All posts tagged Knowledge and Information

#CIO100 The 2019 edition…

Being part of the CIO100 has meant something to me every year that I have taken part, this year I didn’t make the event itself and it looks like it was a roaring success from the photos on social media and the WhatsApp commentary from so many of the CIOs that were there.

Being able to be part of a community of leaders every year that support each other, laughs at each other, finds ways to promote each other, shares stories and battle wounds with each other has been a great way to create a collegiate environment regardless of business area that the CIO works within. I think the key take away from the CIO100 celebration year on year is the similarities that the role brings ‘regardless’ of the business area that the CIO works within.

Its fascinating moving to a new organisation as a digital leader, no longer a CIO, but a member of the team with an interest and a remit in the key items of the CIO agenda I can see now how transferable the experiences of a CIO can be.

I remember reflecting on similar when I moved to Ireland, the way we described the issues faced by us every day delivering digital to healthcare in the UK were so similar to those described in Ireland and yet both sides of the Irish sea thought they were unique.

One piece of advice, if I am qualified to give advice, to all CIOs and aspiring CIOs, get out of the business bubble you may find yourself in, use events and groups like the CIO100 to learn about the challenges of other areas embarking on digital transformation and innovation in a business area. If you have an issue today, I will bet that either it has been solved at least once in a community like the 100 already or at the very least someone else in that group is going through the same issue.

The CIO100 is perhaps the greatest support group that a digital leader in the UK can be part of, a group I am proud to call ‘home’.

Well done to everyone in the list, looking forward to a year of connections, collaborations and having some fun.

… and perosnally from me, whilst I am no longer at Leeds teaching Hospitals Trust without the amazing team there my place would never be so in the CIO100, a huge thanks to all of the team for working with me for 12 months on the crazy journey we called #LeedsDigitalWay.

Super heroes each and everyone of you!

 

Leeds Digital Interns

What does a soap factory, a hotel laundry, a cheese processing plant and a builder’s merchant have in common? They were all places that I learnt my ‘trade’, and somehow I became a CIO in the health service!

Yesterday was a great day for the digital team in Leeds, for the second year running the team interviewed for student placements for the summer. Six bright young things part way through their education in all things digital science came to meet the team and to work with us to decide if the digital team in Leeds is the right place to come and trial the skills they have been learning all year.

So over the next couple of weeks we will welcome; Daniel, Daniel, George, George, Alice and Reece to the team. A gang of Computer Sciences students who have a passion to do something good with their newly developed knowledge, to quench their thirst to try what they know in the ‘real world’! The exceptional thing that made me jump for joy though is that these 25ish year olds all wanted to be in Leeds for one key reason; they wanted to do good with the knowledge they have learned, they wanted to give back, the wanted to deliver return on the reputation that Leeds Teaching Hospitals Trust has built.

So much is written about the lack of faith that our future stars will have in the organisations they choose to work for and yet here I was faced with six stars of the future, all six of them looked ready to burst with enthusiasm. We delivered a presentation to them first, a bit of who we are and what we do, then another super star, Gareth Edwards one of our informatics nurses showed them what working here was going to be like. One of those age defining moments happened though as our amazing Informatics Nurse used a screen image of a computer game form the 80s and a computer game from now to show the difference in expectation that digital consumers have now. One of our candidates exclaimed; ‘My Dad used to play that game’, the sadness with a wry grin that swept over all of us in the room had to be seen to be believed as we realised just how fresh and ready for the challenge these new guys were going to be! But poor Gareth.

Much has been made of the Leeds Way, Davina Mcall has even explained it to Phil and Holly! When you see the Leeds Way ‘infecting’ new people into the organisation though is when you realise how well as a trust we have built this culture. After three hours with the team, in an assessment type scenario these guys were smiling, laughing and most importantly of all making amazing suggestions that we simply had not thought of. The assessment was a paper based affair, ‘think through how you would build the patient consent for surgery form?’ Remove the paper from the equation.

Now, lets just jump back a moment these are six students with no healthcare experience, the ideas they came up with, the references they were able to make to how people use technology, the way they really were appreciating the difference between digital transformation and IT really, truly blew my mind.

Thinking about colours, size of font, language, sensitivity about information recording, data protection, data ownership, access controls, the physicality of kit, the nature of the form; and most importantly the human nature of what was being considered. All came up in a 30 minute paired task!

So, we now have six new inductees into what we are and what we do; my promise is that their ‘summer job’ will not be like mine was; I won’t simply leave them to do the rubbish jobs, I will try to inspire them, I will try to send them back to their next year with a story to tell and if I can help influence a tiny little bit of the next generation of people who do what we do then crikey I am going to love this summer!

The #LeedsDigitalWay just started to create its next generation.

AI a shiny thing or the next loop in the evolution of digital healthcare.

In 2001 AI was ‘just’ a Steven Spielberg film; in May 2018 it is being described by many as a solution too so many ills within the NHS.

On the 21st of May the Prime Minister provided the NHS with her view on the way Artificial Intelligence could revolutionise the delivery of care for patients with Cancer, Dementia, Diabetes and Heart Disease and by 2030 save 50,000 lives. Grand claims and grand plans and a new direction for government. One that focuses on a digital art of the possible although certainly to leap from paper records in vast wire cages and trolleys as an “ok” solution through to AI as an opportunity for the delivery of care is no mean feat, but a goal we can try to play our part in.

The following day Satya Nadella the Chief Executive Officer of Microsoft gathered CEOs and CIOs from digital business from across the UK to discuss what the team at Microsoft described as “Transformative AI”. The CEO used a quote by Mark Wesiser the prominent scientist of Xerox and the father of the term ubiquitous computing to open his presentation,

The most profound technologies are those that disappear. They weave themselves into the fabric of everyday life until they are indistinguishable from it.

This is where we want our EHR to get to!

The conversation continued to try to deliver the fundamentals in AI. Data is what feeds and teaches AI, it provides the fuel to grow to learn the what and the how.

