By Justene Ewing, Managing Director Digital Health and Care at Waracle and John Connaghan, COO of the Health Service Executive, Irish Government.
Over the next 20 years Scotland is facing a ticking time bomb with regards to health and social care as the population is set to increase by 8 – 9% which in real terms equates to an additional 450 – 475k people. The fact is we’re all likely to live longer due to major improvements in care and breakthroughs in the treatment of conditions and this puts huge pressure on an already struggling infrastructure. Today we’re considering how digital innovation will help and is the investment and focus on digital health and care enough to make the systemic change required? We’ve asked John Connaghan, COO of the Health Service Executive, Irish Government to join us in this blog to consider how our health and care future looks.
There’s no escaping the fact that providing a universal health and social care system is costly. As we discussed in the MHealth for an Ageing population article, the trend of planning for providing health and care for a larger increased population is not unique to Scotland. By 2060, 12% of the European population will be above 80, with another 17.5% aged between 65 and 79. John went on to discuss that “In Scotland by 2037 it’s estimated that there will be an increase of over 200% of the number of people living over 90 years old and over 100% of the number of people living over 80 years. The issue is even more intense as it’s likely to be clustered around the eastern coastal areas.” John suggested in light of the facts around these statistics that current systems around the world simply won’t be able to cope with this increase. Changing the way we spend what is in the public purse (as well as keeping people home longer and in a ‘better’ environment), means we can establish sound economic reasons for high impact change to be initiated quickly and enabled through digital transformation.
Digital is empowering people to be more engaged in their own health and care. Using mobile and wearable gives us the ability to monitor and engage with our health and our family’s health and well-being, to improve quality of life, live better and more productive lives. Such as blood pressure, heart rates, blood sugar levels or even activity vs. inactivity. Crucially it also facilitates people living with long term conditions to stay in their own home or homely settings for as long as it is safe to do so.
Digital is already proven to improve effectiveness, reduce waste, create more capacity and increase access for those involved in the delivery of care and significantly improve the experience for people accessing the services. But there is so much more that can be achieved. Later in this article we talk about examples of incredible breakthroughs but fundamentally being able to track an individual’s journey through the health system is difficult e.g. GP’s or specialists having a full view of a patient’s care. Still today there are examples of test results from hospitals being posted in letters to GPs for paper files as opposed to immediately being updated and available by the entire health system. Collecting data which enables the professionals to build appropriate and personalised care to the individual will be essential.
There are so many areas to consider, today we’re going to focus on a few key areas of change and some challenges associated.
Personalised medicine has been defined as “a medical model using characterisation of individuals’ phenotypes and genotypes (e.g. molecular profiling, medical imaging, lifestyle data) for tailoring the right therapeutic strategy for the right person at the right time”. It also includes the aim to determine the predisposition each person might have to a disease and/or to actions to deliver timely and targeted prevention. More basically getting an idea of our genetic makeup very early on and using that to personalise treatment and care and pre-empt conditions much earlier. Patient care focuses on specific therapies and medicines that work best for them as an individual and how they might respond to the treatment and condition as an individual rather than as a collective group. This is especially important when you consider that 6% of acute hospital admissions are caused by serious reactions to medicine (Europa). You can imagine how this data could be used in the future as to inform preventative interventions, helping people to stay healthier for longer.
Nanotechnology is not a new idea and nanomedicine represents massive opportunities within health and care. One particular application of nanotechnology currently being developed is seeking to administer drugs, heat, light or other substances directly to affected cells (particularly some types of cancer cells). The idea is that particles are engineered to be attracted to diseased cells, therefore directly treating the issue and leaving healthy cells.
Nanotechnology is also being developed to monitor different conditions and help with diagnostics. For example using carbon nanotubes embedded in gel which is injected under the skin to monitor the level of nitric oxide, which is an indication of inflammatory diseases (MIT). Consider how quickly patients, health professionals or carers could act if they were able to receive instant notifications of condition changes as opposed to waiting for scheduled appointments and tests.
Taking it a step further consider how quickly patients conditions could be stabilised with the intervention of Smart Drug Delivery or targeted drug delivery which also employs nanomedicine to specifically target medication to a specific part of the body as opposed to the more conventional drug delivery that absorbs the medication across the body. An example is in chemotherapy where a very large percentage of the drug does not reach the tumor site.
As John discussed diagnostics are no longer the province of hospitals or health professionals and suggested there are two challenges associated with digital health and diagnostics. Firstly the sheer amount of data captured is enormous and complex. IBM Watson’s Healthcare division predicts the amount of medical data stored in various repositories around the world will start to double every 73 days by 2020. They go on to suggest that in 2016 there were 213 million gigabytes of health related information worldwide, with approx. 80% of it undiscoverable by systems. Meaning it’s spread across many different infrastructures, journals, scanned image repositories and management systems – making it completely unusable by a GP for example to consider the full medical picture of the patient sitting across from them. John highlights data and the interconnectivity of infrastructures storing it as a core challenge for any health service around the world.
Secondly the gathering of data using smart technology such as wearables is increasingly a very effective way of monitoring conditions of patients remotely. Whilst potentially overwhelming, consider the incredible benefits of knowing an individual’s genetic makeup from birth and then being able to match that up throughout their life by capturing and recording data from wearables and other smart devices.
Clearly the trend towards digital healthcare is well underway and for the first time Digital Healthcare was called out in Mary Meekers 2017 Internet Trends. The report covers everything from the significant increase of interest from VC’s and investors, estimated at a staggering £3 trillion in overall value. Considering this in the context of our own health system we debated this at length; given the current constraints is enough being invested to move forward and are the policies flexible enough to encourage transformation. John cited one example being the tendering of contracts to large companies which can save time and result in less management effort but not necessarily achieve best value, outcome or innovation.
We’re living longer, positive! We’re likely to live longer with conditions that affect old age; not quite so positive! There’s much discussion about the looming time bomb and inability of our health system to cope with the increased population and the ‘burden’ it will place on budgets. Health systems must adjust, transform and embrace digital as part of their strategy for the future, to provide better services and experiences not only for the users of the services, but for the professionals providing the services too. As John suggests “We must adjust our thinking and start to consider health and care budgets not as ‘cost centres’, but as an investment in our citizens and our communities. Digital health and care is a significant enabler and in successfully embracing digital we will create a significantly strengthened system supporting our people in a more engaged, healthier and wealthier society”.
Waracle’s own experience has highlighted incredible results that can be achieved from clinical trial management and remote patient condition monitoring. If you’d like to discuss more about digital health and care please contact us today.