The Wearable Clinic: Connecting Health, Self and Care

Lead Research Organisation: University of Manchester
Department Name: School of Health Sciences

Abstract

An increasing number of people live with long term physical and mental health conditions, such as diabetes, heart disease or depression. Many of these people find that their symptoms fluctuate in severity over time, including periods of relative calm and episodes during which symptoms become much worse. However, patients with long term conditions typically see their doctor during pre-arranged visits at fixed intervals, rather than on the basis of their current symptoms. For instance, people with chronic kidney disease commonly have appointments every 3 months. These visits are often felt unnecessary during stable periods, during which patients could probably manage well by themselves, but irregular enough to spot worsening symptoms early enough and prevent more severe episodes of illness - what we call 'fall back episodes'.

We propose to develop a set of software tools for smartphones and tablets, called the "Wearable Clinic". This will help patients with long term conditions, together with their carers and doctors, to better manage their health in daily life, respond more quickly to changes in symptoms and prevent fall back episodes. This could prevent unplanned admissions to hospital, which are not only distressing and disruptive for patients and their families, but expensive for the NHS. Furthermore, it could make it easier to integrate care for patients with multiple long term conditions (e.g. both diabetes and chronic kidney disease), who are often treated by different doctors, at different places, and at different times.

For patients, using the Wearable Clinic starts with measuring symptoms in daily life using wearables. These data are then automatically combined with data held in NHS records on their diagnoses, lab results, and treatments in order to predict the likely future course of symptoms, and whether there is a risk of a fall back episode. Finally, the software will propose a modifiable care plan that takes account of the patient's range of existing conditions, current and predicted health status, availability of local care resources, and the patient's own preferences. Where it is possible and safe to do so, care plans will remove clinically unnecessary and unwanted appointments, saving time and money for both the patient and the NHS.

To achieve this vision, we propose to apply data science techniques to analyse data collected from a) medical records and b) wristband wearables and smartphone technologies ('wearables') worn by patients with long term conditions. While the Wearable Clinic concept could potentially be useful for managing a range of long term conditions, we will first test it out in two different conditions, where symptoms are known to fluctuate over time: schizophrenia and chronic kidney disease. Statistical techniques will be applied to see if data collected from patients using wearables can be used to a) predict changes in symptoms and b) produce tailored care plans for individual patients. We will trial methods that collect and use data in ways that take into account individual risk factors (e.g. age, ethnicity) and conserve the battery life of devices.

While the project primarily aims to develop new computer algorithms, statistical models and computer software, we will trial the technical aspects of the Wearable Clinic with a small number of healthy volunteers, people with schizophrenia and people with chronic kidney disease. We will also investigate costs, benefits, and potential risks of the Wearable Clinic in its earliest stages of development and, where necessary and feasible, integrate solutions during the lifetime of the project. A series of workshops open to the public will be held to explore cross-cutting issues such as trustworthy data use and privacy. This will pave the way for future studies and maximise the chances that the Wearable Clinic actually makes it into practice - thus improving the quality of care for patients with long term conditions.

Planned Impact

Economic: To quantify the potential value of the Wearable Clinic for the healthcare system and for patients, we will conduct an early economic evaluation and value of information analysis. This will assess the economic feasibility of the Wearable Clinic concept and inform future investment decisions as well as decisions to conduct further research to reduce the key (developmental and post-market) uncertainty.

The market size for wearable sensors is estimated to be £70B by 2025, giving substantial scope for commercialisation work. It is highly likely that patentable IP will be produced as part of the Wearable Clinic and the research team will work with UMIP (University of Manchester Intellectual Property) and Trustech (the North West's NHS innovation service) who have a strong track record in bringing innovative products to market. This make take the form of creating spin-out companies or licensing technologies as deemed most appropriate. To de-risk this process industrial support has been secured from a number of partners (see Letters of Support), including Cerner as major provider of healthcare IT systems and Withings as an SME in wearable health technology. This will be complemented by support from the Greater Manchester Connected Health Ecosystem, a partnership of >70 organisations, including NHS, social care, patient groups and industry.

Societal: Long-term conditions conditions place a major burden on health and social care services, coupled with significant reduction in quality of life for affected individuals. Half of GP appointments, and £7 in every £10 spent on health and social care, is spent on treating and caring for people with LTCs. The number of people affected, especially those with multiple coexisting conditions, increases steadily as a result of population ageing and lifestyle factors. The NHS faces the challenge of implementing £22bn of efficiency savings by 2020, and it is expected that important savings will have to come from the intelli use of IT for patients with long-term conditions.

