What can digital health learn from the biggest trend in Hollywood block busters, the Re-Boot.
In the last 15 years Spiderman has been through three ‘re-boots’, Tobey Maguire, Andrew Garfield and now Tom Holland. Batman has managed even more changes that have brought various degrees of success (personally I thought Michael Keaton did a great job!). Digital health can learn from this trend, a re-boot or two of how digital health is ‘sold’ to the public, the tax payer and the media is perhaps a little overdue.
The cynic amongst us though would be worried of the PR agency spin at this point, but I would disagree. Earlier this week I was being taken on a high-speed car chase through the streets of Leeds, otherwise known as a taxi ride from the train station to St. James. The usual conversation, what do you do and where do you come from ensued (does anyone else feel they are on a game show sometimes when they are in a taxi?) What was surprising was how much the taxi driver knew about the digital reform of the UK health system, but here is the issue; “Was that the disastrous IT project that failed”, says the taxi driver. No matter where you go the National Programme for IT (NPfIT) is almost universally hailed as a failure, and yet the programme put in place foundations for digital health to rival any country in the world, it put in the ground work to engage the customer whether that’s the clinician or the patient. I guess much as Michael Keaton put in the ground work for the plethora of super hero movies that have become de ’rigour as the summer hit movies!
Ireland still has its own NPfIT. PPARS is still described by the Irish media as a ‘comedy of errors’, and just as NPfIT it has its failings, PPARS today is a success that can be built on! To go back to the superhero movie analogy, PPARS and NPfIT are best linked to the Daredevil and Elektra movies, Ben Affleck and Jennifer Garner vehicles of 2003, fans know these were ‘great’ films, the critics were convinced they were rotten tomatoes, but, they now have influenced some of the best Netflix superhero fodder ever to be made!
The culture and leadership of the digital team is significant in a judgement of success.
Building a team is a trick that every digital leader should accept as their number one priority. Without the team the priorities, the governance, the customer at the centre, any of the benefits of digital will not be delivered! Across the world the delivery of healthcare is under financial pressure and this in turn means that the immortal words, ‘do more for less’ are likely to be uttered to you as a digital leader.
When you then look at what you can do less of there is a risk that the things that ‘could’ be seen as not digital’s responsibility are the first to go. If your mind lands on this as a decision please, please think again!
All over the world organisations are being told digital fails without business change resource, and yet as fast as this is becoming a key message for many business areas health systems are trying to cut the business change element from the budget of digital. In Ireland, we have spent the last three years trying to reinforce the message that the projects we have set as priority projects will fail without proper business change elements. The success Ireland made of the first digital maternity hospitals was a success of the business change functions and the clinical leadership. The need to have 9,500 hours training in one of the hospitals is described in some of the Irish media as a failure, what a shame that is. Business change perhaps shouldn’t be labelled as training, I guess that’s where we went wrong in Ireland, the ‘brand’ of business change resources within the team needs to be clearer, they are the engineers of success!
In my move to Leeds I was recently asked what sort of a CIO I am? One that focuses on technology or one that focuses on information? I think I confused the person asking the question when I said I am a CIO that focuses on the people. The need to create a team that cares most about the business change we are trying to achieve; I hope is part of the legacy I leave in Ireland as I begin the handover of what I do to the next digital leader for healthcare, a team that has moved from one that delivers digital to one that helps create business change through digital innovation.
Resourcing any organisation to be able to achieve a business change is difficult, trying to ‘re-boot’ the view of the team at the same time really does require an engaged and enthused leadership team.
How will we find the right people for the right job at the right time is a tricky question for any digital leader trying to create a cultural change. It’s a challenge that we have worked hard on in Ireland. In November 2015 the department of health gave us permission to recruit 49 new members of staff to the team. An exciting time being able to consider how we could now truly begin to move the ‘dial’ on the ratio of staff available to the business and how we really could begin to focus on the delivery of business change. The trick though was what sort of staff did we need. We were pleased with permission to recruit 49, we had asked for 150 new staff which meant a prioritisation exercise and a structural alignment that matched the resource we were now allocated, a re-boot with a limited budget. Not all of the re-boots require the superstar actors and huge budgets though, think of the collection of superhero TV series now gracing the screens of Netflix, nowhere near the super budgets of Batman Vs Superman, nor do they have the big name actors and yet they are probably making a bigger dent in the film buff psyche than the most recent Batman film ever will, sorry Ben Affleck!
How do we professionalise the digital health function though, how do we become recognised as the go to function to achieve change in healthcare. First and foremost, the logic of success building on success is key. Pick the projects that can be successful, not the easy projects or the quick wins, but the projects that will make a difference and that you know can be achieved. Professionalising the digital role in health is influenced from the outside in to some degree, the clinical engagement in the success of digital will build an organisational ally to help in the consideration of what a professional digital workforce can bring.