Collecting more data therefore will educate AI more quickly; the next horizon is to make the nine billion micro-processors that are shipped every year become SMART devices. The micro-processor in your toaster, your alarm clock, your motion sensor light can become part of the data collection capability that will be responsible for our education of AI. The sheer growing size of data is something well documented, the creation of data will have reached a new horizon by 2020 and will look something like the figures below:

  • A SMART City – 250 Petabytes a day
  • SMART Stadium – 1 Petabytes a day
  • SMART Office 150 Gigabytes a day
  • A SMART Car 5 Terabytes a day
  • Your Home 50 Gigabytes a day
  • You 1.5 Gigabytes a day

20 Billion SMART Devices will exist in the world

(8 bits to the byte, 1,024 bytes to the kilobyte, 1,024 kilobytes to the megabyte, 1,024 megabytes to the terabyte and 1,024 terabytes to the petabyte) The average mobile phone now has 128 gigabyte; the first man went to the moon on a computer that had less memory)

So much data to educate the AI of the world, the insights that could be gained are incredible.

The journey from what we know as an IT enabled world to a digital world sees the move from ubiquitous computing to Artificial Intelligence as a pervasive way of life and then on to a world where we live in a multi-sense and multi device experience.

The impact on the relationship between us and technology has evolved in how it is perceived; technology was ‘simply’ a tool, initially as AI evolved it worked for us as a subordinate and as AI evolves still further it will become more of a social peer in how we consider what it can offer us in healthcare. The most common Christmas present in the UK this year was one of the voice activated assistant, people all over the UK are now having chats with Alexa, Siri, Cortana or simply saying Hey Google to find out some fact that just alluded them or to ask for a simple task to be done.

The original concept of distributed computing (or cloud) gives us the ability to create the computer power and data storage that is needed to evolve AI capability. Distributed compute adds IT complexity, it is now our job to find ways to tame the complexity by ensuring consistency and a unification of experiences, this applies more to digital healthcare than any other ‘business’ as we try to utilise digital as a way to standardise the delivery of care as much as we possibly can.

The definition of Artificial Intelligence is said to have been first coined in 1956 in Dartmouth, the journey from this definition now includes the term Machine Learning first applied to algorithms that are trained with data to learn autonomously and more recently since 2010 the term deep learning, where systems are enabled to go off and simply learn beyond a set of specific parameters. The art of clinical practice, the need to have a human touch though is well understood in healthcare. This is why more and more AI in healthcare is referred to as an ability to augment the delivery of care, AI does not deliver a solution to offer less clinicians in the service, what it does is remove the need to have clinical time spent on anything other than patient care, AI offers the opportunity to increase the human touch. A further quote reinforces this in the book The Future Computed;

In a sense, artificial intelligence will be the ultimate tool because it will help us build all possible tools.

Eric Drexler author of Nanosystems: Molecular Machinery Manufacturing and Computation (1992)

The journey to AI in our world is getting quicker. The journey to AI being successful is best measured when the different components of it reach parity with us humans;

  • In 2016 AI became able to see to the power of us, and passed the RESNET vision test with 96% able to see 152 layers of complexity.
  • In 2017 AI became able to understand speech to the same degree we can the 5.1% switchboard speech recognition test.
  • In January 2018 AI was able to read and comprehend to the same degree as a human passing the SQuAD comprehension test with 88.5%.
  • In March 2018 AI became better than a human at translation, now able to translate in real time successfully to an MIT measure of 69.9%.

The road to an AI augmented world though is about amplifying human ingenuity; AI can help us with reasoning and allow us to learn and form conclusions from imperfect data. It can now help us with understanding; interpret meanings from data including text, voice and images. It can also now interact with us in seemingly natural ways learning how to offer emotionally intelligent responses. A Chat Bot launched in China now has millions of friends on across multiple social media channels, it has learnt to offer help to its ‘friends’ that are demonstrating symptoms of depression, phoning up friends to wish them good night and offering advice and guidance on sleep patterns but in a very human way.

Gartner have reported that the ‘business opportunity’ associated to AI in 2018 is now worth $1.2 trillion! Suddenly AI is the new Big Data which was the new Cloud Computing, which was the new mobile first. All of these terms have had hype but have all in reality brought a new digital pitch to our business strategies and our lives.

Great Ormond Street Hospital in partnership with UCL is leading the way in AI application into healthcare with several projects delivering startlingly real results.

Project Basecode: Transcribing speech in real time and utilising AI capability to add information to spoken word dictation capture.

Project Heartstone: A device for passing messages, verbal and video to patients of GOSH that may be too young to have their own Smart Phone, the device can be expanded to offer services to children who may be deaf or blind.

Project Fizzyo: Puts in place gamification to the delivery of breathing physiotherapy for children with Cystic Fibrosis and captures the information for the clinical record offering analysis as it goes.

Sensor Fusion: Creates perhaps the most immersive AI elements in healthcare today, recording events throughout the hospital, offering machine learning developed advice and data driven descriptions of events as they occur.

At Leeds Teaching Hospitals Trust we have created a platform in the form of our Electronic Health Record (EHR). With this platform we can now begin to consider how this clinical push for AI and the difference it can make to patients lives and the way we work can be achieved in a carful and considered way.

This digital revolution can make a real impact on Leeds; the patients, clinicians and staff enabling us to provide the care we want to provide following the Leeds Way principles with digital as a supportive backbone.

If you want to know more or have an idea as to how you could help in this area get in touch with us via @DITLeeds

International menu of interoperability…

First published on www.digitalhealth.net

When you are on holiday do you play that ‘why?’ and ‘what if…’ game? For example in the USA on a recent holiday we were chatting about why foods are called different things in different countries. A quick poolside thumb poll had the list below as differences between the UK and USA, and we are sure there are more:

  • Zucchini and Courgette
  • Egg Plant and Aubergine
  • Garbanzo Beans and Chick Peas
  • Arugula and Rocket
  • Cilantro and Coriander
  • Scallions and Spring Onions
  • Chips and Crisps
  • Fries and Chips

The only excuse we could come up with for why this happened was timing. These food stuffs were perhaps discovered at around the same time across the world and therefore no name was ever right or wrong, just more timely and geographically rich. The experience of being in a different country and seeing these new words for the same things adds a little nature of the exotic, particularly when the country speaks the same language (kind of).

