How a cup of tea and smart technology are helping families and NHS Trusts to support the aging population.

This is the first in our series of interviews with health experts who are working with innovative technologies to improve healthcare.

We spoke to Howz Founder, Louise Rogerson about the impact of technology on patient care during the Covid-19 pandemic and how NHS teams are innovating with smart monitoring to improve health outcomes.

Louise is a Chartered physiotherapist, specialising in neurology and older people. She’s also Chief Operating Officer at Howz, where she provides clinical insight into product development, manages the customer experience, and oversees the practical side of the business.

During the eight years she spent working as a health commissioner in the NHS Manchester Trust, she noticed that something was missing in the circle of care that was resulting in frail older people making unexpected visits to A&E.  She wanted to see an early warning that an individual needed support, to help trusts commission appropriate services, which in turn could improve results from a health economics and health outcomes perspective.   

“I know that as a physio the earlier I work with somebody, the better their outcomes and the more time you've got to make those critical decisions.  Now, at Howz, I spend my days making that happen.”

We can’t talk about 2020 without talking about coronavirus.  What impact has the pandemic had on the way technology is being used by health professionals?

Most, if not all health professionals, have used some kind of remote monitoring during Covid, primarily in the form of phone or video calls.  Some have started to use devices too.

The impact of Covid has meant delayed care for some people, and the recognition that older people are quite vulnerable.  Remote monitoring solutions have helped health professionals to support patients at a distance.  We’ve been working with NHS partners, like Surrey and Borders Trust to help them to prioritise the people that need help and support.  That’s been a real focus for us all, this year.

We’ve been involved in a research trial with Salford Royal and the University of Sheffield to test the feasibility of Howz technology alongside discharge teams and patients.  Getting a patient home after a hospital visit can be difficult, and discharge teams are doing a fantastic job assessing patients, getting them home and caring for patients at home until they’re independent again.  With this trial, discharge teams are using Howz home kits to extend monitoring in a light touch way, giving the patient and family added reassurance and confidence as the patient recuperates at home. 

When a patient comes out of care and they’re getting better, they tend to stop monitoring their health so closely. They tend to forget to do their exercises or monitor their blood pressure.  With non-intrusive environmental monitoring, you get a barometer of what’s really happening.  With Howz, we are able to deliver information that previously, you might not even get from a conversation with a patient.  

The remote monitoring we’re installing gives the health service, families and individuals what I like to call “the life side of things” – highlighting changes in routine – what time you make your first cup of tea, when you’re active, when you’re not active, whether you’re going out or not.  

And when you’re alerted to changes in routine, it’s an opportunity to check in – be it a call or a visit – to pre-empt and provide care before a patient falls seriously ill.

So coronavirus has certainly brought technology into the home. We’re all having video calls these days.  Are there any other changes that are influencing the acceptance of technology in the home?

This year video calls have certainly become really common and important.  Everyone, including older people is getting used to more technology in the home – tablets, Zoom, Alexa – but with that technology, also comes some anxiety about how the data is used.

In addition, there’s the national roll out of smart energy meters across the country. This could have a huge impact on how we approach preventative and proactive health care, always of course, with the consent of the individual.  

In fact, for me the smart meter rollout is possibly the best opportunity I think we've ever had to do something at a population level that might actually make a real difference.

In what way can smart meters help at scale in improving health outcomes?

Smart meters are an opportunity to tap into information that hasn’t previously been accessible.  When you do a population level review, you get data from different places to decide which services need to be prioritised to specific groups of people in an area.  Previously, that data didn’t really give you an indication of how people are getting on – it didn’t show you trends or changes in routine, for example.  And it’s that observed change that can make all the difference when it comes to proactive care.

With the roll out of smart meters and the approval of individuals, there is the potential that public health teams and clinicians could receive powerful indicators when something is outside of the normal range.  Commissioners can then see specific groups in a whole new way, identifying who might need more care or intervention.  It’s a very exciting possibility.