The re-boot of digital health needs some tools as well as the new actors. The SAMR ladder has worked well for us in understanding where our focus needs to be. Are we Substituting, Augmenting, Modifying or Redefining the delivery of healthcare. Are the terms mutually exclusive or are they an innovation journey that digital healthcare is on?
Dr. Ruben Puentedura’s model gives any digital leader an opportunity not to just re boot the organisation but a model to re boot projects as well.
Lets look at PPARS in Ireland, its original premise using SAMR was to simply Substitute what was currently in use with a digital platform, what went wrong according to the general consensus is that a simple substitution wasn’t enough. The human process was exactly that, not a logical process that digital could be a substitute for but an emotional and geographically different process that actually needed a redefining re boot. The success of eReferral in the last 18 months is because the process has been augmented, and the project team set about the re boot of the process knowing that was the case.
As we move to the EHR programme here in Ireland we know that the whole programme of work has to be about redefining, that is why the business change resource is so important and its why Ireland’s EHR business case insists on the budget and resource allocation for the business change elements,
Einstein’s definition of insanity is perhaps over used, but it fits so neatly here; ‘doing the same things over and over but expecting different results’ is his tried and tested definition. Without a re boot digital health is not going to succeed and we need it to be the next Avengers re boot not the best forgotten Nicholas Cage classic, Ghost Rider.
Consider the re boot theme, build the business change resource and lets get this movie started!
The eHealth Ireland Eco-System was a year old last week, a great achievement for the team to go from the germ of an idea to the formation of a self-supporting Eco-System that has seen the meeting of many ideas and organisations that have been able to be another hand on the tiller, steering the eHealth Ireland agenda.
As part of the birthday celebration meeting we have invited a different keynote speaker from a background outside of health, Niall Harbison, founder of Lovin’ Dublin, inspired the audience with his vision for an integrated Health system. Niall opened his presentation with a slide stating “The world is changing so fast” he brought the audience through a whistle stop tour of what it means to be in Social and Digital Media today in 2016 with a great emphasis on being mobile first.
Niall told us that over 90% of traffic is now via mobile. He spoke strongly on the importance of engaging with our stakeholders through different social media platforms such and commended us on our use of Twitter Hours and our transparency agenda for developing relationships.
Niall spoke about how we all need to be content masters. It’s up to all of us to inform our stakeholders in a way that interests them about what we are doing. It was refreshing to hear Niall speak about what he believed would be the future of health. He spoke about what it was like to not be clinically informed but that he would like to be able to see a future with telemedicine, where he can see a doctor when it suited him, where it suited him and be able to get his prescription sent to him electronically. Niall spoke about how he had great respect for all involved in health and their movement to digital.
He spoke about Apple and how even they, being a multi billion dollar innovation dynasty, have difficulties in mastering this market. The fact that we are trying to digitize something so large and disparate is a challenge and how its often much easier to start with nothing, he likened it to “herding cats”.
This is why he believed that the health innovations would actually emerge from countries where there is nothing currently there. Where they can adopt technologies and build new solutionsquicker. He also pointed to the fact that we can’t believe our stakeholders don’t want or expect this service or will not be able to use it and spoke of the quick adoption by taxi drivers of technologies such as UBER and Hailo and how people would have presumed that taxi drivers would never have adopted that technology
Niall spoke about where health was and asked us to consider what it would be like to pitch Health delivery as it is today in Ireland to Warren Buffet as a business idea, what investment did we think we would secure. If we can’t secure the idea of delivering health as it is done today then just maybe the answer could be a digital revolution was the noise left ringing in many peoples ears.
Niall finished on reiterating his first slide “The world is changing so fast. When will it happen to health?” and an inspirational quote from Michael Jordan;
“I’ve missed more than 9000 shots in my career. I’ve lost almost 300 games. 26 times, I’ve been trusted to take the game winning shot and missed. I’ve failed over and over and over again in my life. And that is why I succeed”
When experts from a wider digital field listen and speak to health audiences it always brings a refreshing and different challenge to what we think and do. Imagine being able to reform health at the speed of an organisation like Lovin’ Dublin has been able to form and become a house hold name. All through my own career I have pushed hard to ensure that we can learn as much as possible from other business arenas in health, after all the facts and figures from various studies point to health globally being way behind other businesses so there is clearly going to be something new to learn.
