Better treatment, better health! People often experience suboptimal health because treatment is not optimal. A new approach is being developed - enabling patients and doctors to improve treatment and improve health.

2. • Physician
• Psychiatrist
• Editor
• Head of department
• Researcher
• Chief adviser
• Software developer

3. So many people,
so many with
chronic
disorders

4. Healthcare
is about
health

5. I want to be
healthy!

6. SUBOPTIMAL HEALTH:
6 COMMON
REASONS

7. 1. Does not use
the best main
treatment

8. 2. Does not use
the optimal
dosages

9. 3. Difficult
to take treatment
as agreed

10. 4. Difficult
to lead a healthy
lifestyle

11. 5. Does not get
enough support
from others

12. 6. Is not happy
with the decision-
making

13. HEALTH OPTIMISATION
1. Finds the
best available
treatment
2. Takes
the optimal
dosage
3. Uses
the treatment
as agreed
4. Leads
a very healthy
lifestyle
5. Takes
part in
decisions
6. Receives
enough
support

14. An approach from the UK calling
for the use of technology
Figure 1. Summary of the four principles of medicines optimization

15. Increasing the effectiveness of adherence
interventions may have
a far greater impact
on the health of the population
than any improvement in specific
medical treatments
Bryan Haynes

16. Increasing the effectiveness of adherence
interventions may have
a far greater impact
on the health of the population
than any improvement in specific
medical treatments
Bryan Haynes
And this is
only problem
#3 of the 6

17. 6 STRATEGIES
FOR OPTIMAL HEALTH

18. 1. Finds the
best available
treatment
2. Takes
the optimal
dosage
3. Uses
the treatment
as agreed
4. Leads
a very healthy
lifestyle
5. Takes
part in
decisions
6. Receives
enough
support

20. BACKGROUND

21. HVA ER BEST
Å GJØRE?TEKNISK STØTTE:
• Systematisk monitorering av effekter
• Monitorering av annen info, som søvn og labsvar
• Optimalisering av compliance
• Integrert kunnskap fra mange kilder
• Rangering av behandlinger ut fra forskning og reelle
effekter
• Hjelp til å formidle kunnskap til henne på en forståelig
måte
• Hjelp til å involvere henne i valget
Contributors:

22. London, Sydney, Seoul, Chicago,
Odessa, Dubai, Singapore
Professor Jack Dowie

23. Frameworks:
1. Multi-criteria decision analysis
2. Single subjects research designs
3. Shared decision-making

24. Multi-criteria
decision analysis
Mathematics Behavioral decision theory
Economics Computer technology
Software engineering Information systems

25. Multi-criteria
decision analysis
Mathematics Behavioral decision theory
Economics Computer technology
Software engineering Information systems
• Includes exactly what is needed for
optimal decisions
• Enables valid and consistent
integration of large amounts of data
• Takes knowledge and preferences
as input for calculations of treatment
values for the individual

26. Single subjects research
designs
Time
DevelopmentVariable

27. • What works for groups of people generally does not
work for you!
Time
DevelopmentVariable
• Measure treatment effects and find out:
Right: With treatment
Middle: Without treatment
Left: With treatment
• Conclusion: Less symptoms with treatment!

28. Shared decision-making

29. Shared decision-making1. Get the decision on the table

30. Shared decision-making1. Get the decision on the table
2. Acknowledge that it´s not possible to find the best treatment
without knowing what´s important to the patient

31. Shared decision-making1. Get the decision on the table
2. Acknowledge that it´s not possible to find the best treatment
without knowing what´s important to the patient
3. Get all available options on the table

32. Shared decision-making1. Get the decision on the table
2. Acknowledge that it´s not possible to find the best treatment
without knowing what´s important to the patient
3. Get all available options on the table
4. Ask what the patient wants the treatment to do for her

33. Shared decision-making1. Get the decision on the table
2. Acknowledge that it´s not possible to find the best treatment
without knowing what´s important to the patient
3. Get all available options on the table
4. Ask what the patient wants the treatment to do for her
5. Tell what the patient can expect from the best and worst
treatment, on all outcomes

34. Shared decision-making1. Get the decision on the table
2. Acknowledge that it´s not possible to find the best treatment
without knowing what´s important to the patient
3. Get all available options on the table
4. Ask what the patient wants the treatment to do for her
5. Tell what the patient can expect from the best and worst
treatment, on all outcomes
6. Find out which treatment fits her preferences most

35. Shared decision-making1. Get the decision on the table
2. Acknowledge that it´s not possible to find the best treatment
without knowing what´s important to the patient
3. Get all available options on the table
4. Ask what the patient wants the treatment to do for her
5. Tell what the patient can expect from the best and worst
treatment, on all outcomes
6. Find out which treatment fits her preferences most
7. Agree on what is the best treatment

