Navigating Healthcare – Patient Safety and Personal Healthcare Management

The NHS at 70

Healthcare, NHS

The crown jewels of British society

The NHS was the crown jewels of British society providing healthcare to every member of society no matter who they were, where they came from and what personal resources they had. It was the great leveler of society creating a single standard of care and service that was accessible to rich, poor and disenfranchised and it was well loved.
To me personally, it was my guide and educator – I was lucky to attend one of the great London medical schools – The Royal Free Hospital School of Medicine. The “Free” hospital created to treat all comers and the original medical school (The London School of Medicine for Women) for women created in an era when women were not admitted to British Medical schools

That hospital and the NHS provided me with a first-class medical school education, access to groundbreaking research that included the early work and discoveries around HIV/AIDS, Hemophilia, Liver disorders and beyond.
The staff in every department were friends, colleagues and members of a community that were family and all pulled in the same direction – that of the patient. I spent time working in different areas during my time, staffing the manual telephone switchboard, helping the porters and security staff, nurses, technologists, and maintenance and quickly realized the well-oiled NHS machine demanded a family of committed people to make it work and deliver outstanding care each and every day.

What Could We Do Better

As we know today, and probably knew 70 years ago and before, healthcare is as much about our environment and resources as it is about medical treatments, technology, and innovation. We know that 60-80% of health is attributable to lifestyle but fail to take account of this in the NHS and in the majority of health systems from around the world.

 

We need a WellCare system not Healthcare

 

The system spends large sums of money providing medications to the population but fails to take account of the most basic needs of the population and acknowledge that food is also a drug. What we put into our bodies contributes to our health and well-being. Failing to acknowledge and manage these elements of health with sleep as the foundation and exercise and nutrition built on top has created a system that treats the failing of these issues at great financial and personal patient cost. Investing in the prevention would create a WellCare system and not the Healthcare System that the NHS is.

Manage and Allocate the Limited Resources with Transparency

It’s an unpleasant fact that few want to address or even acknowledge but the reality of treating people is that in this day and age of innovation, scientific progress and developments we could spend every last penny on treating patients. There is an unlimited supply of possible treatments and a never-ending procession of people needing those treatments. But not all treatments are created equally – some don’t work, some are harmful and in the cases of those that do work there is the wide disparity in the effectiveness and cost. Any healthcare system needs a means of assessing the effectiveness of treatments that includes the financial and resource cost linked to the improvements. The problem with a “free” (the NHS is not free – it is simply free at the point of care, paid for through taxation of the individuals) is the inducement of un-economic behavior by individuals looking for every last treatment option no matter the cost or effectiveness. That path is unsustainable and breaks the system and ultimately harms patients.

Enable Informed Decision Making for Everyone

Doctors Die Differently and do so because they understand the economic and personal tradeoffs between treatments and quality of life. In the data presented by the Johns Hopkins Study of a Lifetime we see a big discrepancy in treatment choices between doctors and everyone else. We make our choices in the context of the knowledge of effectiveness weighed against the personal cost of treatments and quality of life impact. An open an honest assessment of treatment that is clinically effective would level the disparity in treatment choices selected by patients. As a society, we struggle to discuss end of life but it is a reality that everyone faces and we must find ways to educate and support people through all aspects of life and death.

Technology and innovation is essential to the future of the NHS

The future of a scalable meritocratic system accessible to all that does not bankrupt society will be dependent on technology and innovation. Humans remain the core constituents of any compassionate caring system and technology is a supporting player. But as Michael Dell put it:

Technology has always been about enabling human potential

Michael Dell, Dell
Technology has always been about Enabling Human Potential

Technology does not replace the human beings or interaction but rather augments it in ways that extend our capabilities and improves the accessibility and economics.

It is an impossible task for humans to process the amount of data currently being generated about our patients, the knowledge derived from research and advances in science and put it into the context of treatments at the point of care when it is needed most.

