The digital revolution: eight technologies that will change health and care

Comments: 30

The past decade has seen rapid development and adoption of technologies that change the way we live. But which technologies will have a similarly transformative impact on health and care?

The King’s Fund has looked at some examples of innovative technology-enabled care that are already being deployed in the NHS and internationally to transform care. Now, we examine the technologies most likely to change health and care over the next few years.

Some of the technologies we discuss are on the horizon – others are already in our pockets, our local surgeries and hospitals. But none are systematically deployed in our health and care system. Each could represent an opportunity to achieve better outcomes or more efficient care.

1. The smartphone

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Smartphone

It’s been eight years since the launch of these pocket-sized devices we now know so well. We take them for granted but our phones combine: computing power that could steer a spacecraft, a connection to the internet, a host of sensors for health-relevant data like movement and location tracking, plus a touch-screen interface.

Two-thirds of Britons use them to access the internet (Ofcom Technology Tracker 2015), and few would regard these devices as ‘new’, yet the smartphone’s potential is yet to be realised in health and care.

Apps

App stores already feature thousands of health apps, though their uptake for health and care has been patchy. Efforts to curate the best quality apps, for example in the NHS App Library, have had little success so far (Huckvale et al 2015).

One of the more sophisticated apps in use in health care is Ginger.io. In this depression programme, people track their own mood and this is combined with data collected from the sensors in the smartphone about their movements, social app or telephone use. The data can be shared with clinicians and offers people an intervention when their data suggests they might benefit from support.

Hubs

Smartphones can serve as the hub for sophisticated new diagnostic and treatment technologies. So, for example, people with type 1 diabetes dissatisfied with the progress of medical technology companies are driving the development of an artificial pancreas. This links continuous glucose monitoring and insulin-delivery systems that are all controlled by the smartphone. It will adapt its algorithms for insulin delivery to a person’s physiology.

Large-scale research

Smartphones are highly effective data collection devices and they can record a lot of detail about people’s lives. As well as tracking their own health status, people can also help researchers gather large amounts of data on health problems and their determinants using their smartphones.

The first long-term and large-scale opt-in disease studies are just beginning. Apple seeks to support large-scale studies using patients’ iPhones by providing its ‘ResearchKit’ software platform for researchers to tackle any research question. uMotif is seeking eventually to build a 100,000-person study into Parkinson’s disease, tracking variables using a smartphone app.

2. At-home or portable diagnostics

Portable x-ray machine
Devices cheap enough or portable enough to be transported to people’s homes to provide diagnostic information aren’t new – think of a GP doing home visits armed with a stethoscope. But recent innovations mean that devices previously only kept in a hospital or a GP surgery are now portable or cheap enough to be located in people’s homes, and used by patients themselves.

Hospital-level diagnostics in the home

These include portable x-ray machines, blood-testing kits and other technology that can provide more and more of the diagnostics required to support health care, with profound consequences for the way we configure our health care system.

At a recent conference at The King’s Fund on emerging primary and acute care systems, Dr Michael Montalto described how these technologies and others enable the safe, high-quality acute care service that his team has provided for people in Victoria, Australia, in their own homes for 20 years. One recent innovation in this area is the AliveCOR ECG embedded in a smartphone case that helps interpret test results via an app and facilitates secure sharing with clinicians (NICE evidence review).

Smart assistive technology

Many people with disabilities or long-term conditions use assistive devices to help them perform tasks or activities made harder for them by their disability or their condition. These are often available as part of NHS and social care packages. The prospect of using these to gather information in addition to achieving a specific task is motivating several new developments.

Verily (formerly Google’s life sciences arm) has invested in a tremor spoon already on the market for use by people with Parkinson’s disease, for example. By incorporating sensors and deploying its data analytic expertise, the aim is to provide people or health professionals with information about how someone’s tremor characteristics and severity change over time – and to understand more about the disease across a population. Smart inhalers like those in development by Propeller Health work on a similar idea, passively detecting each use, location and the surrounding air quality, allowing insights into what triggers asthma attacks.