36. Shared decision-making1. Get the decision on the table
2. Acknowledge that it´s not possible to find the best treatment
without knowing what´s important to the patient
3. Get all available options on the table
4. Ask what the patient wants the treatment to do for her
5. Tell what the patient can expect from the best and worst
treatment, on all outcomes
6. Find out which treatment fits her preferences most
7. Agree on what is the best treatment
8. Provide support and allow the patient to participate in the
decision process to the extent and in the ways preferred

37. Pilot:
Bipolar disorder

38. Pilot:
Bipolar disorder
• A very complex disorder
• Highly invididual course and
treatment results
• Can be unpredictable
• Serious consequences
very common
• Fatal consequences not rare

39. New knowledge summary
methods
• Fast and frugal
• Patient-oriented
• Decision-focused

40. New knowledge summary
methods
• Fast and frugal
• Patient-oriented
• Decision-focused
Addresses all
patient-important
outcomes

41. DECIDE
TREATMENT:
18 FEATURES
TAILORED TO SOLVE
THE 6 PROBLEMS

42. 1. Does not use
the best main
treatment

43. 1. Does not use
the best main
treatmentLet´s integrate all
available
knowledge!

44. Best research
results

45. + All earlier
experiences

46. + All doctor´s
experiences

47. + Removes contraindicated
and irrelevant options and
outcomes

48. + Measured treatment
results

49. = a fully populated
decision matrix

51. Ranking and expected value
of available treatments

52. Ranking and expected value
of available treatments

53. Ranking and expected value
of available treatments
No action is evidence-
based in this world.
All human behaviour is
knowledge- and
preference-based

54. What health is to her

55. Her personal trade-off

56. Ranking based on trade-off
+ all evidence

57. Personalised ranking, rather than the
recommendations for an “average patient”
in clinical guidelines

59. Let´s pick one
of the best!

60. Let´s find out how
they compare

61. 2. Does not use
the optimal
dosages

62. 2. Can find the
best dosage

63. 2. Can find the
best dosage

64. 3. Difficult to
take treatment
as agreed

65. 3. Reminded of,
signs off, look
at together

66. 4. Difficult to
lead a healthy
lifestyle

67. 4. Decides on,
reminded about,
inspect

68. 5. Does not
get enough
support from
others

69. 5. Decides
on support and
receives it

70. 6. Is not happy
with the decision-
making

71. 6. Decides on
decision quality
and measures it

72. The patient´s
treatment plan
• Main treatment
• Additional ones
• Lifestyle measures

73. New side effects
Life events
Treatment changes
Appointments

74. Objective data
• From the mobile
• From the watch
• From EMR

75. Text, video,
graphics reached
with one click
from the panels

76. 12 panels
condensing huge
amounts of data
= Solid ground
for
shared decisions

77. Where is
shared decision-
making?

78. Where is shared
decision-making?
1. Finds the
best available
treatment
2. Takes
the optimal
dosage
3. Uses
the treatment
as agreed
4. Leads
a very healthy
lifestyle
5. Takes
part in
decisions
6. Receives
enough
support
here here
here
here
here
here

80. Integration in DIPS

81. Coordinated with and reflected in
government whitepapers and initiatives

82. Systems in the
making for
people with:
• Heart disease
• Asthma
• Stroke
• Hypertension
• MS
• COPD
• Diabetes
• Bipolar disorder
• Palliative care
• Lung cancer
• Schizophrenia
• Pregnancy
• HIV
• Psoriasis/eczema

83. 5 studies as per 16.11.16
5 PhDs

84. Results:
SUS score 78
Tested with 88 potential users
Norway, UK, Ukraine
Above 68 is good

85. I don´t want to stop using this
Patients:
I feel safer having this system
I see the big picture very fast
Doctors:
We quickly get to the main issues
Results:

86. System modules

87. 24 interconnected modules
enriching each other

88. Modules in patient decision aids

89. Modules in clinical practice
guidelines

90. You could be an author of a
Health Helper!

92. THE ALTERNATIVE?

93. Take this
and come
back in
a month

94. Take this
and come
back in
a month
We can continue
with business
as usual:
• No systematic measurement of
treatment effects
• Trust that our brains can process
all necessary data
• No digital support outside of the
encounter

95. CONCLUSION

96. Finding out what
works for you should
be as systematic as
finding out what works
for groups
(= research)

97. Optimisation of health
for each and every one of us
1. Finds the
best available
treatment
2. Takes
the optimal
dosage
3. Uses
the treatment
as agreed
4. Leads
a very healthy
lifestyle
5. Takes
part in
decisions
6. Receives
enough
support