professionals have generally been rather slow at adopting technology as a way of improving service delivery and clinical outcomes.”
Perhaps more interesting is the personal health record; enabling individuals to own their health data in an electronic format. Whether this comes in the form of a “smart card” or whether it is stored online is mostly immaterial. What is fundamental is providing the population as a whole with systems that first and foremost they can trust.
The likes of Microsoft and Google have dabbled in this area, but do not seem to have gained any significant response, possibly because when push comes to shove people just do not trust them with their personal health information. This whole area provides tremendous opportunities and appears to be the ideal space that providers of care should be playing in.
Telehealth and remote consultations with patients
It seems like telehealth, the delivery of health-related services and information via telecommunications technologies, has been with us forever. For whatever reason, mass uptake has eluded providers of such services to date. However, a quiet revolution is occurring on the other side of the Atlantic with increasing numbers of health insurers using telehealth services to both augment their relationship with their members and reduce costs at the same time.
Many medical consultations don’t need direct hands-on contact. Indeed, I’ve estimated that about 30% of the patients that I see in my clinic don’t need to be touched at all; a review of pertinent results together with a discussion about symptoms and appropriate treatment modifications often suffice.
With the ever-increasing penetration of broadband internet access in the home, there is no longer the need for dedicated telepresence suites to conduct such interactions. A perfectly adequate audio-visual connection can be made with a webcam and voice over IP (internet protocol) telephony. With the technology seemingly finally catching up with the concept of telehealth, what better arena to use it than in the occupational health setting?
There are six billion people on the planet; four billion of them have a mobile phone. Even if this is only partially true, it is a phenomenal opportunity to utilise this technology for the purposes of health promotion and health management. Couple this with the rapid adoption of smartphones (about a quarter of all mobile phone users in the UK have a smartphone) and the opportunity to communicate and create a real bond between clinicians and patients is huge. Anything from booking an appointment, having a secure email conversation with a doctor, accessing results and viewing relevant informational videos are all possible now.
Creation of virtual health community platforms
The overwhelming majority of the population in the UK has access to the internet and with this comes an opportunity to connect people in ways that simply were not previously possible.
So much of what we do on a daily basis can be measured and, if fed back to us in an appropriate way, can help us to make decisions about our lifestyles or health-related choices in general.”
I have recently been involved in developing a population-based weight loss and physical activity challenge in the state of Minnesota, US. Having analysed the data from the four-month programme, it is clear that being involved in a health promotion activity in a team creates a dynamic that enhances participation and also outcomes (in this case, the amount of activity done and percentage of weight lost).
There is no substitute for getting out there and doing things, but the internet and, more specifically, online communities, can facilitate this. This approach appears to be the evolutionary next step to the more conventional unidimensional information-delivery characteristic of online programmes to date. The popularity of social platforms, such as Facebook, bear testament to this phenomenon; people like to be involved in communities, be it with friends, colleagues or just people who have the same health and wellbeing goals as they do.
So much of what we do on a daily basis can be measured and, if fed back to us in an appropriate way, can help us to make decisions about our lifestyles or health-related choices in general. Take the humble pedometer, once a cheap plastic box that clipped on to a belt, now a 3D accelerometer that can accurately record movement as well as sleep quality. Couple this with heart-rate monitoring technology and you can get a good insight into an individual’s stress profile.
Such technology, although appealing to the health conscious, is also starting to appear more frequently in clinical settings. Devices fitted with a mobile-phone SIM card can transmit such diverse measures as peak flow, ECG and blood sugar to a hospital specialist, a GP or OH physician, enabling “real-time” and continuous assessment of an individual’s health condition to maximise control and minimise symptoms.
One of the barriers to greater adoption is often the base price of such devices. However, for certain high-risk individuals, if these sorts of wearable devices can help keep them well or get them back to work sooner, the financial savings would more than pay for the cost a number of times over.
Hardly a month goes by without the news of the untimely death of a celebrity. Of course some of these deaths are undoubtedly caused by the excessive consumption of substances of abuse, however, some are due to plain-old heart attacks. The truth of the matter is that the most common presentation of coronary heart disease is sudden death. However, we now have the technology to detect significant, but asymptomatic disease in a non-invasive manner.
Occupational health practitioners can use some of these health technology applications to better engage with their patients and provide greater value.”
Electron beam computed tomography, otherwise known as EBCT, can be performed in a matter of a few minutes. It uses very low doses of radiation and provides an assessment of the coronary arteries by detecting calcium in their walls. This preventive screening test is not available on the NHS, although some private medical insurance providers do cover it on premium policies. The potential to prevent untimely death, or at the very least a costly admission to hospital with a heart attack, should not be underestimated.
The same technology can also be used to look for early signs of bowel and lung cancer. The up-front cost of such tests is relatively high, mainly because the scanners are expensive to buy and maintain. However, with a greater emphasis on both prevention and health economics in the delivery of healthcare in the UK, it could potentially save money in both the private and public sectors if the right people were targeted for assessment.
Technology in all shapes and sizes is an integral part of our lives. The majority of the population has embraced technology over the last decade and it is my belief that people’s understanding and acceptance will drive greater uses in the healthcare space in the coming few years.
I also believe that occupational health practitioners can use some of these health technology applications to better engage with their patients and provide greater value to the interactions that they have and the services that they offer.
Dr Peter Mills is director of Glasslyn Health Solutions. For more information, contact 07958 215431.