Empowering Patients - I am not a number, I am a free man or woman Michael Lewis Digital Health Assembly: Open Innovation 2015

1. EMPOWERING PATIENTS
“I am not a number I am a free wo/man”

2. EMPOWERING PATIENTS

3. ANYONE REMEMBER THAT SERIES?
•When was it from
•Where was it filmed
•Sub-text…..
−Individual versus the collective
−Information
−More information

4. LOOK AT THE MEETING THEMES
•Innovative business models
•Empowering patients and staff
•Big Data
•Who is driving the agenda?
Users or the technology providers

5. EMPOWERING PATIENTS AND STAFF
•Empowering comes from knowledge
•Knowledge is synthesised information
•Information is collated data
•Data is the raw source material

6. TECHNICALLY….
•Information shift:
%age of global available processing
power
Pocket
Calculators
PCs Video
Game
consoles
Servers
Mainframe
Phones
PDA
1986 41% 33% 9% 17% 0%
2014 <0.1% 60% 25% 3% 12%

7. TECHNICALLY
•Information shift:
%age change in global storage
capacity
Analogue Storage Digital Storage
1986 2Bn Gb 20M Gb
2014 18Bn Gb 276Bn Gb
9x 13,800x

8. TECHNICALLY
•Information shift:
•In 2014 there was 39Gb of storage for
every human on the planet
•That’s 25 HD movies of data
•Enough to store your genome 20x

9. PHYSIOLOGICALLY
•86Bn neurons
•1000 connections
•100Tb data
•Most assume we can
store more like 2.5
Petabytes of data
•Human storage outstrips
stored data by 100x

10. BUT BY 2020
•Applying Moore’s Law
what is stored about us will
exceed our capacity for
storage by 2030
•But storage has
consistently broken
Moore’s Law
•More likely storage about
us will exceed our
capacity by 2020

11. AND JUST AFTER
•Looking at pure processing
power
•Ray Kurzweil estimates
machine speed of
processing will exceed
human brain speed by
2023

12. HOW DOES THIS AFFECT EMPOWERING
Capacity to store
Ability to process the data
Can be liberating if applied to the right tasks
Can be limiting too

13. FOCUS ON HEALTHCARE

14. TAKE A STEP BACK
UK HEALTHCARE MODEL DATES FROM THE 1940’S
1948 2014
Life expectancy (1) Male 66
Female 71
Male 78
Female 82
UK population (1) 50.3M 64.1M
Major challenges Infection
Nutrition
Death in childbirth
Diabetes
Obesity
Cancer
Major medical
advances
Penicillin
Kidney dialysis
Stem cells therapy
Spinal nerve
regeneration
Infant mortality
(1000 births) (1)
42 4
Budget £437M (2)
(£9Bn at 2014 prices)
£110Bn
(1) Century of Change
(2) NHS Choices

15. TAKE A STEP BACK
UK HEALTHCARE MODEL DATES FROM THE 1940’S
1948 2014
Life expectancy (1) Male 66
Female 71
Male 78
Female 82
UK population (1) 50.3M 64.1M
Major challenges Infection
Nutrition
Death in childbirth
Diabetes
Obesity
Cancer
Major medical
advances
Penicillin
Kidney dialysis
Stem cells therapy
Spinal nerve
regeneration
Infant mortality
(1000 births) (1)
42 4
Budget £437M (2)
(£9Bn at 2014 prices)
£110Bn
(1) Century of Change
(2) NHS Choices

16. TAKE A STEP BACK
UK HEALTHCARE MODEL DATES FROM THE 1940’S
1948 2014
Life expectancy (1) Male 66
Female 71
Male 78
Female 82
UK population (1) 50.3M 64.1M
Major challenges Infection
Nutrition
Death in childbirth
Diabetes
Obesity
Cancer
Major medical
advances
Penicillin
Kidney dialysis
Stem cells therapy
Spinal nerve
regeneration
Infant mortality
(1000 births) (1)
42 4
Budget £437M (2)
(£9Bn at 2014 prices)
£110Bn
(1) Century of Change
(2) NHS Choices

17. TAKE A STEP BACK
UK HEALTHCARE MODEL DATES FROM THE 1940’S
1948 2014
Life expectancy (1) Male 66
Female 71
Male 78
Female 82
UK population (1) 50.3M 64.1M
Major challenges Infection
Nutrition
Death in childbirth
Diabetes
Obesity
Cancer
Major medical
advances
Penicillin
Kidney dialysis
Stem cells therapy
Spinal nerve
regeneration
Infant mortality
(1000 births) (1)
42 4
Budget £437M (2)
(£9Bn at 2014 prices)
£110Bn
(1) Century of Change
(2) NHS Choices