But these differences speak to the single largest challenge that faces our digital health menu today: the challenge of interoperability and integration. When we talk about the delivery of a new healthcare paradigm we speak of the delivery of integrated care, a care delivery experience that places the patient at the centre and has no boundaries. But to achieve this requires information to mean the same thing to all those involved in its delivery. Where this isn’t possible we put in place a perpetually repeating health system; one where learning the parameters of a situation, of an illness, of a prescribed cure are repeated at each gateway to a different healthcare system. We don’t want an exotic patient experience we want an efficient and safe experience.

The journalist Geoffrey Williams once said, “You can’t understand one language until you understand at least two.” Goethe went even further claiming, “He who does not know foreign languages does not know anything about his own.” Moving healthcare delivery to a system-wide approach is the goal of over 50 (locally driven) digital initiatives in the NHS alone. The goal of an integrated health and care record is to provide access to, and translation of, multiple care languages. The pressure facing healthcare systems across the world today will only be resolved through integrated approaches that enable health and social care to work together to manage the front and back door to every major acute hospital in the system. A busy Accident and Emergency Department is no longer the problem that the acute hospital can resolve on its own, it is a system-wide issue that the geography has to resolve together. Access to information will unlock this resolution, but first we need to enable the way we refer to the healthcare to be shared.

For the last two decades sharing information between care settings has been a digital goal. In the late 1990s Hampshire became ‘famous’ for the delivery of an exemplar record sharing environment, linking access to information recorded in the ‘Exeter System’ to information in GP systems, to aid the delivery of healthcare regardless of the setting. The largest issue that stunted growth of this early pilot though was the quality of the data and the ability to index the information. The need for a common identifier across health systems was raised and the NHS Number mandated by a target date. It’s a shame that this would not be the last time the NHS number was mandated by a target date…

Jumping forward to 2017, the Irish health system delivered a unique EU-wide identifier for the delivery of healthcare to its citizens. Huge effort was put into delivering this in an agile manner at a limited cost, and today the number exists and is available but its actual implementation in healthcare delivery itself remains very patchy. We can also look at an example in Leeds today too. Having spoken to other healthcare jurisdictions, the Leeds Care Record has become well known throughout Europe as an example of local systems working together to achieve something quite remarkable. The Leeds Care Record is a platform that enables integration at a level beyond almost anywhere else in the NHS. Over 35 systems are able to share information in a controlled, secure and legitimate fashion. 111 GPs also benefit from having access to what is recorded about their patients’ hospital visit. They also share key elements of the GP record with the healthcare delivery system throughout the geography. And that word is where the Leeds Care Record does fail; it works for the geography of Leeds and so this isn’t integration, this is interoperability. In Leeds, information is shared through the same platform but the reference points for the delivery of care remain in the same ‘language’ of the originating care setting. The reliance is on the interpreter and their own understanding of the information.

Culture plays a huge part in how we create an interoperable health care system which digital supports. In his book Culture, Terry Eagleton tries to define what culture means to organisations. He has four areas that he believes are most relevant to creating the right culture: values, customs, beliefs and symbolic practices. None of these particularly speaks to a standardised way of operating and therefore, if we believe in culture being how we make things happen in an organisation, then interoperability will always be an area we strive to achieve.

In the same book Eagleton, who is from Ireland, notes that the postbox, an original integration tool, donates civilisation. However the fact that Ireland has painted its mailboxes the famous Ireland green denotes a culture, a difference to others. In Leeds we have many gold postboxes, a legacy of the London Olympics, when gold medal winners had the postbox closest to their home town painted gold as an honour. Again, culture flouting a standard.

As quickly as we can, we need to begin to agree nationally (and why not even globally) if we are to achieve integrated or interoperable healthcare systems. The standards to do this exist in so many ways already. Digital health doesn’t need changes to be made at the mega-vendor level, the systems need to adopt the standards and then innovate to exist in a ‘system of systems’ approach.

Maybe we need to use Eagleton’s four cultural reference points as starting points to creating a joint understanding of where we need to get to.

Values: The value of having integrated care has been made clear for decades. Digital leaders are still at the begging bowl though, seeking funding to deliver the necessary platforms that are required to enable information sharing. Information is now becoming more complex, faster in the way it changes and more encompassing of the healthcare experience and value needs to be placed on the innovation needed to achieve a truly interoperable healthcare system.

Customs: Local customs need to be protected but somehow we need to move from the clinical system paradigm. You know the one, where the clinician you have engaged loves the idea of a single system across the hospital, they feel it’s a great idea, but their additional one special system still needs to be protected as well. This has become known as the ‘one plus one’ clinical system and in a hospital it means we have one system, plus one for every adventurous clinician in the hospital.

Beliefs: We need the healthcare system to stand up for the belief it has in the delivery of integrated care. That belief will drive the ultimate understanding of what a system of systems digital solution can provide.

Symbolic practices: Perhaps in the NHS this is about to happen with the launch of the Local Health and Care Record Exemplars funding and a platform to enable lessons to be learned, standards to be tested at local levels (of five million population) and a real drive from the centre and from the ‘spokes’ to truly achieve this.

There has to be a hook to the original Bevan statement about the creation of the NHS, “Healthcare free at the point of contact”, so now we need data ‘free’ at the point of contact and this can only be achieved if we all have the same reference points.

Now, can I get some fries, I mean chips, I mean crisps, I mean home fries…

CCIO Leadership Styles.

Originally published by DigitalHealth.net

Since the publication of Robert Wachter’s book in the spring of 2015, the idea of clinical engagement in all that is digital health has been pervasive. But before ‘the’ book and over the last decade at least, I have seen a plethora of different styles adopted for the role of what we now call Chief Clinical Information Officer (CCIO).

The styles that can be adopted by CCIOs clearly work in different ways to match the culture and needs of the organisation alongside the benefits these digital projects are trying to achieve. The organisation in which I am now working, Leeds Teaching Hospitals Trust, has some amazingly talented clinicians with significant interests in many aspects of digital. As a Trust we are about to embark on the expansion of the CCIO role, creating a clinical leadership team of three, with individual responsibilities for:

  • Nursing and AHP
  • Academic, Research and Innovation
  • Clinical and Medical

The three CCIO roles will now be supported by nominated and clearly identified staff throughout the clinical service units (CSUs). The clinicians across the CSUs will act as the focal point for engagement in each of the CSUs throughout the trust. Also the creation of the office of the CCIO across Leeds Teaching Hospitals Trust will ensure promotion of the CCIO role in a way that facilitates a real width of clinical engagement, not just at the trust itself, but across what is becoming more and more referred to as the ‘place’.

