Epilepsy wearables have placed extra pressure on services, but a new project could have NHS-wide implications, using smartphones, wristbands and apps to help end patient isolation, writes Dr Rupert Page, consultant neurologist and clinical lead for the Dorset Epilepsy Service
The potential for wearable technologies to revolutionise how we deliver healthcare is huge. Peer-reviewed evidence suggests that the data on heart rate, sleeping patterns and diets linked to the patient record is valuable for early intervention or management of long-term conditions.
For the Dorset Epilepsy Service, part of Poole Hospital NHS Foundation Trust, wearable technology is an essential part of a new project that is transforming the way we deliver care services to support patients with this serious neurological condition. This will, we hope, provide more timely support and guidance to our epilepsy patients, helping to reduce common challenges they face such as loss of independence and isolation.
Managing epilepsy is a complex process but with the right treatment, around 70-80% of patients could be seizure-free, building on the current rate of about 50%.
Our challenge is to determine who, from an initial seizure, is likely to go on to experience more epileptic episodes. But the current system has its flaws. Some people will have further seizures after their initial assessments, in some cases just after we’ve seen them, and will neither be admitted nor contact their GP or specialist. Given the period between follow-ups, this means they could go for months without medication or consultation, when with notification there would have been an opportunity to intervene sooner.
Medical devices currently used to detect seizures are often overly sensitive, causing many false alarms
On the other hand, we have epilepsy patients who are embracing wearable technology to alert families, friends and carers as soon as a seizure is detected. This is can be positive for allowing early interventions, but medical devices currently used to detect seizures are often overly sensitive, causing many false alarms that place strain on the NHS.
The result is unnecessary outpatient appointments, ambulance calls or emergency department visits to assess the patient in more detail. The net effect is that clinicians are put under additional pressure to rapidly assess more patients, because of false alarms generated by the technology.
As a specialist service we recognised the need to become more responsive to the individual patients. Rather than relying on routine appointments, we set up a telephone and email advice line to make it easier for patients to tell us when they have problems. Fewer routine appointments have meant greater availability and an ability to react to individual’s needs.
But it became clear that we needed better access to accurate, complete patient information, combined with our specialist knowledge at the point of care to best serve the needs of our epilepsy patients.
Dr Rupert Page, consultant neurologist and clinical lead for the Dorset Epilepsy Service
We have since undertaken a project that uses an app to collect information from wearables, smartphones and clinical portals and integrate it with a patient’s clinical record. Our team is using a system called myCareCentric Epilepsy, from clinical software provider Graphnet, to create an enhanced record that is shared in real-time with patients and clinical teams across a network of expert care.
This gives us the ability to respond rapidly to changes in seizure frequency and potential medication side-effects, meaning that patients may become seizure-free sooner and with fewer visits to the hospital or GP surgery.
For example, the automatic notification of patients with epilepsy being admitted to the hospital, either with seizures or unrelated problems, has allowed our epilepsy care team to proactively advise the admitting team. In a number of cases, this has significantly reduced the length of stay for those patients as well as provided an opportunity to more quickly improve their seizure control.
It’s difficult to know where wearables are going into the future, but I think they will eventually be built into clothing and devices that we purchase and use in everyday life. From a clinical perspective, this is where a big data approach to patient-contributed records could potentially become quite interesting.
We believe we have created a model of care that will help to reduce costs and improve the treatment of the condition
But the most immediate impact will be challenging the current way of delivering more tailored and personalised care to epilepsy patients. Once we have laid the foundations for this new model of care, we can start to introduce new methods of communication to reduce the need for face to face consultation. Skype calls, for example, could be used to replace journeys by our clinical teams across areas of our county affected by poor roads, or for patients who cannot drive because of their seizures. It opens up a whole range of different ways to manage patients who historically have not been a priority in commissioning services to the same degree as those with cancer or stroke have been.
As we go through our evaluation of the project, we believe we have created a model of care that will help to reduce costs and improve the treatment of the condition. We have built this with scope and scalability in mind, to be a model that can be replicated across the NHS for better, safer patient care and a sustainable future.