Sunday Telegraph UK: Business technology supplement April 2011

8/6/2019 Sunday Telegraph UK: Business technology supplement April 2011

1/16

Will the rise o digital healthcare mean more twith patients and less time chasing recor

Record breake

Healthy investment Bloodless coupPage 4 Pa

Its taken o in the

US and the developing

world; now e-health

is coming to the UK

Will treatment by

telephone replace

ace-to-ace

consultation

The best medicine Page 9

Apri

Drug therapy works

best in a virtual world

BusinessTechnology Distributed within the Sunday Telegraph,produced and published by Lyonsdownwhtakes sole responsibility or the contents


2/16

Around 30,000 new medical studies arepublished annually, to add to the hal a millionalready out there, and its estimated that theaverage doctor now needs access to two millionpieces o inormation to provide patients withthe best diagnosis and treatment.

The volume o inormation is so vast thatits almost impossible or clinicians to keep up,says Dr Rubin Minhas, clinical director o theBMJ Evidence Centre, one o the worlds lead-ing providers o clinical in ormation services.

Because o the explosion o scientic re-

search over the last 15-20 years, the traditionalapproach o doctors reading new research intheir spare t ime is no longer reliable. Whatsmore, research is now so sophisticated that itsincreasingly dicult or the average doctor tomake sense o it.

Most doctors read only two or three medicaljournals, and in the consulting room they havean average o just 15 seconds to search orinormation. Under these kinds o pressures itsnot surprising that many doctors lack con-dence in areas outside their specialism, and thatpatient care can suer.

A US study ound that patients were onlygetting just over hal the care they should havereceived, partly because their doctors knowl-edge wasnt ully up to date. And policy-makersare increasingly concerned that much-neededcash is being spent on treatments that have

little or no eect on patient outcomes, or onexpensive drugs that are no more eectivethan cheaper alternatives o which cliniciansmay be unaware.

Patients increasingly need someone whoknows where to nd all the answers ratherthan someone who knows them already,says Minhas.

Doctors need a way o accessing the latestmedical knowledge, in real time, and withrelevance to particular patients. The conceptis called evidence-based medicine (EBM), andit uses the latest technology to record currentmedical thinking and make it available to theproessionals who need it.

EBM is very time and resource-intensive,says Minhas, who is editor-in-chie oClinical

Evidence, the BMJ Evidence Centres market-leading EBM product.

The BMJ Evidence centre employs a teamo more than 50 people who are experiencedat reviewing scientic literature. They ana lyseevery piece o relevant medical and phar-maceutical research rom around the world,assessing its quality as well as its results howrigorously was it conducted, what peer reviewshave there been, etc? beore aggregating itsndings into the database.

The most relevant research can beaggregated within weeks o publication (beorecomputerised EBM, it used to take an averageo 17 years or new research to be put into prac-tice).Clinical Evidence itsel is also appraised by

Accessing research in real timeThe BMJs evidencebase enables doctors

to consider the latestresearch fndings intheir clinical decisions

Business Technology A 2011 an independent report rom lyonsdown, distributed with the sun

Industry view

2

T R F H Lc Action Se .A v c cc c vc .

Rc v k cc Rck c, c , -x c .

A c Rck c v , c

1 c, c c A&E .

B Action Sets, R F c cc, c. E

Action Sets 71 v Rck c cc c , k c .

Up-to-the minute aaids clinical worko

We want to help clinicians identi y poten-tial gaps in a patients care, says Minhas. Thesoware can already analyse patients recordsto see whether theyre receiving the besttreatment. One primary care trust is using itto identiy patients with arterial brillation(abnormal heart rhythm) who havent beenprescribed aspirin or wararin to reduce therisk o stroke. So ar 700 have been ound:statistical ly that means around 20 people mayhave been saved rom having a stroke.

Best Practice can also be used on portablecomputers such as iPads at a patients hospitalbedside or on home visits, and its iPhoneapps are best-sellers. This gives support toclinicians at a time when their access to otherinormation is most limited. Action Sets is anew product rom the BMJ Evidence Cen-

tre, which goes one step urther to providedecision support at the point o care withstandardised care protocols.

The use o EBM the BMJ Evidence Cen-tres products are used by more than a millionproessionals worldwide is helping to reducevariations in medical practice and raise overallstandards o treatment, says Minhas.

I you cant measure what youre doing orcompare it with any independent yardstick,how can you tell whether youre doing it wellor not? he asks.

http://evidencecentre.bmj.com

a network o experts in clinical peer-reviewing,who validate the BMJs procedures andmethodology.

Clinical Evidence also sits at the heart oBestPractice, an online decision-support tool romthe BMJ Evidence Centre, that covers morethan 10,000 diagnoses and 3,000 diagnostictests in around 250 medical elds.

Its intended or anyone whos not in theircomort zone, says Minhas. That could be anon-specialist, or a specialist whose patient hasother conditions that all outside their own area.

Its like having a consultant permanentlyon-hand. And because its designed by doctorsor doctors, its structured and categorised inthe way that doctors expect.

Clinicians can search on a number o criteria,rom specic conditions to symptoms and

diagnostic tests. The results presented mayinclude a summary o the research to date, hot-links to original art icles and papers, high-levelstatistics and other relevant inormation.

The results can be tailored to the par ticu-lar patient, depending on how their diseasepresents itsel, its acuteness and duration, howadvanced it is, and other conditions the patientis suering rom.

Best Practice is now being linked to electronicpatient records, so that during a consultationthe clinician can be automatically promptedwith inormation thats directly relevant to theparticular patient and their condition.

With up-to-date research at their fngertips, medics can prescribe more


3/16

Business TechnologyA 2011an independent report rom lyonsdown, distributed with the sunday telegraph

eHealth In this isForeword

The worlds richer countries are acing a tr iplewhammy when it comes to decisions abouthealthcare. Ageing populations are sendinghealthcare costs spira lling at a time when sloweconomic growth dictates belt-tighteningon expenditure to rein in budget decits.

In the US, medical spending per head hasnearly tripled since 1990. Here in the UK, thecoalition government is making spending cutsacross the board and the NHS, which acesmajor reorganisation, needs to nd 20 billionin eciency savings.

Meanwhile, technology is racing ahead,coming up with new ways both to monitorand diagnose a variety o ailments. The use otechnology to deliver healthcare or eHealth is sharply in ocus or doctors, policymakersand investors as well as individuals.

Prescription or the NHS

Dina Medland

D M j c

Financial Times. S

c .

S c FT.

Sade Laja

S Lj TheGuardian -

c k. H

c kc

c.

Cath Everett

C Ev c j cv

, c k- .

S The Guardian.

Tracey Caldwell

Tc C c

c j c

c c c.

S c GuardianHealthcare Network.

Michael Cross

Mc C c c c

c cc c

c . H

c The Independent

The Guardian British

Medical Journal.

Contributors

Publisher

B Sc

@.c.k

Managing EditorLc C

[email protected]

Editor

D M

@.c.k

Creative Director

M N

@.c.k

Production ManagerS O

@.c.k

Project Manager

A Nv

@.c.k

For more inormation on any

o our supplements please

contact us:

Telephone: 020 8349 4363

Email: @.c.kOnline: ..c.k

Cover photograph:

H Kv/G I

Making connections A c v?

Remote possibilities Sc

Dial the doctor T j c

In a heartbeat P c

On the record C c c c

Human touch: a thing o the past?

While technology can be expensive, itcan deliver better healthcare as well as hugecost-eciencies. For individuals, it canmean improved care, savings on time in bothtransport and diagnosis, and the chance totake more control over their own health, and

how to improve it.In this supplement we look at the extent

and way in which we are adopting eHealthin the UK, and at its uture potential. Weexamine telecare services that operate togood eect, helping vulnerable people, and atremote healthcare delivery in Scotland, wheredistance and access issues provide a convinc-ing backdrop or its benets.

We also look at developments in mobilediagnostic devices, which could have asignicant impact within a ew years on the

treatment o long-term conditions such asdiabetes and asthma. The cost o treatingasthma alone in the UK is about 2.3 billon ayear, and it is a condition that aects aboutone in every 10 children but technology isbeing developed to link asthma detectors to

mobile phones.While innovation remains key to leaps

orward in better healthcare, so does theadoption o the inrastructu re o technol-ogy that enables data to be transm itted rompatient to clinician and back, as well as theacceptance o its standardisation acrossthe NHS. And that is where many o theproblems lie.

But as we take a look at these exciting newdevelopments in eHealth, it is clear that thereare many more on the way, and that theyare arr iving at a antastic pace. While todayhealth-related apps available or smart-phones present data to the user, the next stepwill be or them to connect in real time and becapable o sending data direct ly to clinicians.

