There have been many reports recently about how technology is enabling or will enable patients to both monitor and be proactive in overseeing their own healthcare. This is an area I am really interested in, and I am very much of the opinion that if you can check so much about your life on your smartphone or device: from what’s in your bank account to ordering food, why can’t you check your own health?
People, and more specifically, patients are increasingly demanding freedom and to feel as though they are in charge of their health. For clinics, offering self-care as a warfarin management option frees up their capacity for service providers, allowing the anticoagulation team to direct resources to patients with more complex needs, improving outcomes for the whole patient population and reducing costs.
This raises the question: “What is patient self-care?” and more importantly, is this something that is tenable and even being developed? In my line of interest, specifically around solutions for anticoagulation, patients are now able to test their own blood at home using small, portable INR machines. The result can then be sent to the clinic using a smartphone or an automated phone system and the dosing instructions sent back to the patient on their smartphone, tablet or via an automated phone call. This development is in its infancy, but is proving popular with many patients, for a wide range of reasons, including removing the need to attend a clinic in person. An increasing number of anticoagulation services are encouraging this type of ‘patient self-monitoring’, but there is an even bigger need to create an even more ‘joined-up’ approach to patient care, which includes clinician buy-in.
We’ve been working with Isle of Wight CCG on their self-testing pilot referenced in Matt Fay’s excellent blog “The technology exists for patients to obtain an accurate INR reading themselves, but can clinicians support it?” This has been a brilliant experience and fascinating to find out how using digital technology to deliver a more efficient model of care for patients can improve clinical outcomes and patient safety.
With this pilot, the patient takes a finger prick blood sample at a time and place convenient to them before inputting the sample to the self-testing device. The patient sends their new reading securely to the local clinic via a pre-arranged phone call or by going online, and the digital partner technology integrates this new data into INRstar’s clinically risk-assessed anticoagulation software which automatically feeds into the patient record. The patient’s new warfarin dosage is calculated and relayed back to the patient. Initial feedback from patients taking part in the pilot has been extremely positive with some patients stating that self-testing has changed their lives.
Well, there are many. Not least, control and convenience for the patient, while studies also state that patient self-testing shows a significant reduction of 19% mortality, bleeding (44%) and thromboembolic complications.
A new pilot is just getting underway in which will the patient’s INR is automatically submitted to INRstar via a smartphone without the patient needing to key in any data themselves. The new warfarin dose is displayed every day on the patient’s smartphone. I think that, before long, most patients on long-term anticoagulation will choose this method of monitoring.
It’s enormous – not only for anticoagulation but for long-term conditions of every sort. Patients will be able to track their own condition using small, accurate and cheap POCT devices and wearables – sharing data with their clinicians. Self-learning algorithms will monitor results and send tailored advice and educational material to the patient’s smartphone. Clinicians will be able to monitor patients remotely and focus attention on the patients who most need face-to-face care. Patients will voluntarily share their data with chosen research and support organisations where Artificial Intelligence systems will discover trends and gain new insights.
It all sounds very far-fetched but it is already happening and it is going to change everything.