Surfing the digi-health wave

Surfing the dig-health wave.

This is a summary of a keynote presentation I gave at the NZNO Nurse Managers conference on Nov 4, 2016. The aim of the presentation was to show how digital is being used right now in healthcare settings and what’s just round the coming, quickly ….virtual reality, artificial intelligence, 3D bio-printing…. But also, how to encourage and lead digital transformation in health settings like hospitals, general practice and community health services.

We are on a digital wave

Right now, digital is being used by people to manage their day, do their shopping, plan their travel and connect with whanau and friends.  Almost 90% of NZ mums are on Facebook, ‘insta-stars’ like Taylor Swift have a following the size of Romania, Helen Clarke is on SnapChat and kids pocket money has gone ‘Kash’less. All around us, we are immersed in digital and it’s making our lives smoother, more connected, more in our control.

 Health is learning to surf

The pace of digital change in the health sector has increased rapidly in the last few years. Hospitals are using tools like TrendCare to manage variable demand and allocate resources in a much smarter way. Trendly is being used to identify gaps in service and improve efficiency of service delivery. ‘Hospital at a glance’ systems are enabling ‘whole of hospital’ ways of working. DHBs are finding ways to meet their communities online. App based health coaching is improving long term conditions like diabetes, patients are welcoming the ability to do online bookings, prescription requests and own their medical records with the integration of patient portals while in hospitals, ‘iPads at bedside’ trials are helping patients stay in touch with their families and whanau so they are connected, happier and get home quicker. 

 Meanwhile, in the ‘big picture’ of population health, big data and integration of data sets is giving new ways of targeting health resources where they’re most needed and precision medicine is providing rapid delivery of tailored treatments. Health is on the wave.

 But wait, there’s more

Outside health, advances in 3D printing are opening up innovative ways of delivering medical care from rapid prototyping of new devices to replacing plaster casts with 3D exoskeletons. Podiatry is being ‘re-delivered’ by using patient managed apps that ‘scan’ your feet sending the file to a cloud connected 3D printer so a customized orthotic can be sent to the patient in a matter of hours not days. Put drone delivery into that model, and you get ‘just in time manufacturing’ combined with door-to-door delivery for personalised health that’s controlled and owned by the patient.

 Virtual Reality for the game of life

Virtual Reality provides the ability to take intense data and turn it into images that can be manipulated, anywhere. VR also enables us to construct virtual worlds for training and education. The result? Paraplegics are walking again with VR. After 12 months of using virtual reality training, people with paraplegia are getting up and moving, on their own. The VR training stimulated the neuromuscular pathways to the extent that they ‘regrew’, enabling movement. Stunning.

 The hospital of the near future will have a staff of 100

The last 20 years of medical technology has been about advances in medical diagnostics and treatment. Bigger, more expensive machines, housed in bigger, more expensive buildings leading to ongoing the dilemma of how we afford to provide the latest in medical technology, that the community deserves, with the shrinking Vote Health available.

 The next 20 years will be about the ‘devolvement’ of building based medical services to digital delivery of patient managed treatment and care - because we can and because we have to. Wearable devices, smart fabrics and sensors will enable HCPs to care for patients from a distance and for patients to keep a 24/7 watch on INR, HbA1Cs, anxiety, HR, hormones and even ‘loneliness’ with personalised health coaching and wrap around, ‘high tech, high touch’ digital support. Soon, stroke, cardiac, dementia, mental health and diabetes patients won’t have to enter a hospital at all. They’ll be able to manage their own care, wherever they are plus, all that patient data will be aggregated to give live improvements to risk prediction algorithms and in turn, being feed back to patients to provide personalized, proactive, early interventions. This is already happening with aggregated data from mobile phone users being used to give early indicators of anxiety to improve mental health (we check our messages and social media feeds more when we are anxious).

 We can now keep people well, in their place. The potential costs savings for the patients and their whanau let alone the health sector is enormous. We could do this now with borderless care.

