ARK VOL.6
The Voice of Healthcare
In this issue HOMEWARD BOUND CHANGE THE RECORD THE FUTURE OF HEALTHCARE BREAKING DOWN THE BARRIERS AN EXCITING FUTURE
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HOMEWARD BOUND Technology has transformed the care of patients in hospital. But can it also help to keep them out of it? Scientists around the world are now exploring how futuristic medical devices can allow chronically ill patients to be cared for in their own homes. By Pat Hagan When I grow up, I want to be a dancer. When I leave school, I am going to work in an office. We will spend Christmas with the family and next year we will go to Scotland on holiday. From an early age, I was taught to look to the future, to think about what it will look and feel like. Whether that was years in advance or just a couple of weeks, and I still do it now. As an organised person, I like to profess that I think about everything that the future may hold, but honestly that just isn't true. I never really think about one of the most important things… my health. This may also be the case for many of us. What will our health be like in the future? What can we do to change it now? In this issue of ARK we start to explore the future of healthcare, for example, technologies such as nanosensors will monitor things we wouldn't even dream to think about and utilising smart technologies to access our own information will help us plan, putting us back at the centre of healthcare. And that is an exciting prospect. Editor, Laura Royston Editor in Chief, Rachel McClelland
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Hospitals were once places where recovery and survival depended more upon the level of care sick patients received from staff, rather than ground-breaking treatments. But in the last half-century or so, medical technology has revolutionised the diagnosis and management of almost every major disorder. From MRI scanners that detect illness hidden deep inside the body, to keyhole surgery that leaves virtually no scars, modern medicine has transformed the inhospital experience. Now science faces potentially an even greater challenge – to try and keep chronically ill patients OUT of hospital. The ageing population in developed nations means more people are living longer but with chronic illnesses that need proper management to avoid lifethreatening flare ups. In countries like the UK, these exacerbations can add to winter bedblocking that means hospitals struggle to find room for critically ill patients because wards are full with those suffering poorlymanaged chronic conditions. So what are the technology giants doing to shape future medical care? Much of the innovation centres around fine-tuning devices, systems and programs that will manage chronic illnesses roundthe-clock. The central theme is using technology to predict potential problems so that the patient, carer or doctor can take preemptive action. Patients benefit because better management means fewer risks to health.
Hospitals benefit because fewer beds are taken up with patients suffering complications that are largely preventable. Verily, formerly Google Life Sciences, is at the forefront of this change. It says its aim is to develop smaller, more compatible devices that are capable of capturing vital medical data from patients so they can be cared for more effectively. The company says: ‘We are building devices and tools that are smaller, more powerful and more convenient than ever before.’ ‘Smaller devices fit more easily into daily life so they can monitor conditions more consistently and proactively signal when something is amiss.’ ‘Information exists in every aspect of our bodies — from our genes to our sleep patterns.’ ‘Software engineers, analytics experts and user experience designers at Verily are developing platforms, products, and algorithms that can analyse complex health information.’ Its flagship product is a contact lens with an embedded glucose sensor. The hope is the lens will make it easier for millions of people with insulin dependent diabetes to monitor themselves continuously by measuring the glucose in their tears rather than having to carry out painful blood checks several times a day. Poor glucose control can lead to hospital admission through hypoglycaemia – a dangerous drop in blood sugar levels, or hyperglycaemia, where levels are too high. And in multiple sclerosis, the company is exploring the potential for wearable sensors to provide valuable clinical information on patients’ wellbeing.
