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How will digital healthcare shape
future care delivery and design ?
Prof Jeremy Wyatt
Leadership Chair in eHealth Research...
Agenda
• What is digital healthcare ?
• Some examples
• Why digital healthcare ?
• Where will care be delivered in future,...
For public:
Trust-marked reference sources
Cancer etc. support forums
Online personal electronic health records
Telehealth...
Instant messaging triage by NHS Direct nurse
Devices to support digital healthcare
Helping Hand medicine
reminder
www.medicom.com
Ambient orb to monitor health
status ...
Second Life & serious games
Health Info Island - UNC Chapel Hill & Cleveland Public Library
Not a new idea,
in fact…
Why digital healthcare ?
Old model of care
Focus on acute conditions, reactive
management
Hospital centred, disjointed
epi...
Health care professionals may only interact with people with a
chronic disease for a few hours a year…
the rest of the tim...
Source: NHS Policy Unit. United Kingdom figures.
Demand for care
Labour supply
Demographic challenges to NHS capacity
Questions an architect might ask
Who is the client: NHS, local govt (Manchester);
CIC / SE; commercial (Circle Hinchinbroo...
Home / community care
Active homes
• Sensors to monitor activities of daily living
• Self monitoring medicine cabinet
• Reminders to eat, throw ...
Implanted CardioMEMS sensor & transmitter in distal branch of descending PA
External device sending data to home hub; on s...
Review of
46
trials in
heart
failure –
mortality
Work of Dr Shiva
Sathanandam
A future virtual health scenario
Mrs Smith has high blood pressure and wakes
with a headache. She worries that her implant...
Some issues
• Privacy in your own home ?
• Connecting in real world to supplement virtual
• Using tech to enable:
– friend...
Community health hub
• Analogies: rural telehubs; office space by the hour
• More likely now councils taking increased rol...
Not this…
On the road… ubiquitous healthcare
• Connected car
• ECG sensors in seat back
• Support for self management in diabetes,
a...
Hospital care
Trial of teledermatology to prevent GP referrals
With Depts. of Medical Informatics and Primary Care, AMC Amsterdam
Closing the clinics ?
A new kind of workforce ?
• More junior staff
supported by decision
support systems,
protocols
• Telepresence robots
• Dom...
What must we do in real world ?
• History taking (tele-presence ?)
• Clinical examination, palpation (kiosk with haptics ?...
The potential of home based self
management in LTCs
1. Agree therapeutic objectives
2. Provide education about the early s...
Some implications
• Hospitals get more specialist
• Extensive use of VC facilities + data analytics
• “Hospital discharge”...
Research centres:
potential influence of citizen science
and patient controlled research ?
Citizen Science – CRUK
Cell slider
• Your Contribution Matters
• 2331103 images already
analysed
• Join thousands of other...
Crowd sourcing: potholes & cyclists
http://thepotholegardener.com/page/2/
www.potholes.co.uk – funded by
Warranties direct
Asthmopolis
• Photo of airbus A380
Quantified Self studies
• QS: 28 founder members in SF 2008, 5524 in 42 groups early
2012
• Butter Mind study – RCT with 4...
Summary - benefits of digital healthcare
• Allows patients and carers to do more
• Responsive to user needs:
– “Disinterme...
Financial benefits
£8.60
£5.00
£2.83
£0.15
£0
£1
£2
£3
£4
£5
£6
£7
£8
£9
£10
Face to face Letter Telephone Digital
Costin£...
We can fly airplanes remotely – but should we ?
Holistic health service ?
• Risk of a “Great Revulsion” (Muir Gray), eg GM foods
• In Cheltenham people already spend as m...
APEASE criteria for success in HC
Affordability
Practicality
Effective, cost effective
Acceptable
Safety, side effects
Equ...
Some conclusions
• Clients for health architecture will become more
diverse
• Healthcare will become (much ?) less central...
How will technology shape care delivery and design in future.
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How will technology shape care delivery and design in future.