The Wearable Clinic has the potential to improve patient activation and stimulate self-management in patients with LTCs. Improved patient activation and better self-management are associated with improved health outcomes and lower care consumption, and generally lead to higher satisfaction with health services. The research team has established collaborations with the Manchester Academic Health Sciences Centre (MAHSC) partnership between the University of Manchester and the NHS, the Greater Manchester Academic Health Science Network and Health Innovation Manchester to ensure future translation of the results of the project into the NHS.

Publications

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Fraccaro P (2017) Patient Portal Adoption Rates: A Systematic Literature Review and Meta-Analysis. in Studies in health technology and informatics

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Geifman N (2018) Patient Stratification Using Longitudinal Data - Application of Latent Class Mixed Models. in Studies in health technology and informatics

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Peek N (2018) Three controversies in health data science. in International journal of data science and analytics

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Reani M (2018) How do people use information presentation to make decisions in Bayesian reasoning tasks? in International Journal of Human-Computer Studies

 
Description A Master Class with NHS Digital - Safety Cases for Digital Health
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
 
Description Evidence Standards Framework for Digital Health Technologies
Geographic Reach National 
Policy Influence Type Participation in a national consultation
URL https://www.nice.org.uk/about/what-we-do/our-programmes/evidence-standards-framework-for-digital-hea...
 
Description Input on healthcare technologies from the IET into a Royal Academy of Engineering green paper on pillar 8 of the industrial strategy (Cultivating World Leading Sectors),
Geographic Reach National 
Policy Influence Type Participation in a national consultation
 
Description Demonstrating the feasibility of a Learning Health System for cancer diagnosis in Primary Care
Amount £584,270 (GBP)
Funding ID 25310 
Organisation Cancer Research UK 
Sector Charity/Non Profit
Country United Kingdom
Start 04/2018 
End 03/2021
 
Description Dynamic Risk Assessment for Robotics and Autonomous Systems
Amount £10,000,000 (GBP)
Organisation Lloyd's Register Foundation 
Sector Charity/Non Profit
Country United Kingdom
Start 01/2018 
End 06/2021
 
Description Reducing Medication Errors through Intelligent Safety Reasoning
Amount £60,000 (GBP)
Organisation Bradford Royal Infirmary 
Sector Academic/University
Country United Kingdom
Start 01/2018 
End 12/2020
 
Description University of Manchester Research Institute
Amount £34,000 (GBP)
Organisation University of Manchester 
Sector Academic/University
Country United Kingdom
Start 02/2018 
End 07/2018
 
Description JKM care solutions 
Organisation JKM Care Solutions Ltd
PI Contribution Provided input on low power microprocessor/wireless platforms and the potential for integrating data into care records.
Collaborator Contribution Platform for discussions. Exchange was mainly us providing input to them.
Impact No direct outputs at this time. Information exchange has informed the company's engineering development.
Start Year 2017
 
Description John Rogers bioelectronics 
Organisation University of Illinois
Country United States 
Sector Academic/University 
PI Contribution We are exploring pop-up conformable electronics, electronics which attaches directly to the skin for very long term robust connections, which can also have a 3D structure. In particular we are exploring actuated 3D antennas. We have provided expertise into the potential applications of these structures, focus particularly on their potential use as acceleration sensors. We have provided some initial designs for suitable structures that can be fabricated.
Collaborator Contribution Our partners in Kent have provided expertise in antennas. This allows the 3D accelerometer to be applied directly as a sensing and transmission unit, eliminating the need for conventional collection electronics which add complexity and power consumption. Our partners at the University of Illinois have provided the manufacturing and characterization capability.
Impact This has led to follow on funding from the EPSRC (detailed in funding section).
Start Year 2016
 
Description John Rogers bioelectronics 
Organisation University of Kent
Department School of Engineering and Digital Arts
Country United Kingdom 
Sector Academic/University 
PI Contribution We are exploring pop-up conformable electronics, electronics which attaches directly to the skin for very long term robust connections, which can also have a 3D structure. In particular we are exploring actuated 3D antennas. We have provided expertise into the potential applications of these structures, focus particularly on their potential use as acceleration sensors. We have provided some initial designs for suitable structures that can be fabricated.
Collaborator Contribution Our partners in Kent have provided expertise in antennas. This allows the 3D accelerometer to be applied directly as a sensing and transmission unit, eliminating the need for conventional collection electronics which add complexity and power consumption. Our partners at the University of Illinois have provided the manufacturing and characterization capability.
Impact This has led to follow on funding from the EPSRC (detailed in funding section).
Start Year 2016
 
Description A software engineer adventures in healthcare 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact A talk, similar to TED talks, about my experience, as a software engineer, working in healthcare (attended by around 250 people, mainly generic public).
Year(s) Of Engagement Activity 2018
URL https://www.york.ac.uk/research/events/yorktalks/
 
Description Artificial Intelligence for Health, Public Event: York Festival of Ideas - Dr Ibrahim Habli 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact Would you choose to be looked after by a robotic carer? How about using autonomous systems to help give early diagnoses by analysing health records? Could AI be used to support those with mental health issues?