One is a health tracking wristband that can measure pulse, heart rhythm and skin temperature. At the moment, it’s mainly intended for use in clinical trials, to measure how volunteers respond to drugs – but could evolve into part of a disease management program. Meanwhile, Phillips Healthcare is developing packages that help doctors with the remote management of chronically ill patients in their own homes, or in care. The eCareCoordinator is a package that provides doctors with a daily review of each of their patients, including vital data on blood pressure and weight. This allows them to prioritise patients and adjust care plans or intervene as needed. A separate program the ‘eCareCompanion’ – is for patients and allows them to answer questions about their health and enter measurements to stay connected with their care teams. Using a tablet device, patients can connect with gadgets such as home weighing scales, oximeters, blood pressure meters and even medicine dispensers, to give doctors in their surgeries a complete insight to their health. The application even reminds patents when to take their medications. Earlier this year, the head of NHS England, Simon Stevens, told the World Economic Forum that technology in the community would shape the future of health care. He said: ‘Over the next decade, major health gains won’t just come from a few ‘miracle cures’, but also from combining diverse breakthroughs in fields such as biosensors, medtech and drug discovery, mobile communications, and artificial intelligence computing.’
CHANGING THE RECORD Until fairly recently, it was easier to break into the Bank of England than access your own medical records. Now things have gone full swing, as Dr Lloyd Humphreys, Vice President of Business Development at Patients Know Best explains. By Pat Hagan Doctor says, patient does. It’s how medicine has always been practised in the UK. Questioning a GP’s medical opinion, or demanding to see medical notes, was something previous generations would never have dreamed of doing.
‘But once you give that information to patients to own a lot of the problems evaporate’.
But times have changed and so has freedom of access to information.
PKB, launched in 2008 and is like a highly secure version of Facebook.
So much so that, with Patients Know Best (PKB), ownership of vital personal health records is passing out of the hands of the medical profession and into those of patients themselves.
Patients can get online access to their latest medical records via a computer or smartphone and can grant other people access too. This links the different care teams that may be looking after them, giving them all a single view of the patient’s record, potentially making treatment and diagnosis much easier.
The idea is simple; as patients move between primary care, secondary care, mental health services, public health and social care, their medical records are supposed to follow them. But everyone knows examples of files going astray, unread or simply ignored and sharing of information between different departments and services has proved a tough nut to crack. The PKB solution is simple but radical. It allows patients to create their own personal health record and empowers them to invite any clinician, professional or family members/friends, to be a part of their health network. ‘The principle is to connect all the different sources of information, take a copy of that information and give it to the patients to own in one medical record,’ says Dr Humphreys’. ‘They can share it with whoever they trust.’ ‘And it connects all a patient’s professionals together in one place’.
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‘Currently, it is incredibly difficult for a GP to see your hospital information, or mental health trusts to view your specialist care information’.
A hospital or GP surgery subscribes to the service and then signs up patients to take control of their own account, often using a smart phone app. Because the software tallies with doctors’ own systems, any notes made during a consultation are automatically uploaded to the patient's record. Gadgets like exercise trackers, blood pressure cuffs and blood glucose monitors can plug into an iPhone and the data can be downloaded onto their records. Today, PKB is active in over 60 UK hospitals and seven countries. The key to success is to make the information platform indispensable to both patients and their professional carers, says Dr Humphreys. ‘What makes it really successful is bringing all of your professionals together in one place so that actually you can interact with them, collaborate with them and manage your care in new ways’.
‘That is when it is useful to professionals’. ‘It’s about bringing people together in one platform rather than simply giving information to an individual’. Free-flowing medical data is one thing. But what’s the evidence that PKB, or similar schemes, have any tangible benefits? There are numerous examples, Dr Humphreys says. ‘For example, there is a trauma service in North Bristol which started using PKB after surgery for traumatic injury’. ‘Using remote follow ups, they were able to reduce the number of unplanned GP visits following surgery by 28% in the first 30 days’. ‘That has a huge impact on GPs being able to offer those appointments to other people’. ‘And we are seeing that right across the board’. ‘It just drives so many efficiencies - you reduce the number of non-attendances and you free up the doctor’s time’. ‘Right now medical professionals are working in the dark because they don’t know what everyone else is doing’. ‘Being able to have a record that travels with the individual just sheds light on the entire healthcare experience. ‘And this reduces all the duplication and delays.’ Another example is Peterborough and Stamford Hospital NHS Trust, which has used PKB for its epilepsy service by using remote technology to monitor seizures.