3. Smart or implantable drug delivery mechanisms

Drug delivery
We know that between a third and a half of all medication prescribed to people with long-term conditions is not taken as recommended (Nunes et al 2009). Several technologies in development could enable patients and care professionals to monitor and improve adherence to a prescribed drug regime either through automation or providing better information about medication usage.

Smart pills

One company has developed sensor technology so small it can be swallowed and combined with drugs in pill form. When the pill dissolves in the stomach, the sensor is activated and transmits data to a wearable patch on the outside of the body and on to a smartphone app. This enables patients and their clinicians to see how well they are adhering to their prescription.

Proteus Digital Health began the US Food and Drug Administration (FDA) regulatory process for this technology in 2015. The treatment now undergoing review combines the technology with an anti-psychotic drug, raising questions about how health systems could use the technology and how privacy and autonomy for patients will be affected. The company are also investigating other potential applications including assisting those with long-term conditions such as dementia and Parkinson’s disease to remember to take their medications.

Implantable drug delivery

New automated drug delivery technology is under development by a firm set up by researchers and engineers from the Massachusetts Institute of Technology (MIT). They are developing an implantable device with hundreds of tiny, sealable reservoirs that open when a small electric current controlled by an embedded microchip is applied (Farra et al 2012). The team developing the device say it could provide a way to automatically release doses for more than 10 years from a single chip. They are developing the technology for long-term condition medication as well as for contraception.

4. Digital therapeutics

Digital therapeutics
Digital therapeutics are health or social care interventions delivered either wholly or significantly through a smartphone or a laptop. They effectively embed clinical practice and therapy into a digital form. At a minimum, these interventions combine provision of clinically curated information on a health condition with advice and techniques for dealing with that condition.

Many digital therapy platforms include a way for people to connect with peers and share their experience, or to connect with health professionals remotely. Whether they are fully automated or blend automation with supervision, the therapy offered can be tailored to the needs of the specific user. Digital therapeutics are often cited as a solution to help manage long-term conditions that call for behaviour changes or to prevent diseases in the long run.

Computerised cognitive behavioural therapy

The use of computerised cognitive behavioural therapy (CBT) in the NHS has a relatively long history. Two recent independent studies looking at early-generation computerised CBT suggested that the main limitations in effectiveness were due to people failing to complete the course. Adolescents were more likely to finish the programmes and so benefited more from them. (Gilbody et al 2015, Smith et al 2015).

Recently, a new generation of automated digital therapies based on CBT has been developed that aims to deliver CBT at scale with better engagement. Sleepio is one example, a six-week tailored programme delivered via the web, designed to treat insomnia, and in doing so help alleviate anxiety and depression. There have been positive early results in randomised controlled trials (Espie et al 2012, Pillai et al 2015). The therapy is personalised in response to data provided by the patient and by using the latest practice in design and delivering the therapy via an animated avatar, the course is made more engaging. Design and personalisation are key elements likely to improve engagement, and therefore outcomes, in digital therapies of all types.

New preventive digital therapies

Another class of digital therapies are in development to help people make changes to reduce the risk of developing long-term conditions. Interventions to change lifestyles through regular coaching and group sessions can reduce the risk of developing diabetes. Sean Duffy, CEO of Omada Health, which delivers online therapies for a range of conditions, gave a presentation at The King's Fund Annual Conference, showing how the company has achieved positive results in its early evaluations in the United States.

5. Genome sequencing

Genome sequencing
Advances in genome sequencing and the associated field of genomics will give us better understanding of how diseases affect different individuals. With the genetic profile of a person’s disease and knowledge of their response to treatment, it should be possible to find out more about the likely effectiveness of medical interventions such as prescribing drugs to treat a disease (pharmacogenomics).

Falling sequencing costs

Twenty years have passed since the first complete genome sequence of a living organism was produced and twelve since the first human genome was sequenced. In that time, the economics of genome sequencing has changed significantly. The US National Human Genome Research Institute estimates that the marginal cost of sequencing a single person’s genome has now come down to $1,000. However, the upfront costs are still high and likely to remain so for a long time.

