Making the person the centre of healthcare Jim Briggs University of Portsmouth, UK HINZ 2009
DELIVERING HEALTHCARE IS EXPENSIVE HINZ 2009
Some statistics (UK) <ul><li>UK spent £118 billion (~NZ$ 250B) on health care (public and private) in 2007 [ONS] </li></ul...
Some statistics (world) HINZ 2009 Source: OECD
Reasons why costs increase <ul><li>patients become more demanding </li></ul><ul><li>new technologies  </li></ul><ul><li>ag...
Reasons why costs decrease <ul><li>Shorter lengths of stay </li></ul><ul><li>Productivity rises </li></ul><ul><li>Competit...
Patients want... <ul><li>Reduced repetition </li></ul><ul><ul><li>Taking history </li></ul></ul><ul><ul><li>Doing tests </...
IN SICKNESS OR IN HEALTH <ul><li>Is the NHS a health service or a sickness service? </li></ul><ul><li>Wouldn't &quot;welln...
Would be better if healthcare... <ul><li>kept people &quot;healthy&quot; rather than interact with them only when they fal...
How to &quot;treat&quot; the healthy <ul><li>Educate and inform </li></ul><ul><li>Encourage reduction of unhealthy behavio...
How can we integrate healthcare more into daily life? <ul><li>Deliver health  nearer  to the patient </li></ul><ul><ul><li...
Being proactive about health <ul><li>Regular wellness checks </li></ul><ul><li>Screening programmes </li></ul><ul><ul><li>...
THAT'S THE PROBLEM. WHAT'S THE SOLUTION? HINZ 2009
Centre healthcare around the patient The Personal Health Service HINZ 2009
Not that easy <ul><li>Health is a complex subject </li></ul><ul><ul><li>can't educate everyone to doctor level </li></ul><...
ICST HELPS HINZ 2009
What is ICST? <ul><li>IT = &quot;Information Technology&quot; </li></ul><ul><li>ICT  added &quot;Communication&quot; </li>...
The information revolution <ul><li>Some beneficial drivers for change </li></ul><ul><li>Best information comes from near t...
Five drivers of change <ul><li>New ways of collecting data </li></ul><ul><li>Richer information </li></ul><ul><li>Bigger m...
1a. New ways of collecting data <ul><li>new sensors </li></ul><ul><ul><li>wearable devices </li></ul></ul><ul><ul><li>devi...
1b. New ways of collecting data <ul><li>development and reduced cost of mobile devices </li></ul><ul><li>wide availability...
2. Richer information <ul><li>Reduced cost of networking and data storage means more data can be shared in more places </l...
3. Bigger markets for relevant technologies <ul><li>Partly due to people's increasing </li></ul><ul><ul><li>familiarity </...
4. Technology as an enabler <ul><li>Technology enables care to be given by wider range of care professionals: </li></ul><u...
5. Partnerships <ul><li>Increasing number of partnerships between health and care providers </li></ul><ul><li>Existing par...
Why collect data near the patient? <ul><li>Make quality part of the process </li></ul><ul><li>Make collecting data an inte...
What isn't &quot;near&quot; the patient? <ul><li>Location shifting </li></ul><ul><ul><li>patient (or a sample from them) h...
What is &quot;near&quot; the patient? <ul><li>During clinical session (while clinician with patient) </li></ul><ul><li>Wit...
Sources of information <ul><li>Hospital in-patient records </li></ul><ul><li>Hospital out-patient records </li></ul><ul><l...
HINZ 2009
Future sources of data <ul><li>Observations (informal) from family, friends or neighbours </li></ul><ul><ul><li>integratio...
Opportunities of quality <ul><li>Information contributing to improving processes </li></ul><ul><ul><li>decision support </...
Opportunities of quantity <ul><li>Population-level analyses </li></ul><ul><li>Models to assess risk to individual patient,...
Issues 1 <ul><li>Integrating data </li></ul><ul><ul><li>common means of identifying patients </li></ul></ul><ul><ul><li>pr...
Issues 2 <ul><li>Confidentiality and privacy </li></ul><ul><ul><li>spectre of Big Brother </li></ul></ul><ul><li>Convenien...
Challenge <ul><li>Not  about the technology </li></ul><ul><li>It's about engineering services to ensure that the right (qu...