Dr Humphreys says: ‘Rather than bring a patient into hospital to wait for a seizure to happen so you can diagnose it, actually being able to video that seizure at home and share that with your professionals just drives a lot of efficiencies in terms of reduction in bed days’. ‘It’s a much better patient experience because it is less stressful and the actual seizure that you get to see drives a much better clinical diagnosis’. ‘This is the whole principle about PKB, which is why it is so important’. ‘It can drive patient experience, change the nature of the relationship and also saves the NHS a huge amount of money.’ But it’s not just about health. In the past, failure to connect between health care and social care has been a major issue. PKB hopes to bridge the gap, says Dr Humphreys.
‘For example, we are working with Staffordshire and Stoke on Trent Partnership Trust, one of the largest community trusts, which is a joint health and social care organisation’.
‘So empowering patients to care for themselves involves lots of cultural challenges.’
‘It will allow us to cover the entire population of Staffordshire’.
‘But now the door to patients owning their own records has been given a good push, there is no going back’, says Dr Humphreys.
‘In London, we are involved in a project connecting 400 GP surgeries, six acute hospital trusts, four social care boroughs and two mental health trusts’. ‘So it doesn’t matter if you are a social worker, mental health practitioner or work in A&E, you will be able to see one record.’ But he admits this cultural change won’t come easily to health professions trained to safeguard information. ‘Sharing your information with patients wasn’t originally how doctors were trained’.
It’s still relatively early days for PKB.
‘I think we will be the owners of our own healthcare and managers of our own healthcare and that service design and delivery will be wrapped around the individual collaboration with your network’. ‘And medical practitioners will all be using technology as the primary driver of healthcare management’. ‘But I also think we will be able to start to shift the balance away from ill-being to wellbeing through prevention and personalised medicine.’
If you’d like to share your story, email arkmagazine@cmemedical.co.uk
THE FUTURE OF HEALTHCARE Barry Shrier is a serial entrepreneur, CEO and Founder of London-based Health Tech Innovation Labs (HTI Labs). An American by birth, Barry has spent much of his working life in the UK successfully working in and then, just as successfully, exiting the tech sector. By David Jacobs, Principal Health Writer
Better placed than many to offer insights into today’s healthcare trends, David Jacobs from Lewis-Barned discussed with him how he expects emerging healthcare technology to contribute towards the creation of a more sustainable and affordable model of wellness. For those of you unfamiliar with HTI Labs you need to know that Shrier started the business in 2014 to collect, connect and then support healthcare innovators, entrepreneurs and financiers to ‘improve the health of humanity’. The business seeks to achieve this mission by boosting innovation and entrepreneurship in health related technology. Shrier says he was motivated to apply his skill
set to healthcare (which he describes as a ‘beautiful and noble’ profession) when he came to understand that his own father had lived out a long life in good health and free of pain thanks, in no small measure, to the excellent healthcare he received.
Core issues identified
Public healthcare systems and finances are under considerable strain due to longer lives and an ageing population in virtually every country of the world. Along with this comes a growing incidence of so-called lifestyle conditions that are associated with greater economic prosperity and higher disposable incomes, such as Type II Diabetes. As Shrier says, this presents a global challenge that must be tackled for the good
of society. Shrier sees innovation in healthcare technology as part of the solution to this challenge and one that also offers the prospect of improved outcomes for less expenditure. He offers a simple example of
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the potential efficiency gains to be had from the rapid adoption of healthcare technology using the case of a GP and her patients who engage in ‘telemedicine’. Here the initial consultations are conducted over the
phone/videophone. This is easier, faster, and cheaper, and enables the GP to provide more consultations with more patients during the course of the day.