We have expanded beyond the human brains capacity to absorb, process and apply the knowledge and must rely on technology to augment the brains abilities and place information into the context of the individual patient and the care choices available.

Selecting the innovations that deliver the most value

Innovation impacts each and every area of the NHS and will continue to do so but the challenge will be to select the innovations that deliver the most value to the largest number of people based on scientific peer reviews.

Innovation is not confined to the clinical treatment but extends to every element of the NHS system and the delivery of wellness care. It is changing the design of facilities to include features that improve care and outcomes – for example by adding natural light and open spaces.

Innovation is allowing patients the option to access their care team at any time and from any location – for example bringing the care team to the patient as we used to do with home visits but now using technology to extend the reach and scalability.

Innovation is building rooms and beds that can be efficiently and effectively cleaned between visits while maintaining comfort and welcoming surroundings. It is using available data to predict potential health issues before they occur and reaching out to patients helping to guide them to better healthier choices and wellness. Innovation is allowing parents to stay with their child in the hospital when they are sick and in need of care in comfortable and caring surroundings.

Innovation is offering dignity and compassion to those facing death and offering realistic options for no treatment and hospice care.

What can Britain and the NHS learn from the rest of the world?

Over 700 years ago, China had village doctors who were paid by the villagers when they were well but received no money when the patients were sick. This is the principle of wellness over sickness care. In Norway, they have a wide and uniform implementation of a digital health record that is accessible to everyone that needs it including the patient – tied together with a unique patient identifier designed for that purpose. One Citizen, one record.

The European Union allows citizens to cross borders and different health systems but to receive urgent care while traveling and administers the cross-country charges, managing fees and removing the patient from worrying about payments while they are sick and abroad.

Look also to Africa and the innovation that takes place on a continent with access to far fewer resources and technology to see what’s possible with the existing technology. Small incremental steps in using technology to boost healthcare services such as text messaging have been wildly successful and yet remain simple, easy to implement and understand and accessible through all social groups in society.

In Rwanda, they have integrated drone delivery for hard-to-reach locations, offering lifesaving support that was previously almost impossible. Expect to see more of this and bi-directional capabilities for resources, tests, and samples as well as lifesaving treatments.

Finally, in Korea, they have a culture of celebrating aging and the elderly that includes dignity in end of life and the inclusion of everyone in the family and their health. Korean culture sees the 60th and 70th birthday as a big family affair and the inclusion and the universal expectation that roles reverse once parents age, and that it is an adult child’s honorable duty to care for his or her parents’ health.”

A version of this appeared previously here

The NHS at 70 was originally published on Dr Nick – The Incrementalist

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Telehealth is Here – Getting There Quicker with Incremental Steps

Telehealth is Here – Getting There Quicker with Incremental Steps

The Incrementalist Graphic Til Jolly

This week I am talking to Dr. Til Jolly, CMO for Specialists on Call (SOC) Telemed who are delivering enterprise-wide telemedicine to over 450 hospitals

Dr Jolly is an Emergency Room physician with a fascinating background that includes working for the NFL Super Bowl “Emergency Preparedness Team” planning super bowls around the country over multiple locations. He shares some of his experiences in that role and some of the things he learned along the way – learning from previous events, clear role assignment and division and above all practice (he’s talking about the medical teams but I’m sure that’s true for the NFL teams :-))

We talk about the small incremental improvements that have been adding up in Telehealth delivery – as he puts it the barriers are not technology anymore and there has been some good progress around reimbursement. In an interesting twist and different perspective, he looks back with fondness at the introduction of the Fax machine and the positive impact it had on care with the ability to fax EKG’s direct to clinicians.

The resistance is no longer coming from patients and in some instances is clinicians and health systems who want to find “traditional” methods of care delivery but the writing on the wall is clear: Telehealth is here to stay and will be a major part of helping support our aging population even mitigating some of the loneliness these individuals have


Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next two weeks at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.


