We were recently joined by a panel of experts to discuss digital apps and wearables in health and care, exploring how these technologies can be integrated into the health system now and in the future. Our panellists included Gail Lowe, high intensity users lead & county integrated discharge hub lead across Staffordshire & Stoke-on-Trent and Soo Hun, innovation & digital eco-system lead at Digital Health & Care NI.
Recent projects with digital apps and wearables
Our panel began by explaining some of the recent projects they’ve been working on in terms of utilising digital apps and wearables within their organisations. Gail shared how she has been working on improving services for frailty patients, noting: “Our main focus is admission avoidance and decreasing the length of stay where it’s safe to do so.” This led the team at Royal Stoke University Hospital to procure the MySense platform, “a set of sensors that go in the home”.
Going into further detail on how this technology works, Gail said: “There are tap, fridge, toilet, bed, chair and door sensors, as well as a wearable that monitors steps. It can also monitor your heart rate, but we don’t use that because this is not a medical device. It’s purely to measure someone’s functionality, creating a dashboard that is read every morning by our telehealth officers, who then note any changes in behaviours or patterns.”
Gail explained how this can alert the team if there’s a health deterioration or a functional deterioration, with the telehealth officers being trained in admission avoidance. “If a change has been noticed, we will call the patient first and if we can’t get hold of them, we’ll try family or a care provider. If it’s something simple, it can be dealt with over the telephone. But if it’s something that we feel needs escalating, we’ll advise 999 or we’ll go out and visit.” She added that they can also provide links to virtual wards, which has “worked really well”, noting that their main aim is “keeping people as well as possible and at home for as long as possible”.
Sharing some details around success rates and results, Gail highlighted: “In the last 12 months we’ve had 125 people on the system. We started off with 25 and then we went to 50, going from one telehealth officer to three. We’ve reduced the cohort by 89 ED presentations, 96 admissions and a total of 962 bed days.” This, she added, is “quite significant”.
In Northern Ireland, Soo explained how her team have been looking at apps as a means of providing digital care to the population as well as healthcare professionals. “During the pandemic, it was decided by our senior officials that we needed something to support our staff online as well as the citizens at large. So, we commissioned an organisation called ORCHA (Organisation for Review of Care and Health Apps), who built an HSC apps library for us.”
According to Soo, ORCHA’s research has revealed that there are around 350,000 health and care apps available on the marketplace, but “unfortunately, about 80 percent of them don’t actually pass the test where quality assurance is concerned”. Because of this, only one percent of those apps are surfaced within the library, meaning that healthcare staff don’t have to carry out their own independent reviews of the entire 350,000 offering.
It also means that ORCHA can “reliably and securely recommend apps”, with Soo highlighting the usefulness of this within NI’s mental health strategy. “Our mental health strategy specifically references a digital mental health model, requiring us to provide alternative ways to support healthcare professionals using digital tools. It uses a step care model, starting from step one, which is early prevention, all the way to complex intervention at step four. So, we have been looking at using the app library for step one at the moment.”
As part of this step, a campaign was launched in November 2024 called the Adult Mental Health and Well-being Campaign, with a curated set of apps listed within the library to support conditions such as depression, stress and anxiety and meditation, Soo explained. “We’ve had nearly 30,000 visits to the library, with about 50,000+ page views, with 1,300 apps having been downloaded. And the most downloaded apps cover things like dementia, stress and anxiety, depression, healthy living and sleep hygiene.”
Using insights from wearables to inform care
In terms of wearables, the team at Digital Health & Care NI have been involved in an ongoing Innovate UK project, looking at using Fitbits to support over 65s who have had one or more falls, to help them build their confidence again. “They can see the number of steps they’re taking in a day and their sleep information, etc., with some of the early results showing that having this information to hand has helped the patients build up their confidence, so they don’t worry about having another fall as much.”
The team are also testing if the data from the wearables can be used to predict future falls: “Basically, we take a baseline of what they are currently doing and if they don’t do any further exercises, then we can try to encourage them to take on more activities. It can also flag if they’re not getting enough sleep or waking up to go to the toilet in the middle of the night. With this information, we’re trying to see whether we can be more proactive in our actions moving forward.”
Gail echoed much of what Soo said about using the data to be more proactive when it comes to care, explaining how the MySense dashboard collects information that will help them get to the point where they can make predictions. “If someone isn’t as active as they were, then we know they’re probably going to be at a higher fall risk,” she explained. “Patients can see how many steps they’ve taken in a day, while also giving their families access to that information. And sometimes we’ll have families contacting us before we’ve had a chance to look at the dashboard in the morning, telling us that their dad has been in and out of bed a lot the night before or he hasn’t gone to bed at all. So, we can see if there is something happening outside of the patient’s norm and we can then react to that.”