The need to move from ‘sick care’ to ‘healthcare’ According to Shrier, part of the solution is for all of us to recognise that we have to look after our own health. As he says: “The provision of health services throughout history is one characterised by sick care, not healthcare. If you are unwell, you go to your doctor; if you need something more serious, you go to hospital; if you have a problem, you take a pill or have surgery. In other words, if you are sick then you seek care and the medical profession looks after you.” As we ‘move beyond the pill’, Shrier sees an opportunity to use education and technology to move the healthcare industry towards enabling self-managed healthcare; a form of healthcare that involves healthier living, better diets, preventative medicine and more timely medical interventions. This advance involves everyone using healthcare and tech to improve, and take responsibility for, their own health and wellbeing. Shrier observes that this is already happening slowly with things like smart watches, smartphones and apps, explaining that it’s also an enticing model financially, offering us “the opportunity to save billions of pounds every year.” According to Shrier, new monitoring and delivery technologies also offer our ageing population the chance to move from the high cost elder care setting of a hospital, a setting
that patients and their families typically don’t want, to lower cost elder care that can be effectively delivered at home, the very place most patients would prefer to be cared for if they had the choice.
Responding to a societal need
Delivering such a shift within any single healthcare market is challenging – and global delivery shifts the challenge to another level. However, the creation of HTI Labs is Shrier’s response to meeting this challenge head on. Enabling, facilitating, and supporting people – including engineers, medics and businesses – with great ideas for new tech based wellness products, attracting enthusiastic investors, and then successfully helping entrepreneurs and innovators commercialise their products is at the heart of the HTI Labs global service.
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BREAKING DOWN THE BARRIERS Telehealth and telecare can transform the way we deliver healthcare but the real challenge is overcoming resistance in the NHS. That is the frank message from Angela Single, healthcare technology trailblazer and a key industry thought leader. Angela, a registered general nurse by background, has held a number of senior posts in the NHS and has spearheaded the introduction of healthcare technology in a variety of settings, including establishing Healthwatch - the first telehealth service in the UK overcoming on By Julie Penfold the ground resistance in the NHS. Having established Healthwatch and Primecare, a community support service for high needs patients, Angela went on to develop the first international integrated telehealth and telecare code of practice. Her 18-year career in healthcare technology has also included roles as chair of the Department of Health sponsored 3millionlives industry group and clinical director at BT Global Health. “I’ve spent the last 18 years developing solutions for healthcare and I like to think I was the first person to bring the telehealth model to the UK,” says Angela. “In the beginning, people didn’t really understand the difference technology can make, yet technology has significantly changed our day-to-day lives. Patients want healthcare to be the same. I was at meeting at the Kings Fund - and spoke to a group of specialist registrars who explained they had antenatal patients asking why they needed to go to a clinic. They wanted to know why they couldn’t just log on and access their healthcare as they would to book plane tickets or make a bank payment. We have challenges from patients and service users to come up with innovative solutions and we tend to be very slow in making changes.”
BARRIERS TO INNOVATION IN HEALTHCARE
As an executive MBA alumni of Judge Business School, University of Cambridge, Angela specialises in advising healthcare organisations, start ups and SMEs on technology development which solves real clinical and healthcare problems. She has an in-depth understanding of the challenges around developing and implementing technology in healthcare and 8
admits the financial climate has presented issues around funding innovation. In June, NHS England announced plans to provide a new funding route for medtech innovations. This new route will include the introduction of an innovation and technology tariff category to accelerate uptake across the NHS of new devices and apps for patients with long-term health conditions such as diabetes, asthma and heart conditions. It also aims to fund new healthcare innovation for a wider range of health conditions such as infertility, pregnancy, weight management and common mental health disorders. The new tariff is something Angela is knowledgeable on as it was part of plans discussed during her time as chair of 3millionlives. She still feels, however, that it is difficult to get to the implementation stage within the NHS as funding and resistance remain key barriers. “I advise a lot of start-ups and they may have something that is really good and that achieves a solution but it’s difficult still to get it into the NHS,” she says. “Innovation requires people to think differently and there is still resistance among our professional colleagues around accepting technology in healthcare. We love using it in our personal lives but the NHS can be a little more tech-phobic. I have come across nurses that have no confidence in their technology skills and I recently worked on a health care project where some healthcare staff had no access to email. We are so far behind in the NHS. “One of the reasons I’m so passionate about using telehealth and wearables in healthcare is they make such a difference to patients lives, particularly those living long-
term with chronic disease,” she adds. “Technology can help patients to manage their condition and it can help with monitoring. Patients can become better connected with their GP or practice nurse through technology but I think our clinicians at times don’t want that. Healthcare technology can really benefit patients yet we tend to focus more on what an innovation is going to do for clinicians or the funding ROI and worry about whether this will lead to more work for them.” Fitness trackers such as Fitbit are hugely popular with consumers but as they are regulated under the fitness category by the NHS, they are not required to meet the same rigorous standards as medical equipment. Angela feels this is a missed opportunity. As fitness trackers are not clinically-validated software, they are currently only referred to on an individual GP basis rather than NHS-wide.