18. TAKE A STEP BACK
UK HEALTHCARE MODEL DATES FROM THE 1940’S
1948 2014
Life expectancy (1) Male 66
Female 71
Male 78
Female 82
UK population (1) 50.3M 64.1M
Major challenges Infection
Nutrition
Death in childbirth
Diabetes
Obesity
Cancer
Major medical
advances
Penicillin
Kidney dialysis
Stem cells therapy
Spinal nerve
regeneration
Infant mortality
(1000 births) (1)
42 4
Budget £437M (2)
(£9Bn at 2014 prices)
£110Bn
(1) Century of Change
(2) NHS Choices

19. TAKE A STEP BACK
UK HEALTHCARE MODEL DATES FROM THE 1940’S
1948 2014
Life expectancy (1) Male 66
Female 71
Male 78
Female 82
UK population (1) 50.3M 64.1M
Major challenges Infection
Nutrition
Death in childbirth
Diabetes
Obesity
Cancer
Major medical
advances
Penicillin
Kidney dialysis
Stem cells therapy
Spinal nerve
regeneration
Infant mortality
(1000 births) (1)
42 4
Budget £437M (2)
(£9Bn at 2014 prices)
£110Bn
(1) Century of Change
(2) NHS Choices

20. TAKE A STEP FORWARD
FORCES ACTING ON THE OBJECT..
Health
Care
Provision
Consumer
demand
more
Tech &
individual
care
Costs are
increasing
Life-span
is
increasing
Consumer
knows
more
Co-
morbidity
Delivery
Budgets
restricted

21. CONSIDER THE DIFFERING AGENDAS
WHO IS THE DRIVER, WHO IS THE PASSENGER
ay
Patient
Deliverer
Provider
Payor

22. DIFFERING AGENDAS
PATIENTS AGENDA
• Wants the best care for themselves and family
because they paid for it (indirectly or directly)
• Want to know it is there if needed, safety-net
• Is informed about what the alternatives are
• Has access to basic data eg NHS Choices
• Will get access to more data eg FFT
• PAC to A->A
• Immediacy
• Service mentality

23. DIFFERING AGENDAS
DELIVERERS AGENDA
• Wants to give the best care possible
• Pressured by bureaucracy, top down imposed
systems and paper-filling
• Does not appreciate hyper-informed patients
• Is concerned about metrics, tools,
transparency
• Wants to know about innovations, and how
they will be paid for
• Not a Service mentality, it’s a vocation

24. DIFFERING AGENDAS
PROVIDERS AGENDA
• Wants to give the best care possible
• Is concerned about metrics, tools,
transparency, efficiency, standards, (No
Stafford here please)
• Pressured by finance and budget constraints,
frequent system changes
• Over-whelmed by reporting, and paper-filling
• Has a service mentality

25. DIFFERING AGENDAS
PAYORS AGENDA
• Wants to give the best care possible as
recognises health = wealth
• Wants to drive a ‘healthy agenda’ to address
health challenges
• Trying multiple systems to squeeze efficiency
• Complex delivery system so requesting
reporting, and paper-filling to compensate for
insight

26. DIFFERING AGENDAS
WHO IS THE DRIVER, WHO IS THE PASSENGER
• What are the common themes
• Demand increasing, age, co-morbidity, lack of
incentive to improve, neuro-degenerative
conditions, cost of care
• Need to drive efficiency, but without the top
down imposition of systems, being able to
deliver more for less
• Culture clash --- one man’s transparency is
another man’s exposure

27. HELLO BRICK WALL

28. COST PRESSURES
%GDP spent on healthcare will need to nearly double

29. COST PRESSURES
%GDP spent on healthcare in UK up 50%

30. DIGITAL IS GAME CHANGER
INNOVATION AT THE INTERFACES
• Most creativity and innovation occurs when
different worlds collide such as digital and
healthcare

31. EMPOWERING/ENABLING
1. Micro/mobile-systems
2. myHealth
3. Personalised medicine
4. Portable records

32. MICRO-SYSTEMS
Bringing health IT into the 21st century
Individual v the Collective

33. MICRO/MOBILE SYSTEMS
THE REVOLUTION IS ALREADY HERE IN OTHER SECTORS
100M wearables by 2018

34. DON’T WORRY BE ‘APPY
THE REVOLUTION IS ALREADY HERE IN OTHER SECTORS
• Centrally designed, centrally deployed
systems have failed multiple time
• Small systems leveraging existing technology
will be the norm

35. DON’T WORRY BE ‘APPY
THE REVOLUTION IS ALREADY HERE IN OTHER SECTORS
• Booking medical appointments on your phone
• Repeat medication, results
• Phone becomes your portal to health
• Becomes your portal for your family’s health
• Personal, private, pervasive, portable.