Technology cannot deliver better health-care without that crucial ingred ient a human

being. As we move towards a world wherehomes will increasingly be lled with sensorshelping us conduct all our daily business,including healthcare, we need to retainperspec tive on using the technology that isalling in price to best eect. The humble SMSor text message sent on a mobile phone ca nsave administ ration costs as well as lives byreminding patients to take their medication.Its all eHealth but success will ultimatelylie in winning over the sceptics.


4/16


Telehealth

4

clinicians we like to be able to lay our handson patients. In other words, there is no sub-stitute or the proessional human touchin diagnosis.

Telemedicine has a useul part to play, butit is ar more limited than some people wouldlike to suggest, Buist says. The cost is un-likely to make any revolution easible as youneed healthcare proessionals at both ends to

actually conduct tests.The UK has its air share o sceptics whenit comes to the use o gadgets rather thanpeople in the eld o hea lthcare deliver y. Yetnew diagnostic devices are created every dayand the latest Healthcare Innovation Expo inLondon in March saw a wide range o exh ibi-

tors including big players such as BT, whichhas a major investment in both devices and inhosting soware.

Perhaps inspired by Teleonicas activitiesin Europe, BT clearly believes that there willbe a convergence o services and technologiesin telehealth and telecare.

To counter the sceptics within his proes-sion, Gutteridge cites his own experienceswith patients in his care. The most importantthing rst is to establish trust and a relation-ship with the patient, he says. I the patientdoes not trust you as a physician, then digita ltechnology is not going to work.

He gives the example o a haematology pa-tient who comes in to have blood taken, withthe rest o the communication and diagnosis

this countr y, when they see a patient, recordall inormation that patient gives them on anelectron ic system. Thats a store o inorma-tion available to everyone in theory, includingthe patient. Some leading GPs even givepatients access to their records in the surgery,or even at home, he says.

It means that i you have diabetes orhypertension, or example, you can begin to

see whether you are getting better.On the NHS Yorkshire and the Humber swebsite, a set o videos explains clearly themany ways in which digita l health is becom-ing a routine part o healthcare deliver y. Forexample, telecare has helped in the care opeople with terminal diseases, aiding them tolive well and be cared or in thei r own home.

Telehealth is extremely useul in chronicdisease management, where the role othe doctor is oen one o dose adjustmentonce the patient has begun treatment.Unsurprisingly, where distances are great andaccess to doctors and hospitals is dicu lt inparts o Scotland , or example there havebeen greater advances in using machines andvideo screens to supplement the worko doctors.

But even in Scotland, where the Scottish

Centre or Telehealth has been conductingproject-based work on a variety o ronts,translating project work into mainstreamdelivery remains one o the challenges.

Dr Andrew Buist is a GP at Blairgowrieand deputy chair o the Scottish GeneralPractitioners Committee. He has reservationsabout the eectiveness o telehealth, alsoknown as telemedicine. The communityhospital in Blairgowrie has assessment equip-ment or the minor injury un it with theaccident and emergency un it 15 miles awayin Perth which he concedes is quite useulin a very practical way, but he adds: As

done remotely. When the patiencomes up, Gutteridge uses secursend it to her and conduct a dialowhat to do next in terms o prescis still leading-edge in the UK, h

The barr iers to overcome in eehealth in the UK are also nancnext our years, the NHS has to mo eciency savings. Communi

nology is here and available andup by proessional groups who git makes a dierence to their woHowever, the market in medicalstill very expensive, Gutteridge

But the use o better inormatnication technology in the NHS

gaining ground, and he believesthe next 10 years, telehealth wilise the way we deliver healthcar

Its already started. Globally,spread use o mobile phones hasparticularly helpul in developinor delivering healthcare. The Ubeen besotted with its mobile phsmartphones gr ow in popularitynumber o healthcare apps givinadvice on everything rom exerting smoking.

As healthcare inormation anincreasingly delivered using newwhich empowers the individualbattle or hearts and minds aninvestment seems bound to o

By Dina Medland

The jargon can be conusing, but the mes-sage is straightorward . Whether you call ittelehealth, eHealth or health telematics, it isabout the remote provision o healthcareservices with the use o technologicalinnovation.

Worldwide the phenomenon is gathering

pace, with growing investment rom organi-sations and individuals looking or equityreturns. But in the UK, there remain signi-cant barriers to overcome, and the pictureacross the board is ar rom uniorm.

Between 1.6m and 1.7m people in Englandcurrently benet rom telecare services, orcontinuous, automatic and remote monitoringo patients to allow them to live indepen-dently, according to healthcare charity theKings Fund. But there are on ly about 5,000users o telehealth the remote exchange odata between an individual and a healthcareproessional and they are par t o a pilotprogramme costing 30m.

In a move aimed at providing more clarityaround the use o health inormation systemsby the NHS and to make the system workbetter, Dr Charles Gutteridge was appointed

national clinical director or inormatics inJanuary 2010.According to Gutteridge, ormerly medi-

cal direc tor at Barts and the London Trust:Inormatics tr ies to bring together the ideathat inormation about your health and theuse o systems is a way o really changingpeoples health essentially it is about makingthe connection between the technical bit andthe inormat ion bit.

Telehealth, he says, is only par t o thewider concept o digital health in somecases it can simply be about streamlining therecords process. About 99 per cent o GPs in

As the NHS adapts toincreasing fnancialchallenges and newpatient needs, thedigital revolution

could be just whatthe doctor ordered

The eHealth phenomenon is gathering pwith growing investment rom organisatand individuals looking or equity return

Is remote medicine

the best cure?

Leading the way Charles Gutteridge is boosting


5/16


Telehe

nurse or midwie, that health proessionalshould be able to access our patient recordand provide us with the same level o carewed expect in the surgery via simple remotetechnology. With one single IT system, youcan do all o these things.

When the patient asks about their care,they expect not only ully inormed cliniciansbut also ull access to their own electronicpatient record. These days, we can obtain aquick credit check or explore years o bankstatements surely viewing our own medical

easiest way to both empower patientsand improve ways o working?

The answer is simple. Engage with an ITsystem that works across the board. Syst-mOne rom TPP has been designed rom theoutset with the patient in mind.

When we phone our car insurance com-pany, we expect them to have all the relevantinormation to hand just by conrming ourname and regist ration number. Its quick andecient, it makes sense. So why settle or anyless when we make a vi sit to A&E, or see a newdoctor? Doesnt it make sense or clinicallyrelevant inormation to be at the caregiversngertips? Wouldnt that provide better, moreproessional care or the patient?

With SystmOne, shared care is the mostbasic yet crucial concept. It real ly is simple:by connecting the NHS through IT, clinicianscan oer the best, saest and most ecientpatient care.

SystmOne can work elsewhere to givepatients better control. Were used to order-ing groceries over the internet, or paying anelectric ity bill over the phone. Shouldnt ourhealthcare be as accessible? Patients should beable to securely order prescriptions 24 hoursa day, or book or change an appointment overthe internet.

When we get a home vi sit rom a doctor,

data should be just as simple?eHealth is about making our lives ea

not more complex. By investing in systthat actua lly work in every area o hecare the NHS can rebuild the relationbetween patient and clinician, dramatiincrease eciency and, crucially, put tpatient rmly back in the driving seat.

D J P cc c TPP

www.tpp-uk.com

The recent White Paper,Equity and Excellence:Liberating the NHS , highlighted the needor a patient-led NHS where choice andquality o care are paramount. Yet while theindustry has been busy over the past decadetrying to convince clinicians o the ecien-cies IT can bring, the rest o the world hasmoved on. These days, technology plays sucha large par t in our lives that its no longer asurpr ise when lie is made easier by the toucho a button or the click o a mouse its simplywhat we expect.

The patient has, like in ever y other area o lie,become a consumer. We expect fexibility,variety, excellent service and most impor-tantly, readily available inormation. Patientswant to be in control o who cares or themand how that care is delivered. So whats the

Putting the patient in the driving seat

We can obtain a quick credit

check or explore years obank statements surely

viewing our own medical

data should be just as simple?

SystmOne has been driving the NHS orward or over a decade,

delivering proven IT systems across a range o healthcare settings

Going theextra mile

Renrewshire residents o all agesare benefting rom the councilstelecare service

R Cc 3,000 v v k - c C 24 vc.

Sc vc c 2008,

c c c - c c c c c T c vc c v k k, , k c .

Tc vc , R Cc . C fc k cv c k v .

A v v , c v c.

Acc R Cc, vc v c

. I c c cc, v q vc .

T jc fccv . O v , v 42,000 c c.