The cost of sequencing could fall further thanks to new sequencing techniques using nanopores developed over the past few years. Nanopores are very small holes that DNA molecules can pass through. When an electric current is induced through the pore, variation in the current as DNA molecules are passed through can be used to infer their make-up. Oxford Nanopore Technologies uses this approach to offer very small genome sequencing devices, far more portable than the larger, fridge-sized machines used in traditional laboratory-based sequencing.

Population-level studies

Major projects are under way internationally to gather large databases of genomes and analyse them to find relationships between genetic make-up, people’s disease risk and experience, their physical characteristics and their behaviour.

In the United Kingdom, the government is sponsoring the 100,000 Genomes project in England. Human Longevity Inc in the United States promises to build a database featuring 1 million genomes by 2020 and currently has 20,000 sequenced genomes linked to other data about the person’s physical characteristics. Verily aims, with its Baseline study (a research collaboration between the company and Stanford and Duke medical schools), to analyse large amounts of volunteers’ linked genome, lifestyle and physical data to develop a better understanding of how all that data looks when a person is healthy and identify the changes that indicate disease at an earlier stage.

6. Machine learning

Machine learning
Until recently, computers weren’t especially good at recognising patterns in messy data. Or rather, the way we programmed them meant they weren’t very good. New techniques have now been developed in the applied mathematics and computer science fields that have allowed more effective use of computers for tasks like this. Machine learning is one such field. It is a type of artificial intelligence that enables computers to learn without being explicitly programmed, meaning they can teach themselves to change when exposed to new data.

New insights into big datasets

Several new businesses hope to use these techniques to provide diagnostic support. Enlitic in the United States has created a tool for radiologists that uses previous findings and other data associated with existing images in its databases to spot patterns in images and the data to help spot likely mistakes and rule out extremely unlikely options. Both IBM’s Watson and Google’s DeepMind – the two most famous artificial intelligence organisations – have started to explore potential applications in health care. For example, IBM Watson is studying whether applying machine learning to large amounts of unstructured data like clinical guidelines, scientific literature and treatment protocols could help optimise cancer treatment.

Here at The King’s Fund, we are working with colleagues at Demos’ Centre for Analysis of Social Media to see what is practical and ethical in terms of applying machine learning techniques to user-generated content on the internet. We are hoping to understand the insights that health systems can glean about patient need and how services meet that need.

7. Blockchain

Blockchain
Blockchains were conceived in 2008 and the most well-known application is the digital currency Bitcoin. The technology has potential uses in a wide range of other fields, particularly financial services and government functions, where it is already being deployed.

Blockchains are decentralised databases, secured using encryption, that keep an authoritative record of how data is created and changed over time. Their key feature is they can be trusted as authoritative records even when there is not a single, central, respected authority updating them and guaranteeing their accuracy and security. This derives from the mathematical properties of the way the data is recorded and the difficulty it would take to break the rules and successfully alter the record.

Decentralised health records

Electronic records for health care are now widely used, but they are stored on centralised databases, secured and provided by a small number of suppliers. Some commentators have described how a decentralised database using blockchain technology to contain all or some of patients’ health information would work, with the patient or clinician given the keys to control who else sees the data.

They argue that the system would be more resilient as no single organisation houses the data and that switching to or incorporating blockchains into existing systems could help to speed up the transition to interoperable patient records. The technology could be applied to create accurate records of health interventions and eventually verified outcomes, which could be used as the basis for reimbursing providers for the health outcomes they achieve for their local population.

8. The connected community

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Connected commmunity

Behind all technologies, there are people. The internet and the devices and technology it has enabled have facilitated the development of many communities, bringing together people around a common interest, a shared identity, a social movement, or even just hashtags.

Peer-to-peer support networks

Connected communities for health are growing in their membership and their diversity. Several platforms bring together people with interests in health and care within countries and across the world to support each other, share learning and even provide a platform for tracking their health data or helping them manage their condition.

MedHelp, PatientsLikeMe and HealthUnlocked are just three of these social networks for health. Alongside these dedicated networks, platforms such as Twitter and Facebook that dominate the social network market in the United Kingdom have also become key places for disseminating and discussing health and care information and best practice – as Daniel Ghinn of Creative Health told our Digital Health and Care Congress in 2015.

