SPHERE - A Sensor Platform for HEalthcare in a Residential Environment (IRC Next Steps)

The UK currently spends 70% of its entire health and social care budget on long term ("chronic") health conditions. These include diabetes, dementia, obesity, depression, COPD, arthritis, hypertension and asthma.
We need to be better at:
-- Understanding the cause of these illnesses
-- Helping a person to avoid developing them
-- Creating new treatments
-- Helping the patient self-manage their conditions

All these require working with a patient over months or years, outside of a traditional hospital environment. In a very real way, we need healthcare to go where the patient goes; the single place that most people spend most of their time is their home. Consequently, SPHERE project is seeking to develop non-intrusive home-based technologies for measuring health related behaviours at home over long periods of time.

The requirements for these technologies are:

-- They should require little or no action from the patient, since our daily lives are busy; being ill is distressing and time-consuming; and when the benefit may take months or years to achieve, there is often not much day to day motivation to be bothered with measurements or devices.
-- They should work reliably in the home; a home is not a hospital or a laboratory - it is smaller, full of furniture, pets and people, often not brightly-lit and often challenging to get wireless network coverage everywhere. This poses lots of problems for researchers.
-- They should be acceptable; bringing healthcare home with us doesn't mean we want to turn our homes into hospital and it definitely doesn't mean we want people spying on us!

Since 2013 this has been the SPHERE vision and we have worked with scientists, doctors, engineers and more than 200 members of the public to achieve the project's initial goal of creating a cheap sensor system that can be installed in a home. More than 30 people have had the experience of living with the sensors over periods from days to months and, by the end 2017 we expect more than 200 people will have had SPHERE sensors in their own home, in many cases for months.

Although the first-generation system was only completed in late 2016 and at the time of writing is still under test in the first "pilot" homes, the system is already moving into real patient applications - we are applying for ethical permission from the NHS to use SPHERE for patients recovering from surgery. Later in 2017 we will be applying for ethical permission to use SPHERE with a group of dementia patients.

The initial testing of the sensor system has gone well but, especially as we start to think about large scale use of the SPHERE system across potentially hundreds or thousands of people, the team have learnt a lot from the early pilots and have some priorities for significant improvements:

1. The SPHERE video system needs to be better at evaluating the quality of someone's movement, such as getting out of a chair, even when the view of the person is blocked by items of furniture. Evaluating quality of movement is important in physical and mental health conditions.
2. The SPHERE wristband lasts for over a month on a single charge, however we want to remove as far as possible the need to charge it at all, because the more ill someone is, the less likely they are to do this.
3. Digital data gathered from sensors needs to be turned into understanding for doctors; this is especially difficult in a home environment because every home and every household is different.

These are major research issues and will be the focus of the technology parts of the SPHERE programme, while the clinical parts move forward with patient populations.

The NHS itself has recently said: "if the UK fails to get serious about prevention then recent progress in healthy life expectancies will stall, health inequalities will widen, and our ability to fund beneficial new treatments will be crowded-out by the need to spend billions of pounds on wholly avoidable illness."

Like many developed nations, the UK faces huge challenges dealing with long term health conditions such as diabetes, dementia, depression, COPD, arthritis and asthma. Whether seeking to understand the mechanisms, trying to avoid onset, creating new therapies, or supporting self-care of these conditions, we need non-intrusive technologies able to capture data on causes, symptoms and exacerbations over long periods of time.

SPHERE has been developed in partnership with health professionals, specifically with the intention of producing a sensor system that can be used by the NHS. Early SPHERE work is already funded with clinical cohorts e.g. to characterise recovery after Orthopaedic (Bristol) and Cardiovascular (Sheffield) surgery. There are on-going discussions with leading centres on subjects such as personalised behaviour change programmes, physical activity interventions in patients with COPD and new forms of free-living gait analysis.

Local government has a statutory responsibility for public health and SPHERE has close engagement with Bristol City Council, as described in its letter of support.

SPHERE was designed from the outset as a tool for clinical research, helping us understand what causes these illnesses and develop new treatments. SPHERE is already collaborating with many health researchers but as it now demonstrates its applicability through its 100 Homes trial, it will increasingly be working for impact in partnership with major UK institutes (UK Biobank, the Dementias Research Institute, Inst. for Biomedical Informatics) and continuing discussions with GSK around digital clinical trials.

SPHERE has a stated objective to engage with policy-makers e.g. with Public Health England (the Director spoke at their annual conference) and one of its Directors sits on SPHERE's advisory board.

Many health issues are global concerns, and indeed the SPHERE director has been invited to speak at the British Embassy in Tokyo in Feb 2017 to an audience of Japanese policy makers and academics on the subject of dementia (
countries such as Japan and Singapore have the world's "oldest" populations).

With Europe's 2nd largest medical technology industry, UK companies, large and small, are well-placed to address this need. SPHERE has met many SMEs (including Cascoda, Cascade3d, Pumpco, Folium Optics and Loc8tor) to assist them in their approach to this market. SPHERE will partner with organisations such as the Digital Catapult (see their letter of support) to help many more UK companies understand how to address those needs with new technologies, how to develop more reliable in-home wireless networks, develop analytics capabilities for domestic data, etc.

SPHERE is also developing relations with corporates including IBM, Toshiba, BT, Sony, TI, Dyson, BT & Jaguar Land-Rover. UK employers such as Loc8tor (see letter), Janssen Healthcare Innovation, McLaren Technology Group, IBM & Toshiba all have on-going research or stated intentions for collaborative research with SPHERE.

SPHERE will also work with standards bodies such as IETF (see letter from the 6TiSCH working group chair) to influence the evolution of wireless network standards for health applications. While the potential health benefit, the market and the industrial potential are all quite apparent, the adoption of pervasive in-home technology for health delivery runs the risk of creating a range of new issues, including around security, trust and privacy. By conducting its research in close partnership with the public (SPHERE was 1 of 3 finalists in the UK Public Engagement Awards), SPHERE will seek to disseminate the issues to the public in an open way - this indeed is one of the fundamental purposes and responsibilities of University research. Furthermore, within the programme proposed herein, SPHERE will particularly address the extent to which some populations might be differentially advantaged or disadvantaged by this type of health delivery