THE FUTURE PICTURE
If quality clinical data on the efficacy of wearables such as fitness trackers could be collated enabling the introduction of Fitbits and other models as NHS approved patient monitoring tools, Angela feels they could pave the way in healthcare management in the future. “We currently have this huge chasm between what is happening in our day-to-day lives and what happens in the NHS. It’s also about applying common sense as it’s crazy that we’re not using these in healthcare.” When asked what the future of healthcare looks like, Angela is optimistic. She is excited by the uptake of online consultation systems for general practices (NHS England’s General Practice Forward View) and looks forward to seeing this change
Innovation requires people to think differently and there is still resistance among our professional colleagues around accepting technology in healthcare.
implemented. “NHS England wants to work closely with clinicians to get systems and solutions in place that work for them, yet it’s not just about the clinicians. It must include involving patients too. People are coming up with designs for technology that I don’t feel meet patient needs, only that of clinicians. “However, I am seeing glimpses of positivity going forward, if the NHS does not adopt technology, the companies won’t survive or go elsewhere” she warns. “The NHS is overspending dramatically and we as healthcare professionals need to get much more confident and innovative in our use of technology. If we don’t, the NHS is going to continue to overspend. Entrepreneurialism in healthcare can generate income and it presents a real opportunity for us to find solutions rather than bringing in systems from outside the UK. Simon Stevens is encouraging doctors to develop entrepreneurial ideas but we need more people to do that. Nurses and allied health professionals should also be encouraged as sometimes the simplest solutions can make the biggest difference.”
AN EXCITING FUTURE It’s becoming a daily challenge to open a newspaper or online article without reading about our health service struggling under immense strain. The rise in healthcare demand, a continuous funding squeeze and a need to safeguard quality are merging to exert huge pressure across the entire system. By Rachel Coope
The scary thing is that these challenges are not limited to England alone, but are faced by health systems across the world. With a growing ageing population, rising patient expectations and changing patterns of disease these pressures are unlikely to abate. The consensus is that healthcare needs to change and the economic prosperity of Britain will all depend on a radical upgrade in prevention and public health. Uncertainty and unpredictability will be intrinsic aspects of the challenges facing our future healthcare service. Technology is currently changing the way we approach health and care and undoubtedly it will proceed to do so, but as well as the gadgets and technology we use, change will be as much about different ways of working and relating to each other. Published in October 2014, The NHS five year forward view, echoes this, stating that future solutions will involve rethinking how healthcare is organised and delivered. All aspects of the healthcare system, including patients, staff and the systems themselves will all be asked to start the journey towards future healthcare together.
Patients; it’s my health, my healthcare
As mobile technologies evolve and become part of everyday life, so does the potential of widening the channels of communication between doctors and patients into email, apps and Skype. There are existing apps for smartphones and tablets that allow patients to monitor their own weight and activity levels, but even bigger changes are in the works. Using wearable wireless sensors you can use your
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smartphone to generate your own medical data, including measuring your bloodoxygen and glucose levels, blood pressure and heart rhythm. If you’re worried you may have an ear infection, a smartphone attachment will let you perform an easy eardrum exam that can rapidly diagnose the problem without a trip to the GP.
Apps are just the start. More wearables such as necklaces that can monitor your heart function and check the amount of fluid in your lungs, contact lenses that can track your glucose levels or your eye pressure (to help manage glaucoma), head bands that can capture your brain waves and wristwatch sensors that are equivalent to an intensive care unit on your wrist will become more prominent, potentially replacing a hospital room with your bedroom. As a result, except for ICUs, operating rooms and emergency rooms, hospitals of the future are likely to be roomless data surveillance centres for remote patient monitoring.