Remote possibilities

By Sade Laja

Matthew Cole has multiple sclerosis and dia-betes. The doctor who monitors his illnesses isbased more than 170 miles away in Aberdeen.

Beore his local health board NHS Ork-ney, the smallest in Scotland, star ted using

telemedicine, the distance between patientand doctor was a big problem. In Coles casehe would either have to go all the way toAberdeen to see his doctor or the doctor wouldtravel to Orkney to see him.

Beore I would have to go to a clin ic andthere would be hundreds o people to see thedoctor and I would only get two or three min-utes with him, Cole explains. But now thereare only three or our other people waiting to

see the doctor and I get 10 or 15 minutes withhim.

The 44-year-old visits his local hospitalin Orkney and sees and talks to his doctorthrough a web camera and screen, while anurse is on hand to make sure his vital signsare ne.

It has made th ings a lot easier. Its no di-erent rom talk ing to the doctor ace to ace,he says.

James Ferguson, clinical lead at the ScottishCentre or Telehealth, believes the majority opatients would rather have virtual consulta-tions than physically see a doctor.

Patients dont like coming to big hospita ls.They cant park, t heres MRSA its horrible!he says. Most people would ar preer to be

managed in their community or closer to homei they can.

However, telemedicine is not about distance,Ferguson says. It is easier or healthcare pro-essionals and organisations to accept the useo telehealth when there is a physical distanceinvolved because there is no alternative, but

you could apply exactly the same system in themiddle o a big city to improve the delivery.

Whatever the dr ivers or the use o tel-emedicine by public bodies, the tool appearsto be helping to improve the care delivered tovulnerable people.

Asked what he would say to patients whowere dubious about using telehealth, Coledeclares: I would tell them that its brilliantand that it makes lie so much simpler.

Distance and

access issues haveled healthcareproessionals inremote parts oScotland to developalternative treatments

James Ferguson believes patients preer virtual consultations


6/16


Industry view

6

exciting industry innovation which weanticipate will take the healthcare proessiona signicant step closer to eliminat ing adversedrug events. FIRSTLight has been developedspecical ly or electronic search and display,making it very easy and very quick to ndwhat you are looking or which w ill saveclinicians valuable time.

The key benet that FIRSTLight will provideto clinicians is a one-stop-inormation-shopabout how and when to use, or not to use, amedication. As importa ntly, it can be used bynursing sta, technicians, pharmacists anddoctors to answer instantly a range o medica-tion queries in a wide variety o care settings.The versatility o accessing FIRSTLight romyour desktop computer or when on the move

within healthcare culture, and both processchanges and inrastructure development must

be ongoing and iterative.For more than a decade, Intel has worked

with healthcare leaders around the worldto design and deploy robust IT solutions orhealthcare, a nd we continue to do so. Weprovide onthe-ground support in dozens ocountries to help healthcare organisationsidentiy the workfow changes and inorma-tion inrastructure needed or optimal careand eciency.

Established more than 30 years ago, FirstDataBank is best known in the UK or itsmedical drug knowledge base.

Multilex Drug Data File (Multilex DDF) isused by the majority o primary care pract icesin the UK as part o their patient-adminis-tration system, providing clinical decisionsupport to GPs at point o prescribing.

First DataBank has also successullymoved into the secondary, mental health andcommunity care settings where Multilex DDFprovides ully integrated medicines manage-ment inormation including eDischarge andePrescribing.

First DataBank is based in Exeter, Devon,and employs more than 70 sta, includ-ing a highly skilled editorial team drawn

rom clinical, pharmacy or other healthcarebackgrounds.

In 2010 it launched an innovative product,FIRSTL ight, which oers the breadth o FirstDataBanks trusted medicines inormationas a web-based tool, accessible on demandrom any point in the clin ical workfow,in consultations or on the move. A uniquestand-alone resource, FIRSTLight deliv-ers comprehensive drug inormation thatempowers clinicians and supports saer, asterclinical decision-making.

First DataBank managing director DarrenNichols says: FIRSTL ight is a tremendously

increasing number o people involved in caremanagement.

The next trend is co-ord ination. To sup-

port the move to team-based models o care,healthcare systems must accommodate theinormation and workfow requirements oeach and every individual and organisationinvolved directly or indirectly in patient care.

Collective responsibil ity is our third c.Alternative payment schemes will becomemore prevalent, pushing groups o healthcareproessionals to share end-to-end respon-sibility or the collective health o largepopulations. They will be paid collec tively orquality-based results.

Finally, community-based care will becomeincreasingly important, as greater emphasis isplaced on wellness and caring or patients inthe most cost-eective locale that is suitableor their needs. Care capacity will rest on agrowing workorce o community healthworkers who must be trained, monitored and

evaluated, and whose workfows must be sup-ported with mobile tools and inormation.

Start now

Embracing these enabling technologiesrequires changes in behaviour and culture.Careu l attention must be paid to workfow re-design, workorce development and businessprocess to ensure this is a lasting x. Reormand innovation must become embedded

via an iPhone and iPad could drareduce medication errors that artreating patient s in the absence inormation about a drug, he ad

We realise not all hospitals hintegrated clinica l systems in plclinicians resorting to paper-basor mainstream search engines. Foers a trusted resource that is and authored by our team o clinand health inormatics specialismodern, intuitive user interacepowerul search unctionality, ivery easy and very qu ick to ndlooking or.

Ethan Richardson, product mJAC Medicines Management at M

Inormation Systems, leading pro clinical systems into secondaacilities, reviewed the new toolFIRSTLight has an innovative ition architecture which ensuresauthored drug inormat ion is eaat the point o care.

Interested clinic ians can signFIRSTL ight website or a ree trcan view the content and get a einterace and search unctiona lilaunch ollows later in 2011.

www.frstdatabank.co.uk/frstlig

Integrated care deliver y is a runavoidable demographic and c

it does now represent a tremendnity or healthcare leaders to truahead o changes that are inevita course to higher-quality, moreand more cost-ecient care.

Ax G UK c

I C

www.intel.com/healthcare

As global populations age and the prevalenceo chronic disease rises, it is increasing ly clearthat no country can deliver higher-qual ity,

aordable healthcare without signicantlyreorming the way health systems unctionnancially and improving co-ordinationamong all those who care or patients.

This approach requires secure, shared ac-cess to accurate clinical inormat ion. As such,it needs the Department o Health, NHS andother organisations to continue to design andimplement a new inormation inrastructurethat can deliver the right data to the rightstakeholders in ways that improve clinicaloutcomes and lower the cost o care.

Twenty-rst century healthcare requiresmore intelligent care delivery where the pa-tient is at the centre o care, and Intel providesan architecture that oers increased accessand encourages innovation across the system.

Four trends

From Intels perspective, the needs o the NHSare shaped by our trends or requirementsthat must be addressed by any inormationarch itecture. We call them the our Cs.

The rst is complexity. Healthcare systemsare being asked to manage an environmentthat encompasses patients with more complexillnesses and co-morbidities. In addition,they are dealing with ever more complexdata types and inormation streams and an

Charting a course to cost-eective ca

Managing medicines with First DataBank

FIRSTLight delivers

comprehensive drug

inormation that empowers

clinicians and supports

saer, aster clinicaldecision-making

Whether on the move or in consultations, the innovative FIRSTLight system oers

health proessionals vital drug inormation, wherever and whenever they want it

An ageing population and extreme pressure on costs mean health services must take a more ocused approach to their use

Managing patient care is becoming mo

Drug data at your fngertips


7/16


Industry v

admissions in 75 per cent o cases, and reducelength o stay.

However, the need to save cash and balancethe books is the biggest challenge acing NHSmanagers r ight now, according to a survey bythe NHS Federation. The government has toldthe NHS to nd between 15bn and 20bneach year in eciency savings over the nextthree years rom 2011 to 2014. However, itsnot just a matter o cutting costs or serv ices,but about maintaining and improving t hequality o service at the same time.

Re-ablement is about returning patients tohealth by taking the most expensive careinto a less expensive setting. It means thathealthcare proessionals are managing thedelivery o services in the home servicesthat would traditionally be delivered within acare setting where peer support and advanced

care are available. However, or re-ablementto be eective, home workers need the righttools to support them.

This change in ocus is not without itschallenges. The shi towards increasinglevels o re-ablement is not a straightorwardone, says Challiner. But it is my belie thattechnology can help to address some o thechallenges. Care can range rom somethingas simple as having someone who knowsthe patient on the end o the phone to givethe right advice, to soware which helpsclinicians manage their patient interactionsthrough workfow management, supporting

decision-making and providing inormation.Clinical Solutions is in a position to see this

rst hand. Its solutions serve more than 100mpeople across the world and the company hasworked with publicly unded and insurance-based organisat ions in the UK and in othercountries including the US and India. Theclinical algorithms and scripts that power thesolutions have been proven sae in more than60m clinical transactions.