 

Listen along on HealthcareNowRadio or on SoundCloud

Telehealth is Here – Getting There Quicker with Incremental Steps was originally published on Dr Nick – The Incrementalist

Digital Health Summit

This is Australia’s premier health innovation convention on the technologies that are revolutionizing healthcare and the implementation of ehealth initiatives and I was honored to be asked to give a keynote presentation at the Digital Health Summit taking place in Melbourne 29-30 March 2017. The bonus was listening to so many great presentations throughout the day from some great speakers.

The Perfect Storm for Healthcare

The opening session that set the tone for the future came from Alfred Poor, Editor for Health Tech Insider who eloquently described the perfect storm of The Internet, wireless communications and the pervasive smartphones that last year shipped 1.5 Billion – enough to provide one for every 5 people on the planet. Innovation that can take off the shelf technology and create accessible telehealth programs that reduce readmissions from 20% to 6%.

Everything from wearables devices to non-invasive sensors and monitoring to allow the capture of data on patients, improve care and treatment options and allow the elderly to safely stay in their home. Innovations that address the major challenges around the world in the society that needs to adapt and focus on wellness:

2009 Continua Health Alliance Brigitte Piniewski, MD

 

Stuart Smith took us through the potential for Gamification: exploring the magic of video games in health and rehabilitation providing repeated examples where implementing Gamification to engage with patients was seen as some kind of Voodoo by his colleagues who were amazed at the incredible success and high utilization by patients

He showed examples of rehabilitation patients using Sony Play Station with Microsoft Kinect that made the rehab program a positive experience and even had the audience dancing along with Dance Dance Revolution explaining how they had adapted this to elderly patients and using Glenn Miller and Big band music

With the explosion of data comes increasing risks to the security and privacy of data and Nathan Steiner Veeam Software detailed the expanding risk and the staggering incidence of data breaches that extend well beyond healthcare which remains the top target for hackers. No surprise and notably the FBI highlighted the hacking community that is targeting vulnerable FTP servers.

Julian Bright and Adrian Medhurst from Amelie AI took the audience on an interactive journey with an Artificial Agent focused on mental health issues and braved the Live Demo gremlins as captured on this Periscope:

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Personalized Medicine

 

Dr Robert McLeay, Founder, DoseMe highlighted the changing nature of medicine that improves on the old style model of guess work on drug choice and dosage and builds individual models to reduce the side effects and maximize the selection of the right drug for patients first time round – practical personalized medicine available for your patients today

Professor Phil Robinson, Head, Cell Signalling Unit, Children’s Medical Research Institute (CMRI), co-lead of The Australian Cancer Research Foundation International Centre for the Proteome of Cancer (ProCan) shared the exciting international progress being made in fighting cancer with industrial scale proteomic system that they have set up in the Children’s Medical Research Unit that was Announced by Vice-President Joe Biden on 17 July 2016 in Melbourne as part of the Cancer Moon shot that has rapidly grown to include 10 Nations, 18 Institutions. They are now producing huge amounts of proteomic data and creating Digital Proteme Maps that has been committed to the public domain indefinitely to facilitate ou sharing and learning and will be providing new options for targeting cancer. You can see more about their project here.

Digital Health Innovations from the Front Line

 

We heard from 2 clinicians from the US Aenor J Sawyer, MD, MS Director, UCSF Skeletal Health Health Innovation &Tech in Ortho University California, San Francisco and Dr Megan Ranney, Associate Professor of Emergency Medicine; Director, Emergency Digital Health Innovation program, Brown University. They shared the experiences from UCSF and Brown University of applying digital technology in the clinical setting offering insights into the use of sensors, Virtual reality and how to evaluate the technology in the context of a busy hospital and Emergency room.