Join us as we discuss what AI might mean for our future health. Is the potential for AI to revolutionise healthcare overhyped or could it transform the NHS? Our expert speakers include Ibrahim Habli, Lecturer in the Department of Computer Science, University of York; Pali Hungin, Head of the School of Medicine, Pharmacy and Health at Durham University; Jess Morley, Technology Adviser with the Department of Health and Social Care; Gurch Randhawa, Director of the Institute for Health Research at the University of Bedfordshire; and Charlotte Stix, a Research Associate with the Leverhulme Centre for the Future of Intelligence. The session will be chaired by Tim Adlam, Head of Mechanical Engineering at Designability, who will also deliver the keynote speech.

Brought to you in collaboration with the Assuring Autonomy International Programme, which is supported by the Lloyd's Register Foundation and the University of York.
Year(s) Of Engagement Activity 2018
URL http://yorkfestivalofideas.com/2018/talks/ai-for-health/
 
Description Blog post for EPSRC on "Sleep disturbance in dementia - a better night's sleep for all." 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Invited blog post for the EPSRC during national dementia week.
Year(s) Of Engagement Activity 2018
 
Description Contributor to Health Innovation Manchester dementia care roadmap. 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Policymakers/politicians
Results and Impact Scoping of potential future care pathways for dementia in the Manchester region. Contributed to the wearable sensing aspect.
Year(s) Of Engagement Activity 2018
 
Description Digital Health and Patient Safety Conference - Dr Ibrahim Habli 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact NHS Digital and the University of York are hosting a dedicated digital health and patient safety conference that is to be held at The Leeds Met Hotel on 22nd March 2018. King Street, Leeds, LS1 2HQ.

This boutique event is free of charge and is aimed at health and social care professionals, safety engineers, managers and policy makers, focusing on current and emergent trends and challenges in digital health and safety (health IT clinical risk) management.

The motivation for the conference is to continue to build the community of interest within our domain and provide an opportunity for people and organisations to share their successes, views and challenges. It is hoped that this event will be the first of many. We are venturing out smaller and sharing good guidance, practises etc; and hope by this method that we can grow the community.

The day will consist of a number of talks covering practical tools for safety management, human factors, standards for Health IT and medical devices, lessons from an acute system deployment, apps, machine learning and close with a panel session.
Year(s) Of Engagement Activity 2019
URL https://digital.nhs.uk/news-and-events/events/digital-health-and-patient-safety-conference
 
Description Invited presentation to IBM Research in Yorktown USA 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Invited presentation to IBM Research in Yorktown USA, June 2017. Focus was on our "wearable clinic" work.
Year(s) Of Engagement Activity 2017
 
Description Invited presentation to the Army Research Laboratory 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Invited presentation to the Army Research Laboratory. Specifically invited based upon our EPSRC funded work.
Year(s) Of Engagement Activity 2017
 
Description Keynote presentation, ICTC conference, South Korea. 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Industry/Business
Results and Impact Keynote presentation at a particularly business focused conference in communications and ICT.
Year(s) Of Engagement Activity 2018
 
Description Leader of a Royal Institution Engineering masterclass - an computer science outreach event for 14 year olds focusing on computer architecture 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Schools
Results and Impact Dr Alex Casson lead a Royal Institution Engineering masterclass - an computer science outreach event for 14 year olds focusing on computer architecture, July 2017.
Year(s) Of Engagement Activity 2017
 
Description Meeting with NHS Digital to discuss apps safety regulation and assessment 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact A meeting with Assurance Services at NHS Digital to discuss the regulation of apps and AI-based systems in healthcare (NHS)
Year(s) Of Engagement Activity 2018
 
Description Mobile Monday presentation 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Industry/Business
Results and Impact Presentation on mobile healthcare as part of 'Mobile Monday' organised at PwC Manchester.
Year(s) Of Engagement Activity 2018
 
Description Organiser of joint EPSRC-Alzheimer's Society workshop on technologies for sleep disturbance in dementia. 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Study participants or study members
Results and Impact Workshop discussing potential research into sleep disturbances in dementia. Output was a plan for potential activities in this space. Led to an invited EPSRC blog post.
Year(s) Of Engagement Activity 2018
 
Description Presentation at Pro-Manchester "mobile technology in devolved healthcare" panel event, PWC Manchester, UK. 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Industry/Business
Results and Impact Presentation on the future healthcare landscape in Manchester. Some follow on discussions had.
Year(s) Of Engagement Activity 2018
 
