Abstract
Background
Healthcare systems are under increasing strain, predominantly due to chronic non-communicable diseases. Connected healthcare technologies are becoming ever more capable and their components cheaper. These innovations could facilitate both self-management and more efficient use of healthcare resources for common respiratory diseases such as asthma and chronic obstructive pulmonary disease. However, newer technologies can only facilitate major changes in practice, and cannot accomplish them in isolation.
Focus of review
There are now large numbers of devices and software offerings available. However, the potential of such technologies is not being realised due to limited engagement with the public, clinicians and providers, and a relative paucity of evidence describing elements of best practice in this complex and evolving environment. Indeed, there are clear examples of wasted resources and potential harm. We therefore call on interested parties to work collaboratively to begin to realize the potential benefits and reduce the risks of connected technologies through change in practice. We highlight key areas where such partnership can facilitate the effective and safe use of technology in chronic respiratory care: developing data standards and fostering inter-operability, making collaborative testing facilities available at scale for small to medium enterprises, developing and promoting new adaptive trial designs, developing robust health economic models, agreeing expedited approval pathways, and detailed planning of dissemination to use.
Conclusion
The increasing capability and availability of connected technologies in respiratory care offers great opportunities and significant risks. A co-ordinated collaborative approach is needed to realize these benefits at scale. Using newer technologies to revolutionize practice relies on widespread engagement and cannot be delivered by a minority of interested specialists. Failure to engage risks a costly and inefficient chapter in respiratory care.
Acknowledgments
We are grateful to Joseph Clift, Daisy Ellis, and Dan Poscover for constructive discussions in this area.
This manuscript is based on discussions that took place around meetings of the Respiratory Effectiveness Group.
Author contributions
JDB, AC and ALD had the initial idea for the manuscript. RWC, JDB and DR drafted initial sections. The concept and content were revised at meetings with RAM, KB, and DP. The manuscript was finalized by ALD, AC and JDB and all authors approved this. All authors contributed toward data analysis or literature search, drafting and revising the paper and agree to be accountable for all aspects of the work.
Disclosure
RWC has a patent on the use of acoustic analysis to assess inhaler use. DP has previously had research funding to develop software to assess inhaler technique. The other authors report no conflicts of interest in this work.