Communities contributing to research

Some online communities are already contributing to research about their health conditions, offering people the chance to be ‘data donors’ and providing a simple way to share their data with researchers. PatientsLikeMe has already been used to contribute to nearly 70 published studies, including a study credited with new discoveries about the disease progression of amyotrophic lateral sclerosis (ALS).

Healthbank offers a different model, and is described as ‘the world’s first citizen-owned health data transaction platform’. Members pay a one-off fee to store health data securely and control who it is shared with. The organisation is a co-operative, so profits made using the patient data are paid out in dividends to its members.

Conclusion

With new technologies like these come new opportunities for our health and care system: improving the accuracy and usefulness of information we can gather on our health as citizens and patients; changing how and where care is delivered; and offering new ways to prevent, predict, detect and treat illness.

But along with these opportunities come challenges:

  • how to ensure universal access to any benefits through the NHS, ensuring the system doesn’t get left behind by a consumer market and fail to provide poorer or excluded citizens with their benefits
  • how to encourage uptake of new care methods and models built around them throughout our system
  • how to deal with the great volume of health information these technologies can generate.

The technologies we’ve highlighted here are not an exhaustive set. Many of them could transform health and care but more evidence is needed on their costs and benefits to deliver on their promise. Ask too much or give too few opportunities for real-world testing and we risk protecting an outdated status quo. Ask too little and we risk spending public money on something ineffective.

Above all we must not lose sight of the people behind the technology and their needs – the patients, citizens and communities for whom it will be put to work.

Acknowledgements

The authors would like to thank the following: Eric Topol for his insights into blockchain and new directions for digital health; Craig Venter, Ruby Gadelrab and Brad Perkins for a vision of the future of genomics; Pat Saxman, Peter Hames and Sean Duffy for their insights into digital therapeutics; Donald Jones for his insights on drug delivery and patient-driven data; Michael Pellini, Luke Hutch and Joon Yun for helping develop our thoughts on precision medicine; Nick Dawson, Rebecca Hope, Chris Natt and Scott Noppe-Brandon for their expertise on innovation. Rupert Dunbar-Rees and David Ewing Duncan for reviewing early drafts and providing valuable feedback; and Vishal Gulati, Jack Kreindler and Daniel Kraft for their support and assistance in the research phase.

Comments

#545292 Michael Branags...
CEO
Device Access UK Ltd

Great report on Digital Heath Innovation at a time when the NHS needs to try and relieve the growing demands with 900 more admissions per day in 2015 over 2014 - digital Heath and wearables are a great idea to monitor people at home. Trouble is they are not drugs and therefore don't come with an easy reimbursement route. Some of these technologies were showcased as far back as the 2011 NHS Innovation showcase demonstrating the millions saved by adoption but uptake has been terrible. Is it really easier for the NHS to build 22 new 800 bed hospitals in the next 6 years to meet current demands than finding a way in the system for non pharma MedIcal Technologies to be paid for in the system?

#545293 Pearl Baker
Independent Mental Health Advocate & Advisor/Carer
Independent

The 'SMART PILL'
Parts of this idea is 'frightening' it is almost to difficult to comprehend what could be in 'stall' for those individuals suffering from a Mental Illness (LTC) Many patients do not have their medication reviewed for years, often walking around in a 'Zombie' like appearance, denied any offer of New Drugs that could help their condition, and quality of life.

'Implantable drug delivery'?
Not on my 'patch' it is all about 'promoting their product, which saves 'MONEY' by having less Professionals around to do their 'JOB'.

Who is responsible for ensuring the 'Health & Social Care' of the patient now? and who will be in the future if this MAD 'money making' Company have their way? by virtue of a 'Rubber Stamp' by this Government, who are unable to deliver quality 'Health & Social Care' now due to 'Funding'.

'Genome Sequencing' is so far in the distant future as 'every individuals is different. This idea is 'back to front' first find out each person's 'Genome Sequencing', then It is down to the Professionals qualified in their patients illness to decide what is best for their patient.

'Compulsory Treatment Orders' is something I will always be against. I was invited with two other organisations by the DOH to give verbal evidence in LONDON, and still support this today.