Description Presentation to Antennas group, University of Kent 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Postgraduate students
Results and Impact Discussion on future collaborations, particularly with a visiting researcher from Japan.
Year(s) Of Engagement Activity 2018
 
Description Presentation to Bioelectronics researchers, University of Toronto, Canada. 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Resulted in seed funding to form an international collaboration.
Year(s) Of Engagement Activity 2018
 
Description Presentation to EEG research group, Fudan University, China. 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Postgraduate students
Results and Impact Discussions of potential collaboration opportunities
Year(s) Of Engagement Activity 2018
 
Description Sharing health and care records: designing IT systems around your local population's needs 
Form Of Engagement Activity Participation in an open day or visit at my research institution
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact This conference explored the different models for sharing healthcare records that have been developed over the past few years and provided delegates with the opportunity to learn how local areas are overcoming these challenges.
Year(s) Of Engagement Activity 2018
URL https://www.kingsfund.org.uk/events/sharing-health-and-care-records
 
Description Support for electrical engineering teaching (Tahmina Zebin) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Schools
Results and Impact Tahmina Zebin conducted a session on Common-Emitter Amplifiers and its design, January 2018 at Trinity High School, Manchester
Year(s) Of Engagement Activity 2018
 
Description Tahmina Zebin volunteered and judged 'IET Faraday Challenge Day' for BBC Microbit Coding with Year 8 pupils from different schools(February 2018 @UoM). 
Form Of Engagement Activity Participation in an open day or visit at my research institution
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Schools
Results and Impact Volunteered and judged 'IET Faraday Challenge Day' for BBC Microbit Coding with pupils from different schools (February 2018 @UoM).
Year(s) Of Engagement Activity 2018
URL https://faraday-secondary.theiet.org/faraday-challenge-days/
 
Description Talk and stand at Exhale, a public event on mental health and well-being 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Patients, carers and/or patient groups
Results and Impact Co-investigators (including a public collaborator) gave a short talk about the Wearable Clinic and the public involvement aspects at the 'Exhale' event, an open public exhibition on mental health and well-being held in Manchester on January 21st. The talk attracted an audience of approximately 10 members of the public, several of whom approached our drop-in stand for further information about the project and to invite us to visit local patient groups with a mental health focus to advertise future research participation and public involvement opportunities.
Year(s) Of Engagement Activity 2018
URL https://www.facebook.com/ExhaleEventsExpo/
 
Description The Wearable Clinic Launch Event 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Study participants or study members
Results and Impact We held an event to formally launch the project. This brought together researchers involved in the project, which are spread across different faculties and schools at The University of Manchester and the University of York. Also in attendance were interested parties from across the University, as well as from business, NHS Digital and two representatives from our patient engagement group. A series of presentations introduced The Wearable Clinic programme and the group were given the opportunity to ask questions and provide comment.
The strengths, weaknesses, opportunities and threats of the project were then debated. The event was rounded off with informal networking. We have had several requests for more information from NICE and we have made the slides available on a website.
Year(s) Of Engagement Activity 2017
URL https://www.herc.ac.uk/research_project/wearable-clinic-connecting-health-self-care/
 
Description The Wearable Clinic seminar - Challenges and Opportunities in Assistive, Wearable and Precision Health Technologies 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Other audiences
Results and Impact Sandra Woolley from Keele University gave a talk on her research including the development of the 'AllergiSense' platform which aims to assist in training patients and clinicians in the use of adrenaline injections (so-called 'Epi-Pens'). Also of interest to The Wearable Clinic, Sandra introduced her research in activity monitoring in patients with Dementia and developments of the 'CircadianSense' system. This sparked interesting debate from the audience around many of the aspects relevant to The Wearable Clinic, such as safety, health economics and technical constraints.
Year(s) Of Engagement Activity 2018
URL https://www.herc.ac.uk/events/wearable-clinic-seminar-challenges-opportunities-assistive-wearable-pr...
 
Description Wearable Clinic Twitter account, blog series and newsletter 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact We have set up a public facing Twitter account (@Wearable_Clinic), blog series (2 editions to date) and an accompanying newsletter to disseminate concepts, outputs and participation opportunities associated with the Wearable Clinic. The Twitter account has 171 followers (as of 11th March 2019) and links to monthly blog posts (e.g. https://www.herc.ac.uk/2019/03/01/what-is-wearable-clinic/), study updates, research outputs, participation opportunities (e.g. study recruitment, job adverts) and other relevant news from the team and wider media. In particular, these activites have supported the recruitment of people with chronic kidney disease to take part in focus groups and interviews to elicit patient preferences in relation to using digital technologies, which is part of work package 4.
Year(s) Of Engagement Activity 2018,2019
URL https://twitter.com/wearable_clinic