How technology is vital to intelligent disease management

In England, around 15 million people have a long-term condition.

Among these, heart failure, chronic obstructive pulmonary disease, asthma, diabetes and kidney disease are the most common.

They account for half of the top 10 reasons for an emergency admission and 70 per cent of total inpatient bed days.

The insidious burden of chronic disease has been growing for decades draining resources, expanding health inequalities and multiplying costs. In 1990, healthcare accounted for 5 per cent of the UK’s GDP. Today, it is around 12 per cent of GDP and almost half of UK government spending. There is no end in sight to healthcare expenditure without making changes. Current approaches to diagnosing and managing patients with long term conditions remain unsatisfactory. For example, COPD is known to be one of the costliest inpatient conditions treated by the NHS at around £2 billion each year. According to the National Institute of Health and Care Excellence, one in eight emergency hospital admissions is for a patient with COPD.

Multimorbidity, which refers to having more than one condition, is also a growing issue with a projected two-thirds of adults aged over 65 expected to be living with multiple health conditions by 2035. In line with the ageing population, healthcare spending would need to increase exponentially to even maintain today’s precarious standards.

As with many other industries, technology can transform expensive services into affordable goods. Digital models of care can join up services and provide access in new ways to create seamless pathways across care settings. The course-correcting solution for chronic disease lies with technology. Better data structuring and application of artificial intelligence (AI) in direct care will give clinicians the tools they need to provide care proactively. These unprecedented demands will begin to subside as patients with chronic disease are kept well out of hospital. A recent study by NHS Greater Glasgow and Clyde examining the effectiveness of a co-designed digital service model for the management of COPD, uncovered valuable insight into how digital enabled home care for COPD may be used to maximise the impact of hospital at home spending, especially by taking a longer view of virtual ward initiatives.

Used across the NHS in Scotland and now launched in Hull University Teaching Hospitals NHS Trust through a recent SBRI award, the Lenus COPD Service is clinically evidenced remote monitoring technology that effectively uses data to introduce clinically actionable, AI derived, risk prediction scores. These predictions are being trialled as part of an NHS Artificial Intelligence in Health and Care Award to further help reorientate the management of COPD patients to a proactive and preventative model.

Perhaps in 50 years we might look back at economic costs and the way care teams work and be shocked at the level of reactivity and lack of guideline-directed pathway automation. There is no shortage of healthcare data being generated today but how it is understood and best utilised for clinical uptake is vital to changing the current trajectory of chronic disease.

Rayhan Abdullah Zakaria, Chartered MCIPD