EMPOWERING PATIENTS

“I am not a number I am a free wo/man”

EMPOWERING PATIENTS

ANYONE REMEMBER THAT SERIES?

•When was it from

•Where was it filmed

•Sub-text…..

− Individual versus the collective

− Information

−More information

LOOK AT THE MEETING THEMES

• Innovative business models

•Empowering patients and staff

•Big Data

•Who is driving the agenda? Users or the technology providers

EMPOWERING PATIENTS AND STAFF

•Empowering comes from knowledge

•Knowledge is synthesised information

• Information is collated data

•Data is the raw source material

TECHNICALLY….

• Information shift: %age of global available processing power

Pocket Calculators

PCs Video Game

consoles

Servers Mainframe

Phones PDA

1986 41% 33% 9% 17% 0%

2014 <0.1% 60% 25% 3% 12%

TECHNICALLY

• Information shift: %age change in global storage capacity

Analogue Storage

Digital Storage

1986 2Bn Gb 20M Gb

2014 18Bn Gb 276Bn Gb

9x 13,800x

TECHNICALLY

• Information shift:

• In 2014 there was 39Gb of storage for every human on the planet

•That’s 25 HD movies of data

•Enough to store your genome 20x

PHYSIOLOGICALLY

•86Bn neurons

•1000 connections

•100Tb data

•Most assume we can store more like 2.5 Petabytes of data

•Human storage outstrips stored data by 100x

BUT BY 2020

•Applying Moore’s Law what is stored about us will exceed our capacity for storage by 2030

•But storage has consistently broken Moore’s Law

•More likely storage about us will exceed our capacity by 2020

AND JUST AFTER

•Looking at pure processing power

•Ray Kurzweil estimates machine speed of processing will exceed human brain speed by 2023

HOW DOES THIS AFFECT EMPOWERING

Capacity to store

Ability to process the data

Can be liberating if applied to the right tasks

Can be limiting too

FOCUS ON HEALTHCARE

TAKE A STEP BACK UK HEALTHCARE MODEL DATES FROM THE 1940’S

1948 2014

Life expectancy (1) Male 66 Female 71

Male 78 Female 82

UK population (1) 50.3M 64.1M

Major challenges Infection Nutrition

Death in childbirth

Diabetes Obesity Cancer

Major medical advances

Penicillin Kidney dialysis

Stem cells therapy Spinal nerve regeneration

Infant mortality (1000 births) (1)

42 4

Budget £437M (2) (£9Bn at 2014 prices)

£110Bn

(1) Century of Change (2) NHS Choices

TAKE A STEP BACK UK HEALTHCARE MODEL DATES FROM THE 1940’S

1948 2014

Life expectancy (1) Male 66 Female 71

Male 78 Female 82

UK population (1) 50.3M 64.1M

Major challenges Infection Nutrition

Death in childbirth

Diabetes Obesity Cancer

Major medical advances

Penicillin Kidney dialysis

Stem cells therapy Spinal nerve regeneration

Infant mortality (1000 births) (1)

42 4

Budget £437M (2) (£9Bn at 2014 prices)

£110Bn

(1) Century of Change (2) NHS Choices

TAKE A STEP BACK UK HEALTHCARE MODEL DATES FROM THE 1940’S

1948 2014

Life expectancy (1) Male 66 Female 71

Male 78 Female 82

UK population (1) 50.3M 64.1M

Major challenges Infection Nutrition

Death in childbirth

Diabetes Obesity Cancer

Major medical advances

Penicillin Kidney dialysis

Stem cells therapy Spinal nerve regeneration

Infant mortality (1000 births) (1)

42 4

Budget £437M (2) (£9Bn at 2014 prices)

£110Bn

(1) Century of Change (2) NHS Choices

TAKE A STEP BACK UK HEALTHCARE MODEL DATES FROM THE 1940’S

1948 2014

Life expectancy (1) Male 66 Female 71

Male 78 Female 82

UK population (1) 50.3M 64.1M

Major challenges Infection Nutrition

Death in childbirth

Diabetes Obesity Cancer

Major medical advances

Penicillin Kidney dialysis

Stem cells therapy Spinal nerve regeneration

Infant mortality (1000 births) (1)

42 4

Budget £437M (2) (£9Bn at 2014 prices)