It isn’t just hospital rooms that are on the way out; labs are too. Via your phone you will soon be able to perform an array of routine lab tests using an attachment to your Smartphone. Blood electrolytes; liver, kidney and thyroid function; analysis of breath, sweat and urine - all can be checked with small fluid samples in little labs that plug directly into smartphones. Most importantly, you can do your own routine labs at a fraction of the current cost and time. Finally, in the next decade, it will be possible to monitor almost every organ system, as firms start to produce nanosensors to be embedded in your bloodstream. These microscopic sensors within your body can float in blood or be fixed to a Micro-Stent in a tiny blood vessel. You will then be able to keep your blood under constant surveillance for the first appearance of cancer, autoimmune attacks on vital tissues or the tiny cracks in artery walls that can lead to heart attacks or strokes. With all these new tools, it is no surprise that we’re talking about the possibility of “doctorless” medicine, but let’s not get too carried away. Doctors will still be a necessity - but patients will have a lot more control. The end result of mobiles being used in every aspect of healthcare is that the patient will take centre stage for the first time.
Systems; the ‘where’ and ‘how’
With an increasing number of elderly people and people with complex needs, the care system will need to be much more connected. This means breaking down the barriers between primary and secondary care, physical and mental healthcare, and health and social care. Central to this ambition is enabling hubs of care to develop outside hospital settings. Out-ofhospital care needs to be integrated to
support this ambition and to anticipate and respond to people’s needs before crises develop.
The Peek Vision app is just one example of how smartphones are transforming healthcare. It’s a huge growth area – there is wearable technology and various apps New technologies have an extremely that let people sample and test vital role to play in this transition. their own blood, DNA and Through secure, encrypted urine, mental health apps video links, specialist that help with Using wearable nurses and consultant relieving anxiety and wireless sensors, you teams have the low moods, just to can use your smartphone facilities to run 24 name a few. hours video to generate your own Technology consultations. medical data, including advances have Current high measuring your bloodthe potential to definition camera change where and oxygen and glucose levels, and screens can how people get blood pressure and enable staff to assess their health needs heart rhythm. conditions including met, therefore breathing complaints, increasing the possibility rashes, and chest infections of enabling people to turn and head injuries, without the need their own homes into hubs of care, for a one-to-one consultation. Staff will also dramatically altering the healthcare system. have the ability to see patients to diagnose, review and asses patients The future is now conditions, intervene to prevent Each of the innovations explored in this deteriorations; judge future care needs journey have the potential to improve the and provide routine follow-up and delivery of care and lessen the burden on outpatient services. the NHS. However, transformation will only With current technology developing happen if many changes occur in tandem rapidly, the ambition is to enable more and at speed - at a pace set by the current people’s homes to become hubs of care, challenges facing healthcare. Long gone supported by much greater outreach from are the days in the British healthcare hospitals. This vision is to deliver a much system of working to a centrally planned wider range of service in the home, such as blueprint, rolled out in every hospital and intravenous antibiotics, chemotherapy and clinic. New ways of working, technologies, speech therapy. medicines - while all these should be properly evaluated and shared, there will An exemplar piece of technology that be no silver bullets. A willingness to try and allows for home diagnosis is Peek Vision’s fail and try again will be crucial as the easy-to-use app that turns a smartphone solutions will need to be as complex as the into a portable diagnostic tool for eye care. problem(s) they are trying to address. An estimated 80 per cent of blindness and There is a profound insight into future care visual impairment cases are thought to that is rarely articulated in current debates; have been avoidable and the shared that it is less a shift from the current rigid challenge of many of these cases is ‘system’ to a different rigid ‘system’ but diagnosing patients in remote settings, more a shift to a much more uncertain especially if the only equipment available and unpredictable world characterised to use is the bulky examination machinery by change. found in most hospitals.
The Voice of Healthcare
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