 

After lunch, the panel session on the future of aging was hosted by The Hon Bronwyn Pike, former Victorian Minister for Housing, Aged Care, Community Services, Health, Education, Skills and Workforce Participation focusing on the innovations in place and how the sector can benefit from the data and analytics increasingly available from the digital transformation taking place. and then a detailed review of the great Victorian Stroke Telemedicine Program that has been rolled out with great success by Prof. Christopher Bladin, Program Lead – Victorian Stroke Telemedicine Project, The Florey Institute of Neuroscience & Mental Health with a proven protocol that is statewide and heading nationwide

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Social Media in Healthcare

 

Professor Enrico Coiera, Director, Centre for Health Informatics, Australian Institute of Health Innovation offered some tantalizing insights into the way that social media is changing the way we think about health. Not only does Social Media offer a means of reaching and engaging with patients it is also a potential avenue for treatment. The social propagation of obesity as detailed in this New England Journal of Medicine article: Network Medicine — From Obesity to the “Diseasome” and these complex networks are of direct relevance

He left us wondering of social media can treat social disease (his BMJ article Social networks, social media, and social diseases talked about this concept)

Modeling of Data

 

James McCaw, Associate Professor in Mathematical Biology, The University of Melbourne shared insights into the modeling for influenza forecasting and pointed out that despite how much progress we have made in medicine the influenza pandemic of 1918/9 (Spanish Flu) would have a similar effect on the population today

The models for prediction have improved but he likened them to weather forecasting capabilities from the 1970’s

 

It was a great day filled with insights from a wide selection of experts covering a huge range of areas. All the talks were engaging with practical tips and wisdom that the attendees could take back and use.

Digital Health Summit was originally published on Dr Nick – The Incrementalist

Our Remote Future in Healthcare

Its an exciting time to be in healthcare and medicine – technology is bringing so much innovation and opportunity to improve the delivery, quality and reduce the cost of healthcare. Much remains to be done

At our our recent DellWorld conference we captured insights into this exciting future

As Dr. Jai Menon vice president and chief research officer for Dell Research Data said data may well be the oil of the 21st Century and in healthcare this is especially true as we see an explosion of insights and data into our health, clinical status, genome, biome and beyond

We finished sequencing the first human genome in 2003

and things have only accelerated from there with sequencing now taking less than 24 hours and costing less than $1,000

Just this one area is going to add huge amounts of data that needs to be turned into knowledge as I shared in this presentation to the Austin Healthcare Thinktank Roundtable

http://www.slideshare.net/nvt/slideshelf
But even before we get to that point there are so many opportunities emerging into our daily lives to improve the service and the healthcare delivery system. Telehealth or Telemedicine is a clear winner and the regulatory and reimbursement systems seem to be catching up (details in this presentation form Connected Health).

Integrating the data and providing intelligence and insights from the mass of data that is sweeping over healthcare will be important but as we gather more our understanding improves expect this area to accelerate with deeper more meaningful insights tied closely to the ability to integrate the data from multiple (and importantly non-traditional sources).

To get a sense of the opportunities and changes coming watch the video compilation form the conference below:

 

Its a great time to be in healthcare as we open new doors to knowledge with the data

Our Remote Future in Healthcare was originally published on DrNic1

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Patient engagement lessons from Africa

Posted in #mHealth, Africa, education, HealthIT, Patient Engagement, Technology, Telemedicine by drnic on September 29, 2015

I was raised in Gabon on the equatorial west coast of Africa

and though I’ve never practiced there, I consider myself African and continue to be interested in the delivery of healthcare on the continent. Though health resources are scarce, my colleagues there have made creative use of the tools available. In Gabon, and indeed across much of the rest of Africa, text messages are routinely used to provide timely health messages about medications, clinic appointments, health risks and general health information. They are way ahead of the U.S. in proactive use of mobile technology for health improvement.