Clinical engagement in digital is like pasta. There are so many different ‘flavours’ and ‘types’ and picking the right one is dependent on the digital ‘dish’ you are creating around your system. Many pasta types have regional variations and some have different names in different languages, for example ‘rotelle’ is called a ‘ruote’ in Italy and ‘wagon wheels’ in the USA. Let’s take three types of pasta and see if we can make this analogy work for the CCIO role:

  • Spaghetti – A long thin cylindrical pasta.Italian in origin, which translates into ‘thin string or twine’.
  • Rigatoni – Medium to large tubes with square cut ends. Italian in origin and translates as ‘large lined ones’, usually served in large quantities.
  • Cavatelli – Small pasta shells that can be described as looking like hot dog buns. The Italian name translates as ‘little hollows’, however there are 27 different names for this type of pasta.

In the last few years the model for clinical engagement in the digital agenda has transformed hugely. I remember discussing how to ensure that the initial delivery of the National Programme for IT’s Summary Care Record needed to be clinically led and this was way back in 2006. The amazingly driven Dr. Gillian Braunold pushed every part of the technology team so hard, often to the point of distraction as the need for clinical engagement was so new to us. But more than a decade later her style and her ideas for how clinical engagement can be achieved are really coming to the forefront as examples of the best ways of working. The concept of complete clinical ownership from an early stage of any digital project was something she championed way back in the early 00s.

The clinical engagement in place for the Summary Care Record was not seen as a CCIO role, more the twine that held the whole programme together. Certainly as the first sites went live the programme would have failed in its initial goals if it weren’t for the clinical engagement that had taken place. Clinical engagement in this case had to focus not on the benefit to the clinician impacted, the GP, but on the patient benefit and the longevity of the record of care, beyond system verticals. Dr. Braunold, even as far back as 2006, was talking about the fabric of information needed to offer the best care for patients, regardless of clinical setting, which is perhaps our earliest example of a digital fabric being raised.

This type of clinical engagement is epitomised, I think, by Spaghetti, due to the long twines of connectivity. In many ways the way spaghetti also has popularised the ‘dish’ also draws comparisons to what Dr. Braunold did in those early days.

To deliver business change in healthcare we need to engage our customers and they need to co-define the art of the digitally possible. At a recent presentation one of my CCIOs in Leeds put a statement up on a slide that I fell in love with:

“Dear clinical teams, please come to us with problems not solutions, then we can help fix your problem together!”

Clinical engagement in an acute hospital can often fall into the 1+1 story. The engaged clinician completely agrees that a single source of truth for clinical information is necessary throughout the organisation as long as their specialist and favourite application is also to be accommodated. That’s why in 2014, in Ireland, the health system had over 3,000 applications and in Leeds today I have over 300.

This influences my next example, which to this day I think is a brilliant illustration of not just engagement but full scale leadership. In 2014, the Cork region of Ireland decided to push forward with digital referrals from GP to hospitals. This project not only needed clinical engagement but clinical leadership of a kind, to that point, not seen in Ireland when it came to digital.

Joyce Healey, a physiotherapist, volunteered to lead the project and took it from the germ of an idea to a fully functioning solution, initially embedded in GP systems and then on to the possibility of integration into hospital systems across the whole country. The strength of the clinical leadership though is what is important here. Joyce not only took on ownership of the clinical engagement but the leadership of the project itself. It was agreed not to have a national project manager in its earliest days as the lead clinician suggested that the best way to truly ensure the project remained clinically focused was to actually be at the ‘coal face’ of the project.

The work here then calls back to the pasta analogy in that the sheer pervasive nature of the CCIO work in this project made sure that clinical engagement drove success. Lasagne delivers the meat filling with a layered approach to holding the dish together, maybe this is the best example we can use here, holding a superb dish together through a structure that worked well and ensured that the core elements of the ‘dish’ arrived where they needed to.

The development of the CCIO function in Ireland followed a similar path to the eReferral project. A council of clinicians was created under Joyce and then added to with successive and successful CCIOs. The initial style of ensuring that clinical leadership was apparent in everything the team did and this became a key part of the way of working for digital across the whole country. By the end of 2017, there were over 300 CCIOs in Ireland. This number has been criticised in some quarters as the vast majority of them did not have ring fenced time to act in this role, but, the nature of the way they were appointed into the roles has seen them enabled in being local clinical leaders for all things digital and they have become powerful and enabled as an influential voice for the digital health transformation across the country. The large group now created, and the way in which they line up to offer their expertise and advice, also works well with the Rigatoni pasta analogy, the sheer volume needed to create the dish!

I wonder who is the most influential CCIO in the business today? Who is the most famous pasta dish? For me it has to be the person described as ‘THE’ digital nurse: Anne Cooper. I worked with Anne for a while in the National Programme for IT and saw her vision for what clinical leadership should be, her vision of ‘card carrying’ NHS professionals ensuring that large digital programmes were successful, flows way back to the early 2000s. What Anne embodies different to so many CCIOs though, is her ability to not just represent the clinical need for digital inspired change but also her ability to translate from digital to clinical to citizen and patient speak. The Cavatelli pasta dish is known by 27 names throughout the world, let’s face it digital health and care programmes have so many different names for the same benefits that we are trying to deliver that perhaps Anne’s style is easily analogous to this type of pasta.

There are so many clinicians in the digital leadership business today and so many CIOs that truly now believe in the CCIO role; not as a nice to have but as an intrinsic element to achieving success. Professor Joe McDonald in his role as chair of the national CCIO leaders’ network in the NHS posted to social media in the run up to Christmas;

“A CIO isn’t just for Christmas, also without a CCIO a CIO is like one hand clapping.”

This new way of thinking reflects the views of almost every CIO I have spoken to in health and care recently. We are asked to collaborate as digital leaders but without a CCIO we will struggle and probably fail. The new ways of working that CCIOs bring to the digital agenda ensure that we are no longer moving to the digital bleeding edge without at least a clinician on hand to patch us up!