I have no idea how they operate CTO when we have 'incapacity' legislation?

'Innovation' is still out there! how can we make it work better?

All those requiring 'Health & Social Care' can be improved, by all those responsible, including Carer's having a 'single' system of communication.

The Computer 'password' entry allows Carers with concerns, GPs Consultant's SW CPN anybody responsible for that person's 'Health & Social Care' 'emergency' 'out of hours'. All Meetings will be recorded in the Computer.

My idea saves the time and energy spent by everybody contacting each Professional individually. Its called 'INSTANT ACCESS'.

Why I favour my idea of Computer access to those responsible for 'Health & Social Care' and their Carers, and my previous idea for Pharmacy access is simple. The Majority of people have a Computer, for those unable to 'operate a smart phone or even own one is even more remote.

The Patient is number ONE, the preferred access is down to them and their ability to 'cope' with a system in their own home is essential, they could be encouraged to input a daily 'diary' in how they are feeling.

A Care Manager Co-ordinator is assigned to a client, daily access to the patients notes.

There is 'innovation' and 'innovation' that allows Companies interested in making money as their number one priority as second to the patient's Health & social Care'.

It is important not to lose sight of the role of the CQC, the 'Protector' from NEGLECT for some!!

Losing sight of ACCOUNTABILITY!

#545294 Dave Ashton

This preoccupation with (or addiction to?) microwave-emitting wireless technologies in the NHS is really extraordinary and irresponsible.

Presumably, the pre-eminent reason for the existence of a National Health Service is to promote health and treat illness, and yet the ubiquitous provision of wifi, smart devices, and other wireless technologies will inevitably achieve the opposite outcome.

Before succumbing to the superficial allure and "convenience" of these technologies, it may be worth remembering (or learning of) a few things.

1) Wi-fi, mobile phones, DECT cordless phones, wireless laptops and tablets, smart meters, smart wearables, even wireless baby monitors, all emit pulsed, modulated, microwave-frequency radiation, which is officially classified by the World Health Organisation / International Agency for Research on Cancer as a possible carcinogen, on the basis that it increases the risk of developing a glioma (see IARC Monograph 102).

2) This non-ionising radiation has been linked to many other health conditions, including autism, ADHD, Alzheimer's, SADS, auditory dysfunction (eg. tinnitus), cognitive dysfunction, dermatological issues, gastrointestinal issues, musculoskeletal issues, respiratory issues, sensitisation, and so on. There are decades of scientific research to back this up.

3) The insurance industry refuses to accept liability for claims related to this radiation. SwissRe categorised it as High Risk in it's 2013 SONAR report, saying: "The ubiquity of electromagnetic fields (EMF) raises concerns about potential implications for human health, in particular with regard to the use of mobile phones, power lines or antennas for broadcasting"

4) There is a long-running legal case, Murray v. Motorola, bought by a number of brain tumour victims, and their surviving relatives, against the telecoms industry for brain tumours which they say were linked to mobile phone use.

5) Two US government departments, the Department of the Interior and the Environmental Protection Agency, have released internal documents in which they note that the exposure standards for this radiation are set on the mistaken assumption that because non-ionising radiation cannot heat bodily tissues by an appreciable degree, then it is therefore "safe".

6) The Parliamentary Assembly of the Council of Europe issued Resolution 1815 in 2011, in which they say: "While electrical and electromagnetic fields in certain frequency bands have wholly beneficial effects which are applied in medicine, other non-ionising frequencies, whether from extremely low frequencies, power lines or certain high frequency waves used in the fields of radar, telecommunications and mobile telephony, appear to have more or less potentially harmful, non-thermal, biological effects on plants, insects and animals as well as the human body, even when exposed to levels that are below the official threshold values".

7) France has outlawed children under three from being exposed to wifi radiation in nurseries and public places, and restricts the exposure of older children.

8) 217 international experts in the study of the biological effects of this radiation have warned the UN, all UN member states, and the World Health Organisation, of an "emerging public health crisis related to cell phones, wireless devices, wireless utility meters and wireless infrastructure in neighborhoods" (see the International EMF Scientist Appeal).

