The term ‘disruptive’ often has negative connotations, but when it comes to innovative technology in healthcare, it is overwhelmingly positive. While there is little doubt the health and social care system will see considerable clinical and operational gains from the implementation of emerging innovation, it still has a long way to go to be considered a leading user of technology and to reap the benefits it can provide.
We are fast approaching, if not there already, a stage where the main challenge isn’t the technology itself but the ability to make the cultural, operational and financial shifts required to adopt at pace and scale once it is proven.
In this article, we look at some of the ways in which health and social care organisations can make incremental leaps adopting innovative technology, some of which are available today, and some that are close on the horizon.
The role of technology in integrating health and social care
UK hospitals continue to see an unprecedented demand for care. During the 2018 winter, one in five hospitals ran out of bed space, with 99 declarations that Trusts had reached their 100% occupancy across a two-week period1. In addition, the average daily bed occupancy of general and acute beds has increased from 89.8% to 91.4% over the past five years.
The issue of ‘bed blocking’ is very well known and driven by two main factors:
- The UK population is increasing and getting older. By 2046, it is estimated that 24.7% of the UK population will be over 65, compared to 18% in 2016.
- More patients with long-term conditions are increasing the complexity of patient care requirements, e.g. the number of all patients with diabetes has increased 12% over the past five years alone.
Another well-established reason for a breaching maximum bed capacity is not being able to discharge patients who are medically fit but still require some level of support, due to lack of resources in the community and social care settings. Technology can assist this process in several ways:
- Data capture such as remote monitoring & medicine – by using telemonitoring technology, patients who are generally well but require ongoing monitoring can return to their home in the knowledge that should their health decline, or a problem emerge, their clinical team will be automatically alerted. This potentially enables earlier discharge but allows a quick response if the patient’s health deteriorates. Mainstream technology continues to advance rapidly (the latest iWatch has an inbuilt ECG) and while nervousness over patient confidentiality and privacy will remain, the number of use cases is set to expand exponentially. One such medical-grade solution is Kardia EKG, which is able to record a high standard cardiac rhythm using a small and relatively inexpensive ‘credit card’ size pad that links to a smartphone. With the application of special algorithms, amongst other features, the software can assess for arrhythmia, and keep a close watch on patients with atrial fibrillation – even detecting this early. This frees up considerable clinician time and may detect heart rhythm irregularities sooner than periodic outpatient clinics might, improving clinical outcomes.
- Transforming data to usable information then to knowledge – there are many national programmes looking at how technology can help make health and social care work together more efficiently. The early direction from NHSX is eminently sensible and recognises that the health system needs the right core technical infrastructure and data must be interoperable to provide the best possible chance for innovative platforms to be deployed with legacy ones. It is possible however, to achieve better integration with existing technology. By using existing data integration engines, data analytics tools such as Microsoft’s Power BI, and existing management systems, it is possible to derive powerful insights across regional health systems.
Doing more with fewer clinical resources
One of the consistent themes of the latest wave of disruptive technologies in healthcare is undoubtedly maximising the use of available data. In the past, data has resided in silo’s, unable to be harnessed in ways now possible. Data is now increasingly integrated, and will become ever more so, as data standards and interoperability improve.
Organisations should plan ahead to consider what insights can be drawn and how the outputs can be used to drive faster fact-based and real-time decision making. Scan4Safety is five years old and has been successful in improving both patient safety and efficiency, underpinned by common identifiers and standard data formats and has generated a wealth of rich data in the demonstrator sites. By correctly analysing large datasets, patterns emerge that can help highlight significant cost savings and efficiencies, with low complexity or inexpensive changes.
Another such application is the use of ‘smart testing’ which uses AI to rapidly diagnose disease. The University of Glasgow and NHS Tayside and Dundee University have been using this approach to test the cost-effectiveness of an intelligent Liver Function test(iLFT).
It may even be possible to use predictive analysis to proactively alert operational managers to problems that are yet to occur. The challenge is seeing through the noise of the data to identify changes in key factors which drive the problem.
Machine learning and other artificial intelligence technologies are also extremely powerful and have the potential to transform data analytics and clinical care. One way that machine learning can be used is to augment the ability of clinicians to find disease in patients. Using algorithms, new software solutions can now rapidly analyse patient diagnostic images to find clinical signs of illness.
Significant improvement in operational efficiency may be realised by using in-home devices to capture data on patient progress following surgery, thereby ensuring close monitoring, and crucially negating the need for follow-up appointments in person. Having such large volumes of patient data (as opposed to data collected purely in the clinical environment) will provide a much more accurate view of how the patient has healed, and at a much lower cost.
Personalised medicine
We are entering a world of personalised medicine, in which therapies, medication and interventions are bespoked to our unique genetic makeup, medical history, environment, and personal characteristics. Large-scale initiatives such as the 100,000 Genomes Project, in which the goal of sequencing 100,000 complete human genomes was completed in December 20184, will enable the recommendation of treatments that are optimised for an individual’s genetic profile. This will lead to many improvements and efficiencies including earlier detection of disease, improved health outcomes, less need to repeat or try new treatments due to ineffective drugs, less time in hospital, fewer drugs needed, and less time required by clinicians.
In the future, with the aid of handheld DNA ‘Point of Care’ scanners (such the MinION portable real-time device for DNA and RNA), a patient’s entire DNA profile will be uploaded, and illnesses or markers of future disease picked up before the patient is even aware. Such technology certainly raises ethical and moral questions, but the potential for re-engineering our model of care from one that is reactive to proactive is considerable.
Ultimately, where the current regime may be struggling to keep pace, personalised medicine will also go a long way to assisting health and care commissioners and managers keep up with the ever-growing clinical complexity of patients’ clinical and medication needs. In an encouraging presentation to the Guild of Healthcare Pharmacists, Blake Darke, NHS Commercial Medicines Director articulated how the commercial frameworks at a national level will evolve to facilitate routes to market for innovative medicines and reiterated the importance of manufacturers considering the evidence required for commissioning as well as regulation in the development process.
How can we help?
Akeso & Co understands the challenges our clients encounter linking emerging and disruptive innovations to a tangible goal / strategy for both individual organisations and collaborations. Understanding the potential impact of emerging technologies is a complex exercise.
Akeso & Co has an innovative technologies team and are the appointed Category Tower Service Provider for Diagnostics, Pathology & Therapy Technologies and Services as part of NHS Supply Chain and constantly seeking advancements in the area of diagnostics, therapies and point of care testing. We are working with NHS England and a number of Public Health bodies to put in place sector leading frameworks to access a range of technologies including Genomics technologies.
We encourage technology companies to take an end-to-end view of the clinical pathway in which their innovation/technology will be used, to understand its potential to improve clinical outcomes, add value, reduce risk and bring about clinical improvement and operational efficiency.
For more information, please call Scott Healy on 020 3011 1381, or email info@akesoco.com.
Chris Robson