How an app a day can keep the doctor away

Health and fitness apps and wearables are not only for marathon runners and triathletes – they are working wonders in terms of increasing activity in people of all fitness levels and in doing so aiding chronic disease prevention and management. And now that people have their own personal health data in the palm of their hand, they can take an informed approach to maintaining or improving their health.

But will real-time access to your vital stats help or hinder the patient-doctor relationship? “For the most part, the technological advancements we have seen in healthcare have been a welcome development, and, in particular, the innovations in personal health technology have allowed patients to take a more proactive role in their health,” says Dr Maitiú Ó Tuathail, a Dublin GP.

He explains that, for example, it is now possible for people to record an ECG (heart tracing) on their phone with a device called the AliveCor, which will alert them if their heart is beating irregularly.

“For people with atrial fibrillation, where the heart beats irregularly, this has meant that patients can monitor and manage their medical condition with greater independence. Moreover, it can give doctors very useful information.”

In terms of general health and wellbeing, being accountable to an app can make people get a handle on poor lifestyle habits.

“In more everyday use, it is telling people the amount of exercise they have done, and the amount they should do for their age and/or weight,” says Ó Tuathail. “Lifestyle factors, such as poor exercise levels, play a key role in many medical conditions, so this technology is allowing people to see their levels of inactivity, and assisting them in addressing it, all in a scientific way.”

With such a huge range of apps and technology relating to health and fitness now available, understandably, some are better than others.

"I find the apps that the mainstream providers supply with their wearable devices are all excellent, such as Apple Health and Fitbit, in particular," Ó Tuathail says. "They are very impressive in terms of the way they integrate with your personal digital devices and the way that they interpret the date they generate." A downside of these particular wearables? The cost. "They are expensive, which means they are not yet accessible to everyone, but with time the price is sure to reduce."

Positive development

Ó Tuathail sees it as a largely positive development that patients can access their personal health data. “It is giving patients autonomy and information that would previously never have been available to them. And it’s their data so they are entitled to it,” he says. When this information is combined with education around what it ultimately means for the patient’s health, it means that technology can be both useful and powerful.

Maurice Mulvenna, professor of computer science at Ulster University, says the democratisation of digital health is allowing people to better understand their own wellbeing.

One area in which technology is having a major impact is that of mental health. “We are all used to quantifying our physical health, with the inbuilt pedometers on smartwatches and smartphones,” Mulvenna explains. “We are working to see if this can be done with our mental health.”

His team at Ulster University has been working with artificially intelligent “chatbots” or smart speakers for use in mental health for several years now. These may offer a new way to help people deal with mental-health issues such as anxiety and depression.

According to Mulvenna, the technology, known as natural language processing, has been around for years but hadn't been exploited until the arrival of platforms such as Google.

“Smart speakers such as Alexa and Google Home mean that all of a sudden you had millions of people giving data and this improved the algorithms and understanding of what people were saying. Increasing intelligence means what they can say back to us has also improved.”

The application of chatbots or smart speakers in mental health was inevitable. “One of the benefits of the chatbot technology is that it is available 24/7. Also, it’s not human, so it’s non-judgmental. It doesn’t care that it’s talking to someone at 3am if it can offer advice that has value.”

Ground-breaking projects

Mulvenna and Ulster University are involved in a number of ground-breaking projects involving chatbots. Their collaboration with the Northern Irish social enterprise Inspire Wellbeing saw chatbots used in employee wellbeing services, and they’ve since begun work on a new project, which aims to use the technology for supporting the mental health and wellbeing of people in sparsely populated areas.

The international MENHIR (Mental health monitoring through interactive conversations) project involves listening to people’s voices and using audio-processing capabilities to understand the stress levels of the person. “We know that people may manifest their anxiety or stress in different ways, such as a change in the pitch of their voice. We are trying to find out if we can detect that and if we can, then we can offer better chatbots because not only do we know what the people are saying, but we also have an idea of how anxious or not they are.”

Rather than replacing the interaction between a patient and a qualified mental healthcare professional, Mulvenna says the technology will only augment this interaction. “It still means that people can self-assess their mental health and wellbeing and engage with their healthcare professionals, but it may also mean that people can do it through a smart speaker at any time of the day or night, so it just gets rid of the time and geography constraints. It also frees up the healthcare professional’s time.”

Back in general practice, Ó Tuathail believes health apps will have a dramatic effect on the doctor-patient relationship in the very near future.

“It is giving us an insight into the patient’s life and health on a 24/7 basis, in a way that would previously have been unimaginable. We are undoubtedly going to see patients presenting to doctors soon with a copy of their latest ‘healthcare data’, such as heart rate, heart tracing, oxygen levels, etc, which will greatly add to consultations,” he says.

“The challenge now will be how both patient and doctor will adapt to accommodate this new technology as it quickly becomes the norm.”