And so on...

Wireless technologies have absolutely NO place in the NHS, and to think otherwise is to ignore the many thousands of scientific papers showing the harmful biological effects, and to throw away any pretence of implementing a Precautionary Principle aimed at protecting everyone - but especially children, pregnant women, the elderly, and those already vulnerable to illness.

#545296 Denise Silber
CEO
Basil Strategies / Doctors 2.0

Always a challenge to draw borders between the technologies. I think it is most interesting to look at what brings the greatest impact in terms of scalability, versus pilot projects. After online search via Google, online communities are undoubtedly the tool that has had the greatest favorable impact to-date on people with medical conditions, primarily communities of patients/caregivers and secondly professional communities. The next greatest scalable change and which is imminent will be the combination of online appointment fixing, access to online providers via Skype-type platforms, and connected objects in the home (quantified self, EKG, stethoscope, otoscope), generating massive telehealth. It doesn't matter whether these contacts occur on home computer or mobile device.

#545300 Rech, RL. MD, M...
Physician and Clinical Researcher
Private Clinic

It is very clear for professionals in the health of large Medical Centers, which required a discussion we implement new technologies in order to increase the safety of patients also the distance.
Many outpatients lose an entire work shift to display tests to their doctors and have the dose of your medication adjusted. A large percentage of these contacts could be virtual. In fact many of these contacts are already made by WhatsApp, Facebook Messanger, E-mail, SMS or even a phone call.
Patients travel for long periods interrupt their psychotherapeutic treatments because they can not do for Skype, Face Time or other ... That's better than having your virtually session?
Urge that regulate such practices ... It is necessary to discuss with an open mind for this new time. Determine which calls can be made in virtual form, how the calls must be recorded, how the professionals can be paid, how to establish cybersecurity.
We can not ignore the benefits to patient healthcare and better physician results with regulated forms and situations in which the virtual contacts and virtual guidance can or should happen

#545302 Esther O'Sullivan
Head of Digital Strategy
BMJ

Really pleased to read this as these eight technologies can and should be transformative to health care, and should therefore create a really exciting time for the health service as it adopts and adapts them to become more efficient. One of the challenges I would add is the cultural changes required to engender acceptance of these digital revolutions as useful tools for us all, and not to be blocked because of fears around technology and change.

#545303 Adam Hoare
Managing Director
Red Embedded Systems Ltd.

Absolutely agree. We demonstrated some years ago a 45% reduction in A&E attendances for people with long-term conditions by supporting them remotely at home using video. We have connected dialysis machines back to the hospital and connected remote blood pressure and weight measurement devices to support people at home. We are currently developing technology specifically aimed at supporting people with learning disabilities to live in the community and get better access to healthcare. In all cases there is no reimbursement mechanism. Prevention and remote support for people does not fit into the reactive, "wait till it is a crisis" way that health and care is funded. If we had drugs that could deliver the outcomes we provide there would be a route to market. If the system wants to move away from crisis management it will need to fund the things that stop crises happening.

#545304 Ileana Welte
President/Managing Director
BIg White Wall

Excellent review although disappointing to see a lack of focus on UK scaled evidence based interventions such as Big White Wall, IESO, Silvercloud, and Headspace to name a few. Scaling digital in integrated pathways is real innovation.

#545305 Richard Pope
Clinical Director
Dynamic Health Systems

A timely reminder that we already have many of the tools we need to improve productivity within health and social care - and we HAVE to improve productivity to deal with the tidal wave of long term condition related ill health - 'creating' additional healthcare professionals is neither a long term solution or even a realistic prospect. We have shown that contacts with primary care can reduce by 55% at the same time that biomedical measures of condition control improve when individuals engage with digital health services. Personalization, leveraging a person's care network and using I.T. to create new, more productive and much more citizen focused response systems within the healthcare sector have to be key to sustainability - so this list ticks the box for us.

