Risk diagnosis: the rise of healthcare apps and wearable technology in the UK
Wearable technology and the apps that support it are a growing part of the healthcare ecosystem, extending beyond the wellness and lifestyle sphere in which they largely originated, to support monitoring, diagnosis and management of a variety of health issues, particularly chronic conditions such as diabetes, asthma and arthritis.
The global healthcare wearables market is projected to be worth around $27 billion by 2023. In the UK, healthcare bodies including the National Health Service (NHS) have encouraged the use of such technologies and begun to put in place the regulatory framework both to support their adoption and to manage the risks they present.
A recent example of the NHS encouraging the greater use of wearables and apps, with more focus on prevention and on the delivery of healthcare remotely, was the announcement by NHS England that it was issuing thousands of fitness trackers to patients with Type 2 diabetes. There are also several examples of more localised initiatives. As part of the NHS ‘Test Beds’ project, dementia patients in Surrey are involved in a two-year project that will use technology to try to enable them to remain at home for longer. Patients and their carers are being provided with sensors, wearables, monitors and other devices, which will connect into the Internet of Things and hopefully reduce the need for care in nursing homes or hospital.
Considerable hope and expectation is already being attached to these technologies and the scope for data analytics and artificial intelligence (AI) to facilitate better diagnoses and outcomes. We have seen evidence for example that AI can outperform medical practitioners in the analysis of skin lesions, pathology slides, ECGs and medical imaging data.[i] They may present either the raw data and/or their analysis of it to doctors or other healthcare professionals and providers, perhaps accompanied by a self-diagnosis. This trend is likely to intensify as there are increasing signs of convergence between wearable fitness and wearable medical devices, leading to what are often essentially consumer electronic devices being used to acquire physiological data, which in turn can be interpreted by smartphone apps and provide medical advice. The ability to access, analyse and present such data can feel empowering for consumers and patients hence these wearables and their supporting apps have been described as ‘the new “Dr Google”’.
Healthcare professionals and providers can face a difficult balancing act between managing patients’ expectations of what use such data can be (and how easy it is to interpret in a meaningful way in a diagnostic context) and the potential insights it can provide. If a professional discusses and analyses the data with a patient, or encourages them to retain and share it with a doctor or other health provider, there may be exposure to liability if a subsequent health issue arises for the patient and there is an allegation that there was a failure by the professional to identify it, or to properly assess and explain its implications. Such issues could be more problematic if a patient has been specifically advised to use (or even prescribed) a particular wearable device and there is an allegation of harm to the user, particularly in relation to a failure to monitor or interpret data properly. Any bodily injury in such scenarios could be caused by (1) user error (2) technology failure (3) physician error and difficult causation issues could arise.
This technology can generate huge banks of data, whether across a whole range of health and wellness factors, or focussed on a very specific issue. There is a risk that allegations could arise that the data capture, storage, interpretation or transmission has been in some way compromised by a defect within the wearable device and/or any app used with it. Compliance with the Data Protection Act and GDPR requirements is key and there are particular challenges around transparency, consent and data minimisation, given the nature of the products and the interface. With an increased focus on the sharing of data involving medical wearables and apps, often involving third parties (including insurers and employers as well as medical professionals), there must also be a focus on data security risks. In many ways this is an issue common to the broader Internet of Things, of which medical technology is an important subcategory.
As the Topol Review into how to prepare the UK healthcare workforce for a digital future earlier this year exemplified, the direction of travel is very much towards using new technologies (including wearables and apps) to empower individuals and health professionals to monitor and prevent health issues, or to manage them as effectively as possible, preferably outside hospitals, care homes etc. This coincides with a greater interest in consumer wearables and apps and their healthcare/wellness capabilities and we are likely to see greater convergence, requiring new approaches to risk management and risk transfer. Our experience in underwriting our Virtual Care policy has highlighted the importance of having a well-rounded, integrated insurance solution that covers multiple risks traditionally associated with the medical and tech sectors and avoids the risk of having unintentional gaps in cover.
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About the author:
Nick Pearce is a healthcare liability underwriter at Beazley writing medical malpractice and associated liability risks on a worldwide basis as well as the recently launched UK Virtual Care product. He joined Beazley in March 2016 and has almost more than 20 years of experience in insurance including over a decade focused on healthcare liability risks.