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    A hands-off approach: Managing health remotely with wearables

    Dindson Phua

    With an ageing population and growing numbers of people living with chronic health conditions, healthcare providers are increasingly looking to technology to relieve the strain on already stretched resources. Beazley underwriter Dindson Phua examines the interconnected risks in a fast-moving area of healthcare.

    In Singapore and across South-east Asia, the rise in cases of diabetes has been blamed on many factors, from increased urbanisation and ageing populations to diet and lack of exercise. The number of Singaporeans with the disease is set to exceed 1m by 2050, up from 400,000 just a few years ago, causing the government to wage ‘war’ on a disease it estimates cost the country $1bn annually to manage.1

    As part of its strategy, Singapore’s Ministry of Health has called on individuals to take greater ownership over their own health2, recognising those who are engaged in their own care are more likely to avoid complications associated with the disease.

    Technology, including wearables and mobile apps, has a role to play in this, providing opportunities to both relieve pressure on healthcare resources and to enable those with chronic conditions, such as diabetes, to have more control over their health.

    With the growing health crisis and awareness of the benefits of active management of conditions, it is not surprising the mHealth sector is booming.
    Tech companies that build wearables, apps and mobile technology to provide access to healthcare support and monitoring are playing a significant part in the growth story within digital health. However, new technology is not without its risks for the digital health sector and patients.

    While many such firms may have a clear picture of the cyber and product liability exposures they face, careful attention needs to be paid to the potential for bodily injury and medical malpractice claims that could arise from data or tech failures where people’s health is concerned.

    Potential risks include:
    Incorrect or inadequate data capture and storage resulting in misdiagnosis, cyber attack or data compromise;
    Failure to intervene due to delayed or failed communication of information to clinicians; or
    Failure by a clinician to treat due to flawed technology or product failure.

    Recognising the interconnectedness of potential risks associated with technology, cyber and medical malpractice is an important defence for mhealth and other digital health companies.

    Monitoring risk

    The digital health sector has made huge advances in 2020 due to increased demand and pressure on health services dealing with the pandemic. And as patient safety is the priority, awareness of the potential shortcomings of technology particularly in such a fast-moving environment is vitally important.

    A study published last year by Nanyang Technological University into the most popular diabetes apps available found many lacked crucial functionality. Worryingly many lacked real-time guidance on what to do for dangerously high or low blood sugar meaning users could suffer severe health complications unless urgent action is taken.

    Even where an app has the functionality to help the user manage their condition, the reliance on technology increases risk and complexity. Technical issues with algorithms or the software within the app could prompt the user to take a course of action detrimental to their health or provide false assurances regarding their blood sugar levels.

    An example of this occurred last year when a glucose monitor and app popular with parents of children with type 1 diabetes suffered such a failure. The device provides real time blood glucose monitoring and alerts via mobile app when blood sugar levels climb too high or drop too low. However overnight the app, unbeknown to users, stopped sending warnings with many users only finding out much later when they started to feel unwell.4

    Where individuals are reliant on an app for self-management of their condition and a fault in design leads to injury, both the doctor who recommended its use and the designer could be liable and be drawn into claims for compensation. Having insurance in place that covers bodily injury risk is vital for digital health practitioners whether they are delivering telemedicine, creating the apps or wearables, or the tech platforms behind them. The problem for the medical professional is that their traditional medical malpractice insurance will not necessarily cover claims for bodily injury arising from a failure of design in technology they recommend to patients. The same is true for the company that developed the app.

    Tech developers and medical professionals who recommend the use of apps or other technology to patients need to understand their risk exposures and ensure their patients are also fully aware of how to use them and what to look out for. Greater self-care of chronic conditions promises to alleviate some of the pressure on both health services and patients’ own health conditions but requires awareness all round on both the potential and the limitations of integrating tech and data into monitoring and managing health conditions.

    1 Ministry of Health HealthHub.sg website

    2 https://www.healthhub.sg/live-healthy/1273/d-day-for-diabetes

    3 https://www.reuters.com/article/us-health-diabetes-apps/most-type-2-diabetes-apps-lack-real-time-advice-on-blood-sugar-management-idUSKCN1RS26Y

    In Weekend Outage, Diabetes Monitors Fail to Send Crucial Alerts, New York Times (2019)

     

    About the author:

    Dindson joined the International Financial Lines team at Beazley, Asia in September 2020. He is responsible for underwriting Beazley's full suite of specialty lines products and spearheading the healthcare portfolio expansion within the region. This includes underwriting Virtual Care, Beazley’s tech-led health and wellness insurance solution.

    Dindson Phua
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