#545306 owen david
medical consultant
DGH

Love some of these cool ideas - and i suspect many older people will accepted them in significant numbers, but many currently needing health and care have complex problems which will continue to need an individualised multifacited complex health and care approach. O

#545307 Anantha Naik Nagappa
president
Association of Community pharmacist Of India

Technologies are welcome with very high expectations and we feel greatly relieved by the relief they promise to over come the most important issues in health care reform. However the health is defined by diet and exercise which we often neglect and become the victims of negligence and start expecting the technology to protect us from the illnesses.

#545308 Gareth Presch
Founder
World Health Innovation Summit CIC

Great report - I would add that #Blab will become a useful tool of engagement. All of the above are interesting and can be useful but we must ensure that staff are shown the benefits and the reasons for implementing new technology. The benefits of giving staff more time to treat must be shown. Patient involvement is paramount. Using the above effectively will provide the health service with great opportunity to focus more time on patient care while reducing workload for staff. We plan to support our communities and services in anyway we can and have our first summit on health innovation in Carlisle on the 10th & 11th March 2016 - www.worldhealthinnovationsummit.com @HIC2016

#545612 David Dundas
Managing Director
Lion Industries UK Ltd

The greatest challenge will be to educate the general public in how to integrate themselves into these and existing health technologies. The demands on the NHS are growing fast and an important way to help finance them is through improvements to NHS efficiency with new technology; a key element to also improve efficiency is the education of the public in how they can reduce NHS waste of resources, by respecting appointments and not abusing services such as A & E when they have a minor injury or ailment that can be treated locally. Education of the public is key to balancing the NHS books.

#545613 Jason Maude
CEO
Isabel Healthcare Ltd

The potential is indeed exciting if only healthcare and the NHS is particular can make use of these technologies which, in many cases, have been available for years and have proven their worth.

Many UK companies have fabulous technologies which they manage to sell all around the world EXCEPT to the NHS! The Kings Fund should try and get to the bottom of why the NHS makes it so difficult to deal with and campaign for changes. The loser is the patient and tax payer.

In the section on machine learning you continue to believe the PR put out by IBM about the capabilities of Watson. The FT yesterday ran a very good article about the reality of Watson: http://www.ft.com/cms/s/2/dced8150-b300-11e5-8358-9a82b43f6b2f.html#axzz...

My own UK based company has been providing diagnostic support tools to clinicians and patients for over 15 years. Our main market is....the USA where we have over 150 institutions using it on a daily basis improving the quality of care for US citizens!

#545614 Sophie Carus
Event Producer
Health Service Journal HSJ

Great article, thank you.
I'm currently working on a major HSJ summit on Modernising Healthcare and the role of technology, taking place in May. If you're interested in getting involved in any way, please contact me at sophie.carus@emap.com

#545615 ben colman
Information services manager
Salford City Council

We still tend to develop technologies and then expect our customers to change their behaviour, rather than designing such good tech. that the customer wants to change their behaviour. A few years ago, banking had a go at going digital, retreated a bit and re-opened some branches and is having another go now. There are still a lot of people who enjoy and benefit from real, physical contact with other human beings - we need tech that genuinely is so easy that it frees people up to develop social interactions.

#545619 Lucy
Patient Safety Reporting Lead
National Reporting and Learning System

The NHS Couch to 5K mobile phone app, which you use whilst running has helped many people improve their fitness, including myself. So encouraging and sets small targets - speaking as someone who couldn't run for more than 30 seconds at a time previously to going on to complete a 5k charity run. All down to the app (and the person who encouraged me to get it!).

#545622 Harry Longman
Chief Executive
http://gpaccess.uk/

Best comment. People will do what works for them, and won't need persuading. They will be relieved. Hence in our view the biggest potential patient and provider benefit is in the biggest volume of NHS demand, of which 90% is in primary care. It's not a disease specific or patient subgroup specific niche, its the day to day undifferentiated demand which takes up the great majority of capacity.

#545634 Matthew Honeyman
Researcher
The King's Fund

Ileana,

Thanks for reading and commenting. Please be assured that we are well aware of the good work being done by Big White Wall and others. Indeed, we referred to them in The Future is Now, a previous publication on similar lines. See http://www.kingsfund.org.uk/reports/thefutureisnow/.