Summary The personal health service needs excellent information about its patient HINZ 2009
http://www.chmi.port.ac.uk [email_address] HINZ 2009
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Making the Person the Centre of Healthcare

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Jim Briggs
University of Portsmouth
www.chmi.port.ac.uk
(1/10/09, Forum, 9.45)

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Making the Person the Centre of Healthcare

  1. 1. Making the person the centre of healthcare Jim Briggs University of Portsmouth, UK HINZ 2009
  2. 2. DELIVERING HEALTHCARE IS EXPENSIVE HINZ 2009
  3. 3. Some statistics (UK) <ul><li>UK spent £118 billion (~NZ$ 250B) on health care (public and private) in 2007 [ONS] </li></ul><ul><li>8.4% of GDP </li></ul><ul><li>Was 6.6% of GDP in 1997 </li></ul><ul><li>Aim (pre-recession) to get to 9.5% - around EU average </li></ul>HINZ 2009
  4. 4. Some statistics (world) HINZ 2009 Source: OECD
  5. 5. Reasons why costs increase <ul><li>patients become more demanding </li></ul><ul><li>new technologies </li></ul><ul><li>ageing of the baby-boom generation </li></ul><ul><li>increasing life expectancy </li></ul><ul><li>population growth </li></ul>HINZ 2009
  6. 6. Reasons why costs decrease <ul><li>Shorter lengths of stay </li></ul><ul><li>Productivity rises </li></ul><ul><li>Competition for provision of services </li></ul>HINZ 2009
  7. 7. Patients want... <ul><li>Reduced repetition </li></ul><ul><ul><li>Taking history </li></ul></ul><ul><ul><li>Doing tests </li></ul></ul><ul><li>Safer care </li></ul><ul><ul><li>Evidence-based </li></ul></ul><ul><ul><li>Better checks on its delivery </li></ul></ul><ul><li>Reduced travel to obtain care </li></ul><ul><li>Shorter stays </li></ul><ul><li>More convenience </li></ul>HINZ 2009
  8. 8. IN SICKNESS OR IN HEALTH <ul><li>Is the NHS a health service or a sickness service? </li></ul><ul><li>Wouldn't &quot;wellness&quot; be better? </li></ul>HINZ 2009
  9. 9. Would be better if healthcare... <ul><li>kept people &quot;healthy&quot; rather than interact with them only when they fall ill </li></ul><ul><li>was more integrated into everyday life </li></ul><ul><li>was more proactive than reactive </li></ul><ul><li>was personalised to an individual's needs, desires and lifestyle </li></ul>HINZ 2009
  10. 10. How to &quot;treat&quot; the healthy <ul><li>Educate and inform </li></ul><ul><li>Encourage reduction of unhealthy behaviours </li></ul><ul><li>Encourage fitness </li></ul><ul><li>Support for self-monitoring and self-diagnosis </li></ul>HINZ 2009
  11. 11. How can we integrate healthcare more into daily life? <ul><li>Deliver health nearer to the patient </li></ul><ul><ul><li>in local clinics </li></ul></ul><ul><ul><li>in the patient's home </li></ul></ul><ul><ul><li>in the patient's workplace </li></ul></ul><ul><ul><li>in places they would normally visit </li></ul></ul><ul><li>Deliver health when the patient wants it </li></ul><ul><ul><li>not just 9-5 </li></ul></ul><ul><ul><li>weekend opening </li></ul></ul><ul><ul><li>24/7 access to services </li></ul></ul>HINZ 2009
  12. 12. Being proactive about health <ul><li>Regular wellness checks </li></ul><ul><li>Screening programmes </li></ul><ul><ul><li>breast cancer </li></ul></ul><ul><ul><li>diabetes </li></ul></ul><ul><li>Support for self-diagnosis </li></ul><ul><li>Support for self-managed preventative care </li></ul>HINZ 2009
  13. 13. THAT'S THE PROBLEM. WHAT'S THE SOLUTION? HINZ 2009
  14. 14. Centre healthcare around the patient The Personal Health Service HINZ 2009
  15. 15. Not that easy <ul><li>Health is a complex subject </li></ul><ul><ul><li>can't educate everyone to doctor level </li></ul></ul><ul><li>Many providers of care </li></ul><ul><ul><li>many different agencies involved across several sectors </li></ul></ul><ul><ul><li>including the patient and their family and friends </li></ul></ul><ul><li>Many levels of care </li></ul><ul><li>Care is provided in many different locations </li></ul>HINZ 2009
  16. 16. ICST HELPS HINZ 2009
  17. 17. What is ICST? <ul><li>IT = &quot;Information Technology&quot; </li></ul><ul><li>ICT added &quot;Communication&quot; </li></ul><ul><li>ICST adds &quot;Sensing&quot; reflecting: </li></ul><ul><ul><li>wide range of sensing devices </li></ul></ul><ul><ul><ul><li>environmental </li></ul></ul></ul><ul><ul><ul><li>personal </li></ul></ul></ul>HINZ 2009