£110Bn

(1) Century of Change (2) NHS Choices

TAKE A STEP BACK UK HEALTHCARE MODEL DATES FROM THE 1940’S

1948 2014

Life expectancy (1) Male 66 Female 71

Male 78 Female 82

UK population (1) 50.3M 64.1M

Major challenges Infection Nutrition

Death in childbirth

Diabetes Obesity Cancer

Major medical advances

Penicillin Kidney dialysis

Stem cells therapy Spinal nerve regeneration

Infant mortality (1000 births) (1)

42 4

Budget £437M (2) (£9Bn at 2014 prices)

£110Bn

(1) Century of Change (2) NHS Choices

TAKE A STEP BACK UK HEALTHCARE MODEL DATES FROM THE 1940’S

1948 2014

Life expectancy (1) Male 66 Female 71

Male 78 Female 82

UK population (1) 50.3M 64.1M

Major challenges Infection Nutrition

Death in childbirth

Diabetes Obesity Cancer

Major medical advances

Penicillin Kidney dialysis

Stem cells therapy Spinal nerve regeneration

Infant mortality (1000 births) (1)

42 4

Budget £437M (2) (£9Bn at 2014 prices)

£110Bn

(1) Century of Change (2) NHS Choices

TAKE A STEP FORWARD FORCES ACTING ON THE OBJECT..

Health Care

Provision

Consumer demand

more

Tech & individual

care

Costs are increasing

Life-span is

increasing

Consumer knows more

Co-morbidity

Delivery Budgets

restricted

CONSIDER THE DIFFERING AGENDAS WHO IS THE DRIVER, WHO IS THE PASSENGER

ay

Patient

Deliverer

Provider

Payor

DIFFERING AGENDAS PATIENTS AGENDA

•Wants the best care for themselves and family because they paid for it (indirectly or directly)

•Want to know it is there if needed, safety-net

• Is informed about what the alternatives are

•Has access to basic data eg NHS Choices

•Will get access to more data eg FFT

• PAC to A->A

• Immediacy

• Service mentality

DIFFERING AGENDAS DELIVERERS AGENDA

•Wants to give the best care possible

• Pressured by bureaucracy, top down imposed systems and paper-filling

•Does not appreciate hyper-informed patients

• Is concerned about metrics, tools, transparency

•Wants to know about innovations, and how they will be paid for

•Not a Service mentality, it’s a vocation

DIFFERING AGENDAS PROVIDERS AGENDA

•Wants to give the best care possible

• Is concerned about metrics, tools, transparency, efficiency, standards, (No Stafford here please)

• Pressured by finance and budget constraints, frequent system changes

•Over-whelmed by reporting, and paper-filling

•Has a service mentality

DIFFERING AGENDAS PAYORS AGENDA

•Wants to give the best care possible as recognises health = wealth

•Wants to drive a ‘healthy agenda’ to address health challenges

• Trying multiple systems to squeeze efficiency

•Complex delivery system so requesting reporting, and paper-filling to compensate for insight

DIFFERING AGENDAS WHO IS THE DRIVER, WHO IS THE PASSENGER

•What are the common themes

•Demand increasing, age, co-morbidity, lack of incentive to improve, neuro-degenerative conditions, cost of care

•Need to drive efficiency, but without the top down imposition of systems, being able to deliver more for less

•Culture clash --- one man’s transparency is another man’s exposure

HELLO BRICK WALL

COST PRESSURES

%GDP spent on healthcare will need to nearly double

COST PRESSURES

%GDP spent on healthcare in UK up 50%

DIGITAL IS GAME CHANGER INNOVATION AT THE INTERFACES

• Most creativity and innovation occurs when different worlds collide such as digital and healthcare

EMPOWERING/ENABLING

1. Micro/mobile-systems

2. myHealth

3. Personalised medicine

4. Portable records

MICRO-SYSTEMS

Bringing health IT into the 21st century

Individual v the Collective

MICRO/MOBILE SYSTEMS THE REVOLUTION IS ALREADY HERE IN OTHER SECTORS

100M wearables by 2018

DON’T WORRY BE ‘APPY THE REVOLUTION IS ALREADY HERE IN OTHER SECTORS

•Centrally designed, centrally deployed systems have failed multiple time

• Small systems leveraging existing technology will be the norm

DON’T WORRY BE ‘APPY THE REVOLUTION IS ALREADY HERE IN OTHER SECTORS

• Booking medical appointments on your phone

• Repeat medication, results

• Phone becomes your portal to health

• Becomes your portal for your family’s health

• Personal, private, pervasive, portable.

