Article | How patient-collated data is supporting evidence-based care

Dr Haidar Samiei, a consultant in emergency medicine and a clinical director for Optum (formerly EMIS), explores how health apps are not only empowering patients, but also providing clinicians with early access to important insights to support evidence-based care.

The pandemic was a tipping point for public trust in digital health and the use of apps. Research by the Organisation for the Review of Care and Health Applications (ORCHA) found that during the pandemic, health app downloads increased by 25% , with 54,546 healthcare and medical apps available on Google Play Store.

For people with chronic conditions such as diabetes and atrial fibrillation, the phenomenal growth in health apps is providing them with greater insight and control of their health. And, with their permission, vital data which clinicians can use.

The data collected through apps designed to monitor long term illnesses are now often requested ahead of planned medical appointments. And indeed, as a consultant on an emergency department, they help provide important insights. In fact, it’s now second nature to ask to see the data collected on a patient’s smartwatch or smartphone – especially if they’re presenting with a heart complaint.

But you would be wrong to assume it’s only those with long term illnesses using apps to monitor their health. I should know, I’m one of those very people.

In recent years we’ve seen a significant growth in people tracking a wide range of other issues such as brain health, stress, anxiety and sleep pattern behaviours. NHS staff were encouraged to use mindfulness apps during the pandemic. The one I personally use is linked to my smartwatch so I can monitor my progress.

Bio-hacking is also building in popularity – using data to understand your body so you can make incremental changes to diet and lifestyle to improve health and wellbeing – especially amongst athletes.

We’ve also seen a rise in proactive health mentoring with complex health issues too.

A recent report by Balance, an app designed by Dr Louise Newson to track the symptoms of perimenopause and menopause, revealed that on average a woman will visit her GP 10 times before she will receive the right support and HRT help.

It’s something I see on a regular basis. Patients find themselves in emergency departments with chronic period and undiagnosed or untreated menopause related symptoms that often require multiple visits before someone can put symptom patterns together and reach a diagnosis.

Now, with app technology such as walking balance measurement, or the Apple Menstrual Cycle Tracking app, patients can attend their clinical appointment with symptom data already mapped - effectively helping to shorten the period between exploration and treatment, and consequently changing the care pathway.

Technologies are developing at pace to not only track health trends, but also to respond to them and provide therapeutics.

Although not available yet in the UK, the NightWare app is being prescribed instead of medication to veterans in the States struggling with Post Traumatic Stress Disorder (PTSD).

NightWare is an FDA-cleared, prescription digital therapeutical that improves sleep for adults with nightmare disorders or nightmares associated with PTSD. Using Apple Watch technology, the application works by tracking a person’s heart rate and monitors for symptoms showing elevated levels of stress while sleeping. Once that pattern starts to emerge, the watch will use a series of vibrations or other actions to arouse the person sleeping to get them out of that sleep state.

Here in the UK, apps are increasingly being recommended instead of prescribing medication where appropriate. In May this year (2022) NICE recommended a £45 app that GPs can prescribe as an effective alternative to sleeping pills for people suffering from insomnia.

The Sleepio app, which currently has been downloaded by 10,000 Android users, was slated to benefit up to 800,000 people who would usually be given advice on sleep hygiene or medication, such as Zolpidem and Zopiclone which can be addictive.

While medical devices are being increasingly linked to smartphone apps, such as an insulin pump that can digitally record fluctuations in blood glucose levels.

While all of these apps are targeting a specific condition, what about the apps that aren’t, but through data collection can help clinicians predict a future health issue?

In the care sector, monitoring hydration levels and how steady a person is on their feet is growing in popularity as person-centered care becomes more important to help maintain health and dignity in old age. But it’s also creeping into more general consumer health tracking technology.

The evidence gathered from a person suddenly developing a limp or becoming unsteady can tell clinicians a lot about their state of health. For older people, it can show a decline or even point to early signs of dementia.

Apple added fall detection tracking to the Apple Watch and it’s only a matter of time before health metrics such as this sit side-by-side the insights gathered as standard on most smartphones such as heart rate, number of steps, calorie intake and sleep trends. Imagine being able to track heart rate and walking balance following medication changes, or physiotherapy interventions for example – that would be a game changer.

In providing clinicians with insight to support evidence-based care, health apps are highlighting the need for some traditional care pathways to evolve – something which should be embraced.

For years we’ve all been chasing the dream of early intervention. Now, through the data that’s collected on patients’ smartwatches and by smartphones, we finally have access to those crucial early insights.

As a consultant in emergency medicine I like to think that this means more people being treated and helped earlier, benefiting from earlier intervention and prevented from as many visits through our doors as possible.