The eHealth Ireland agenda is not unique, but, it is now moving at a rate that requires a different type of support to see it succeed, one straight out of the innovation and new thinking kit back. In the words of Bob Wachter at a recent Kings Fund event,
The purpose of digitisation is not to digitise, but to improve quality, safety, efficiency and the patient experience of healthcare.
With that ringing in our ears we are ready for the next year!
First published as a blog article on in the Health Management Institute of Ireland Journal.
One of the most critical parts that must be carefully considered when creating an eHealth fabric for any care delivery system is not the latest innovation but actually how will the system react under the worst case scenario. Many systems deployed in the public sector have breached key project management quality criteria (time, cost and quality) due to the need to have a system that meets very very high levels of availability, but in some cases those high levels of availability have not been built against a business back drop but simply a series of assumptions.
In health this is different; if the delivery of health care becomes reliant on technology then technology must meet that need!
Once eHealth is part of the delivery of health care for a country it can’t be stopped. Imagine me in my role explaining to the department or minister’s office that this is not a once off investment; it’s not a project that ends. Investment in technology to support health care delivery is now part of the funding needed to deliver health.
In Ireland we have an accepted and approved strategy (eHealth Ireland from 2014) we have an approved plan to deliver this strategy (Knowledge and Information Plan from 2015) but we don’t have a funding profile beyond 2016 or a clearly articulated delivery vehicle for technology beyond the existence of the Health Service Executive which is said to now be on its final delivery focused journey. However Ireland took a giant leap of faith in 2015 that will begin to reap dividends in 2016. It was a simple leap, that if technology is deployed into the system it needs to be done so against a back drop of reliability and functional requirements; not new technology for the sake of technology.
Chris Hadfield in An Astronaut’s Guide to Life on Earth comments,
“Focus on the journey, not on arriving at a certain destination. Keep looking to the future, not mourning the past.”
This we feel is a great mantra for us to adopt for the delivery of eHealth Ireland. We need to take the permission derived from the strategy and plan and ensure that focus is applied to the benefits that can be released and in incremental steps that provide new benefits to patients and clinicians every step of the way.
For the first time in a decade the technology team of the HSE has permission to add resource to its headcount. This gives the team capacity to move at a relatively agile pace to implement the content of the Knowledge and Information plan. It allows the momentum around clinical engagement to be continued and will see the view of the future coming into reality.
The founder of Turntable Health in the US in early January commented,
“We’re in this sort of weird limbo where the technology is expected to do the heavy lifting, but we haven’t really transitioned the human relationship… it’s gone.”
Zubin Damania is clear in his comment that there is a need so well-articulated through the US experience in the last year to ensure where health care IT is implemented the clinical engagement needs to be kept at the top of the priority list. The eHealth team in Ireland continues to place this at the heart of what it does. The appointment of the Chief Clinical Information Officers council and now the leader of this group sitting on both the senior management team of the HSE Office of the Chief Information Officer and the eHealth Ireland Committee ensures that the voice of the clinician is so prominent in all that is being considered. This type of open and transparent governance will be added to in 2016 to include the patient voice, currently this is well covered with relationships with IPOSSI (Irish Platform for Patients Organisations) and the like, but we know more can and should be done in this space. An initial step into this area is the public consultation pieces, one has already been started in the area of the Electronic Health record and has seen a phenomenal response, a further consultation will be underway in January on the Privacy Impact of the Individual Health Identifier.
As Chief Information Officer I have an ambition I have been criticised for in the last year, that ambition is to not have any IT projects by 2020. This is not because we see IT being ‘finished’ in health in Ireland but because projects should be clinical or business change or continuous improvement projects, within those projects technology and/or information should be a part, not the raison d’être for the project.
Recently the CIO of New Relic Inc. was quoted in a similar vein,
“Successful CIOs will need to be more effective at managing the holistic technology and data environment regardless of who ‘owns’ the resources”
The office of the CIO within the HSE sees Yvonne Wassenaar’s comments here as being crucial to the ultimate position of the new resources within the team, this new capacity will not be seen as simply more technologists, the capacity will be the resource needed to bring benefit from technology and information within health in Ireland.
An exciting start to 2016!
Originally published in Health Management Institute of Ireland
The amazing work of Chip and Dan Heath in the book ‘Switch: How to change things when change is hard’ describes a series of analogies that reference organisational change. One of these is the elephant at the beginning of the path into the jungle with the ‘driver’ and a selection of passengers. This is almost the perfect storyboard for the implementation of an eHealth fabric into the health system of Ireland.
Let me explain, changing the direction of the elephant can only be done by the driver through brute force without the elephant being happy to change its direction. If the elephant is already on the path some way before the driver and passengers get on then it will be more likely to continue than if it is at the very beginning of the path.