One thing Gail said she and the team are very keen on is using wearables and digital apps to enable patients to take responsibility for their own health and well-being as well, something she notes was “invaluable, from a confidence point of view”.
Using digital apps to support waiting lists
Next, Soo took us through some of the ways digital apps have been helping to support patients who are on a long waiting list in NI. “We’ve been working with ORCHA to develop specific pathways that can help patients who might be waiting for care. So, if an individual is waiting and they need to lose weight or quit smoking, then we want to be able to provide them with the right information and digital tools to help support this.”
Soo went on to use pain management as another example: “Let’s say pain management is a little higher priority for the patient at the moment. We can signpost or recommend certain types of pain management apps that might work for them while they’re on the waiting list.” She explained that patients have the option of free and paid apps through the library, but that they try to recommend the free ones to help tackle health inequality issues as well.
Challenges with implementing this type of digital tech
Gail then took us through some of the challenges and key lessons she has learned from varying digital projects, starting with a lack of confidence from patients in the beginning. “The first 50 patients’ families weren’t keen to have MySense on their phones. But we have made that a condition of using the system, that families will have it as well. And that has really been embraced more recently.” She went on to add: “We’ve done a lot of work with MySense to make sure this solution works for us, so that we can see the data over a 24-hour period and get the information that we need.”
Gail emphasised the importance of detecting subtle changes: “So, if someone’s susceptible to UTIs, we will notice that because we can see that someone’s toilet activity has changed. If the temperature drops too low, we can give people a call and ask them to turn the heating up a bit.” She shared how this sort of interaction made them more aware of financial inequalities and how to tackle them: “We’ll work closely with vulnerable patients who are struggling to pay heating bills or beat the cold to get them the right financial advice.”
Some of the challenges and learnings Soo encountered early on were around digital literacy concerns. “We were worried about the level of acceptance from the older generation when wearing a Fitbit, but we were pleasantly surprised by the outcome.” Expanding on this, Soo explained: “We brought in a service design partner to help us understand some of the needs and requirements of the people who were going to use the apps and digital literacy was one of the things that came up. But most of the time, when we got into discussions with patients, we found that some people felt that wearing something like a pendant, singled them out as being frail or needing a medical aid. Whereas a Fitbit is seen as a more empowering tool that younger people use.” She noted how patient perception isn’t always something that most companies pay attention to, but that it “actually does make a difference” when introducing new tech.
Funding and management of digital apps and data
When it comes to managing the data stored within the app, Soo gave some insights into the process with ORCHA and how they evaluate every single app. The assessment is based on three levels of criteria, according to Soo, with the first one being the level of clinical and professional assurance, where several questions are taken into consideration, including, “who’s been involved in the development of the app? Has it had clinical backing? Is it based on research and evidence?”
The second element focuses on data privacy and security, asking, “how well are they securing the data? Are they encrypted? Do they have Cyber Essentials accreditation? Is it in the cloud?” And the third layer looks at whether the app is being transparent with the patient and the people who are using it. Soo also noted the importance of looking at usability, accessibility and whether or not the app has been co-designed with end-users during development. “All of those things add up to a score and the higher the score, the better the app is. That way we can say that we have taken all the necessary precautions to make sure that the data patients provide is safely and securely looked after.”
In terms of funding, Soo said that in some cases Digital Health & Care NI has commissioned their own apps. “We fund apps because we see that there’s a need for them or because there’s a gap in the market. Then we make those apps available for everyone to use, whether it’s a digital resource or a training tool.” She added: “Even as we commission these tools, we try and build in the ORCHA validation as part of our statement of requirements because that means that whoever is developing the app has to adhere to a minimum standard we expect them to meet.”
Future opportunities
Finally, when looking ahead, Soo and Gail considered what this landscape might look like in the near future. “My vision or ambition would be that we eventually get lots of people using digital apps and wearables across all ages,” Soo said. “In five years, it won’t be a big issue for the older generation to use this tech and we can better educate people on how to use the data from the wearables to make relevant suggestions.” She also touched on using the data to help with more predictive and proactive care: “If we can get better biomarkers and better sensors that can actually give us early indications that there might be something wrong, then we can be more proactive.”
Gail added to this, stating: “I think it would be really good in the future to get people using this tech before they develop care needs. The next generation will probably be more technologically minded, although we do have some older patients who are very tech-savvy already.” She spoke about the systems in place, adding: “I’d like to see a national forum where we can look at which systems work for which patients and the cost implications. Somewhere we could go and get some advice and support on what’s worked out in the past and the systems available. Probably then, from a procurement perspective, you’d have more control.”
We’d like to thank Gail and Soo for sharing their insights and joining our panel.
