Are we set up properly for the provision of health services required by people in 2015 and years to come? The idea of an annual checkup with your GP seems anachronistic – in an era which offers the potential for constant monitoring.
We now have the potential to monitor personal KHIs (Key Health Indicators) 24*365. But we do not have the systems (and professionals) in place to process the data. We do have the professionals who are capable of identifying the KHIs – and in many cases we have the technology capable of capturing the KHIs. But we do not seem to be offering the monitoring and services (both proactive and reactive) to deal with exceptions in the KHIs.
So how might this work? Perhaps blood pressure is a KHI for a patient – systolic and/or diastolic. Perhaps these would be monitored constantly for the patient. When either measure found to be outside certain limits may want to cause an action to take place – from rest to call doctor to go to hospital. But presumably the circumstances may also be relevant – did the reading take place during a squash match, while sedentary, after a row? Is there a trend in the readings? What are the patient’s weight measurements?
As per usual one of the challenges will continue to be to have the patient alter her/his lifestyle – take the relevant exercise, rest, follow the right diet, whatever. And of course the monitoring can expand to cover a lot of this – for now with some cooperation from the patient in terms of recording her/his intake.
How does the healthcare provider operate in this new environment? The doctor now becomes more of a coach – e.g. we are working together to get you to live to be 100 years old while living independently, travelling under your own steam, etc. In order to do this we need to put some monitoring in place and you need to agree to some life style changes. And the coach probably needs to be a team of coaches – rather than the traditional GP. Also, if 100 is the target, will probably need some succession planning.
Different people will react differently to this change in role of the health advisor/ coach. Potentially may give people a better overview of their health and the impact of choices they are making. For instance if you choose to play a collision sport and accept a number of concussions what is the likely impact? What will we adjust in terms of monitoring to detect/manage any negative impact? In these circumstances the sports team’s medical advisors would be required to interact with the player’s medical coach – probably with a view to sharing some of the montiroing results (subject to patient’s permission).
Another interesting area relates to chronic disease management – surely there will be significant gains in this area through regular monitoring and data collection? Sites such as www.patientslikeme.com are already offering patients the opportunity to record daily updates of their own condition as experienced by them – including their perception and experience of the efficacy of a range of treatments. Unfortunately, for now, many doctors struggle when presented with this level of information – tending to want to go back to asking all the old questions, ignoring the data available to them (how many of them actually review the data when made available to them before the consultation with the patient?). But they do not yet have a commercial model for this new data rich world.
The debate/ argument/ disagreement about introduction of free GP care for children of 6 and under is now really heating up. There seem to be a few elements at play, including:
- GP view that this change is being forced upon them
- GP view that the government is taking a very specific interpretation of competition law to prevent GPs coming together to argue their case
- GP view that their’s is the one part of the health care sector which is working effectively and why (on earth) would anyone want to break this first up#
- Government determination to push forward with this as one of the first steps in introduction of UHI (to include Primary Care).
I tend to look at GPs much as I look at myself – running their own consulting businesses – with a combination of smaller customers (individual patients) and larger customers (GMS patients through government). And we share many challenges – be it cash management, winning new business, changing economic circumstances, funding a pension, whatever.
But I just read back through the ‘Future Health’ document published by the Department of Health in November 2012. And it’s there in black and white on page 32: ‘…the removal for fees for GP care…..this reform is required because the body of evidence that user fees are a barrier to accessing care at the primary care level and thereby cause late detection of illness, poorer health outcomes and greater pressures on the acute hospital and long-term care systems.’ And they make it clear that the y intend introducing this on a phased basis.
So, in spite of the fact that many may believe the GP system is serving us well, it is clear from the Department’s point of view that the GP system is part of the problem.
And as I reread the Department’s strategy for health and its intentions re primary care and a much broader and more integrated primary care environment I struggle how to see this can be married with the traditional role of the self employed GP. Yes – many go ahead GPs have come together to form practices which enable them to provide a wider range of solutions and to share/ develop specialties. But the language of the document seems to be very focused on integration of GPs and lots of HSE employed professionals (or perhaps the plan is that more of these professionals would operate outside the HSE?) – this does not seem to be clear in the document).
Universal Health Insurance has a long way to run – seems that the GPs are being thrown into the mixer upfront.
As with all websites – the question to be asked: who are you serving?
American Medical News references a recent report from the Journal of Healthcare suggesting that medical practitioners and hospitals need to addess accessibility of their web sites – content should be written for the reader, not for the writer.
This is a challenge for all websites – not to bombard the reader with technical jargon.
Excellent example quoted is: ‘For example, some websites have data related to ventilator-acquired pneumonia, but they used only the acronym. Or they used “nosocomial infections” instead of the more understandable term “hospital-acquired infections.”‘.
The report also references limited use of social networks. This is also consistent with findings of recent Deloitte report – suggesting only 6% of physicians using social media to communicate with patients.
As someone who depends on doctors for medical advice, someone who works with doctors and someone who promotes innovation through technology I am frustrated at the inconsistencies across healtcare in the adoption of IT.
Core questions for me seem to be:
- Does adoption of IT solutions have the potential to improve patient healthcare?
- Can IT reduce risk to the patient?
- Can IT assist medical professionals in getting more of their decisions right?
- Can IT be implemented without significant impact on the business of the medical professional?
- Does IT offer the medical profesional and the patient improved communication/ cooperation/ collaboration?
- What are the downsides for the patient and for the doctor?
- Are there quality applications and secure frameworks available to the doctor and the patient?
This new report from Deloitte, based in the US, would suggest that adoption is slow and inconsistent.
It would seem to me that market forces will ultimately drive this – and by market force I mean choice for the patient, requirement to communicate/ collaborate and regulation or the increasing requirement to demonstrate the quality of proceses followed.
Interesting to read Paul Rellis (CEO Microsoft Ireland) pushing significant amounts of technology in Education and Health as ways to address much of the problems we have.
Would agree 100% with Paul Rellis’s ideas around uses of digital technology. However seems to me risk putting cart before the horse. First we need a clear vision of what we are looking to achieve, then commitment from those in Health & Education to achieve the vision, commitment from the investor (govt.) in terms of any required investment. The technology bit is not actually that hard – using Microsoft technology, other proprietary technology and open source technology – in any, to be agreed, configuration.
But first let’s set vision, get some commitment and manage the change.
Great presentation illustrating the trends in healthcare spending in the US – up to 2007. Includes one slide comparing with a number of other countries – including UK.
Brought to my attention by @endamadden on twitter.
Do we have similar information available for Ireland?
Interesting post on project healthdesign: The Doctor’s Role in a Health 2.0 World.
Describing the patient as the ceo for his own body ie he takes responsibility, while the doctro is described as the consultant – advising the patient, seems like a good model, which reinforces the idea that the patient needs to manage his own lifesytyle, etc.
The other interesting obeservation relates to the general ‘information overload’ being experienced by all of us in all walks of life. It is quite possible that a patient may know a great deal more about his specific condition than the doctor providing the advice. However the doctor hopefully brings a broader picture and understanding. Seems no reason why the patient and doctro should not collaborate in advaincing the situation. Of course this does tend to turn the more traditional doctor/ patient model on its head.
innovation through technology