You are not convinced still are you? What can this possibly have to do with the implementation of an eHealth fabric into Ireland I hear you yelling!
The formation of eHealth Ireland at the end of 2014 and the publication of the eHealth strategy helped Ireland understand the art of the possible, it didn’t start the elephant journey it simply allowed us to figure out there was a path, a driver and an elephant.
2015 has been the first year for eHealth Ireland, a year that has enabled it to define the direction, make some success of that direction and understand what next. We have started on the path; let us superimpose the Knowledge and Information plan as the path in the elephant analogy. The plan was published in the spring of 2015; it takes the great work of the eHealth Ireland Strategy and the thinking around this and operationalises it. The plan provides the health service of Ireland with a route to implement eHealth solutions that will come together to create the digital fabric that we all agree is so necessary for health to be delivered in a modern world.
The plan also describes the necessary operating model that the Health Service Executive’s office of the CIO would need to adopt to be able to deliver innovation whilst also keeping the lights on a service that is heavily reliant on the ‘human prop up’.
The operating model implemented by the HSE OoCIO is known as a Bi-Modal solution. As an organisational solution it provides the HSE OoCIO with the capability areas to manage operational IT and to develop and indeed deploy some strategic solutions that it needs until such a time as eHealth Ireland can truly come into its own right as an organisational entity.
So, back to our analogy, we have described the path, as the analogy says though to get the elephant to move along this path it will need to feel it has made some headway already. The OoCIO picked a series of projects and priorities to focus upon in 2015. The feeling of embarking on a journey needed to be felt right across the organisation and quickly if faith was going to be created in the delivery of an eHealth fabric.
The key priorities that have set the elephant on its path had to be wide ranging, some needed to be prioritised due to foundation need others were due to clinical or patient engagement, and all were to bring success of some degree in 2015. The four to pick out and reference here particularly are:
Individual Health Identifier (IHI) – At last a key data foundation for the assurance of patient safety through information, an ability to implement information security and a tool to enable efficient audit and management of the health service was implemented in September of 2015.
eReferral – Building on a successful pilot rather than closing it down with lessons learnt was the catalyst for this project. eReferral is the ability to utilise solutions in place already and to create a digital referral process from GP to hospital.
Chief Clinical Information Officers Council (CCIO) – The clinical driving force that keeps the technology enthused OoCIO on the straight and narrow. Ensuring that technology is here to solve a problem not look for one.
Electronic Health Record (EHR) – The signing of national contracts for the delivery of a single lab information system and the final clinical validation of a single Maternity and Newborn EHR as well as the publication of the EHR case for change ensure that eHealth Ireland is taking appropriately paced steps towards an EHR for the countries health system.
So, we now have the path defined and the distance we have travelled on it thus far clear to the elephant. We have the elephant, the health service itself, moving slowly but surely, methodically taking care not to break anything along the way. We have the ‘driver’ defined in the eHealth Ireland function and its structure and the passengers on the elephant as the clinical leadership and senior management team of the health service itself all being able to guide and influence the driver.
This huge elephant has fundamental strengths that need to be made the most of if it is to pass along this path. It has a wealth of knowledge and learning that can be applied to the movement down any new path if brought to bear in the right way. The ‘driver’ is well placed to ensure that the change in direction that sometimes will be required can be influenced rather than demanded, small incremental steps that keep the path illuminated will be a more assured way of getting to the end point of the journey.
However the end point of this journey is not a final drinking spot for the elephant but the continued evolution of a digital fabric to support the capability of the health service of Ireland, a grand ambition for the ‘driver’ and the team to have.
Credit and thanks to Peter Sondergaard of Gartner for the inspiration, advice and guidance.
12 months ago at the inaugural eHealthSummit in Croke Park in Dublin, I was asked to speak at the Locknote panel on the challenges for eHealth and the Implementation of the eHealth Strategy in the next 12 months. Top of my wish list for enabling the eHealth Strategy was the implementation and availability of the IHI and IHPI for use in Ireland. I outlined that it was the single biggest barrier to enabling the eHealth strategy to be fully realised. I was delighted to sit as part of the attendees at this year’s conference to hear that the IHI system had gone live and that the HSE had a seeded database of individual health identifiers for every patient in Ireland.