Orthopeadic surgery as we know it, will change

Stem cell regeneration is already being used instead of surgery. In the next 5 – 15 years, the ‘mash-up’ of nanotechnology, stem cell therapy and 3D printing will enable printing of new knees, hips and cartilage made from the stem cells of the patient and 3D printed in a bioengineered, injectable solution that will grow into the bone matrix. Star Trek meets MacGyver.  This will totally disrupt the current model of orthopeadic surgery and enable the devolution of building based, centralized services.

 I’ll rest in my own home thanks

Ask any older person and the majority will want to stay in their own home for as long as possible but safety and care management means that they end up in expensive, resource intensive, rest homes. Right now, there are start up companies providing home based tech solutions that surround the older person with smart sensors that register vital signs, recognizes changes in behaviour patterns that could mean dementia or a fall and provide immediate contact with whanau and medical services. Rest homes are using medical robots to provide one-to-one care and connection and what’s more, the residents like them. The costs of an ‘in-house’ medical robot, in home sensors and wearable devices are far less than current aged care services, while allowing the older person to maintain their independence for as long as they want. This also means the healthcare assistant currently working in rest homes (for minimum wage) would become skilled, digi-health coaches, technicians, robot operators and social networkers. We better start adding ‘digital’ to healthcare courses asap.

 The machines are coming

Take your brain, now read a research article on the latest advances in cancer diagnosis and treatment and apply that to a patient case. How long would that take? 30 minutes, 2 hours, a day? Now connect your brain to 1 million other brains. Read and analyse the article. How long would that take? Machine learning can analyse 1 million books and keep a watch on 170,000 clinical trials….a second! The power this gives oncologists and researchers will change theirs and their cancer patient’s lives.

 Already patients are using an app based, artificially intelligent GP via a chat bot on their phones to get diagnosed and treated instead of having to go to a general practice. No more waiting rooms, no more 7 minute patient consults, no more ‘hard to reach’ patients. True, patient-centred care.

Use the rip. Digital drivers

So what will it take to create a digital transformation in healthcare? Not at the technological edge of healthcare but built into the ‘normal’ day to day care we provide now?

 The two key factors that drive digital change are one, cost efficiency and two, ‘consumer’ demand.  We have both these drivers happening in health providing the motivation and the ‘why’ to make it happen. Currently, when digital transformation takes place in healthcare, a ‘whole of setting’ approach has been used with ‘buy in’ from Board to operational level.

 Blending the learnings together, gives a broad ‘model’ to start from.

1.     Base on user experience and care

2.     Take a ‘whole of setting’ approach

3.     Gain buy in across the organisation

4.     Map the patient and treatment pathway

5.     Map the user experience pathway

6.     Identify the ‘blocks’

7.     Re/develop the pathway based on the user experience (both patient and deliverer)

8.     Apply digital solutions to reduce the ‘blocks’ and/or provide an enhanced user experience

Please note, this list doesn’t start with digital tools. It starts with care.


Future surfing

How we deliver health is rapidly opening up. While we are short of HCPs across the sector and need more, we also need to borrow from the digital action of banks, airports, airbnb, Alibaba and Uber to both reduce the demand on health services but also to allow HCPs to operate at the top of their scope. We can use digital to take over a range of admin tasks, increase the power and speed of diagnosis and maximise the use of specialised resources through digital care. Healthcare and the patient no longer need to be in the same room.

Imagine patients using an airbnb type app to book their treatments, Kaumatua picking up their new smart sensor 3D knee brace from their Marae, nurses using ‘surge pricing’ to contract their services and driverless cars or better still drones, collecting blood samples from in-home robots.

Imagine a DHB that has no hospitals, a rest home that has no residents, a general practice that has no consult rooms.

Imagine how the ‘model’ of health could be transformed.

Health will always be about people, it will always be about care but it will stop being about buildings and location. ‘High tech and high touch healthcare’ is not our future, it’s our now.