The NHS Digital Academy that Rachel Dunscombe is leading the creation of fits to this analogy too. What Rachel and the team are doing is setting up the Master Chef and cooking school for CIOs and CCIOs throughout the NHS. It feels like at last the opportunity is there for us all to learn from every Gennaro Contaldo there is and begin to truly build little Jamie’s Italians throughout the NHS!

All power and ragu to the CIO CCIO relationship!

 

 

 

 

Handover CIO

First published in CIO Magazine, November 2017.

In 1797 George Washington instigated the first handover period for the presidency of the USA, he handed his responsibilities to John Adams. Since the 1960s a 72 to 78 day handover period has featured in every transition of the presidential role, and yet in almost all other public sector and civil servant role changes a handover period simply doesn’t happen, in all the CIO roles I have had I have never had the opportunity to conduct a proper handover one that means you hit the ground running, rather than running to catch up.

In a few days time I will leave Ireland for Leeds after three years working in a country with a passion for what digital can do for healthcare. When I resigned from my post my boss, the director general of the health service here in Ireland could see that there was a need to have a careful, considered and informed handover process to maintain the pace of change that we have been working to. In a break from what would have been the easy decision it was decided to look outside of the Office of the CIO for an interim person to hold onto the digital healthcare business and to receive a handover. Appointing a progressive, digital business leader to the role of interim CIO eight weeks before my departure has meant we have been able to work through a handover of the business, we have been able to agree priorities for 2018 and at this time in the Irish political calendar we have needed to agree how the budget for next year should be spent.

CIOs need to get better at succession planning, I would suggest one of the reasons we have not been seen to be great at this so far is that we have very much an individual stamp on the businesses we run as CIOs. Our styles and how we work with the ‘business’ to achieve digital goals is one of our core values, handing that to another is always difficult.

With an interim CIO appointed we began to plan the handover, we broke the content down into areas that would make the most impact the quickest, what this did was highlight a prioritisation process for the work of the team and the office.

There were five themed areas that we agreed would be our area of focus:

1 – Delivery of Person Centred Care

2 – Trust and the Protection of the health systems assets

3 – Value add services – Patient focused innovation and proving the digital capability.

4 – Create Insight and Intelligence through data that is already collected.

5 – Connect the Care Delivery Network

The digital strategy has been in place since 2015 and the delivery plan for this was agreed in 2016. This means the interim CIO can move into the continued delivery of this, however what does need to be refreshed is a new operating model for the Digital team, an operating model that reflects changes in how service is delivered and how engagement can be brought from a digital responsibility to an organisational scalable way of working. This now becomes a priority for the new CIO, not always ideal, making changes in the early stages of taking on a new role but a necessity to continue to enable the evolution of the team.

Being able to instigate a proper handover has given the organisation the opportunity to really consider the way the team works as one function. In a recent Gartner presentation the idea of four digital accelerators was raised and how these are now being applied to the future of team working. These areas are; Digital Dexterity; Talent, Diversity, Skills and Goals; Network Effect Technologies and the Industrialised Digital Platform. The handover process with these as core values as to where and what is done next has helped hugely as we strive to put in place a robust way forward that continues to drive a new pace to digital in healthcare.

The handover process has included not just a new ownership of the digital agenda but a new face of the change being brought to healthcare through digital. Therefore involving the new interim CIO in all engagement events has been part of the process and one that has seen the new CIO move into the public eye. The handover has also been delivered in the public domain using social media as the platform to enable the team and our partners to see the process and to meet the new CIO in a virtual way. The #HandoverCIO has been used as a way for stakeholders to see the activities that are underway. The culmination of the handover process was a meeting of all partners to an open interview with me and the new interim CIO, the design of the session was to make it part of one of the quarterly Eco-System meetings but also to ensure that the partners could see that they were going to be able to continue to evolve the relationship they have from a traditional vendor relationship to one that continues to be described as a partnership.

The transition from Bill Clinton to George W. Bush in 2001 was a fraught process best epitomized by the Clinton prank of the removal of all of the ‘W’ keys from keyboards throughout the Whitehouse. The transition from CIO to CIO often does end up with a lack of knowledge of where ‘the bodies are buried’, a phrase used when I came to Ireland in 2015. A colleague offered his services on my first day to help me avoid digging up the bodies that had been carefully hid. By working on a handover process and a proper transition there can be no ‘buried bodies’, no surprises and no need to re-learn what has gone before.

Handover has been great, but now its time to let go as the quote suggests below…

Make yourself available for advice if they want it, but only if they ask for it – don’t stand in the shadows trying to hang on to something you’ve decided to stop doing. Professor Graham Moon

Giving up your ‘baby’ is hard to do but as a CIO in transition to a new role it has to be done smoothly and the new CIO empowered. As handover comes to an end please support a new CIO with advice and guidance, Jane Carolan is a digital leader that is now a CIO, she is excited to be in the role and can’t wait to engage with the wider CIO community, tweet Jane @janemcarolan

Whose data is it…

Biden Vs Faulkner, whose data is it any way.

 

Having a common enemy, a common ‘bad guy’ will always help a cause. A figurehead to rally against is one of the best motivators for the creation of a movement. Maybe in the last few weeks the Biden vs Faulkner showdown will be the catalyst for a new lease of life for the patient data movement. If the reports are true the Chief Executive of Epic; the Digital Health multinational may have ignited a new enthusiasm for patient data openness, by challenging Joe Bidden as to why on earth a patient would want access to their own data.

The conversation is said to have gone like this; Faulkner was amongst a group of healthcare executives gathered together to discuss with Biden the Cancer Moon-shot. The internet based magazine Politico reported that Faulkner raised questions about the utility of patients being given access to their own health records in a digital format.

“Why do you want your medical records? They’re a thousand pages of which you will understand 10,” she allegedly told Biden.

“None of your business why, I, the patient want access to my information,” Biden is said to have responded. “If I need to, I’ll find someone to explain them to me and, by the way, I will understand a whole lot more than you think I do!”