On reflection on the last 12 months since the first eHealthSummit was held, I believe that a phenomenal amount of progress has been made in the area of eHealth in Ireland. The establishment of eHealth Ireland along with the publishing of the Knowledge and Information Plan giving us a roadmap for the next 5 years is exactly the type of progress that I felt was needed in order for us to achieve the goals of the eHealth Strategy. There is real enthusiasm and a renewed energy in the industry as a result of the transformation that is happening in the HSE. There is significantly more involvement from industry and academia in the plans for the future. There were several examples at this year’s conference of the really good work being done both in Ireland and other European countries such as Scotland, Finland. The implementation of the EHR in Temple Street University Hospital along with the National Rollout of electronic Referrals across Ireland along with the availability of dates for when all hospitals will go live with electronic referrals before March of 2016 show that real progress is being made.
There was much discussion from the floor and observations from clinicans that there is a real and practical need to enabling the sharing of information across the Health service and to utilise what’s currently available both within the Health service and from industry partners. It was acknowledge by Ciaran Ryan of the ICGP that GP’s have very good systems and electronic patient records in their practice and that they would love to see further sharing of and access to information across the Healthcare industry in Ireland. The inclusion of the National Healthlink Project as part of the future IT Architecture vision in the Knowledge and Information plan shows a real commitment on behalf of eHealth Ireland not to rip and replace systems that are performing very beneficial services but to utilise and expand them to meet the future needs.
Reflecting on the years progress both from the standpoint of the National Healthlink Project and from the eHealth industry in Ireland, I feel we are positioned in a much stronger place with some of the key enablers now in place for significant movement in the right direction in the coming year. I look forward with renewed enthusiasm to reflecting on even more progress between now and eHealthSummit16 as part of the Senior Management Team of the Office of the Chief Information Officer as I begin my journey on enabling the Access to Information function as outlined in the Knowledge and Information Plan.
I hope that Dougie Beaton, and the rest of this years Locknote panel get their “Dear Santa’s wish list” and can reflect on similar progress in the next 12 months.
For as long as I can remember I’ve enjoyed fixing things. From a young age I had a wealth of opportunity bringing bikes in various stages of disrepair back into use. As I grew so did the scope and scale of my tinkering. I had more curiosity than capability and occasionally courted catastrophe. I ranged over most of the topics covered by books in the town library: engines, cars, electrics, construction, demolition, homemade gunpowder… I’d fix it or make it work better and at times break it entirely.
Kevin Kelly in his recent book Cool Tools (http://kk.org/cooltools/) describes a tool as ‘an opportunity with a handle’. Our household tool-bag back then was meagre and the tools were given many opportunities they never expected. At the time it was called ‘making do’; these days it would be called ‘innovation’.
It was no surprise to those close to me that I became an engineer. Engineering developed skills for making, fixing and improving things: science, maths, logic, problem solving, reliability, safety, project management, usability. I spent much of my career in the software industry where the tools I worked on captured, processed and analysed data to provide insights into customer problems which could be used to improve results. These tools brought together people, the way they work (processes) and technology to fulfil specific business needs.
A dozen years ago I started working in the health system. The clinical information system programmes I’m involved in focuses on enabling care professionals to reliably, effectively and safely support patients to get well, stay well or live a fulfilled life with illness.
The balance of concerns is different from the global software industry, but the essential issues are similar: enabling people to adapt the way they behave and work using updated or innovative tools to gain insights that improve decision making both at the point of care for the individual patient and for the long-term outcomes of communities. An engineering and systems training is useful in finding solutions to these complex real-world healthcare problems. But getting the right balance of people, process and technology in support of reliable, equitable, effective healthcare is challenging.
During a recent system implementation I supported a care team as they started on their first day using a new electronic patient records system. I was training a nurse manager late in her shift and a person she was caring for had a severe reaction to the treatment he was undergoing. The medical equipment provided alarms which helped her focus on the critical issues immediately. I watched her revive the older man and as she touched his cheek gently, I heard her speak calmly and tenderly until he was stable. I stood by as this nurse reacted promptly and effectively. My natural reaction is to step in and fix, but in this situation I could only contribute by getting out of the way and remaining silent. It was a key reminder that the tools my team brings forward need to make it possible for every care professional to work in that person-centred way without fluster and frustration. The tools need to provide the appropriate information at the right time to allow the professional and patient to make the best decision possible. Each of the tools my team deliver are not ‘an opportunity with a handle’ but are ‘an opportunity with a keyboard’.
Like the old days these tools aren’t always perfect, but innovative use of them can work wonders.
Delivering these tools requires an understanding of the unique challenges patients face and the challenges across diverse care settings. Many of our best days are when we meet patients, hear their stories and through that learn what is important for them. Working with nurses, doctors and support staff to address challenges in care delivery make up many other good days. Together we have to answer many substantive questions where answers are not obvious. A common thread in the successes is when the team recognise sectoral, institutional and personal biases then reach a shared answer to the essential question: “what is in the best interests of the patients?”