Technology enables healthcare providersto deliver care traditionally reser ved or hos-

pitals outside that setting, Challiner says. Itcan help to acilitate remote and ace-to-acecare. Assessment tools within the applicationssupport the clinician working in the contactcentre or with the patient in their home andhelp in the process o returning the patient tohealth, avoiding unnecessary or costly reer-rals, and saving bed days, through supportingearly discharge and preventing readmission.

For those with long-term conditions,monitoring devices in the pat ients home(telehealth and telecare) can alert clinicians toa change in the patient s condition even whenthey are not with the patient. This oers anearly-warning sign that can be acted uponbeore it is too late and admission becomesinevitable.

In practice, Clinical Solutions sowareprovides a means o communicating with and

recording encounter s with patients. Its Hos-pital At Home application provides telephonetriage, structured history taking, structuredphysical assessment, care advice and prescrib-ing acilities in the context o the patientsmedical history and current health problems.These capabilities combine to simpliy theprocess, putting patients at the centre o theircare inorming and empowering them, andadvising the healthcare proessional deliver-ing services.

Challiner says: Our solutions are privatecloud based. Wherever and whichever deviceand communication channel the clinician

Given a choice, when our health is suering,theres no place like home; it is where we ca nrelax, and eel sae.

Dr Jean Challiner, chie medica l ocer atClinica l Solutions, agrees. In my experienceas a clinician, this rings tr ue with the majorityo patients, she says. Whether recover-ing rom surgery, receiving treat ment or a

long-term illness or car ing or a new baby, themajority o us will want to be at home, withour amily and in our own amiliar space.

In a recent ar ticle on thisisnottingham.co.uk, which identied plans or replacingimmediate care beds with home services,Councillor Stuart Wallace, deputy cabinetmember or adult social care and health,supported this view. By moving to providingthese serv ices in peoples homes, where wecan, we will be able to provide better, moretailored and personalised care and support,he says.

The government is committed to investingin re-ablement helping people back to healthby providing qual ity care in the home or com-munity so reducing the time that patientsspend in a secondary care environment suchas hospital. It is clearly more cost-eective or

patients to receive support at home, ratherthan unnecessarily taking up hospital beds.A recent article in Health Service Journal

stated that care in the home under the(British Red Cross care in the home) schemeshas been shown to prevent ambulancecall-outs and resulting two-day hospital

Technology can bethe clinicians bestriend in providingquality care at hometo help patients returnto health

No place like home

For the NHS its not just a

matter o cutting costs

or services, but about

maintaining and improving

the quality o service

or the patient uses, they can access andchronise their inormation, when theyit. Our Hospital At Home mobile devicethem to remain in touch with all the intion they need rom the patients bedsihome. The ability to link to the web methat we have a world o inormation at ongertips, that we wouldnt have hadeven 10 years ago. We should be betterexploiting this way o accessing inormwhy should health be any dierent romother markets?

A key advantage is using technologto rapidly create a detailed record o thencounter and the actions taken by heaproessionals. This provides an audit trwhich enables clinicians to refect in dethe quality o care provided.

This ability to audit actions at everstage o the process oers accountabiliclinica l governance or those deliveringservices. And the patient (and their amhas peace o mind that they are receiviresponsive, consistent, high-quality anpatient care.

Challiner adds: Re-ablement, or a mtowards delivering ca re in the home toprevent admission or readmission to hois about delivering complex care in a saway. We should let technology take onmore complex aspects o care. In doing

we reduce the risk to patients and provhealthcare proessionals with a technicriend to support them and their patientheir day-to-day roles. This improves tpatient experience and quality o care an added bonus reduces the cost o careas well.

To nd out more about how ClinicalSolutions technology can help deliverhealthcare in the home, please call+44 (0)1256 337 300 or [email protected].

www.clinicalsolutions.com

A reassuring voice at the end o the phone

No need to go to hospital


8/16


Industry view

8

It is widely known that the NHS needs tond up to 20bn o eciency savings by2014 just to stand stil l but how many peopleully understand why these savings are soimportant? We have an ageing populationand providing or the uture care need s o ourpeople represents an immense challenge. TheUK population is pred icted to rise to 71.6m by2033, an increase o 17 per cent over the next20 years, while the number o people aged 85will reach 3.3m.

The solution is to drive eciency in allareas o the NHS, maximising use o nancia land human resources, and moving the deliv-ery o care out o hospital into the communityand nearer to the home. Delivering care in the

community is not only in line with patientpreerence but is more cost-eective thantraditional institut ionalised care. Wider use oinormation technology is the key to meetingthese objectives and Advanced ComputerSoware Group is central to that agenda.

Advanced is a leading provider o backoce and management inormation systemsto the NHS including out-o-hospital solu-tions. Supporting both health and social careproviders in the community, Advanced hasIT solutions targeted specica lly to help theNHS meet its prime objectives o reducingspending, increasing saety and improvingthe patient experience and outcomes or all.Solutions can also be deployed eciently andsaely via the Advanced Application Cloudto reduce the cost o managing essential ITunctions.

Doing more with less

The key is to understand the requirementso commissioners responsible or purchas-ing care, and o the provider s responsible or

Intelligent systems cut costs

to deliver more and better quality care byeliminating the time they current ly spendperorming lengthy administration unctionsand reducing travelling costs and time.

Adding capacity

iNurse, one o Advanceds clinical mobiledevices, is a patient management system thatenables community nursing teams to record

and communicate patient care data usinghandheld mobile devices. iNurse is proven tosave each nurse a min imum o one hour perworking day. For example, i the product wasused by a team o 300 nurses, saving onlyhal an hour per day, the results would be theequivalent o adding 18.7 ull-time nurses peryear at a salar y cost o over 748,000. Moreimportant ly, this would translate into anadditional 28,500 patient visits per year. Withthis kind o return on investment there isarguably no reason or a health provider not toembrace technology and, spec ically, mobiletechnology as a way to drive down costs

delivering that care. Their ocus is improvedeciency and the ability to deliver eectiveoutcomes or care that will be increasinglydelivered in the community setting. Toachieve this, both commissioners and careproviders require better inormation aboutpatient needs and the resources available toserve them. This is where Advanced is helpingthe local NHS.

In 2010, NHS Wakeeld Distric t investedin a business intelligence solution romAdvanced. One o NHS Wakeeld District sbiggest IT investments to date, the solutionprovides valuable insight into how the pri-mary care tr ust (PCT) is perorming in relationto the health needs o its population. Health

in the Wakeeld District is generally poorerthan other parts o England, which providesthe PCT with considerable challenges and a re-quirement to measure needs and perormanceaccurately. Since implementation, thousandso pounds o savings or NHS WakeeldDistrict have been realised through improvedoperational eciencies and more streamlinedprocurement.

In addition to business analysis andmeasurement tools, Advanced can providethe business systems required to support theNHS back oce unction and has suppliedmultiple NHS customers with AdvancedFinancials. These systems underpin ecientdelivery o nance, procurement and HRunctions and proven savings o 5.2m havebeen realised at the Countess o ChesterHospital NHS Foundation Trust,while the

Royal Berkshire NHS Foundation has realisedsavings o 500,000 as a result o their eec-tive deployment.

Going mobile

Most o us have come to depend on and expectmobile technology as part o our day-to-daylives but within the NHS it is surpr isinglyunderuti lised. Advanced believes that mobileworking and mobile technology generallyhave the potential to deliver transormationalbenets or health.

Mobile solutions are undeniably a means togain substantial eciency savings. They alsoprovide good quality and essential clinicaldata at the point-o-care, enhancing patientsaety by making key inormation availableto clinicians and removing the need orcondential health records to be carried in

paper orm.Advanced mobile solutions deliver core

patient data securely and accurately via avariety o mobile solutions. This data capturecan be congured to include access to thenational Summary Care Record and mayinclude end-o-lie preerences.

Advanced recognises the need to providesolutions appropriate to the nature o theservice being delivered and oers mobilesolutions on laptops, smartphones, mobilephones, tablet PCs and digital pens, which canall be integrated with national clinical systems.Moving to mobile working will allow clinicians

and improve patient care.A similar mobile product rom

or the social care market is iContive and revolutionary point-o-designed specical ly or providehome care, extra care and suppoThis product requently results savings o over 20 per cent. I allauthority care workers achieved

eciency gain, an ext ra 34.4m vcould be delivered. I all private ollowed suit then a urt her 11or local authorities could be del

Ultimately the task o the resNHS will be to reduce costs whiling the rontline to deliver the bpatient-centred care. The Advanis to work with all providers andest range o technology partnerrobust, innovative solutions to hin delivering its objectives.

www.advancedcomputersotwa

Ensuring back ofce systems are accurateand up to speed is helping the NHS to reduce

costs but not quality

Mobile technology could transorm healthca

All at the touch o screen


9/16

reach $1.9bn (1.2bn) by 2014, with hear tmonitoring in the US accounting or mostearly mobile monitoring, ollowed by otherchronic diseases such as asthma, diabetesand epilepsy.