The culture of digital health organisations in the UK and Ireland has changed over the last decade so substantially that Faulkner’s comments sent many of us into shock. I distinctly remember arriving in Ireland and in 2014 and being asked to take part in a patient advocacy roundtable. At this event the gentleman who represented the Parkinson’s patients of Ireland towered over me and demanded that I, “… stop pussy footing around and get my data shared if it means that a cure can be found for this god-awful disease!” His premise was that if I didn’t he would and he wanted his information now, on a memory stick so that he could give it to an academic.

In the US we are told that the way the patient portal payment structure was created for meaningful use means that vendors were paid on a ‘log in attempt’ basis, this meant it was in the vendors interest to lodge a member of staff in waiting rooms and ‘help’ patients log in to their records, just the once. Pretty much taking the meaning of the phrase meaningful use and throwing it away.

We can also think back to the National Programme for IT in the UK and its version of patient access, HealthSpace, I can place a clear reason why that didn’t take off too, it was so very very hard to authenticate yourself before you could use the service. It required to visit a library with three forms of ID, to receive a letter with a PIN and then set up a significant password structure, the drop off rate before people got to view their records was huge, and understandably so. And yet here we are in 2017 with a new start up bank, N26, who have the technology to allow you to authenticate who you are with a camera on a mobile phone, from the safety of your own bedroom you can have a bank account up and running in eight minutes! Technology moves quickly and really does allow us to implement the digital health dreams we have.    

So there are a few technology examples of Faulkner being right, well at least the technology not facilitating her being wrong! But, now glance over to Finland and Catalonia two regions that have proven the ideals that Biden has described for patient access to information to not just be the art of the possible but be actually here now, information in the hands of the patient and making a difference to the care being delivered.

The first time I heard the solution that Finland has created to this issue I was in awe; the work is a partnership with Microsoft and shows the innovation and ingenuity of the possible through partnership, clever thinking and a will to put the patient at the centre of what can be done. In Finland the national electronic health record is effectively a set of data that is mirrored to two windows. The first is the clinical EHR, the first place the clinician sees information about their patient, the second window is the patient version of the same, the key difference is the patient can add information to the record via their ‘window’. The patient can add free text or wearable gathered data or home held diagnostic information, the clinician can see this information and decide to add it to the clinical side of the record. The clinical governance of the information is still held with the clinician but the ability is now presented to the clinician for them to value the patient input to the record and move it over to their ‘window’ on the information, thus giving it the clinical validity it deserves.

Suddenly the comment made by Faulkner become even more ludicrous; the patient information is not only about them and owned by them but now has real clinically valid input into the care being prescribed and practiced, let’s not forget that this is the person Faulkner is worried won’t understand the information, they are now an author of some of the information.

The next success story here must be the amazing work that Tic-Salut have done across Catalonia in this area. They have created an eco-system throughout the region that has driven a new type of credibility to the delivery of patient access to information. The proliferation of health apps is huge; in Catalonia the market place for these apps to be released into has been created by the health system itself. An accredited app store for the healthcare system built to allow patients and clinicians to use health apps with confidence. Unique though to Catalonia is the arrangements put in place around the data that these apps can use. If you have an accredited health app one of the conditions is where the data is made available, not just within the app but in a secure, audited and protected way the data can be used within the health care systems own information systems. What Tic-Salut have done here is ensure that the lines between clinical data created by clinicians can be blurred with the data created or collected by the citizen and patient without overloading the clinical team with data, after all data is only useful when it becomes information.  

Then we come to our own projects; in Ireland we have a decade long history of under investment in digital health to first get over to allow patients digital access to information, but, in Epilepsy we are seeing an almost immediate patient impact by having access to information. The patient portal trialled in the delivery of care for patients with Epilepsy has been a huge success for many reasons. First and foremost the portal and its functions have been co-designed by the patients and families themselves, the elements you can do with the portal are exactly what the patient wanted to be able to do. So viewing the clinical note is there as a function that has been seen as being useful but also the new ability to record a seizure, its severity and frequency and type has enabled a new paradigm in the delivery of care.

The ability for a patient to be significantly involved in reviews of medication efficacy through the capture of data has seen around 100 patients come off anti-epilepsy drugs since the portal has been introduced. I have championed digital solutions for the care of epilepsy since coming to Ireland in 2014, largely because of the passion that clinicians and patients, the careers and the special interest groups have shown for what can be done here. I hope that this light house on the art of the possible in Ireland can continue in to 2018.

In Ireland we have a plethora of digital health start-ups and new organisations. The Jinga Life team for me are delivering a solution that is a ‘light at the end of the tunnel’ for what can be done in Ireland. A design unlike any I have seen in healthcare, truly a delight to use and see. The concepts of Jinga Life is to concentrate on the key member of the family who is ‘tasked’ with the care organisation of the family. In their research over 90% of care is managed and organised by the female in the family. The Jinga Life portal allows the family member a tool to organise that care and to provide new data that can become clinical information to the clinician. Part of the success on the build of Jinga Life is its clinical and patient focus, definitely one to watch and one that I hope will show Faulkner yet again how wrong she is.

In the same week that Ireland launches its Open Data portal this data debate rages on, whose data is it anyway? Much can be discussed here but one thing we do know, its not the data of the digital vendors that are out there, and we need to seize back the ability to get at that data. A patient engaged, involved and aware of the information that is used for their care is a patient that can be part of the clinical delivery process, a patient empowered to help themselves.  

Hospital in a box…

First published as a KLAS blog in June 2017.

Do you remember being a kid at Christmas time, toys came wrapped and in boxes and by Christmas evening so many of us had reverted to playing with the boxes that all the new toys had come in! Imagine your parent’s frustrations…

Imagine if the hospital EHR came in a box ready to deploy, would we be ‘playing’ with the box within the first week I wonder? Once upon a time we used to talk about a hospital without boundaries, in some areas that evolved to a liquid hospital, as we move to the next decade a new idea is starting to emerge, a new parallel, the digital hospital in a box.

No this isn’t a chapter in the SIMS game or an elaborate Minecraft playground, this is where clinicians, patients and managers want to be! The mobile experience has continued to evolve at such a pace that the expectation of what we can do with our devices puts eHealth into a new world, a world we want to go. A world that seems like it could be attainable with just a little different type of effort.