There are many opportunities for improving individual health outcomes and system-wide performance. The keys to unlocking improvements are in the hands of both patients that seek care and the professionals that organise and deliver care. My team works to provide the best possible tool-bag and the skills to use it for the patients and their care providers to make the best decision for the individual and their communities.
I was discussing a way to describe how eHealth can change the way in which hospitals deliver care recently with a learned colleague. He has come up with the phrase, the ‘Liquid Hospital’, which I have to say has grabbed my imagination completely. The concept of a Liquid Hospital is very much one not just supported by technology but actually made possible through technology and innovative ways of working. Its not that much of a stretch of the imagination to see it being possible but will require a large amount of business managed change and can’t be made so ‘just’ through the implementation of technology.
Moving away from concepts of episode centric care will be a significant challenge for all considerations within any health care system worldwide. Let’s not forget even the concept of an Electronic Patient Record (EPR) is based around recording the episodes of care that occur rather than around the patient. Breaking down the systemised walls for the provision of care will be key to the innovation that we describe here as the Liquid Hospital. Although as the concept evolves, we note a flaw in the name. The Liquid Hospital does not refer to one institution or hospital – the concept really is around the delivery of seamless care and wellbeing support to people (not just patients), however for the purposes of this blog let’s stick with the name.
The idea is quite simple really; once the patient is in hospital the technology allows the episodes of care that the patient requires to come to them, rather than the patient being shipped around the hospital for different treatments and the risks that come with that. In other words, the system becomes clinical centric. I know from a stay in hospital in 2010 that being moved from ward to treatment room and back again is at the least uncomfortable and at worst darn right scary. The concept doesn’t just stop there though. It does also propose to achieve that panacea of eHealth – a truly paperless environment, as not only do treatments flow around the patient, so does information.
Imagine an outpatient visit to a liquid hospital. You arrive in reception and check in with a clinician who takes your identification and confirms back to you some details to allow you to confirm to them the reason for your visit. As a patient you have elected to collect information on your condition at home so you quickly synchronise the smart device you have with the hospital systems. This shares your medication record and real time recordings of how your condition makes you feel.
As your consultant comes to you they are fed this information to their tablet computer and are analysing the outputs in the lift as they come to meet you in your own personalised consultation room. As the consultant comes into your room your records are shared on the display on the wall for both you and the consultant to consider. You have also elected to share the consultation output with your primary care professional and therefore the actions the two of you now collectively take are recorded and made available to them.
You elect to have a procedure related to your long term condition. Whilst with your consultant you choose when and where that procedure will take place and you are electronically introduced to the clinician who will be your key point of contact when you return for the procedure. Your consultant is then able to provide advice on what you need to do before coming in to hospital for the procedure and download this advice to your smart device for you to consider with your family when you are home.
You also consider a slight change to your medication. The consultant is able to provide you with advice and guidance from around the world and connect you to patients like you with a similar condition via a secure social media outlet. This allows you to consider the impact of a change in medication with a peer group over the coming weeks and access some key support.
Your clinician can provide you with a new prescription directly to the pharmacist of your choice and you can call there on the way home knowing your drugs will be ready for you. A copy of your prescription and your summary notes are also sent to you for your own health record as you have elected to keep this information in your own health vault solution in addition to the electronic record in the hospital.
A few days later your long-term condition takes a turn for the worse and you decide to drop into the primary care centre, which is in your village. You ring the centre and are asked to provide the information you have collected over the last few days via your smart device, which you can do whilst you are on the phone. The primary care centre advises you to up the dose of medication ever so slightly and alter the time you are taking your prescription and within one day your illness settles down and you don’t need to go in to the centre.
The time of your procedure and your short stay in hospital draws ever nearer. Rather than have to attend the hospital for a pre-op meeting you have decided to share your own collected data with your key contact in the week leading up to your visit and have a brief video conference with the clinician. All is looking well and the clinician does not need to see you face to face. Although you are a little anxious, the hospital has arranged for you to be part of a secure group on a social media site and you are able to communicate with patients from around the world who have been through a similar experience, and this goes some way to settling your fears.
On the day of your attendance at hospital you check in comfortably with very little fuss. You are provided with a secure tablet PC that is linked to the hospital’s WiFi, and all of your notes and updates will be on this device during your stay so that you have the comfort of seeing them as well as them always being with you during your stay. It’s your choice throughout your stay as to who you additionally share the information with, electronically. You elect to send all information to your own personal record and some of the key facts to your primary care centre. You also decide to email your nearest and dearest a summary of each day to help them feel less worried about your time in the hospital’s care.
After the procedure you are out of hospital very quickly. Your after care is already arranged and as you hand back the hospital tablet computer with your information on you can already see it has arrived both in your own personal record and at the primary care centre.