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Talk on 'How will Technology Shape Care Delivery and Design in Future' for AfH AGM at RIBA Feb 2015.

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How will technology shape care delivery and design in future.

  1. 1. How will digital healthcare shape future care delivery and design ? Prof Jeremy Wyatt Leadership Chair in eHealth Research Clinical advisor on new technology, Royal College of Physicians
  2. 2. Agenda • What is digital healthcare ? • Some examples • Why digital healthcare ? • Where will care be delivered in future, and what will happen there ? – Care outside hospital – Care in hospitals – The role of clinical research organisations • How to judge if this is useful ? • Conclusions
  3. 3. For public: Trust-marked reference sources Cancer etc. support forums Online personal electronic health records Telehealth to support self care in long term conditions Cyber doctor For health services: eLearning Transcription of dictated reports Remote reporting of X rays, pathology slides Remote control of surgical robots What is digital healthcare “Redesigned services supported by appropriate digital technologies”
  4. 4. Instant messaging triage by NHS Direct nurse
  5. 5. Devices to support digital healthcare Helping Hand medicine reminder www.medicom.com Ambient orb to monitor health status www.ambient.com Diabetes monitor & insulin pump
  6. 6. Second Life & serious games Health Info Island - UNC Chapel Hill & Cleveland Public Library
  7. 7. Not a new idea, in fact…
  8. 8. Why digital healthcare ? Old model of care Focus on acute conditions, reactive management Hospital centred, disjointed episodes Doctor dependent Patient as passive recipient; self care infrequent Information & Communications Technology (ICT) used rarely Technology dominates New model Focus on long term conditions, prevention & continuing care Integrated with people’s lives in homes & communities Team based, shared record Patient as partner; self care encouraged & supported Dependent on ICT & devices Clinical needs dominate
  9. 9. Health care professionals may only interact with people with a chronic disease for a few hours a year… the rest of the time patients care for themselves… Access to health professionals
  10. 10. Source: NHS Policy Unit. United Kingdom figures. Demand for care Labour supply Demographic challenges to NHS capacity
  11. 11. Questions an architect might ask Who is the client: NHS, local govt (Manchester); CIC / SE; commercial (Circle Hinchinbrooke); person with LTC eg. home dialysis What does the client want / need ? What activities must the space support ? How to know if it’s successful ?
  12. 12. Home / community care
  13. 13. Active homes • Sensors to monitor activities of daily living • Self monitoring medicine cabinet • Reminders to eat, throw away time-expired food… • RITA – avatar for people with dementia / frail elderly alone • Charging zones for wearables, smart phones, measurement devices • Home robotics – lifting, stairs, bath, butler robot ? • Central locking, smart environmental control (Nest)
  14. 14. Implanted CardioMEMS sensor & transmitter in distal branch of descending PA External device sending data to home hub; on screen questions and chart Telehealth devices
  15. 15. Review of 46 trials in heart failure – mortality Work of Dr Shiva Sathanandam
  16. 16. A future virtual health scenario Mrs Smith has high blood pressure and wakes with a headache. She worries that her implanted drug reservoir may be empty. Her ambient health orb is a reassuring green, so she turns to her video wall and asks “Cyberdoc, how is my blood pressure recently?” The voice responds “Your drug reservoir needs a refill in 3 weeks but blood pressure readings are under control recently and normal today. Your blood sugar sensor shows normal readings too. Do you have some symptoms you want to discuss?” Meanwhile Mrs Smith’s wall graphs her recent blood pressure and lists the 20 most common symptoms in people of her age group locally. She responds, “No, don’t worry. Remind me to book my refill in two weeks, please.” Wyatt & Sullivan, BMJ 2005
  17. 17. Some issues • Privacy in your own home ? • Connecting in real world to supplement virtual • Using tech to enable: – friends & family to connect & participate in care – elderly contribution to society • What does a buggy-friendly neighbourhood look like ? Glide-in cinemas / pubs / supermarkets ?