Below are a few examples of the remarkable achievements they’ve made with cell phones and text messages. Most of the examples were compiled by IRIN, a news service that focuses on humanitarian news and analysis, plus a few others that I’ve added to the list:

Health check-up by text message

  • A recent study published in The Lancet noted that Kenyan patients who received weekly text message check-ups were 12 percent more likely than a control group to have an undetectable level of HIV virus a year after starting life-prolonging antiretroviral (ARV) treatment.
  • In the south-central Ghanaian village of Bonsaaso, using mobile phones to contact health workers has lowered the maternal death rate.
  • TxtAlert, a product of the Praekelt Foundation, is a mobile tool that sends unique, automated SMS reminders to patients on chronic medication. This reminds them to take their medication or perform other necessary tasks. A special tool, called “Please Call Me” allows patients to call their doctors even if they don’t have any airtime available by pinging their doctor who then calls back.
  • A pilot project in Cape Town, South Africa, used text messages to improve adherence to tuberculosis regimens.
  • Medic Mobile allows patients to get home-based care even if they can’t be physically visited by a caregiver. The organization launched a pilot program in Malawi, where more than 100 patients received treatment for TB after their symptoms were noticed by the community and reported by text message.

Health information

Health literacy is often low in Africa, and text messages have proven an effective way to increase knowledge

  • In Tanzania, text messages are sent to pregnant women based on their due dates, providing important information that is relevant to each stage of their pregnancy.
  • On Valentine’s Day 2008, a Dutch NGO started an eight-week campaign in Uganda’s southwestern district of Mbarara with the slogan, “Don’t guess the answers, learn the truth about HIV.” The campaign led to a 100 percent increase in visits to the voluntary counseling and testing center run by the NGO’s health partner. This year, the same NGO used a text message quiz to test malaria knowledge in a fishing village in eastern Uganda.
  • In Ethiopia, people can call a confidential hotline anonymously with HIV-related queries.
  • On a 24-hour toll-free medical hotline in the Republic of Congo, set up by the government, the UN Children’s Fund (UNICEF) and a mobile telephone network operator, health professionals respond to queries about pediatric emergencies.

I could go on, and on and on, listing successful use of cell phones and text messages. The bottom line is that African health workers are using this technology in useful and creative ways to provide communication with patients.

Many U.S. medical professionals have been reluctant to use text messages and other mobile technology, and lag far behind their African colleagues in this area.

So what’s behind this disparity? Two factors, both related to infrastructure, have boosted use in Africa and delayed use in the U.S. First, because there is no significant landline infrastructure in much of Africa, cell phones account for 90% of all phones on the continent. In the cities, adoption has been near universal. (Pre-paid cell minutes are now used as a form of currency, as an alternative to sometimes volatile official currencies.) In many remote locations, where even clean water and electricity are scarce, you can get a cell signal and power a cell phone with a small solar charger to gain access to voice calls, text messages and the Internet. Cell phones have become a vital link for the continent.

With scarce health infrastructure and near-universal adoption of cell phones, health care workers were quick to see the usefulness of text messages, which only cost about 2 cents each.

Conversely, in the U.S., we have highly advanced medical infrastructure that has been in place for decades. A large proportion of primary care physician practices were established long before cell phones became widely used, and they still depend largely on the landline infrastructure they’ve always used. Same for most hospitals and outpatient clinics. Changing protocols, workflows and thinking patterns for these organizations isn’t easy, particularly if there is no urgent incentive to do so.

Many healthcare organizations also are concerned about HIPAA compliance and security in mobile patient communications; while those are valid considerations, there is a host of information that can be exchanged through mobile devices that wouldn’t violate the patient privacy regulations. And with a secure patient portal that can be accessed via smartphone, physicians can use mobile technology to share even protected information.

So why should physicians and hospitals change the way they work? Three reasons: meaningful use attestation, better outcomes and market competition.

While texting is not a part meaningful use attestation, it is a tool that could help you meet the criteria for getting patients to log in and view their health records. A text message with a link to your portal could prompt many to take a look just out of curiosity. And chances are, they’ll use their smartphone, not a PC to access your portal. Just this year, the number of users who access the internet with a mobile device exceeded the number who use a PC to gain access. So you’d better be sure your portal is mobile-friendly.