Twice in one week I have been shown patient applications on mobile devices that enable patients to take control of their care wherever and whenever they want to.

The digital Haemophilia support capability deployed in Ireland allows a patient to be in complete control of their care and the treatment plan they have, ‘live’ from their very own smartphone. Ordering new treatment to be delivered and allowing the health system to track this treatment brings a level of patient safety never before seen. The solution also takes the theories of ‘just-in-time’ efficiencies and applies them to healthcare. Just like the fast-moving consumer goods industries where ‘just-in-time’ was invented, this has brought remarkable cost savings and the removal of so much waste in the delivery of drugs to the patient.

The second app is a collaboration between a charity, an academic partner, a technology delivery group and the health system. The epilepsy patient application now delivered in Ireland brings a huge change to the delivery of care to people with this long-term condition. Communication with clinicians is important for any patient with any long-term condition, and the impact on patients with epilepsy has been particularly revolutionary. A patient can now record and communicate the frequency, type and severity of a seizure to their clinician who can use the app to securely communicate suggested changes to the drug and treatment regime.

For patients with a genomic sequence they can now see the geneticist’s opinion of their illness enabling the control of illness to be shared and the nature of the ‘expert patient’ to evolve considerably. In a remarkably short period of time, some patients have been able to come off the drugs they have been on for long periods due to near real-time evaluation of efficacy of the drugs regime they are on and the shared ownership of data about their illness.

When we consider the impact of digital advances on healthcare one of three things can happen; it can continue to evolve at a slow pace but a ‘safe’ pace; digital solutions can optimise what is delivered already, or truly digital could transform the way healthcare is delivered.

The question we are asking ourselves as digital leaders in healthcare is, are we trying to change the way healthcare is considered and delivered or are we ‘simply’ trying to improve it. A supercharged hospital in a box could be the answer we have all been looking for.

On a recent study trip to Barcelona I was lucky enough to meet the team from TicSalut. More than anywhere else I have seen, the Catalonian health system has ‘cracked’ the mobile application and data problem for health, and the way they have done this is by taking the concepts of a mobile engendered Eco-System and making it real in every possible way. Catalonia has built the first box for the hospital to be packaged in! How have they done it?

First and foremost, they have managed to maintain control of the market place by offering a type of accreditation which has significant value to the builders of mobile applications. Their brand is trusted, respected and brings value to patients, by offering a marketplace for accredited apps they have managed to ensure an agility to market without stifling the innovation capability of its growth.

TicSalut have gone a step further than merely a ‘kite mark’ for health apps though. As part of the accreditation process the organisation asks that, with patient consent, the data collected in the app is not only made available to the app supplier but also the healthcare system of Catalonia. A clinician can see the information a patient or carer has and from a clinical point of view decide if the information is a valid addition to the clinical record, accepting it into the EHR of the patient where appropriate. The patient then can see they clinical record and can make use of the information inside the apps they have decided to use themselves. All of this strikes me as a bit like a box with both sides pushed open, truly a system facilitating a new eco-system approach to the delivery of healthcare.

Innovations like these don’t come overnight, of course. TicSalut have been building towards this for 10 years, ensuring that a new paradigm in innovation and openness of data can be achieved for the patients they serve. The concept of the health and wealth of the ‘nation’ really being at the heart of what they are delivering. The links to innovation through universities and academic fellowships are now well established. The apps are always recommendations and not mandatory, also the patient still chooses the app that they want to use. Prescribing an app can take place but it still always comes back to a patient choice.

Throughout Catalonia where clinical apps are used they can also be rated and reviewed by clinician and patient, taking from the travel industry and sites like Trip Advisor the clinical solutions deployed via mobile are crowd source reviewed and the results of this adds weight to the kite mark applied to the app.

If we are to apply the successful digital lessons of other business areas then we need to ‘wow’ the customer. Healthcare has a difficulty in defining its customer which makes this goal complex but, in the case of the hospital in a box this becomes easier. We need the patient that is receiving care to want to be part of the journey and the clinician who is delivering the care to understand the benefits of the information they are receiving, the veracity of that information. Maybe the much used three V definition of Big Data (Volume, Veracity and Variety) can find better application in simple clinical information!

The new concepts of digital allows businesses to become services rather than costly (sometimes wasteful) capital expenditure items. Take for example the work Phillips has done at Schiphol Airport, by applying circular economy principles Schiphol Group and Philips have created a new way of working, a new partnership. Philips now has responsibility for delivering light to the airport, responsibility for the fixtures and fittings and ultimately the recycling of the fittings. By taking this responsibility Philips can offer their most innovative and cost effective lighting solutions as a service to the airport, making a capital free investment for Schiphol in lighting innovation. Now apply this to healthcare, and try to do it without creating perverse incentives.

An EHR service cost model in a public healthcare system, facing the budgetary challenges we all understand, cannot be charged for digital solutions per bed or per patient basis easily. Doing this will instead cause a different consideration; whether to put information into the EHR. Yet, the digital service model can still work. A hospital in a box, a digital solution deployed to the patient first can work in this way, we are seeing this with the consumer driven shift in primary care, Babylon Health, WebDoctor.ie and VideoDoc and others here in Ireland are all facilitating some service model type solutions to the delivery of primary care interaction. The patient becomes the payer for the service in a different way; but in a way that enables innovation to be fostered rather than kept to a decade long cycle of investment.

Service solutions or the new term ‘platform businesses’ are pivoting throughout the globe and becoming new innovations; Tesla becoming an alternative power company, charging home based batteries overnight on off peak electricity or Uber becoming a way of ordering the delivery of vaccinations direct to the citizen in need, and so many more.

The ability to deliver health as a service to patients seems today to be hooked to the mobile capabilities though and particularly to this idea of the healthcare system in a box. In the space of a single piece of writing then we have managed to move from a hospital in a box to the whole healthcare system!

Digital leaders in every jurisdiction of the globe are trying to consider where in the tipping point they are, “are we here to optimise the health system with digital? Or are we here to enable a transformation?” The “healthcare as a service” concept, facilitated by the healthcare system and being delivered in a digital box can transform the health systems of the world! We know that digital is ready but the human factors along with the business change elements, are the more difficult parts to resolve. That’s why I believe the concept of a healthcare system in a box is useful, it simplifies what we are trying to do. Samsung talks about the unboxing of the mobile phone for different reasons at the moment, but if we can deliver, and then unbox the digital healthcare system then maybe we have a route to achieve the business engagement and change that so many healthcare systems need.