  18. 18. The information revolution <ul><li>Some beneficial drivers for change </li></ul><ul><li>Best information comes from near the patient </li></ul><ul><li>Now many sources of information </li></ul><ul><li>Having large quantities of information opens up new opportunities </li></ul><ul><li>Some essential issues to resolve </li></ul>HINZ 2009
  19. 19. Five drivers of change <ul><li>New ways of collecting data </li></ul><ul><li>Richer information </li></ul><ul><li>Bigger markets for relevant technologies </li></ul><ul><li>Technology as an enabler </li></ul><ul><li>Increasing partnerships </li></ul>HINZ 2009
  20. 20. 1a. New ways of collecting data <ul><li>new sensors </li></ul><ul><ul><li>wearable devices </li></ul></ul><ul><ul><li>devices that measure things that previously couldn't be measured </li></ul></ul><ul><ul><li>devices that can measure more accurately, more frequently, more conveniently, at less cost </li></ul></ul><ul><li>miniaturisation </li></ul><ul><ul><li>data can be collected in ways that were not feasible </li></ul></ul><ul><ul><li>reduced discomfort to patient </li></ul></ul>HINZ 2009
  21. 21. 1b. New ways of collecting data <ul><li>development and reduced cost of mobile devices </li></ul><ul><li>wide availability and low cost of mobile networking </li></ul><ul><li>ubiquity of web-based apps as a user interface </li></ul>HINZ 2009
  22. 22. 2. Richer information <ul><li>Reduced cost of networking and data storage means more data can be shared in more places </li></ul><ul><li>Easier to store/transmit complete record </li></ul><ul><ul><li>Reduced pressure to summarise (and thereby lose) information </li></ul></ul><ul><li>Images of various types can be used in preference to text </li></ul>HINZ 2009
  23. 23. 3. Bigger markets for relevant technologies <ul><li>Partly due to people's increasing </li></ul><ul><ul><li>familiarity </li></ul></ul><ul><ul><li>ability </li></ul></ul><ul><ul><li>willingness </li></ul></ul><ul><ul><li>to use technology </li></ul></ul><ul><li>Partly due to demands on providers to invest in technology </li></ul><ul><li>Partly due to internationalisation of markets </li></ul>HINZ 2009
  24. 24. 4. Technology as an enabler <ul><li>Technology enables care to be given by wider range of care professionals: </li></ul><ul><ul><li>nurses instead of doctors </li></ul></ul><ul><ul><li>junior doctors instead of consultants </li></ul></ul><ul><ul><li>general practitioners rather than hospital doctors </li></ul></ul><ul><ul><li>nursing auxiliaries instead of registered nurses </li></ul></ul><ul><ul><li>care workers rather than health workers </li></ul></ul><ul><li>Technology enables care to be given by: </li></ul><ul><ul><li>the patient him/herself </li></ul></ul><ul><ul><li>their friends, family and neighbours </li></ul></ul>HINZ 2009
  25. 25. 5. Partnerships <ul><li>Increasing number of partnerships between health and care providers </li></ul><ul><li>Existing partnerships are becoming better recognised </li></ul><ul><li>Partnerships tend to break down barriers to information sharing </li></ul><ul><li>New partnerships between: </li></ul><ul><ul><li>public and private sector organisations </li></ul></ul><ul><ul><li>health sector and social care </li></ul></ul><ul><ul><li>professionals and patients </li></ul></ul>HINZ 2009
  26. 26. Why collect data near the patient? <ul><li>Make quality part of the process </li></ul><ul><li>Make collecting data an integral part of the clinical process (not an extra) </li></ul><ul><li>Best quality data goes directly into the information system without human intervention </li></ul><ul><ul><li>no transcription errors </li></ul></ul><ul><ul><li>no &quot;judgement&quot; or &quot;coding&quot; getting in the way </li></ul></ul><ul><li>Second best comes from closing the feedback loop </li></ul><ul><ul><li>patient is usually best quality checker </li></ul></ul><ul><ul><li>clinician who records information is next best </li></ul></ul><ul><ul><li>make data visible to patient at time of collection </li></ul></ul>HINZ 2009
