How will technology shape care delivery and design in future.
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
• 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 ?
Trust-marked reference sources
Cancer etc. support forums
Online personal electronic health records
Telehealth to support self care in long term
For health services:
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”
Why digital healthcare ?
Old model of care
Focus on acute conditions, reactive
Hospital centred, disjointed
Patient as passive recipient; self
Information & Communications
Technology (ICT) used rarely
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
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
Source: NHS Policy Unit. United Kingdom figures.
Demand for care
Demographic challenges to NHS capacity
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 ?
• 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
• Home robotics – lifting, stairs, bath, butler robot ?
• Central locking, smart environmental control (Nest)
Implanted CardioMEMS sensor & transmitter in distal branch of descending PA
External device sending data to home hub; on screen questions and chart
Work of Dr Shiva
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
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
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
• 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 /
Community health hub
• Analogies: rural telehubs; office space by the hour
• More likely now councils taking increased role, ageing
• Could house telepresence, haemodialysis,
chemotherapy infusion equipment
A new kind of workforce ?
• More junior staff
supported by decision
• Telepresence robots
• Domestic / delivery
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?)
The potential of home based self
management in LTCs
1. Agree therapeutic objectives
2. Provide education about the early signs of
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)
• Hospitals get more specialist
• Extensive use of VC facilities + data analytics
• “Hospital discharge” is not about leaving the
building – RCP Future Hospital Commission
potential influence of citizen science
and patient controlled research ?
Citizen Science – CRUK
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participants, said to show 1% increase in online word recall
exercises. Pub online / conf posters.
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 (?)
Face to face Letter Telephone Digital
Mean public sector cost per completed encounter
across 120 councils
Source: Cabinet Office Digital efficiency report, 2013
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 much on
complementary therapies as NHS spends on community
• Those who can, might opt for old fashioned, face-to-face,
APEASE criteria for success in HC
Effective, cost effective
Safety, side effects
Source: Michie et al. The Behaviour change wheel, 2015: 22
• Clients for health architecture will become more
• Healthcare will become (much ?) less centralised
• 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