The healthcare system in a box provides for our ability to be a multi-channel business, at last the engagement of our hard-to-define customer base can be done comparatively easily as we suddenly have many more digital routes to engage through. Engagement has to be done on the needs of the ‘customer’ rather than the organisation and therefore the idea of multiple channels means we can offer the ability to engage in the same way as so many businesses do who successfully put the customer at the heart of what they do, the box has so many routes into it!

One of the advantages of moving to a concept where the digital hospital is delivered through the proverbial box could well be the ability to lock the hospital in a box and use it to protect the data and the experience of the patient. Recent cyber threats and the escalation of the vulnerability of healthcare to cyber-attack gives us, the digital health professional, a new challenge to overcome. Placing the digital experience of the patient into their own hands provides healthcare with, at the very least, a new level of vigilance. We don’t ask one person to adhere to hygiene standards to enable infection control best practice to become standard, we ask everyone, maybe that is what can be achieved by ‘crowd sourcing’ the customer in the cyber threat battle.

We have had the cardboard box since 1817, and now whether it’s Calvin and Hobbes creating a time machine (or a ‘transmogrifier’) or the gag real on the computer game Metal Gear, the cardboard box is an accepted part of growing up; even the national museum of toys in the USA has a box in it, the only non-branded ‘toy’ it has as an exhibition. So, if the humble cardboard box can become a toy for all our children since the early 1800’s then I am sure as a concept for healthcare it can become the answer to the truly patient focused electronic health record!

The Liquid Hospital…

First published for KLAS research, republished here for completeness…

Liquid healthcare systems.

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 it will require a large amount of business managed change and can’t be made so ‘just’ through the implementation of technology. The thinking is starting to mature here and in November Ireland’s minister for health began to use the phrase a health system without boundaries, after all digital doesn’t recognise the ‘physical’ boundaries of a hospital or GP Practice.

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 Health Record (EHR) 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 article let’s stick with the name as a term.

Simple ideas

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 2016 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 digitally and directly into their system ready for next time you the patient are with 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 made available 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. It has been available the last five years at least if not longer. The big change is perhaps twofold; investment in the aspects of technology to drive this (including training and development) and the change in how care is delivered at a business and service 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 brought to a wider audience (and bought into) by clinician and patient alike maybe this could be an innovation we can make reality, its certainly describes a system that puts the patient at the centre and yet is only just beyond our own reach. A tangible view, just over the horizon of eHealth in action.

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 HSE’s own integrated care programme and reform programmes beginning the concepts of change, the creation of the Individual Health Identifier and concepts like ‘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.  Our 2020 vision sees health without walls made possible by digital.

 

 

MedTech the leap from Sci:Fi

Ahead of the Dublin Tech Summit (#DTS) in mid-February where we will be considering the links between what was Sci:Fi and what can now be described as Med Tech.

The leap from Science fiction to a reality gets less and less and less. Amazon Echo, Microsoft Cortana and Apple Siri, are coming so quickly from an odd idea to an accepted part of the daily life. How long before these technologies bring a new information style to healthcare. The digital persona that the Echo and the lovely Alexa are creating for Amazon are said to be worth over $200,000 per person. In some jurisdictions amazon can now value the lifetime revenue from a cohort of customers that have signed up for their Prime service to such a degree that they can actually trade against the expected profits they will make.

Would we want similar technology to come to healthcare, many today wouldn’t but what will the time line and generation gap be before we are happy for this to be the case I wonder? As many people unwrapped the Amazon Echo for Christmas this year the reaction on social media was very mixed, from why would you want the ‘stool pigeon’ in the room to I want one! And by keeping the cost of what in reality is quite an impressive piece of kit low we can see Amazon and others begin to make huge strides in tying up this market place.  

Digital personas are starting to exist in many businesses lines; imagine the Amazon digital persona of a Prime user with an Echo and its uses in the consumer arena applied to the delivery of healthcare. The data based prediction of buying patterns and the commercial power this now drives has huge potential. As Amazon step into the pharmaceutical and FCGs market places this is going to grow and grow on its impact on healthcare, the fast followers of this technology are going to be able to make a big splash in healthcare quickly.  

The digital twin is a concept now used by Rolls Royce and GE in the management of aircraft engines. Imagine a healthcare system that makes a digital twin and then offers to run ‘you’ in the same way as Rolls Royce run the aircraft engine, spotting the issue before it happens. Genomic sequencing could begin to offer us that opportunity, especially if we linked the data to a service akin to the Echo, where not just the scientific sequences were information the situational analysis of health but also the context of the person, we after all have been talking about the advent of contextualised healthcare for over a decade.

Again many will object and won’t want that information to exist or be willing to take the information risk of the information being misplaced, but some, perhaps a next generation will see the benefit of this. The blur-ing of the lines between next generation digital and Sci-Fi is becoming easier and easier, what is interesting though is the impact of digital on healthcare, the disruptive impact of technology on commerce and wider business verticals has been huge and yet in healthcare its still in its infancy, a bit like Sci-Fi of the 1970s I guess!

The beauty of slow adoption though is that untried and tested technology can be avoided and lessons can be learnt from other business areas more easily. Also, the ability to gain engagement from the user base, the clinical teams wanting to use technology has become much much easier. The consumerisation of technology has reached such a peak that more often than not the new Sci-Fi like advancement has often been tested in the home before it lands in the clinic. Take Microsoft hello, no longer will a clinician need to touch the keyboard to authenticate, hugely powerful in the application of electronic health information at the point of care. Mobile computing more generally opens up the place where care can be delivered. AI allows questions to be asked of learning made more quickly than ever before.

In the last two years Ireland has enjoyed its fair share of global recognition for its involvement in the most important Sci-Fi brand ever, Star Wars and the filming of those crucial scenes in episode seven. In the last two years Ireland has also leapt forward in its application of digital to healthcare, truly looking at how to make use of the next digital disruption enthusiastically.

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