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“2020health is an important and thoughtful contributor to the health debate”

Dr Sarah Wollaston MP, Chairman, Health Select Committee


Arrhythmia Watch New era in CVD eHealth, but UK slow to adopt

Studies presented at the recent World Heart Federation’s World Congress of Cardiology (WCC) in Melbourne showcased new research on best practices in the design and development of healthcare mobile applications (mHealth). However, evidence suggests that telemedicine, e-health (healthcare practice supported by electronic processes and communication) and mHealth systems are not taking off in the UK as expected.


Around 75% of the world’s inhabitants now have access to a mobile phone.1 Out of the estimated 6 billion phone subscriptions worldwide, 5 billion are in developing countries.1 Figures show there were over 30 billion app downloads worldwide in 2012,2 including a surge in the uptake of apps focused on education and information rather than entertainment.

This wide access to mobile applications provides enormous opportunities to improve the reach and effectiveness of health self-management programmes and enhance communication between patients and healthcare professionals, particularly in the field of cardiovascular disease (CVD). In order to ensure that apps are responsive to the needs of patients and healthcare professionals, experts say the development of best practices in the field is a priority.

National examples presented at the World Congress of Cardiology (WCC) illustrated how effective e-health strategies can be designed to educate and improve health outcomes in the prevention and treatment of CVD in two very different healthcare settings.

Australia: using e-health to support lifestyle changes and prevent CVD

E-health programmes can be very useful in the prevention of CVD, in particular to support lifestyle changes in patients at high risk of CVD or who have already experienced a cardiac event. In this study, led by The George Institute for Global Health, Australian academics reviewed how web and mobile apps could be best designed for effective CVD risk reduction and found that the use of personas and journey maps are valuable tools to create effective e-health tools.

To reach this conclusion, a multi-disciplinary team of researchers ran a workshop with the purpose of mapping a journey framework, actually reconstructing the steps of a CVD patient from life before their cardiac event to post-hospital care. Interviews, photo-diaries and a workshop involving CVD patients and those at high CVD risk were held, to capture personal experiences and refine the journey. Following this, four “personas” of patients were created, each of them representing different risk profiles across a range of demographics, including needs, backgrounds and ages.

Using these personas and mapping, the team identified the main touch points where e-health tools could provide additional support to respond to specific patient’s needs, such as ‘help me understand my risk of CVD’ or ‘help motivate me’.

“E-Health is reshaping healthcare delivery across the globe. It provides new opportunities to improve healthcare for patients and optimise lifestyle-related changes for cardiovascular disease prevention. User-centred tools like the CVD journey maps and personas help us to understand people’s needs of users in relation to their lifestyles, motivations and choices and can help in the development of successful, helpful and relevant mobile applications for all,” commented Associate Professor David Peiris, Program Head Primary Health Care Research, The George Institute for Global Health, University of Sydney, Australia.

Apps for all: best practice in developing mobile apps in a low resource setting in India

A study undertaken by Dr Dhruv Kazi and colleagues studied the role of an m-health intervention to reduce death and disability from stroke among low-literacy patients on anticoagulation treatments. This study, based in Bangalore, India, tested a number of prototypes with stakeholders in the healthcare system, including patients, nurses, physicians, administrators, information technology staff, engineers, and software developers in hospital and community-based settings in Mysore and Bangalore. The results showed that:

•Patients and providers were enthusiastic about mobile technology-based solutions for healthcare, but less than 50% had used a healthcare app prior to the interview
•Despite the higher costs, patients preferred voice-based solutions to text- based solutions because of limited literacy and numeracy
•Use of drop-down menus and syntax clarification significantly reduced user-error and improved efficiency, particularly among low-literacy users, e.g., dates (MM/DD/YYYY vs. DD/MM/YYYY), phone numbers (e.g., with or without preceding area code) and laboratory results involving decimal points
•Patients and providers requested versatile apps that could be accessed from a variety of devices (e.g., desktops, tablets, and android phones)
•Role-based passwords and data encryption were feasible mechanisms for data security even in low-resource settings

“These overarching principles can guide entrepreneurs, software developers, public health experts, and governments as they develop locally-relevant mobile solutions to address the ongoing epidemic of cardiovascular disease. We found that agile development practices – including rapid, iterative prototyping and early, frequent engagement of patients and providers – yielded invaluable insights that greatly enhanced the usability and acceptability of the final product. Well-designed and validated mobile applications can revolutionize the delivery of affordable, high quality healthcare in low-resource settings, but only if they are sensitive to the needs of the end-user. Applied correctly, m-health has the potential to alleviate the burden of cardiovascular disease in the most vulnerable sections of society,” explained Dhruv Kazi, Division of Cardiology, University of California San Francisco, USA.

But, barriers to eHealth in the UK

Telemedicine in the UK has “not taken off at all as one might have expected” in the view of independent IT expert, John Cruickshank, speaking at a recent London meeting, ‘Technology for older people’ organized by 2020health in association with Microsoft.

There still seems to be plenty of barriers to this new technology according to John Pugh MP, Chair of the All-Party Parlimentary Group on Telehealth, who has been prominent in “pushing for the advance of telehealth” in the UK. Mr Pugh remains convinced that it is not the value of technology which is in question, but our relationship with this technology. While skepticism remains that we may be replacing the human interface, “older people can engage with technology” and are competent with laptops and mobile devices, in his view. Evidence suggests that patients in some circumstances are happier interacting with a computer than some doctors!

Creating a persona (see above) has proven useful in improving adherence to medication and treatment plans, for example, according to Phil O’Connell, Global Simple Telehealth Lead, Staffordshire & Lancashire, Commissioning Support Unit. In this case the persona is Florence or Flo, a web-based messaging system which responds to patients in a friendly manner and shows that “somebody cares about them”. In his view the vast majority of patients like technology but it is clinician-fears that prevent its adoption.

This view was endorsed by Professor Arlene Astell from the University of Sheffield’s School of Health and Related Research, who is Project Leader for a pioneering study conducted by the, Challenging Obstacles and Barriers Assisted Living Technology (COBALT) research team, who discovered that older people are actually happy and eager to embrace new devices and equipment.

The research group, have been working closely with a wide range of older adults and health and social care professionals across the UK to identify why there is currently a huge gap between developments in technology and the low uptake by people in their daily lives.

Extensive research has found that when asked to describe technology they love – older adults frequently mentioned mobile, phones, computers and digital cameras. Reasons included that the technology is easy or convenient to use, it enables them to keep doing things that are important to them and meets their needs.

Such technology can play a major role in helping people remain at home and to live independently as long as possible. Allowing the elderly to remain in their own homes and out of hospital is a priority for health and social care providers and technology has a vital role to play, Professor Astell believes.

Telemedicine clearly has its benefits but who will pay for the facility? Neil Pearson, Healthcare Market Development Manager, Microsoft, UK, suggested that ‘information governance’ (ie policies and procedures and controls to manage information) impedes the uptake of this new technology. Funding streams may also be changing particularly with implementation of the Health and Social Care Act. This aims for a radical restructuring of the health service in England, giving GPs control of much of the NHS’s £106bn annual budget. This will see the introduction of more competition into services, which is intended to reduce administration costs and to cope with the ever-rising cost of caring for an aging population, and new, innovative and expensive medicines and treatments.

Microsoft provides Healthvault, which is a web-based platform to store and maintain and individuals health and fitness-based information, which can also help track and monitor chronic conditions. For more information, please visit


1. World Bank, Information and Communications for Development 2012: Maximizing Mobile, 2012

2. Mobi thinking. Global mobile statistics 2013.