  18. 18. Community health hub • Analogies: rural telehubs; office space by the hour • More likely now councils taking increased role, ageing population • Could house telepresence, haemodialysis, chemotherapy infusion equipment
  19. 19. Not this…
  20. 20. On the road… ubiquitous healthcare • Connected car • ECG sensors in seat back • Support for self management in diabetes, asthma ?
  21. 21. Hospital care
  22. 22. Trial of teledermatology to prevent GP referrals With Depts. of Medical Informatics and Primary Care, AMC Amsterdam
  23. 23. Closing the clinics ?
  24. 24. A new kind of workforce ? • More junior staff supported by decision support systems, protocols • Telepresence robots • Domestic / delivery robots
  25. 25. What must we do in real world ? • History taking (tele-presence ?) • Clinical examination, palpation (kiosk with haptics ?) • Psychotherapy (computer based behaviour therapy) • Taking blood etc. specimens (blood / saliva self testing, lab on chip) • Invasive procedures, surgery (kiosk with robot?)
  26. 26. The potential of home based self management in LTCs 1. Agree therapeutic objectives 2. Provide education about the early signs of deterioration 3. Elicit their own warning signs 4. Capture disease activity information 5. Give people their own information in usable form 6. Support adherence with drugs, appointments 7. Provide a safe envelope – and appropriate actions when patient moves outside it • (Wyatt & Wyatt, in preparation)
  27. 27. Some implications • Hospitals get more specialist • Extensive use of VC facilities + data analytics • “Hospital discharge” is not about leaving the building – RCP Future Hospital Commission report
  28. 28. Research centres: potential influence of citizen science and patient controlled research ?
  29. 29. Citizen Science – CRUK Cell slider • Your Contribution Matters • 2331103 images already analysed • Join thousands of others giving time to Cell Slider and become part of our worldwide collective. • Each and every click adds to our totaliser above. You can make a real difference. 30/24
  30. 30. Crowd sourcing: potholes & cyclists http://thepotholegardener.com/page/2/ www.potholes.co.uk – funded by Warranties direct
  31. 31. Asthmopolis
  32. 32. • Photo of airbus A380
  33. 33. Quantified Self studies • QS: 28 founder members in SF 2008, 5524 in 42 groups early 2012 • Butter Mind study – RCT with 45 people, showed that eating 60g of butter / day improved speed of calculation. Methods unclear, no controlling for IQ / education etc. Reported in blog 2010 • Blueberry study – running since 1999, hundreds of participants, said to show 1% increase in online word recall exercises. Pub online / conf posters. 34/23
  34. 34. Summary - benefits of digital healthcare • Allows patients and carers to do more • Responsive to user needs: – “Disintermediation” – talk direct to specialist – Delivery anywhere (mHealth), anytime (global) – Mass customisation – the long tail • Greater patient control, eg. over data (Mydex) • Better data improves quality, research • Access to a wider market – health tourism • Lower cost of delivery (?)
  35. 35. Financial benefits £8.60 £5.00 £2.83 £0.15 £0 £1 £2 £3 £4 £5 £6 £7 £8 £9 £10 Face to face Letter Telephone Digital Costin£perencounter Mean public sector cost per completed encounter across 120 councils Source: Cabinet Office Digital efficiency report, 2013
  36. 36. We can fly airplanes remotely – but should we ?
  37. 37. Holistic health service ? • Risk of a “Great Revulsion” (Muir Gray), eg GM foods • In Cheltenham people already spend as much on complementary therapies as NHS spends on community services • Those who can, might opt for old fashioned, face-to-face, holistic care
  38. 38. APEASE criteria for success in HC Affordability Practicality Effective, cost effective Acceptable Safety, side effects Equity Source: Michie et al. The Behaviour change wheel, 2015: 22
  39. 39. Some conclusions • Clients for health architecture will become more diverse • Healthcare will become (much ?) less centralised in hospitals • The type of activities carried out in hospitals will change; some staff may even work from home • Homes will need to adapt, too • Community health hubs to support people with long term conditions

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