By Chris Crockford

With the appearance of more and more mobile apps that help people manage their health, fitness or long term condition, the debate must soon begin whether it is better to promote preventive primary care by empowering people to carry out their own personal health check-ups. Or we might encourage check-ups at the point of primary care such as the doctor but enable patients to do it for themselves.

An alternative of course is that we do not bother at all with health check-ups. It might seem blunt but effectively this is the most commonly deployed methodology at present. How many people check their blood pressure when they deem themselves fit and healthy? I wonder how many blood pressure checks the average human undertakes in their entire lifetime? I cannot imagine it is very many, and yet the technology to do so is relatively inexpensive.

Most people above the age of 40 who see their primary care practitioner will undertake a blood pressure check at some point. The test is performed by the practitioner using equipment that takes a snapshot reading of a person’s blood pressure there and then, and from that the practitioner has to make a judgement about the state of their health.

Recently healthcare and medical IT companies in the UK have started to equip surgeries with “healthpods”, areas of the surgery that a patient can go to at any time during opening hours and test themselves. Normally in the UK the equipment on offer is a set of weight scales and a blood pressure monitor. People do indeed come in from the street and test themselves, making a note of their readings and effectively trending themselves. They can report their findings when they next see their clinician.  

Empowering people to take an active interest in their healthcare and their “physiological-telemetry” must be a good step but still causes data protection issues because data is moved from the reception area to an electronic patient record. Imagine the trouble caused by interested patients running their own trending software on a smartphones, tablet or laptop at home? How does a user export the weight trend that they have carefully collated over the last year proudly showing their clinician how their body mass index (BMI) has fallen in line with expectations? Yes the patient can have a reading taken when they get to the surgery but the fidelity of all that data over time has been lost.

One way forward might be the opportunistic screening of all patients that come through the surgery doors. By taking a set of parameters from the patient, and inputting their scores into a risk stratification algorithm, comparing the patient against the national average might just identify those who will need treatment before they reach the point of no return.

Over the years many such scoring systems have been developed such as the Framlingham Score, CHADSVASC, and QRisk2. Each of these scoring systems has unique risk constructs that are controlled by the types of data brought into them, and they each offer different risk stratification for different types of disease. It can easily be seen that as these kind of algorithms and scoring systems evolve, that eventually they are going to replace the annual GP health check, and eventually evolve to mobile handset and device offerings.

In the US and elsewhere the pharmacy chains are already offering various kinds of physical parameter checks and will eventually move towards tests that involve risk stratifications. Users will be able to test themselves against the national or regional average. If the electronic patient record could be updated by the pharmacist with this risk stratification data then the clinician might also have some really useful information at their fingertips. This assumes that we can move past the current status quo where everyone fears for the security of their medical records and regulatory barriers exist to transferring data. This vision of the future requires a relaxing of regulations on transferring the data acquired in a pharmacy, such as the probability of a patient suffering cardiovascular disease, to their own clinician.  

Personally I’d like to see more products such as Microsoft’s HealthVault which allows people to upload their personal physiological-telemetry data to a repository irrespective of how it was acquired. It would be great if such a repository could be linked to the electronic patient record. I think given the choice I would fear cardiovascular disease more than any trepidation I have about Microsoft’s HealthVault.

As systems evolve we will however see more clever ways to forewarn people of their individual risks from various conditions. We will see more and more opportunistic self-testing booths in GP’s surgeries and pharmacies, and eventually there will be more intelligent risk stratification tools developed for mobile applications. Eventually we might get cheaper health insurance because a patient’s VO2Max score is in the 50s and their QRisk score is good as well. And one day people might even start bragging on Facebook about their mhealth scores but we are going to have to undergo some significant changes first.

The editorial views expressed in this article are solely those of the author(s) and will not necessarily reflect the views of the GSMA, its Members or Associate Members