The Howz monitoring kit includes a smart plug that you fit to your kettle.  How can something as simple as making a cup of tea help health teams provide proactive care?

Being able to see when someone has their first cup of tea or when they get up and start moving around is a really powerful indicator of how a patient is getting on.  That first cup of tea can show a patient, family member, carer or health professional how stable an individual’s routine is. 

In practice, with the Howz system, for example, a family member might receive a push notification to their phone if that first activity is unusually late one day, and they can then give them a call to check how they’re doing.  

Whereas, for health professionals and departments, you’re looking for changes over time, so the setup would be an alert if there’s increased night activity over the course of a week, for example. A health professional can then decide to check in on that patient to see what’s causing that change and intervene where necessary, changing medication or helping the patient with their routine.  We’ve seen this working really well with a housing association that uses the Howz system.

So something as simple as a cup of tea can help both families and NHS Trusts work together with technology to support a vulnerable individual. 

If a Trust is considering using Howz technology, what’s the most important thing to consider?

I think for me the technology works best when we work collaboratively with the NHS provider and co-produce a solution for exactly what they want and need.  During Covid, we’ve been working with clinicians to track the key measure that really matters, be it temperature, pulse, oximetry and so on.  And we focus on that.  There are plenty of options.

The second thing is defining which alerts matter for clinicians versus which matter most for the patient and family.  This solution helps clinicians, families and patients.  With a Howz monitoring solution in place, families and clinicians can be more confident in letting a patient go back home, and more confident that they can reduce hospital visits by delivering early interventions when they’re needed.

The final thing to note for health teams is that the data itself is factual, rather than diagnostic. Howz alerts you to increased activity at night and the clinicians then have the conversation to diagnose why that’s happening.  Tapping into changes in a patient’s routine is very innovative, because it brings insights into how patients are coping, giving medical teams an additional layer of information beyond the normal medical parameters we’ve tended to focus on in the past. 

Our aim with Howz, is to facilitate a conversation, by giving clinicians the information they need without them having to spend more time in front of a computer screen.  Instead, they can focus on direct care, spending meaningful time with the patients that need care, supporting them. 

What impact can smart monitoring have on patient care?

For me, it really improves the communication and care that’s possible between the health service, the family, the team around the patient and the patient themselves.  There’s continuity, support and reassurance.  With alerts set, the patient, the family or a health professional can see trends before they get too serious.  And if a patient does happen to have a fall and need to visit a hospital, you have the data to be able to see what was happening and for how long, which gives you additional insight to make a call on how to prevent a fall happening again.

Is this technology just suitable for older patients?

We’ve certainly seen the positive effects for older people and their families in helping individuals who want to stay independent for as long as they can.  But the technology also has the potential to help trusts provide proactive care in deprived populations – identifying individuals living in fuel poverty or individuals with chaotic lifestyles through a system of monitoring.  In addition, it can help people living alone with mental health issues or with a disability. 

And it’s light touch.  People don’t find monitoring their kettle intrusive, because it’s not. What it is, is a very powerful way to assess a routine to see which individuals need a little more care and support.

What’s your hope for the next couple of years?

If I could wave a magic wand, I’d love to see the entire UK population benefiting from the potential of a system that makes smart meter data meaningful, in that it could give individuals actionable information about their routine.  I’ve seen how it helps individuals keep themselves healthy.  And I’ve seen how it’s benefiting health professionals like myself to spot changes in routine, so we can diagnose patient problems early on before they become too serious.

Howz home monitoring can tap into smart meter data, and through analytics and powerful processing, detect changes in routine that give clinicians real insights that matter.  Howz means clinicians won’t be drowning in data, but acting on it to support patients at home, rather than in a hospital.

I would love it if we were using that data to do population level health planning, to prioritise the services in the areas that have greater need, and help deliver services we know can make a real difference to people’s health.  I think technology is the way we’re going to be able to do that at scale as a country.