  27. 27. What isn't &quot;near&quot; the patient? <ul><li>Location shifting </li></ul><ul><ul><li>patient (or a sample from them) has to go somewhere else for some information to be collected </li></ul></ul><ul><li>Time shifting </li></ul><ul><ul><li>information not available until some period after it is required or desired </li></ul></ul><ul><ul><li>delay may be consequence of location shifting; or </li></ul></ul><ul><ul><li>delay in arranging for test; or </li></ul></ul><ul><ul><li>delay in obtaining results </li></ul></ul>HINZ 2009
  28. 28. What is &quot;near&quot; the patient? <ul><li>During clinical session (while clinician with patient) </li></ul><ul><li>Within patient's sight and sound </li></ul>HINZ 2009
  29. 29. Sources of information <ul><li>Hospital in-patient records </li></ul><ul><li>Hospital out-patient records </li></ul><ul><li>GP and other primary care records </li></ul><ul><li>Out of hours services </li></ul><ul><li>Ambulance service </li></ul><ul><li>Treatment/walk-in centres </li></ul><ul><li>Pharmacies </li></ul><ul><li>Opticians, dentists, … </li></ul><ul><li>Patient self-testing </li></ul><ul><li>Home monitoring </li></ul><ul><li>Care home monitoring </li></ul><ul><li>Friends and family </li></ul><ul><li>Sport/leisure monitoring </li></ul><ul><li>Workplace monitoring </li></ul><ul><li>Many more … </li></ul>HINZ 2009
  30. 30. HINZ 2009
  31. 31. Future sources of data <ul><li>Observations (informal) from family, friends or neighbours </li></ul><ul><ul><li>integration in email, calendar or mobile phone systems </li></ul></ul><ul><li>Monitor use of credit/debit cards, travel passes and other forms of identification/entitlement </li></ul><ul><li>Supermarket loyalty schemes provide information about food buying (link to obesity) </li></ul><ul><li>Genomic information </li></ul>HINZ 2009
  32. 32. Opportunities of quality <ul><li>Information contributing to improving processes </li></ul><ul><ul><li>decision support </li></ul></ul><ul><ul><li>better care (spot outliers) </li></ul></ul><ul><ul><li>identify deterioration </li></ul></ul><ul><ul><li>predict adverse outcome and prevent </li></ul></ul><ul><li>Audit to gain knowledge </li></ul><ul><ul><li>symptoms </li></ul></ul><ul><ul><li>diagnosis </li></ul></ul><ul><ul><li>treatment </li></ul></ul><ul><ul><li>outcome </li></ul></ul>HINZ 2009
  33. 33. Opportunities of quantity <ul><li>Population-level analyses </li></ul><ul><li>Models to assess risk to individual patient, e.g.: </li></ul><ul><ul><li>mortality </li></ul></ul><ul><ul><li>morbidity (e.g. bed stays, frequent flyers) </li></ul></ul><ul><li>Specialise/focus on: </li></ul><ul><ul><li>specific medical condition </li></ul></ul><ul><ul><li>specific physiological state (incl. age, chronic condition) </li></ul></ul><ul><ul><li>environmental factors </li></ul></ul><ul><li>Monitor patient's whole life rather than episodes </li></ul>HINZ 2009
  34. 34. Issues 1 <ul><li>Integrating data </li></ul><ul><ul><li>common means of identifying patients </li></ul></ul><ul><ul><li>provenance (quality) of data </li></ul></ul><ul><ul><ul><li>accuracy </li></ul></ul></ul><ul><ul><ul><li>confidence levels </li></ul></ul></ul><ul><ul><ul><li>context </li></ul></ul></ul><ul><ul><li>quantity of data is always going to be an issue </li></ul></ul><ul><ul><li>much data is redundant but you don't know which </li></ul></ul><ul><ul><li>timeliness (for diagnosis or prevention) </li></ul></ul><ul><ul><li>centralisation (logically yes, but often physically no) </li></ul></ul>HINZ 2009
  35. 35. Issues 2 <ul><li>Confidentiality and privacy </li></ul><ul><ul><li>spectre of Big Brother </li></ul></ul><ul><li>Convenience or expediency often trumps security </li></ul><ul><ul><li>in which case, obtaining consent is meaningless </li></ul></ul><ul><li>Many patients assume that their records are already integrated </li></ul>HINZ 2009
  36. 36. Challenge <ul><li>Not about the technology </li></ul><ul><li>It's about engineering services to ensure that the right (quality) information is collected, gets to and is used in the right place at the right time </li></ul>HINZ 2009
  37. 37. Summary The personal health service needs excellent information about its patient HINZ 2009
  38. 38. http://www.chmi.port.ac.uk [email_address] HINZ 2009

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