In the UK, mHealth pilots have tended toocus on getting inormation to patients ratherthan a two-way communicat ion. London-based iPlato Healthcare i s involved in a mobile

patient support service in partnership withthe National Hospital or Neurology and Neu-rosurgery (NHNN). More than 50 epilepsypatients have signed up to the service, whichbegan in ea rly 2010 and helps patients keep to


Mobile technol

A c 2.3 12k c, c A UK. A c NHS c, c .

I A N(AND) f k c c . I c c c c c .

T c c x x , c v v.

I c k , . M c VH : T cv

k , c 4,000 . Hcc c .

A c 10 c c c c c .

W f c v , H.

F c, k v . I c v c fc c v.

A c v c . T , c c vc GP. Fck

c c SMS .T c c B c

c c cc c v. S , AND c c -- c GP c v c k.

D cc v AND, k c v c cc cc .

T c c GP v c , H. W v

, v c

www.applied-nanodetectors.com

Asthma monitoringby mobile phone

By Tracey Caldwell

Its called mHealth, and using mobile phonesor health data collection and providinghealthcare inormation is well established indeveloping countries and North Amer ica butin the UK and Europe use o the technology isstill in its inancy.

However, mHealth could make a realdierence to both patients and healthcareproviders acing increasing challenges.

For example, up to 80 per cent o health-care costs are spent on treating people withchronic illnesses at a time when the pressureon healthcare budgets is ocusing minds onthe high and rising costs o treating theseconditions. Reducing the costs o GP visits

and unplanned hospital admissions hasbecome a priority.

Technology could be the answer. Manychronic conditions can be monitored bypatients themselves in their homes and mobilephones can be a convenient, user-riendlyway o capturing health data and sendingit in real time to healthcare providers. Theyin return are able to respond and advise thepatient by mobile phone.

The European MHealth Alliance(EuMHA) was established last June to pro-mote mHealth in Europe, which lags behindthe US and Canada. Analyst rm JuniperResearcher s have orecast that, globally,revenues rom mobile health monitoring will

Mobile phones canbe a convenient,user-riendly way o

capturing health dataand sending it in realtime to healthcareproviders

Ringing the changes on healthcareUsing the phone isnt just about calling the doctor mobile healthmonitoring could transorm the way patients receive the care they need

Drug alert: text messages remind patients to take their medication

Ac Scc L D. O c c c .

http://adherence-science.com

R C- SME R - Pck vc c cc c- c v.

http://regpoint.eu

I B c I W- V S P cc vB .

www.intelesens.com

P L- P Hc vc , -, HIV.

www.iplato.net

SIM cv cc .T SIM c c SMS kc.

www.simpill.co.uk

OBSMEc OBSMEc -q Ox. I PRO cccc .

www.obsmedical.com

mHealth in the UK

recommended treatment by sending rem ind-ers to their mobile phones.

Its a service that, according to the NHNNsProessor John Duncan, could save money andree up resources i, by taking their medica-tion more regularly, patients have ewerseizures and thereore have less need orhealth services.

Inormation can also be sent to healthcareproviders by mobile phone. For example,health data may be captured by body-wornsensors or breath sensors, or by apps thatcollect data entered by users.

Currently, smartphone apps tend to supplydata to the user rather than send it directly tothe doctor. One example is the iTMP Digitsystem or the iPhone. It includes the app andsensors such as heart-rate monitors the app

collects data rom wireless sensors in cheststraps which measure hear t rate and sends theresults to an iPhone or display and trackingby the user as an aid to tness.

The next step is to connect apps in realtime to clinicians and that capability iscertain ly available. One company oeringthe technology is Belast-based Intelesens,which supplies a wireless vital signs platormdesigned to communicate with mobile phonesvia Bluetooth in order to transmit cardiacinormation to clinicians.

The uture is out there and it could bemobile.


10/16

positive health outcome in this scenar io?It may be challenging but its also an

opportunity or mobile operators to increasetheir appeal and prots by better connectingpatients with healthcare inormation. Voda-one has made a 5m investment to set up themHealth Alliance, a collaboration with theUnited Nations Foundation and RockeellerFoundation to help grow the use o mHealth inemerging markets. Closer to home, O2 has cre-ated a new branded division cal led O2 Health,

oering a whole range o new services.These brands are hopeul that theyre

in the right place at the right time, as careproviders are increasingly looking to remotehome care as a way o keeping our ageingpopulation active and independent.

While these in itiatives havent yet made itinto the high street, they are already sellingdirect ly to healthcare providers wanting toremotely manage patients vital signs viawirelessly connected peripheral sensorssuch as ECG monitors, spirometers, weighingscales, temperature sensors, blood, glucoseand pressure monitors, and pulse oximeters.

Research has ound that patients tendto perceive mHealth very dierent ly to theprescript ive eHealth services that have su-ered rom a lack o adoption despite massivegovernment investment. One example is theNHSs Patient Portal, which has so ar beenused by less than 0.06 per cent o eligiblepatients. The key actors seem to be the a-nity and reliance pat ients already have or

their mobiles and the additional control andempowerment that they enjoy when usinga tool that is already car ried, unshared andbelongs to them.

As the impact o patient access to qualityhealth inormation continues to emerge, per-sonal mobile video content is perectly placedto be used by patients, healthcare providersand communities to transorm health educa-tion and motivate individuals to change theirbehaviour and maintain health ier long-termliestyle choices.

The private sector has taken the leadand 3G Doctor has been working with some


Industry view

10

Located in a remote corner o Ireland, Dr FionaKavanagh is no ordinary countr y doctor. Inaddition to her rural prac tice, shes an adviserto 3G Doctor, launched in 2006 to providemembers o the public with 3G video consulta-tions with inormed, registered doctors.

As the worlds rst serv ice putting aninormed doctor in your pocket, 3G Doctor isa leading example o how mobile phones arerapidly changing the way we engage withhealthcare services.

Mobile healthcare, or mHealth, is a rathergeneral term that reers to the use o mobiledevices and network technologies by patientsand their carers. Youve probably alreadyexperienced it in the orm o convenient textmessage appointment reminders rom your GPor dentist, but the market is moving quickly asconsumer appetite grows or the latest videomobiles and touch-screen tablets rom brandssuch as Apple, Nokia and Samsung.

Smartphone subscribers can access tenso thousands o health and wellbeing appsto help count their steps, track their tness,monitor their sleep, plan their diet, securelyaccess their health records, motivate them toexercise more or simply help them unwindand relax.

Doctors have always been quick to adoptnew communication technology and most in

the UK are already using smartphones as criti-cal work tools to securely access their e-mail,look up medical inormation and even placeorders or prescriptions. So bear that in mindnext time you see a GP staring into a smal lscreen: its probably not a Facebook update,SMS or game o Snake!

Sometimes the health benets o mobilesare obvious to everyone. I youre a parentyoull know how stressul it can be waiting ora child to arr ive home, and the relie o receiv-ing a text telling you why theyre delayed.At other times, the health benets are a littleless obvious and hard to evaluate whats thevalue o knowing you are always within a rmsreach o a connection with your riends andamily i youre one o the seven mill ion wholive alone in the UK, or example? Is there a

Healthcare in your pocket? Theres a quiet

revolution going on which means expert medicaladvice is closer than you think, says 3G Doctor

mHealth is about howmobile phones arerapidly changing theway we engage withhealthcare services

GPs are quick to embrace technology

o Harley Streets leading clinics to launchservices that enable specialists to send useulmobile video to their patients.

Statistics show there are as many peopleaged 50 or over with an iPhone as there areunder 25, so smartphones are no longer used

just by the young and healthy, but are increas-ingly capable o improving the healthcareexperience. The concept o doctors prescrib-ing an app or that is a g reat way to engage

patients and a good opportunity to controlthe spiralli ng healthcare costs and loss oproductivity that resu lt rom poor health andliestyle choices. The impact o mHealth willbe to use the most underutilised individua lin todays paternal istic sickcare systems:the patient.