The projects featured here aren't meant to be exhaustive and we can't reference all of the many initiatives out there in the NHS and further afield. I agree with you that one of the biggest challenges is how we commission and deploy these at scale.

Matthew

#545661 Nusrat Latif
Executive Director
Medicine Watch

People not products drive revolutions. NHS employees who embrace technology enable a domino effect with patients.

Sadly we still have many senior NHS prof's who request emails to be printed before we read them, GP surgeries without patient email access still using fax machines and many surgeries like mine where I can not access my patient records still... forget Skype or Telemed, that's Star Wars fantasy world to them.

Add to that NHS' single biggest investment outside of staffing is in a prescription for a drug - culture and mindset of people needs to shift for digital-revolution to be the game changer it should and could be, if only we stop standing in it's way.

#545712 Dr Maeve white
doctor community dublin
irish health service

thank you for this valuabe work which is healpful to me

#545818 Nusrat Latif
Executive Director
Medicine Watch

Good article and timely. Historically we support NHS to shared learning through traditional physical enviroments.

We have moved towards digital only - one can not argue with the scale, pace and transparency of digital / social / mobile can reach.

2 things always at the front of our mind:

1. What do the millennials think/desire/do - a tip we learned from Sir Bruce Keogh when he launched the whole idea of 7 day week at one of the chief execs breakfast meetings we arranged

2. What about disruptive tech eg Uber, Amazon, NetFlix...
it is only a matter of time before an Amazon type org. starts supplying goods/drugs to the NHS right / wrong?

Lord Carter's findings around variations would be eliminated if we used digitech to enable transparency, openness, honesty... the standard principles and ethics that most business are built on (the NHS/public sector like to keep it hidden, force us to make FOI applications, or worse listen to industry when they say 'we can't tell you the price we sold it to your colleagues in the neighbouring trust due to commercial sensitivity, and we wonder why we have publishers like telegraph carrying out undercover operations around alleged corrupt officials, if we were transparent and open they would have nothing to go undercover about!)

While many wait and hide and fight the revolution... the millennial-thinkers are a already building it

#545899 Alan Kennedy
Chairman
Crawley CCG

Helpful article but missed an important point. We have invested substantial funds already in disconnected technology. You have only to look at our urgent care system to see that the problem isn't the lack of records but their availBility at point of care. The focus for NIB is defining interoperability standards. Whilst we wait how many people have heard of cloud based multi channel technology?
Others sectors have used this to drive serious innovation by being able to connect legacy systems.
In a world where we will have little free money surely we should at least aspire to connect previous investment in technology before we adopt the right technologies identified here?
Look at the Patient Relationship Management initiative for NHS111 in London for an example of delivering connected records for urgent care clinicians quickly. Better safer decisions, reduced costs better patient experience. So don't forget to ask for cloud based multi channel technology!

#546018 qsdf
etudient
s

thanks

#546094 Dr Zakiuddin Ahmed
ehealth Visionary
Healthcare Paradigm

Good futuristic view
However, we should also keep in mind 3D printing & Big Data

#546110 Ian McDowell
Director
Patient Powered Medicine

This is about more than devices. We are not in the same kind of world anymore. The ethical questions that sit alongside the usability ones will not be determined by remote authorities, but by communities of health in conversation. But those communities of health must embrace providers and recipients, professionals and lay people, working and learning together. Only then will we be using these new technologies to their full potential.

#547566 paul Jhass
Strategic Projects lead
Kent Community Health Foundation Trust

This sound very exciting. We are working on a wound care project with telemedicine as intergral part of it.
I would be keen to expolre the opportunity to work with other partners to validate this model .

#547656 Nandini
doctor
health services

nothing now!

#547658 Samuel Aboagye
laboratory technologist
joehans medical consult

Reading through give hope for the future in medical care.it very laudable.
Assistance and advise are welcome.our facility now going on annual mobile services screening.
Help update the service of health care.Thank you

#547659 Samuel Aboagye
laboratory technologist
joehans medical consult

Reading through give hope for the future in medical care.it very laudable.
Assistance and advise are welcome.our facility now going on annual mobile services screening.
Help update the service of health care.Thank you

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