DON’T WORRY BE APPY SCALABLE & DELIVERABLE

0 200 400 600 800

UK repeat prescriptions

Flights on UK airlines

M per year

5000

163

0 1000 2000 3000 4000 5000 6000

GP appointments

Ocado orders

000 per week

DON’T WORRY BE ‘APPY HOW WILL MOBILE EMPOWER THE PATIENT

•What does the future look like

•Check you in for appointments by geo-location when you are 50m from practice

•Notes ready with Physician

• Know where to go

• Know how long the wait is

• This is all possible today

MYHEALTH

Taking responsibility for your self

Using technology to direct interactions with healthcare delivers

MYHEALTH IF I DON’T LOOK AFTER ME WHO WILL?

•We will all be rewarded for looking after our own health

•Access to treatments/reductions in cost

MYHEALTH MY DATA WILL BE WEARABLE SHAREABLE & MAYBE UNBEARABLE

•Asynchronous appointments, empowering inclusion, concurrent not transactional

• Less Sherlock Holmes/House more caring conversations

PERSONALISING HEALTH

I am not a number, I am a series of numbers

Upfront, personal and revealing

PERSONALISED MEDICINE DIGITAL INNOVATION GOING TO IMPACT: GENOMICS

• In the past it took 13 years and $2bn to read the first human genome, now it takes 2 days and £1,000

• 7 Impacts:

− 3.5millionUK citizens will suffer from a rare disease, 75% are children and most die before age 5.

− Power to stratify medication according to disease

− Power to exclude/include antibiotics to where it will work

− Reduction in imaging diagnostic usage

− Increase in regular patient monitoring when conditions known but not yet expressed i.e. increased primary care burden

− Care pushed to tertiary/quaternary and reduction in secondary/DGH usage

− Increased usage of monitoring technologies

PERSONALISED MEDICINE DIGITAL INNOVATION AND GENOMICS

• Have to develop ability/ethical climate to store/access/distribute data (not another care.data) and explain why it is beneficial

• Storage

− Each Human genome requires 1.4Gb space

− UK requires 70 Petabytes (1PB = 1 million Gb)

− Storage costs for UK £15m

− In 1994 a PB storage would have cost $100 Billion, in 2014 cost is $120,000

− Today we can read/transfer 1 full Genome every 2 seconds

• Public v Private

PERSONALISED DIAGNOSIS HOW IS DIGITAL INNOVATION GOING TO IMPACT: NEUROPSYCH DIAGNOSIS

• 820,000 people with dementia in the UK, will double by 2034

• Tested many products in 11 years and premature big hopes for bapineuzamab and solanezumab

• At Cambridge Cognition the IP is 28 years of neuropsychological test data, hundreds of 1000’s of data points and norms, stored in Cloud

• Used power of big data to develop tests for early identification of Alzheimer’s, ADHD, depression, anxiety, schizophrenia, Parkinson’s.

PERSONALISED DIAGNOSIS HOW IS DIGITAL INNOVATION GOING TO IMPACT: NEUROPSYCH DIAGNOSIS

• No biomarker, disease is hard to diagnose, no accurate imaging

• Taken power of big data and developed an iPad based 5 minute test to reassure the ‘worried-well’ and identify really early dementia

• Personalised medical approach to give the right treatment to the right patient, and where no treatment required, no costs

• In 10,000 tests, 50% were ‘normal’ and reassured, 25% needed extra referral

PORTABLE RECORDS

These are my numbers, but I am happy to share if you ask nicely

PORTABLE RECORDS EMPOWERING THROUGH OWNERSHIP

• Top use for Evernote in USA is for storing personal health records

• Move away from them being my records about you to your records

• Benefits

− Entitlement to care

− Improved emergency care

− Move providers easier

− Sharing between providers

• Challenges

− Letting go

− Privacy

− Security

EMPOWERING

•Why hasn’t this happened already?

DIGITAL IS A GAME CHANGER

• External drivers are pushing

• Technology is pulling

• Patients are asking

• Medical profession is cautious

• Possibilities are enormous

DIGITAL IS A GAME CHANGER

• External drivers are pushing

• Technology is pulling

• Patients are asking

• Medical profession is cautious

• Possibilities are enormous

DIGITAL IS A GAME CHANGER

• External drivers are pushing

• Technology is pulling

• Patients are asking

• Medical profession is cautious

• Possibilities are enormous

•Thanks……………………….