The social care provision you require in the first few days is arranged on line and again, as the patient, you have decided what information to share and with who. The social care clinician visiting you at home asks if they can view your record in more detail and you grant them access there and then. The information they are able to get from this satisfies any initial concerns they had and they are able to discharge you within three visits.
How much of a stretch of the imagination do you feel this is? The technology is there to facilitate this. Perhaps it has been available the last five years at least if not longer. The big change is perhaps two fold: investment in the aspects of technology to drive this (including training and development) and the change in how care is delivered at a business level. Healthcare provision and change related to it is often compared to changing the direction of a sea bound oil tanker, but, if the description of this kind of benefit can be described (and bought into) by clinician and patient alike maybe this could be an innovation we can make reality.
Some countries across Europe are starting to put in place the building blocks to enable this change: in Scotland, a change to the commissioning model, facilitating health boards across all care delivery to allow the holistic delivery of care and here in Ireland, the reform programme itself, the creation of the IHI and the concept of ‘money follows the patient’ will all start to enable this dream to become reality.
Technology and a business change programme truly can break down the physical walls of the care institutions of the country and allow care to flow around the patient in a manner as transparent as H2O.
With thanks to James Batchelor of Southampton University in the UK for his help on thinking through ths concept, which he deserves credit for as his own.
The race for the truly smart home is on, when your fridge can create your shopping list on your phone. It can add to that list as your friend takes the last cold beer, advising you which supermarket to call at on the way home from work to pick up the best value replacement! Then the Internet of Things has become truly valuable.
This isn’t science fiction, this is here now, the Palo Alto company Nest Labs are now making the API behind this and other smart home solutions available ranging from kitchen appliances to the smoke detector and thermostat.
As your home starts to build an IQ what will the impact be on clinical research? I have been wearing the Jawbone Up since February, researching my own sleep versus activity and trying to hit the magic goal at least five in every seven days. The correlation between sleep and activity is clear, however I guess I didn’t need the Up to tell me that if I did lots then I needed more sleep! What is interesting is how that data can be added to with information about location and food consumed, the ease of keeping a food diary to understand the impact on sleep is now there and I now know to avoid cheese for a good nights sleep and that if I am away from home I can expect no more than four and a half hours sleep on the first night.
In a recent Gartner study it was reported that by 2020 there would be 30 billion connected devices worldwide. An IDC report indicates that there will be 212 billion ‘things’ connected to the Internet by 2020! McKinsey have been looking at the value that the size of this market could bring to the global economy, they have a suggested value today of $2.7 trillion against the market place that they define as the Internet of Things, by 2025 they suggest that this could grow to $6.2 trillion. All of these numbers make me shudder though, they seem to be equal in their impenetrable hugeness in a way to some of the big data numbers are.
Then you ‘throw in’ the iWatch in 2015, if it becomes as ubiquitous as the iPhone then many millions of people globally will be recording all manner of health information every day and perhaps making it available without the difficulties of consent to organisations that Apple believe are appropriate to be delivering research.
Tele-Health, eHealth, Tele-Medicine, terms that have been used interchangeably for years without a real leap forward in the beneficial impact they can make on the provision of health care. However as the Internet of Things truly takes hold these terms do come into their own and at last begin to put in place the building blocks to release benefits.
The concept of the Internet of Things breaks down an equally powerful social concept of the Digital Divide particularly for health and clinical research. After all ‘things’ is used as a definition largely to demonstrate how ubiquitous the internet will be, the digitisation and therefore connection of so much ‘stuff’ reducing if not removing the much maligned divide. As the next generation (and what will we go to after generation ‘Z’ I wonder?) takes to the digital world and the next generation of researchers and clinicians become qualified we will truly see an empowered citizen world wide.
Earlier this year I got involved in the creation of a piece of work called ‘The last train to Data-Topia’. In this we described a world in 2030 where research and health care went hand in hand. As the ‘Internet of Things’ moves from being part of the catch phrases of the famous consultancy firms and becomes more related to the reality of what can be done with technology the impact on clinical research can truly begin to be explored, not as science fiction, but as a reality.
eHealth and an easier path to clinical research really has become a possibility if the right ‘Things’ can act as the catalyst needed!
Following on from the guest blog last week I have been reflecting on the success that has been made of the work done in the collaboration space throughout the NIHR and in particular my part of the organisation the CRN.
Having taken a giant leap down the collaborative platform route the NIHR is now starting to understand what a networked organisation with a capable platform designed for collaboration underneath it can achieve.