36. DON’T WORRY BE APPY
SCALABLE & DELIVERABLE
0 200 400 600 800
UK repeat prescriptions
Flights on UK airlines
M per year
5000
163
0 1000 2000 3000 4000 5000 6000
GP appointments
Ocado orders
000 per week

37. DON’T WORRY BE ‘APPY
HOW WILL MOBILE EMPOWER THE PATIENT
• What does the future
look like
• Check you in for
appointments by geo-
location when you are
50m from practice
• Notes ready with
Physician
• Know where to go
• Know how long the wait
is
• This is all possible today

38. MYHEALTH
Taking responsibility for your self
Using technology to direct interactions
with healthcare delivers

39. MYHEALTH
IF I DON’T LOOK AFTER ME WHO WILL?
• We will all be rewarded for looking after our
own health
• Access to treatments/reductions in cost

40. MYHEALTH
MY DATA WILL BE WEARABLE SHAREABLE & MAYBE UNBEARABLE
• Asynchronous appointments, empowering
inclusion, concurrent not transactional
• Less Sherlock Holmes/House more caring
conversations

41. PERSONALISING HEALTH
I am not a number, I am a series of
numbers
Upfront, personal and revealing

42. PERSONALISED MEDICINE
DIGITAL INNOVATION GOING TO IMPACT: GENOMICS
• In the past it took 13 years and $2bn to read the first
human genome, now it takes 2 days and £1,000
• 7 Impacts:
− 3.5millionUK citizens will suffer from a rare
disease, 75% are children and most die before
age 5.
− Power to stratify medication according to
disease
− Power to exclude/include antibiotics to where it
will work
− Reduction in imaging diagnostic usage
− Increase in regular patient monitoring when
conditions known but not yet expressed i.e.
increased primary care burden
− Care pushed to tertiary/quaternary and
reduction in secondary/DGH usage
− Increased usage of monitoring technologies

43. PERSONALISED MEDICINE
DIGITAL INNOVATION AND GENOMICS
• Have to develop ability/ethical
climate to store/access/distribute
data
(not another care.data) and
explain why it is beneficial
• Storage
− Each Human genome requires
1.4Gb space
− UK requires 70 Petabytes (1PB =
1 million Gb)
− Storage costs for UK £15m
− In 1994 a PB storage would
have cost $100 Billion, in 2014
cost is $120,000
− Today we can read/transfer 1
full Genome every 2 seconds
• Public v Private

44. PERSONALISED DIAGNOSIS
HOW IS DIGITAL INNOVATION GOING TO IMPACT: NEUROPSYCH DIAGNOSIS
• 820,000 people with dementia in the UK,
will double by 2034
• Tested many products in 11 years and
premature big hopes for bapineuzamab
and solanezumab
• At Cambridge Cognition the IP is 28 years
of neuropsychological test data,
hundreds of 1000’s of data points and
norms, stored in
Cloud
• Used power of big data to develop tests
for early
identification of Alzheimer’s, ADHD,
depression, anxiety, schizophrenia,
Parkinson’s.

45. PERSONALISED DIAGNOSIS
HOW IS DIGITAL INNOVATION GOING TO IMPACT: NEUROPSYCH DIAGNOSIS
• No biomarker, disease is hard to
diagnose, no
accurate imaging
• Taken power of big data and
developed an iPad based 5 minute test
to reassure the ‘worried-well’ and
identify really early dementia
• Personalised medical approach to give
the right treatment to the right patient,
and where no treatment required, no
costs
• In 10,000 tests, 50% were ‘normal’ and
reassured, 25% needed extra referral

46. PORTABLE RECORDS
These are my numbers, but I am happy
to share if you ask nicely

47. PORTABLE RECORDS
EMPOWERING THROUGH OWNERSHIP
• Top use for Evernote in USA is for storing personal
health records
• Move away from them being my records about you
to your records
• Benefits
− Entitlement to care
− Improved emergency care
− Move providers easier
− Sharing between providers
• Challenges
− Letting go
− Privacy
− Security

48. EMPOWERING
• Why hasn’t this happened already?

49. DIGITAL IS A GAME CHANGER
• External drivers are pushing
• Technology is pulling
• Patients are asking
• Medical profession is cautious
• Possibilities are enormous

50. DIGITAL IS A GAME CHANGER
• External drivers are pushing
• Technology is pulling
• Patients are asking
• Medical profession is cautious
• Possibilities are enormous

51. DIGITAL IS A GAME CHANGER
• External drivers are pushing
• Technology is pulling
• Patients are asking
• Medical profession is cautious
• Possibilities are enormous

52. •Thanks……………………….