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The health care of tomorrow? International learning on community, technology, and avoiding digital exclusion
What does the future of care delivery look like? Anna Charles talks with Dr Steven Tierney and Dr Henry Chung to explore how they have transformed their health systems to better support local communities, and how to address digital exclusion in an increasingly digital world.
Comments
John Grumitt - your right to highlight that the problem is both solvable and being solved. My own company is building a solution delivering large scale, personalised diabetes care, based on the data, using exactly the same techniques we use to target and interact with customers for banks and retailers.
Healthcare has not yet embraced this opportunity. Perhaps the fear of getting it wrong, or the lack of experience of organisational change or indeed the desire to preserve the status quo in the face of limited resources and increased demand have all had a part to play.
Meanwhile, as a patient I want to see providers use my data to deliver services more efficiently and effectively yet am astounded at how slow they are to grasp the opportunity.
Commissioners and providers (as well as policy makers) have a responsibility to take this on. Perhaps as resources become even more constrained, they might do so, but one can only hope they respond sooner.
There are great examples that could be built upon, across geographies and across industries. Credit card operators and banks handle massive data securely and could probably help understanding of the issues, if we asked. Likewise, the Rockefeller Foundation have already started to build on the remarkable benefits shown by universal health data systems in Abu Dhabi (which have achieved significant clinical and economic benefits - all published) in countries as diverse as Ghana and Indonesia.
The WHO, together with the ITU, have a programme to promote the application of information technology and are seeking partners. The International Diabetes Federation are joining forces with the GSMA (the global mobile phone trade association) to encourage diffusion at scale and are holding joint symposia at their congresses in Melbourne in December and Barcelona in February.
It would be great to see those responsible in this country easing the way for progress and for the commissioners and providers to grasp the opportunity before we find ourselves in even greater trouble.
Second, I know that the current DH has made better informatics and a paperless NHS and person held transportable records a priority and key to the integration agenda and of course I agree with this. But is it a triumph of hope over experience when the last NHS IT project cost £8bn (the entire primary care prescribing or criminal justice budget) for what? How can we ensure its different this time. A triumph of hope over experience, driven by the fact that generally conservative ministers are more savvy when dealing with business/industry?
Just asking?
David
The problem is that organisations have chosen the wrong kind of solution. If you buy a cheap "black box", that ticked a form for "risk stratification", you can't then complain that the model is not open or adaptable. But then trying to build the software from scratch in open source is not the answer either - most NHS Trusts just don't have the resource.
The problems of building personalised, localised models of risk, and bringing together complex sets of data to build these models as identified by the commentor above, have been solved in other countries and in other industries. From Tesco Clubcard, to Kaiser Permanente, this is an understood problem with standard tools and approaches to solving it. The real challenge is that the NHS has yet to really understand how key this element is to ultimate success - although hopefully this blog is the start of that understanding. Buying a risk strat tool off the shelf is not the answer. And the start of that answer isn't as hard as some people think.
For most organisations their systems will be proprietary and therefore expensive to develop interfaces for.
The other complication is the range of organisations required - social care, primary care, mental health care, community care and secondary care all interact with each other, and in many cases multiple providers. The overlapping boundaries of the catchment areas (especially in London) make it very difficult to identify priorities for such integration, especially when the NHS organisations involved are subject to repeating reorganisations. This facet led to the development of a summary care record, only for this to be subject to concerns around data protection when operating on a very large scale. And in any event, the summary care record often does not provide the sort of detail that a team responsible for the shared care of a patient need to provide continuity of care.
Integration is especially challenging for such circumstances, where data entered once must be available to all - but only those who are directly involved in the current episode of care. Interfaces are generally easier to organisation on a push basis rather than pull - it is easier to download data from a system than to accept it from another. Reasons include 1) the difficulty of matching data - you may know me as Howell Huws, but that system has me down as Hywel Huws - even with the wonderful NHS Number and 2) the difficulty of matching data structures - my system may not have anywhere to put your specialised dataset. And then you get into how do you provide assurance of data integrity when data items may be changed by people on different systems simultaneously - whose is the master record? Hence the complexity and hence the expense of interfacing between the systems, and why it is so often put into the too difficult pile, and why so few actually get started.
An individual transaction-based approach (referrals, results, discharge notification) is likely to be easier to match to data protection issues, but does not resolve the shared input issue. Perhaps what is needed is a shared case record that only exists for the lifetime of the episode of care, contributed to by all organisations from data entered into their individual system and is then deleted when the GP decides (with the patient's consent, hopefully), that the episode is complete?
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