Collaboration is the watchword across my organisation, it will save time, effort, money and all of these drive efficiencies for the delivery of clinical research and enable the organisation to increase its scope of research and improve quality. However the implementation of a new platform is not what has driven this change. It has been the catalyst, but just a small taster of what additional collaboration can be achieved to support clinical research in the UK is the driver. As a team of people we are a network. The very nature of our organisation encourages us to share: ways of working, content, even the load!
We accepted the challenge to implement what we tongue in cheek called the ‘Google-Verse’. The challenge was o do this quickly for core functionality and release some basic benefits, then, making some of the periphery elements available as the year went on adding to the benefits delivered. Many months into the challenge the platform is now delivering rewards to the organisation. It is slowly changing the culture of the organisation away from a focus on email as a collaboration tool, moving it to a place where the capability to share workload is the common practice.
In the case of our organisation we truly have an example of technology acting as the catalyst for behavioral change on mass. The availability of tools to collaborate has started to influence behaviors not just when the teams are using these tools, but to start to create a culture that looks for the place to collaborate first. We have been able to get a ‘virtual’ Business Intelligence Unit (vBIU) up and running over the same period of time, and we can put some of the acceptance of this down to the willingness of the organisation to collaborate on so much of the work we do.
There is also an element of the organisation coming together in the face of ‘adversity’. In this the adversity is the simple volume of work and pace that it is now looking to deliver on.
However, as we empower the network to consider the benefits they could get from the solutions we have deployed we also created a group of people who are so enthused by the benefits that technology can bring that there is a risk, it’s a nice risk for a CIO, but a risk that needs to be managed. This risk is that the enthused start to destroy the excitement through the eulogy they speak. What do I mean though? Its like when the Grey album first leaked out on the internet, the world loved it, no matter the genre of music they ‘lived’ in it seemed to touch everyone, but because everyone was talking about it the enthusiasm for it began to wane. As I re-visit it now its still a piece of musical genius!
However back to collaboration (and a step away from Jay-Z and the Fab Four).
Collaboration to create success, I believe this is driven by a good leader and built upon solid tools and foundations. I have written before about this programme of work not being led by technology but by the delivery of a networked workforce and the development of that structure, that, as we come to the point where we can close the implementation element of this programme down it is clear this is how we have achieved such significant business change through the implementation of technology.
Earlier this yeah I volunteered to project manage a migration project that would affect everybody within the Clinical Research Network (CRN). The project brief was simple, to migrate over 500 accounts from the traditionally deployed email solution to the new NIHR Hub built on the Google collaboration platform.
Fairly straight forward I thought!
It quickly became apparent that there was a lot more to this project than to simply confirm user account details, migrating the data and let people loose in the wonderful collaborative world of Google. To begin with it was a challenge confirming who the users were, if they needed an email account or even who the host employer was?
Then we began to speak to people about how they used their email. That was an eye opener! It should not have been, I have never worked anywhere where I have been told how to use email everybody has a different idea, lots of different ideas! Some people store emails with massive attachments within their email account, others archive every email going far back (in some cases) as far as 15 years and some opt to save them locally on their machine or on a network drive.
A lot of work and education to do then!
Like any transformational project some of the affected people understandably didn’t want to change, “I really like out Outlook” was an actual quote for a lot of people. To counter this we did a fews things:
It worked! The sceptics and resisters were won over by their colleagues who were empowered as change champions, giving credibility to transformation that would be hard to drive forward otherwise. Demonstrating the new product for people so see what they were going to get was also very effective, reducing the fear of the unknown.
The big day arrived and we did have a few teething issues but our migration partner and change champions were on hand to swiftly resolve the vast majority of issues. Within days people settled in to the quirks of Gmail, quickly learning new ways of working and drop-in sessions continued to be offered to help support the workforce.
For most people the Hub is a now vital tool for their day-to-day job. Gmail has been well established and the initial resistance to change has withered away.
People are using other features such as Google Docs, Google Forms, Drive, sites, groups and forums to communicate and collaborate with all sorts of people from within the NIHR and beyond, seeing the benefit of collaboration tolls in the world of clinical research.
Tasks that once took a huge amount of effort and generated large volumes of email traffic and documentation can be done simply on Drive with minimum fuss.
Polling people or collecting info can now be done on Google Forms or via the forums in Google Groups, meeting can be arranged within the NIHR across one shared calendar, Google Groups can also be used to manage workflow, replacing clumsy spreadsheets and email trails. Google Sites is being used to quickly create information and communication portals across the NIHR.
The list goes on, growing as the appetite and appreciation for the NIHR Hub grows too…..
Collaboration has become the word of the year for clinical research in the NHS because of this ‘simple’ project.