Perhaps the most immediate value of texting and other patient engagement strategies is improved care and better outcomes. Currently, we are not doing a good job of patient communication and education, despite putting time, energy and staff resources on the task.

Often, physicians, nurses and health educators are talking to patients who are too scared, too stunned by a new diagnosis, or just too intimidated by the healthcare system to be mentally and emotionally available to learn. Much of what we tell them is forgotten by the time they are out the door. And even those who don’t completely forget instructions often miss medication doses and appointments due to the forgetfulness that plagues all of us. And they often have trouble taking the advice we give and putting it to use in the real world.

Text message reminders could be used to remedy many of these problems. If the texts are scheduled to automatically send at the time that is most useful to a patient, the immediacy of the information would help patients follow through on treatment and be more engaged in their care.

The third reason that we should start using text messages is that the population under 40, and especially those under 30, use text messages as a primary communication tool. I have kids in that under 30 group, and they never answer the phone when I call or reply to emails (I doubt they even open emails). But a text message gets their attention. In fact, the average teenager sends 3,339 text messages each month. That’s more than 100 texts per day.

Granted, adults don’t text nearly that much, but those age 25-44 send texts more often than they call. And email is declining for many users, because they hate sorting through all the ads. Instead of emails and phone calls, they text and use Facebook and other social media to communicate with friends. Even business use of texts are on the increase, because it offers immediacy without the intrusion of a voice call.

So if you want to remind a patient about an appointment, odds are that a text message is a more reliable vehicle than either a phone call (which usually ends up as a voice mail that is never heard) or an email (which is likely to be missed among all the ads, if the person even bothers to check the inbox). If you send a text reminder at the time that a patient should be taking medication, chances go way up that the dose won’t be missed.

If you have a robust, mobile-friendly patient portal, you can use text messages to alert your patients to information they need on the portal – like their health records, useful research information and links to lifestyle advice like healthy recipes and exercise tips. With a secure portal, you can exchange even the most sensitive data with patients, even from a mobile device.

As this under-30 cohort becomes an increasingly larger portion of your patient population, they will expect your organization to communicate with them in ways that make sense to them, not you. Call only during office hours and wait on hold? I don’t think so. They will expect to use their smartphones to schedule appointments through your portal and receive information and ask questions through your portal, with text alerts to let them know when to check back for answers.

And if your organization can’t do that, they will find another one that will. Because the more future-ready, forward-thinking organizations have already made a move in that direction.

This piece originally appeared in MedCity News

Patient engagement lessons from Africa was originally published on DrNic1

Telemedicine Coming of Age

Posted in Healthcare Information, Telemedicine by drnic on March 14, 2010

HIMSS10 in Atlanta was heavily focused on Meaningful Use. Indirectly related and certainly a technology coming of age was the demonstration of “HealthPresence” from Cisco systems. Their solution designed for installation in doctors offices, clinics and urgent care locations includes a range of additional technology to enable a remote consultation.

I had an opportunity to talk with Frances Dare, Director IBSG Healthcare Practice:

As you can see exciting technology that includes additional features to enable an effective remote consultation. It will certainly take some getting used to on the part of patients and clinicians alike but in terms of spreading and improving access Telemedicine technology really is coming of age.

Right now limited to office based settings in part due to the high end technology requirements but like technology in general this will filter down to individual use, and probably quickly. It may seem far removed from most people’s reality that they connect with their clinician over an internet connection and video conference but think about the success of Skype and a range of other video conferences facilities. In a connected world there will be increasing availability of remote access to satisfy increasing demand, increasing specialization and eventually customer demand.

Have you seen or used this technology a facility near you. Would you use it if it was available. If not what would stop you and what would help you accept this as a good clinical consultation