As well as the impact o mobile video, weare also set to witness an incredible conver-gence o medical technology to the mobiledevice simila r to the development o con-sumer devices led by Nokia in the last decade.Similarly to how an obscure Finnish brandbecame the worlds biggest manuacturer o

cameras (displacing established as Minolta and Canon), calculatoCasio), watches (Timex and Seikplayers (Sony Walkman), the newill see Moores law bring ever mpowerul technology to our nginto our pockets.

Already we have basic phonesend SMS to emergency servicesaccurate location with emergenc

services. Increasingly, we have sdevices being adopted across allsociety which are capable o helcarry in their pocket a tool they securely share their inormationwith an inormed doctor or accehensive medical video library/btool. In the uture there a re evening opportun ities check out thmHealthInsight.com, or experievideo consult at 3GDoctor.com TCan See You Now.

www.3GDoctor.com

3G Doctor


11/16

returned to St Gabriels Medical Centre inPrestwich. A nurse downloaded the data onto a PC using a wireless USB stick and bothan ECG graph and Blooms pulse rateappeared on the screen. The inormationwas double-checked by her GP, Dr JonathanLieberman, who conrmed that her conditionhadnt worsened and she didnt need

there are no electrodes or wir es attached,she adds.

When not in use, the watch displays thetime and date, but on eeling chest pain ordiscomort, users simply press a red buttonlocated where a winder would normally beand the letters ECG pop up on the screen.Aer three seconds, a beep indicates thatthe patient needs to press down on two smallmetal plates at the top and bottom o thewatchs ace or 45 seconds using their thumband index nger.

The back o the watch has to touch yourskin and you have to keep your le arm verystill to create a circuit so that it can recordyour heart s activity. Now thats what I calltechnolog y, Bloom says.

Aer ve days o wearing BroomwellHealthWatchs dev ice continuously, she

any extra care.You dont have to be a brain surge

use it and you dont have to wait weekget the re sults, which could save livessays. You also dont have to go back aorth to the hospita l, which is no joy atime-consuming, the parking is bad anits expensive.

By Catherine Everett

Because o my heart arrhythm ia, Ive usedall sorts o technology and had all sorts otechnology used upon me, but the ECG watchis phenomenal. Its not uncomortable andyou can get on with your lie as normal,says Suzan Bloom, who wore t he mobilediagnostic device or a week aer e xperienc-ing chest pains.

Arrhythm ias, or palpitations, occur whenthe heart races or slows down without warn-ing, either occasionally or on an ongoingbasis. They may result rom a number ounderlying conditions such as heart diseaseor high blood pressure, and symptoms caninclude dizziness and ainting.

Electrocardiograms, which measure the

electr ical activity o the heart, are one wayo understanding how well it is unction-ing. Until recently patients had to visit thei rlocal hospital or GP surgery to be wired up toelectrodes or testing purposes whether theirsymptoms were presenting at that time ornot. Now, with the help o technology, theresanother option the arrhythmia watch.

The device, which is about the size o adivers timepiece and can record up to veepisodes, has one major advantage, accordingto Bloom: It gives you back control becauseyou are the one in charge o when to recordwhat eels like a pain.

Other benets include the act that thedevice is unobtrusive and does not get inthe way because its like wearing a watch and

It looks like a timepiece, it eels like a timepiece, but or Suzan Bloom, herarrhythmia monitor is the answer to taking back control o her health

Getting to the heart o the matter


Mobile technol

to a central server to enable both patient s andclinicians to view trends based on historicaldata. The aim is to understand whether thetechnology improves users health, quality olie and perceived control over their condition.

These are two small pilot projects, but ac-

cording to Keith Nurcombe, Teleonicas globaldirector o healthcare and managing directoro O2 Health UK, the use o such technologyis likely to increase over the next ew years.It will especially help patients with chronicdiseases that need to be monitored and man-aged, he believes.

There a re 15m people with long-termconditions in the UK, ranging rom diabetes toasthma. So about a quarter o the population isusing 60 per cent o health resources, he says.

Nurcombe believes that the biggest inno-vations will be seen among peripheral devicessuch as blood pressure machines and blood

Within the next three years, patients in theUK with long-term conditions such as diabetesand asthma can expect to start using mobileapplications to help them manage their healthmore eectively.

Although it is early days, about 1,000

small-scale pilot projects are under way glob-ally to test how eective the technology is asone element o broader programmes o care.

In a nine-month t+ diabetes Thin k Posi-tive trial 240 diabetics will be supported bythe London Borough o Newhams diabetesspecialist nurse team.

Patients will be divided into two controlgroups, one manually recording their bloodglucose readings, how much insulin theyhave injected and any subjective symptoms,and the other using OBS Medicals mobileelectronic diary application. The inormationrom the second group will be sent instantly

sugar monitors, which will in uture eitbecome mobile devices or be able to comcate with them.

The mobile device will send data to cised monitoring centres staed by clinwho can analyse it in real time and alerother medical proessionals, carers or pthemselves i there is a problem.

Today, you can manually enter resuor use Bluetooth, but devices are xed,Nurcombe says. The technology ex istlinking everything together to deliver to-end capability, but it requires undachange in the way people manage healt

For example, the way that people arreerred or care would have to change24-hour monitoring centres would neeset up, run either by the NHS or the privsector, depending on resources.

Souheil Marine, head o ICT applicatand cyber-secur ity at the United NatioInternational Telecommunication Unioagrees that much work needs to be donbeore the dream can become real ity.

Above all what is needed most is ththat is, the political wil l to develop a namobile health strategy enabling all o tnecessary ac tors to interact, he says.

Managing your healthcare by mobileWith the help o developing technology,healthcare proessionals are looking to long-term solutions to help manage the care opatients with chronic conditions

The ECG watch isphenomenal. Its notuncomortable andyou can get on withyour lie as normal Bloom


12/16

Nurcombe. Already, a simple idea such astext message reminders has cut the numbero missed appointments by 40 per cent orPortsmouth Hospitals Trust. And communitymidwives there can now spend more timewith expectant mothers because digital pens

have halved the admin that results romeach appointment.

Beore, midwives made notes, gave a copy tothe patient, then entered the same inorma-tion on a computer back at hospital. Digitalpens mean the inormation goes securely intothe system stra ight away. So they only haveto write it once.

In Bradord and Sheeld, O2 Health is in-volved in another trial with 30 nursing homes.Telewound management is a more ecientway o treating wounds that can developwith slow-healing conditions. During thetrial, hal the homes will provide their normalcare. In the other hal, nurses will use mobile

A patient turns on a video screen in theirliving room. Moments later, their doctorappears. Then the ir scans, X-rays or testresults appear. Next, patient and doctor talkthrough the options or treatment. This isall using equipment running over standard

broadband, all with the same privacy as theconsulting room and all without the patienthaving to get out o their avourite chair.

Is this utu re-gazing? No. Its about tohappen in the Western Isles, where O2 Healthand the NHS are trial ling a system called SideBy Side which could make a signicant dier-ence to healthcare.

To see specialist s and get treatment,Western Isles patients oen ace a fight orerry crossing to a hospital on the mainland.Thats inconvenient enough, but the trips areoen cancelled because o bad weather. Morerustrat ion and delay or the patient, moreadministrative headaches or the trust.

But Side By Side means patients could soonhave to travel just once or treatment itsel.It also means that consultants can share datasecurely, allowing them to get specialist input

immediately.Such a system is already up and runningin Spain. O2 Health and parent companyTelenica ran a six-month trial between themainland and the Canar y Islands, drasticallycutting the number o return fights. And thesigns in the Western Isles are good. Theresa real appetite to change and use the technol-ogy, says Western Isles NHS med ical direc torDr Jim Ward.

Time or technology

Its the kind o technology whose time hascome, says O2 Health managing dir ector KeithNurcombe, who is a lso Telenicas globaldirector or telehealth. The NHS has to getmore ecient and make resources go urther,he says. But because the populations ageing,there are more and more patients with

chronic conditions. Thats putting more pres-sure on the system just when its eeling thenancial strain.

Telehealth oers a way round the problem,he adds: The whole healthcare system benetsrom using technology to move inormationbetween clinicians and patients reliably andsecurely. Patients get a better experiencebecause they spend less time waiting. Hospitalsree up much-needed capacity and sta get tohelp more patients. Everyone wins.

eHealth isnt just about keeping patientsand consultants in touch. It can have a roleright at the heart o ma instream care, says

Doctor, the patient will see you nowTelehealth puts thepatient in control and keeps themout o hospital. Nowits up to healthcareproviders to thinkabout technology innew ways

I we at O2 Healthsave money and makesystems work better,its because wevemade things betteror the patient Nurcombe, O2 Health


Industry view

12

phones to take pictures o wounds and uploadthem secure ly to an NHS server, and recordsymptoms using digital pens. Specialist nurseswill study the photos and inormation. Thenthey phone or e-mail their counterpart s in thehomes with instructions or treatment.

