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.
The term ‘The Age of’ is used to describe a sweeping change where the difference brought about by a catalyst is noticeable and for a period of time the change applied becomes the definition of an evolution.
At a recent event senior members of the healthcare delivery team in Ireland described the era we are about to enter as the ‘Healthcare Information Age.’ This brings good and bad connotations; firstly it’s a slightly ajar door to push against when the leadership of healthcare are using the area you are responsible for as a descriptor for the reform and change of healthcare and its current delivery culture. However it is also symptomatic of the current technology availability in the Irish healthcare system, that in 2015 we are only just beginning to describe the impact of technology on healthcare as a striking change. I have written before about the pockets of innovation and excellence all over Ireland and about how our focus in reality needs to be about joining these up, and that is how I see us getting to the Healthcare Information Age, or at least one of the steps on the way.
In thinking this through a comment from my A level medical history teacher sprung to mind;
“Before planning for the future study history first to ensure that lessons are learnt and mistakes that others have made before can be avoided, look in the rear-view mirror before turning right into the change lane!”
With this in mind a friend and his colleague developed a description of what they think are the eight ages of healthcare in Ireland:
The First Age – Local and Essential – publicly funded care provided for the poor and indigent (1880’s – 1910’s). Technology in this period of time is just after Edison’s light bulb so care would have the ability to be provided more safely at night however with the advent of Coca Cola in 1886 the path to obesity and tooth decay would have been started.
The Second Age – The Age of Public Health – TB and water/sewage sanitation improvement is the key focus (1912 – 1930’s). Arguably the first analogue computer was ‘live’ at MIT under the name the ‘differential analyser’. A long way from the computer impacting upon health but maybe the first time that more complex analytics of health situations became possible.
The Third Age – The Old versus the New – Strong professional and Roman Catholic Church opposition prevents the introduction of “socialised medicine” in the guise of a Irish National Health Service (1930’s – 1947). A key invention in the path to the study of health was invented during this age, the electron microscope, a new frontier in clinical research is opened through this invention.
The Fourth Age – The Foundation of the Modern Irish Healthcare System – The Department of Health is founded in 1947. It is during this period that the skeleton of the current, public and private system we recognise today was established (1947 – 1970). The forerunner of the internet was booted up for the first time in 1969, the Arpnet allowed US government computers to communicate at high speed over a network.
The Fifth Age –The Centralisation of Administration and Policy – Responsibility for healthcare administration and policy moves from local authorities to eight regional boards. The policy focus is to develop acute hospital care. This age is also characterised by perceived fragmentation and inefficiencies in Irish healthcare. (1970 – 2000). 1992 brought about the first ever Smart pill, perhaps a forerunner to the internet of things being truly applied to healthcare delivery.
The Sixth Age – The Age of Reform – This era is characterised by the most radical organisational restructure of the healthcare system since 1970 with a focus on placing the patient at the centre of the system and care delivery. As the Celtic Tiger grew so did private health insurance subscriptions and the private hospital sector also (2001 – 2007.) This age brings about an explosion of new and exciting elements to the health care environment ranging from the first artificial liver to the fever screening system for buildings to you tube, a tool now used to discover so much more about any illness that any patient may feel they have before they even get a medical opinion.
The Seventh Age – The Age of Austerity – The global financial crisis dramatically impacts funding and resourcing in the Irish healthcare system. Progress on a number of major national initiatives, including the development of a new national children’s hospital, stall. Higher unemployment places greater pressures on the public side of Irish medicine (2007 – 2014). The explosion of the connected person and social media as a disruption to healthcare define this age both areas continue to evolve the concept of the quantified self as a patient experiencing healthcare.
The Eighth Age – The Age of the Digital Economy – Economic recovery is taking hold and the time for planning the next major reforms of Irish healthcare has arrived. Information and digital technology now need to play a greater role in delivering improved outcomes for patients (2014 – Today) In 2015 we will see the explosion of the wearable device that, if the hype is to be believed, will see patients recording information for themselves as part of their daily lives that can be used for the provision of care and driving clinical outcomes.
In studying the past we build a lens to look on the future, the reason my medical history teacher said we should study the past was always to learn lessons for the future to try to influence how we innovate and live. So these eight ages give us the history, but if the history teachers are to be believed then we need to consider this to tell us about the future. The excitement that technology, not just computer technology and data will bring to healthcare in the coming ten years far outweighs the changes over the last eight ages.
I shamelessly stole the term ‘post-modern age’ (where it is related to Health IT) from a wonderful clinician here in Ireland who has provided personal drive to ensure technology can bring about an outcome to care provision.
What does it mean though? In this case, I think it is a descriptor for recent times in healthcare technology in Ireland. This is best typified by looking at the past and using the concepts in healthcare to build the themes for a technology supporting infrastructure. A mix of the modern, where it can be made to work and the past because of necessity due to funding and resourcing. This works well in so many cases, take the Epilepsy EPR a solution grown from within a hospital setting that evolved over a period of time. Or another example is the Picture Archiving Communication Service (PACS) deployed in Ireland under the project known as NIMIS. This solution is a phenomenal implementation with a huge user base, live in 51 sites, with over 10 million exams, 20,000+ users and records for about half the population of Ireland.
