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NHS Mobile

Health Choices: the personalised health app which could help turn the tide on EPR adoption


A new mobile app called Health Choices takes the unrivalled wealth of health knowledge on the NHS Choices website and puts it in citizens’ pockets. The app is also augmented with Microsoft HealthVault, and can therefore offer highly personalised assistance. Nick Saalfeld suggests that it could also herald the consumerisation of healthcare in the UK and a new opportunity to demonstrate the value of electronic Health Records.

If you have a smartphone, you’ll have discovered ‘apps’. They’re the helpful programs on phones which allow you to do anything from navigating a city to killing time with a game of Angry Birds (PM David Cameron’s favourite, apparently!)

Healthcare is one of the fastest-growing areas for app developers for a very simple reason: unlike computers, our phones are intensely personal and we keep them with us all the time. There are already a plethora of apps in health, fitness and wellbeing. The NHS Quit Smoking campaign, for example, has an app designed to offer instant support, advice and personalised encouragement to cigarette quitters.

A brand new app, Health Choices, (designed for all major smartphones, available now on WindowsPhone, iPhone and Google/Android) has now launched which gives users access to much of the information on the existing NHS Choices website from the comfort, privacy and mobility of their pockets.

That includes their very popular health encyclopedia and symptom checkers and lookup services such as your nearest A&E department. Since accidents can happen anywhere, it’s naturally useful to have a mobile service which will look up the nearest A&E to your current location with just a click or two. There are also in-depth scorecards showing the government’s public performance data for your local GPs, hospitals and other NHS organisations.

Putting the patient at the centre of healthcare information

However, the real value of the Health Choices app will be in personalisation. In a ground-breaking partnership with Microsoft, any user of the app can also choose to enter any amount of personal information about their own healthcare situation, for clear and simple advice and later retrieval. The information is stored on Microsoft’s HealthVault platform; a highly-secure and globally deployed specialist medical data repository.

Mark Smith, Microsoft UK Director, Healthcare and Life Sciences, says, “HealthVault is central to Microsoft’s commitment to consumerising public healthcare. It is already being deployed by Trusts to connect patients with clinicians and consultants. With the growth of a thriving marketplace for applications also based on HealthVault, citizens will truly see the benefit of the information associated with their own care – by contributing to it themselves.”

The sort of information consumers are anticipated to store for themselves includes location-based services (my GP or chemists, for example), symptoms and conditions, relevant health news etc. In the pipeline, future versions of the app will include ever more refined personal care planning, like medication usage and prescription histories too. In doing so, the Health Choices app can then offer a progressively more bespoke service to each individual, both in the depth of information services delivered and by presenting them to each user in the most convenient and useful way.

Of course, Health Choices, just like NHS Choices, is not a replacement for GPs and primary care. However, if there’s one criticism levelled at the internet’s provision of healthcare information, it’s that a quick online search usually serves to scare and misdirect patients, rather than giving them useful advice. NHS Choices already offers information which is free from the influence of conjecture or pharmaceutical companies looking to sell their products; now with the personalised assistance of HealthVault, Health Choices can do even more to provide a tailored and relevant service to patients.

My data, my results

But this is only the start of patient empowerment using data. Arif Govani, UK Director of HealthVault at Microsoft says, “The HealthVault platform is available to developers of other apps – and several such apps will be on the market in the next few months. This means that data entered by a patient once in one app, or indeed through an online service, can be used any number of times for different purposes in other applications to improve outcomes”. Typical apps include:
  • Livescape: socially enabled calorie consumption tracking and exercise regimes to aid dieting
  • Expert-24: a range of personal health risk assessments, and then ongoing goal tracking to help users change their health outcomes realistically
  • Numera Social: programs for weight loss, diabetes management, brain training and more…
  • Tools to remind patients when to take combinations of pills
  • Calendars for appointments, physio sessions etc.
The opportunity for clinical and technology professionals in the broader app ecosystem to develop services which will genuinely save or improve lives is almost limitless. The government also sees the opportunity – at the recent launch of Health Choices, Secretary of State for Health, Andrew Lansley, said, "We want to make it easier for patients to find the best NHS services. This is why we are making more NHS data available to consumer groups and IT specialists outside the NHS so they can develop tailored websites and apps for patients. I want to see new products and services being offered to patients like the ‘Health Choices’ app."

As a common database, the more information stored in HealthVault, the richer (and easier to deliver) the resulting patient experience can be. Just as information entered via the Health Choices app can be used (with explicit patient permission) by other apps, so information entered into other apps and ultimately stored in HealthVault can then be used to refine and perfect the NHS Choices experience for each user. It’s a virtuous circle, and all under the control of the individual patient.

This commonality and interoperability is reflected in the underlying systems, too. For the more technology-minded, HealthVault is equipped with all the syntaxes commonly used by healthcare providers, commissioners and insurers; including SNOMED and HL7. From the ground up, it uses open data formats designed to interface with third party products across IP, safely and securely and without major development costs. Whether in the app-space or an enterprise-grade hospital environment, HealthVault is designed to cut across brand and system boundaries.

For the non-technologists, this means, in short, that almost any healthcare requirement, treatment path, outcome or prognosis can be sent to HealthVault from third party systems. This will yield three distinct benefits:
  1. Self-management of healthcare and the sharing of knowledge with specialists will become simpler and more natural for patients
  2. In line with the transparency and utility principles of the Open Data agenda (i.e. ‘take the wealth of government information and achieve more for citizens with it’), public information - from surgery addresses to disease vectors - can be ‘mashed up’ with volunteered personal information to provide greater value and insight to the patient
  3. The creation of useful apps will become simpler, faster, and cheaper for both developers and end users

Another shot at Patient Health Records

Of course, crucial to this are security and patient adoption. The past decade of NHS history is undeniably tarnished with relentless press hysteria about the security of NHS data. And the Health Service itself certainly hasn’t helped, with a litany of lost laptops and complaints to the Data Protection Registrar. The push towards a national Electronic Patient Record ended in ignominious suspicion from patients and their families.

HealthVault offers an interesting alternative. In terms of pure physical security, HealthVault is stored in a resilient top-security network; with football-field sized enterprise-grade systems of a much greater degree of sophistication than could be cobbled together by individual Health Service IT teams.

But much more importantly, HealthVault eliminates the “them-and-us” perception of personal healthcare information. Govani says, “Instead of harbouring suspicions about a faceless administration over which they have no control, the user is always in charge of their own data. They choose who to share it with, and under what circumstances. This, surely, is what is meant by patient empowerment”. When patients see constant, daily value – right there in their pockets – from the information they surrender to healthcare providers, then they are much more likely to adopt online and mobile health management services.

“As a company, Microsoft is also proactive in monitoring access to HealthVault on an ongoing basis”, Govani continues. “Every company seeking to produce an app which touches HealthVault data must go through a rigorous data assessment and onboarding process. They must itemise every piece of data they intend to use, and why. They must clarify each point in the experience at which users will be informed that their data is being extracted or used, and identify what permissions are required. Ongoing, this is monitored in realtime: if an app tries to call up a parameter or field which has not been authorised, the data will simply never be transferred.”

The government’s strategy remains to give every man, woman and child in the UK access to their GP’s records by 2015. Apps like Health Choices and underlying technologies like HealthVault could be just the tonic the public needs to look at health data in a more productive way.

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