Its a screening method to decide whetherpatients need to see a GP or go to hospital. Itsalso a way to pick up problems early, avoidcomplications later, monitor patients over timeand help them recover aster.

Problem frst, technology second

The NHS White Paper Equity and Excel-lence: Liberating the NHS talks about puttingpatients at the heart o the NHS through aninormation revolution and greater choice andcontrol. This includes new ways o providingcare using tec hnology. But technology aloneisnt the solution, according to Nurcombe.

The most important thing is understand-ing what patients and their carers need, hesays. So thats where O2 Health starts. Whenwe talk to healthcare organisat ions, we askthem to tell us what they want to achieve and

how. Then we help introduce technology tomake that change real or the community. Itsbespoke because what we do has to refect thecommunity we work in.

Looking ahead, he adds: In ve years largenumbers o people with long-term conditionswill be monitoring these rom home. For theNHS, ace-to-ace contact is the most expen-sive and dicult to provide. For patients, itsthe most disruptive. In the uture, telehealthwill mean it s only or the patient s who needit most.

However, Nurcombe says technologyand innovation can only help i healthcare

organisations change how they must make a huge mental shi care by specialist s in hospitals acommunity-based care, he say

Thats happening in BerkshirO2 Health innovation. Home Ph

patients go home earlier aer sumonitor their own rehabilitationEast Community Health Servicetrialli ng it since January.

Like Side By Side, its already bSpain, with several Madr id hospwith patients aer knee operatioattach sensors to their knees and cises rom a computer screen thattheyre doing the exercises right.sends data on perormance and pconsultant or physiotherapist, thi the patient needs a personal visexercises can be sent to the Homsystem, depending on how the pa

Berkshire Easts director or bstrategy Siobhan Melia sees Homa way to keep up with increasingphysiotherapy despite squeezed

also creates a patient-centred apwas one o the other reasons I wto pursue it, she says.

That echoes Nurcombes viewresult or patients always comesat O2 Health save money and mawork better, its only ever becauthings better or the patient. Tec

just the enabler or change.

www.o2health.co.uk

www.wihb.scot.nhs.uk

www.teleonica.com

www.berkshire-eastchs.nhs.uk

Back to the uture: patients can access their test results


13/16

Many healthcare proessionals see theirpatients in the eld, a long way rom an ocecomputer or medical network. But they stillwant to give them the best possible care inthe most ecient way, and that means havingup-to-date inormation and the support ocolleagues, as well as minim ising wasted timeand eort.

Heres the story o Jane, a typical com mu-nity nurse:

The th ing I love most about my job isthat no two days are the same. The pat ientschange, the cases are always dierent. Andluckily or me the technology I use is chang-ing. So I start the day by reach ing or myBlackBerry smartphone.

Even the really simple things, like be-

ing able to access a completely up-to-datecalendar with all my appointments, make allthe dierence. Things change so quickly, andnot having to go to the oce to update myschedule means I get to spend more time w ithmy patients.

With GPS on my BlackBerry smartphoneI always know where Im going, with door-to-door directions or all my appointments. Ieven get to know when there are trac jamsso I can make all my appointments on time.

Once I arrive I always give the patient aquick call to check theyre at home and makesure they get the kettle on beore we star t!

Because I can access up-to-date patientrecords directly rom my BlackBerry smart-phone I know exactly what Im going to bedoing during the visit. And I can make notes

An ofce in your pocketMobile technology is helping nurses and other medics working in the communityto maximise their time with patients and away rom the ofce admin


Industry v

during the appointment which go straight intothe patient records database.

I cant tell you how much this has he lpedus to improve patient ca re. Previously Id havehad to carry case les around with me or callthe oce to deliver or receive updates. It usedto take up to three weeks or handwrittennotes to be updated onto a patients record,and sometimes things got mistyped.

As Ive been using my BlackBer ry smart-phone more and more, I had the idea o settingup a BBM (BlackBerr y Messenger) group ormy team, so when I need a bit o advice or asecond opinion I can contact them all togetherin one hit. Were almost never at our desks sowe nd this is a great way o keeping in touch.Even when Im out visiting patients I stay con-

nected to my team.Because Im out o the oce so much it

used to be dicult keeping on top o all theadmin istration. Ive now halved my admintime by using a digital pen and orms to recordthe patient visit. I can complete assessmentorms by simply running the pen over therelevant barcodes on the orm and writing upany other notes reehand. It even recognisesmy handwriting.

I like doing this with my pat ients, as theyseem to nd it a useul recap o what wevespoken about during the v isit. Best o all,the assessment orm and notes are instantlyadded to the patients record and can beviewed by any o my colleagues.

As Im out and about all day my ow npersonal well-being is really important to me

and my employer. Working as a nurse and car-rying medic ines around with me I need to eelthat Im sae. So beore I begin an appointmentI switch on my loneworker application and seta time or the appointment duration. I thereare any problems I can raise a silent alarm atthe press o a button, or i an appointmentsover-running I get a cal l back rom my teammaking sure Im okay.

When youre dealing with condentialpatient inormation, security is critical.I have real peace o mind that my BlackBerrysmartphone can only be used by me. I lock andunlock it with a password PIN and my organ i-sation uses smartcards and readers or extrasecurity.

I simply insert my ID card in the reader

beore I leave the house. I my card and Black-Berry smartphone are more than ve metresapart I get a message warning me that itsabout to lockdown the device. So my Black-Berry smar tphone would lock automatically iit was ever lost or stolen, and the I T guys couldeven wipe it remotely rom the oce.

Being able to work remotely has beenthe most positive change in my job over thepast couple o years. Im a community nurseaer all, and having a BlackBerry smartphonemeans I get to spend more time in my commu-nity, visiting patients.

F

[email protected]

www.blackberry.co.uk/healthcare

J , c j k v . Gv cc k f:

Improved decision-making U c c , xc, c c k c.

Increased responsiveness Qck c c c . B k fc,

k c k cfcc v

Reduced administration time BckB c cv c c cc k.

Improved service and capacity P c f c, v c, cc c.

I , q c BckB k

, , cc c c.

F c k, v cc v c c, c c v , c .

A c , Bck v c q cc c, c c c c.

The ruits oBlackBerry

Giving patients key inormation when they need it


14/16


Industry view

14

health monitors (assisted living); and helpingchronic disease patients such as diabetics by

providing assistance to bring blood glucoselevels back to a normal range (chronic caremanagement). Remote monitoring devicescan automatically cal l or help (social alarms),enabling emergency serv ices to react morequickly and ultimately save lives.

Its all about delivering the best care. Con-sistent and real-time monitoring o vitalparameters or behaviour allows or earlydetection o a deteriorat ion o a patientscondition, enabling timely intervent ion tohelp reduce expensive emergency situationsand hospitalisation. It also encourages morerequent interactions with patient s based onmedical data gathered in rea l-lie situations,improving the continuity o care.

Crucially, patients electronic health recordshave to be strictly condential, so how canhealthcare providers ensure data is protected?Security is indeed a key requirement or the

Federation, an organisation that represents4,500 GP practices in the UK.

As a practi sing GP, Whiteley leaves nostone unturned in the battle to uncovereciency improvements and the resu lts oa recent audit illustrate how big an impacta digital dictation system can make overanalogue technology.

Aer gathering data at Appletree MedicalPractice in Belper, Derbyshire, or a month,Lexacoms digital dictation soware wasshown to reduce urgent patient reerrals rom31 hours and 42 minutes down to one hourand seven minutes. And when processingroutine reerral s, Lexacom soware took anaverage o 26 hours and 48 minutes comparedwith 98 hours and 17 minutes with ana loguetechnology.

In a changing and challenging world, health-care proessionals are increasingly turning

to wireless technology to signicant lyimprove practices around the world. Nationalhealthcare systems are acing challenges inprevention and in how to provide ecientmedical care to an ageing population withgrowing incidence o chronic diseases.

The delivery o healthcare through mobiletechnologies (mHealth) can provide ananswer. Remote wireless health monitoringwill play a vital role in the development onew strategies aimed at improving access toand continuity o healthcare while controllingcosts at the same time.

A key technology to acilitate wirelesshealth monitoring is cellular-based machine-to-machine (M2M) communication. With thepatients prior consent, M2M solutions enablemobile health devices to remotely monitor,connect and communicate the patients health

status to a medical specialist over the air.Thanks to this technology, patients can

benet speedily rom specialised services,wherever they are, especially in remote areas.Complementing ace-to-ace visits, M2Mtechnology establishes an additional com-munication channel between clinicians andpatients, removing geographic barriers andenhanc ing the quality o service delivery.

