About a year ago, NHS England began exploring ways in which the internet of things and other remote analysis tools could help diabetes patients manage their illnesses – and created a consortium of 10 companies to drive the project forward.
According to director of enterprise at the West of England Academic Health Science Network (WoE AHSN), Lars Sundstrom, the programme – called NHS Test Bed – is in the second quarter of a 27-month project. If it is successful, there are ramifications for the way patients manage their own care in the UK and further afield too.
"The acceptance from the medical community that self management is something people do themselves is a particular aspect that a professional will find helpful in receiving the right information," Sundstrom says.
"In other words, when things are not progressing the way they should, there needs to be a system that sends the alert to professionals that says 'I need to take a look at this'. But if everything is proceeding quite smoothly, then they would rather the patient manages themselves."
There are two 'Test Bed' programmes running at the moment. One concerns dementia, and that is located in Surrey.
The West of England's Test Bed programme centres around self-management for diabetes care – it's possible, for example, to connect a glucometer up to the analytics platform created by HPE. The group created a portal of sorts so that the data can be managed and made accessible to both the patient and healthcare professionals. In other words, there are two sides to it – one for the patient and one for the practitioner.
"What we have tried to do is design it with the user in mind right from day one," says Sundstrom. "A lot of work we did around the Diabetes Digital Coach has been done with people with diabetes, and diabetes support groups, and trying to understand from them how they would like to manage their own condition – what information they would like to have, and how they would like to interact with it. That's been critical from day one.
"The great thing about the internet of things is it's moving us to a place where the technology is what you might call unobtrusive," he says. "With IoT, the ability to collect data all the time during your daily life is really critical. To be able to take that data and re-present it to people, so they can use that data to manage their lives in the way they would like to, is really a fundamental part of it."
Open and easy
The AHSN chose HPE to lead the data crunching side because, according to Sundstrom, they were simply the most open from the start.
"They were the most open, most easy company to work with," Sundstrom says. "Some of the other providers had a number of distinct conditions they wanted to bring – they already had some ideas of what they wanted to get out of it for their organisation."
"But HPE just said: we want to understand the problem and see how we can help, and they put no conditions on their participation – they just participated as an open party, like everybody else did," Sundstrom explains. "I think we found that attractive. That openness and ability they have to share everything they do with the rest of the group has been critical to the success of the project so far."
Along with the monitoring aspect, the project has also created 'structured education programmes', a comprehensive body of information that has been validated by health professionals and made available to patients. There are also other companies working exclusively on the social networking side, so that patients with diabetes can talk to one another.
For the data itself, Sundstrom says that this is stored in military-grade data centres so it is as secure as it gets.
The group is measuring success of the project in a few different ways. "My own answer is it will be a success if people use it," Sundstrom says. "That's critical – the number of users that find this useful to them will be the greatest mark of success.
"Having said that, there's some more rigorous methodology being applied to," he explains. "There are health outcomes, currently being measured by an organisation called Health Economics, which is a consultancy arm of the academic groups in Wales – Cardiff and Swansea.
"The other thing that's very important is that patient-reported outcomes are built into the platform, the ability for patients to rate how they themselves are improving," he says.
"We have built in another outcome measure, tracking – what are people using and how often are they using it? You can do that with an IoT platform, so we will also be getting stats ourselves as to what patients are using and find most useful about it."
He imagines that this model, if successful, could be scaled up and applied for other areas of patient management.
"Because we're an NHS England-funded organisation, we're able to have high-level discussions with our health professionals, so we can ask them: how can you see this working in your world?
"There are a few things they come back to me and really want to know. One is: does this help people? Can this be an alternative to the kinds of treatments they have at the moment, and does it really work as a treatment?"
One of the key outputs, Sundstrom explains, is that the offering might not be right for everyone with diabetes – but because of the completely connected nature of the platform, the group will be able to check which populations it is working for.
"We have built patient-recorded medical outcomes, and also technology-acceptance outcomes," says Sundstrom. "So at the end of the project, we will be able to see if it is working in these areas, but most critically, for whom."
"Does it work better in younger populations? Older? These are things they don't yet know around technology and self-management, and I don't think we will know until we do it. There's an assumption from the start this might be more appealing to younger people – I'm not sure that's correct. We might find older people with diabetes might take to this, we don't really know.
"I think one of the key outputs is: this isn't going to be a solution for everyone with diabetes, but identifying those populations to whom it appeals the most, and then if it doesn't appeal to certain populations, we can do what we can to adapt it so it is more appealing to those people. This is something we might do at the next stage."