What is ‘post-modern’ about these implementations? I believe it is in how the best has been made of them, in the case of the Epilepsy EPR it has grown from clinical engagement considering what the outcomes were that were needed and then working with technologists to achieve them. In the case of NIMIS it is the decision to procure a world class PACS solution and enable that as a corner stone for connected health in a country enabling it to evolve as the Radiology Information System is improved and the Individual Health Identifier becomes available.
A new realty though is where the concept of traditional technology changes the health outcomes and care dynamic, where access to large complex data sets that relate to the DNA and genomic nature of every human being will become part of healthcare provision. A start up with a 30 year vision called Human Longevity has an ambition to do just that, applying the principles defined by J. Craig Venter in Life at the Speed of Light to the provision of healthcare and indeed even the regular everyday Electronic Health Record (EHR). The sequencing of a whole human genome will move to under a $1,000 cost by the end of 2015, applying Moores law to this process bares no reality. Human Longevity have the first 10,000 sequenced genomes within an EHR in the USA and have plans to get this to 5 million in 5 years! The availability of this information within the EHR simply describes the next age for healthcare for me.
The next age will evolve from the information age and become something I am not always a fan of using as a descriptor, the Technology age of healthcare will be upon us. The ability to step away from pure information and into an ability to really use technology in the disruption of healthcare will define the next change. Technology will be able to be part of the provider capacity. Technology will be the facilitator that moves health provision away from the old limitations brought on by de-innovation based on old structures, old ideas and old systems.
Technology allows health to more from reactive to predictive through new technology, whether that is a portable genome sequencer like the nano-pore sequencer or the ability to put sensors with visual outputs under the skin like the team at Project Underskin, a product that could be here now but will be acceptable in 5 years!
So, to finish without going too Sci-Fi, I will leave that for another day, ‘The future is already here… it’s just not evenly distributed’ William Gibson
All we need to do is the distribution from innovation to reality to create the next transformative age!
With special thanks to my friend and colleague Derek A. Lande for his help in the development of the different ages of healthcare in Ireland and to the Wired Health team for the inspirational presentations on the future of technology in health.
Innovation is an abstract of what we do every day, but a new system that has been a couple of years in the coming will be delivered by Father Christmas this year. A system that will become the spine of information systems across the clinical research economy in the UK, a system that will live up to its hype and can make the performance management of clinical research more easily achieved regardless of study type or location.
Like kids at Christmas we are really excited to have the new system implemented across the networks. It will be the fruition of many minds’ work to specify and design a system that meets a breadth of requirements. Turning business needs into system requirements, which in turn become a technical specification, has been a challenge, particularly when we consider that we have been attempting to ensure the whole network of users are engaged in the delivery. But, as we reach the last sprints of delivery, we believe we have pulled it off.
Making innovation a reality whilst maintaining engagement with a wide range of users is a challenge. The argument that Information Systems professionals are SciFi writers is often levelled when trying to deliver the “Imagine a World” speech.
Flicking through Sunday ‘Magazine TV’ after the wonderful Andrew Marr had finished tearing the latest political guest apart, I came across a very odd headline, “Would you allow a robot to look after your relative with Dementia?”. And there was me thinking the iOS7 was cutting edge! The thrust of the programme though was that technology is ‘nearly close enough’ to be able to deliver mainstream basic care to dementia patients through solutions at home. To me this seemed like something from a late 80s Sci-Fi TV series.
But it did get me thinking over my black pudding and eggs! How far has technology come in comparison to the old ideals of Sci-Fi, particularly in the field of health care? Some examples that sprung to mind: Star Wars – Immerse Luke Skywalker in a liquid jelly for a day and all will be well with his frost bite:
So after Luke is lost in the snow, gets beaten up by an ugly woolly monster and is visited by the ghost of his recently dead ‘uncle’, he eventually gets rescued. Once rescued, Luke is placed in a tank with a weird liquid that is healing his frost bitten body.
And now in 2013 we are able to do something very similar for patients with burns and indeed frost bite.
Star Trek – Hologram doctor and self diagnosis through apps the crew wear: Short of money and trusting a computer’s data base more than a human brain, Starfleet invest in a hologram doctor and fit the crew out with uniforms that monitor their medical conditions and collect the data for analysis.
And now in 2013, one of the hottest products of the year is the UP Wrist Band by JawBone, the perfect solution for the worried well and stay fit fanatics.
So, back to our solution for the performance management of clinical research delivery in the UK. It is no longer science fiction to think that we can deploy a system that can capture information about all clinical research in real time, and with reference data checks and balances within it that ensure data quality is of a very high standard. It’s a fact that by the first couple of months of 2014, the UK will have a system that enables information about studies, levels of recruitment and other none patient identifiable information to be made available to researchers and sponsors, so that research and trials can be managed in a manner akin to the delivery of other health care provisions.
So the next challenge to the team will be where the innovation comes next. I can’t wait to see how the system evolves and how it inspires and acts as a catalyst for cultural change in the delivery of clinical research. It’s going to be a very exciting time and nearly as exciting as the announcement that the next three Star Wars films are going to be made!
NB – The Central Portfolio Management System is the NIHR CRN system described above, the system is being developed by Tribal Education Limited and deployed by the Knowledge and Information directorate within the Clinical Research Network. The system will be launched in mid December 2013 and be live in January 2014.