Unobtrusive and easy to use mobilehealth devices can suit a variety o telehealthpurposes. Thi s includes monitoring a pa-tients medication compliance (pill reminder);managing elderly patients through wearable

used, Whiteley says. How can that be

ecient when tapes degrade, secretaries losevital time searching or dictations, playbacksound quality is poor, batteries need replacingand tape machines need investment to stopthem breaking down?

It seems there has never been a more com-pelling case or change. Whiteley recognisedthe need to embrace the latest dictationtechnology more than a decade ago andhis company, Lexacom, has been at the ore-ront o digital development and innovationever since.

Today, Lexacom supplies all-encompassingdigital dictation soware to customers acrossthe UK and is the exclusive digital dictationsoware supplier to the LMC Buying Groups

adoption o electronic health recstrict regulations controlling acce

tent o an individuals online medThe answer is sae M2M wire

ogy, which allows or automatic transmission o medical data rostraight into a patients record, dclear and complete picture o allpatients health without comproprivacy o the patient.

With more than 15 years o edigital secur ity, Gemalto providwhich enables healthcare devicemunicate over wireless networksecure ashion. Data transmissioon the latest encryption technolsecurity mechanisms inherent icellular networks.

In addition, Gemalto a lso suppcare providers with smart badgesauthentication solutions to secur

patient records, ensuring only aupersonnel can retr ieve sensitive Combining M2M technology, smother solutions, Gemalto and Cinsignicantly improve end-to-enwireless networks, saeguardingmation and meeting regulatory r

Ax H M K

M2M c C

( G c)

www.gemalto.com

www.cinterion.com

Statistics like thi s point to bigings on administration time andincrease in productivity and edictation technology gives compency and visibility to all work prworkloads, ensuring that patienis processed aster and more re li

Lianne Burke, IT/data manag

tree Medical Prac tice, says: I thtell the sta that we are going toaway, they would all hand their ollowing day. Thats how muchthis digital dictation platorm hapractice.

www.lexacom.co.uk

www.lmcbuyinggroups.co.uk

www.appletreemedical.co.uk

The governments spending review has placed

healthcare expenditure rmly in the spotlight.GP practices and hospitals are acing evengreater pressure to be more responsive topatients needs at a time when every pennythat is spent is being vigorously scrutinised bythose who hold the purse strings.

The current nancial landscape thereoredictates that budgets have to be spent evenmore wisely and the resu lts have to be evenmore impressive. Dr Andrew Whiteley, aGP rom Warwickshire, says: The currentchallenges acing primary and secondary caremean GP surgeries and hospita ls need to beworking hand-in-hand with their acute truststo maximise key eciencies.

One o the issues at the cent re o this e-ciency drive is the sae and reliable transero patient inormation. I a GP practice orhospital can get this right, it has a big impact

on the smooth delivery o patient care urtherdown the line.

It is thereore surprising that a hugenumber o UK healthcare sites still relyon analogue dictation systems to handleand transer vitally-important patientinormation.

At a time when healthcare is ocused onmaximi sing key eciencies, its staggeringthat 30-year-old technology is so widely

Caring about efciency

The power o the machines

M2M technology establishes

an additional communication

channel between clinicians

and patients, removing

geographic barriers to

good healthcare

When healthcare is

ocused on maximising key

efciencies, its staggering

that 30-year-old technologyis so widely used

Andrew Whiteley, GP

With M2M wireless

technology, providers candeliver quality healthcarewherever patients live,without compromising oneither cost or security

GPs can save money and time by embracing the potentialo technology when it comes to patient data

Wireless technology: a walk in the park

Going digital: its all about efciency


15/16

administrat ion system which records adminis-trative data.

According to director o inormatics NeilDarvill, the t rust did not go electronic or thesake o it, but to be able to run a better service.Lost records were generating 30, 40, 50complaints a year, he says.

The electronic system was implementedover 22 months, and more than 500 clinicians

and 130 medical secretaries are trained to useit. So ar, 135,000 records contain ing morethan 41 million pages have been scanned in.The notes appear on the screen as they wouldon paper and clinical sta can add inormationwith a keyboard or a hand tablet. The trustnow plans to close its medical librar y in 2014,saving at least 3.2m over ve years.

The governments inormation revolutionis supposed to empower other trusts to ollowsuit with their own locally-specied technol-ogy, in contrast to the centralised approach othe national programme.

However, two obstacles loom. One is cost:at a time o budget cuts it will be dicult ortrusts to nd the upront investment or IT.There is also the cultural challenge o goingelectronic. In its response to the inormationrevolution consultation, the British Medical

Association raises concerns about lettingpatients take control.The cultura l change o enabling patient

access to their complete records is signicant,it warns. Allowing patient access should bea gradual process which will require pilotingand, i successul, a staged implementation.

The BMA also warns: At this time onancial restra int, there should only beinvestment in this area i an evaluationprovides evidence o patient demand and clearbenets.

It is clear not every doctor is an AmirHannan.

The NHSs track record in going electronicis notoriously patchy, too. While most GPpractices are computerised (systems receiveda hey subsidy as part o the last Conserva-tive governments und-holding scheme),progress in hospitals has proved trick ier.

The NHS in England has been committedto electronic records since 1998. However,progress stalled when the last government

launched its now-notorious 13bn nationalprogramme or IT.

While some systems were transormed X-rays are now presented on computer screensrather than on photographic lms the

implementation o hospital-wide systemsbecame bogged down in acrimonious dis-putes. (The NHS in Scotland and Walestook a less aggressive stance, and in someways the organisations have achieved morecomputerisation.)

In act, the rst NHS hospital to announceit had gone entirely paperless was workingoutside the English national programme. StHelens and Knowsley Teaching HospitalsTrust in Merseyside has computerised itsrecords with a 1.2m document-managementsystem which handles electronic versionso conventional patient notes, and a patient-

By Michael Cross

Greater Manchester GP Dr A mir Hannan hasan answer or anyone who says ordinar ypatients are not interested in computeris-ing the NHS 1,140 o the patients in thepractice, a 10th o the entire list, now have

access to their personal medical records viathe internet.

Hannans practice at Haughton ThornleyMedical Centres is one o only a handul inthe country to oer patients the chance toview their complete, unexpurgated records.Hes been giving patients that access or veyears, according to the GP, with not a singleproblem.

Patients have to attend the surgery toapply or a log-in code, which they receiveaer lling in an online questionnaire dealingwith issues such as how they would react tonding alarming inormation in their records.

Hannan says that giving patients access totheir records encourages them to take moreinterest in their ca re to the benet o patientand doctor alike.

The government agrees. Giving patients

control o their health records is a central parto Health Secretary Andrew Lansleys planto reorm the NHS in England. Under plansor an inormation revolution in healthcare,patients will have access to their own hea lthrecords, as well as swathes o data about theperormance o hospitals, general practicesand individual doctors.

According to the Department o Health,access to health records improves relation-ships with clinicians, and means patientsare better inormed about their care andmedication, and are able to correct errors andomissions. It also increases peoples abilityto manage their own healthcare and theircondence to do so.

However, the revolution will not happenuntil medical records make the leap rompaper to electron ic ormat. All over the world,

health services have lagged behind otherindustries in adopting IT. Even in the US, onlyabout a h o hospitals have ully electronicmedical records.

There are several reasons why healthcarehas proved more resistant to inormationtechnology as compared with, or example,banking. Health records contain messycollections o inormation, including imagesand notes made or a doctors own reerence.And, until recently, computer hardwar e wasnot portable and robust enough to be carr iedby doctors on their ward rounds or in operat-ing theatres.

A c cc c c(EMR) c v v c c k .

T q. I v c

- , c c k c McAc c c

B cc c c j NHS. Bf cc:

Noneedtorepeatthesameinformatioc, c.

Fewerappointmentscancelledbecausc c v v.

X-rayimagesbeinginstantlyavailable.Ac cc EMR -x.

Areductioninprescriptionerrors:syste

c k , c c c c c.

Fasterhospitaldischarges,withbeds ck k.

A EMR vc v c c c c c c c . Hv, c , c c ck.

Putting the record straight

Medical records must make

the leap rom paper to

electronic ormat. All over

the world, health services

have lagged behind other

industries in adopting IT

Do electronic recordsimprove patient health

Paper trail: will our health records ever be ull electronic?


Electronic reco

Giving patients accessto their medical

records is a key part ohealth policy puttingcomputerisation backat the top o the NHSagenda


16/16

Sunday Telegraph UK: Business technology supplement April 2011

Documents

Transcript of Sunday Telegraph UK: Business technology supplement April 2011