Yesterday there was a series of announcements from a Government group tasked with improving healthcare through better use of technology. The National Information Board wants to rectify the fact that healthcare has found it harder than banking, travel or the tax man to take advantage of digital technology.
To do this they suggest a raft of new initiatives. This includes increasing the information on the performance of local hospitals available through the MyNHS portal. There will also be a service that matches the needs of care organisations with potential new suppliers. It is a welcome list of specific commitments.
It also makes for an interesting comparison with changes that led to digital transformations in other sectors. Banking is now more convenient, with services whenever you want them and automatic payments and transfers. It is easier to book travel directly, to find recommended suppliers and to compare prices quickly. The National Information Board are pushing hardest for these kinds of changes: an NHS that runs more smoothly, where patient data is handled like customer data and where there is greater transparency about quality of service.
The banking sector has now gone one step further in its digital revolution - taking advantage of the way people and knowledge connect more easily in a digital era. My colleagues Peter Baeck and Liam Collins have been looking at the phenomenon of crowdfunded finance for a couple of years, announcing last week that this new ways of securing business finance will be worth £1.74bn in the UK by end of the year.
This kind of technology exploits the network effect of the Internet to help fund business ideas with small amounts of money from hundreds of people. What would be the equivalent of crowdfunding for the healthcare sector? What would move digital health beyond efficiency savings into a more radical kind change?
Nesta’s People Powered Health funding programme supported the design and delivery of innovative services for people living with long term health conditions. This included prescribing social activities in Newcastle, retreats for people suffering from similar conditions in Lambeth and a neighbourhood network in Leeds.
These diffuse forms of medical care need to be part of the changes promised for the NHS, whether strictly digital or not. At our Future Shock event, we suggested a new scheme to realise the ambition for greater self-care in the recent NHS Five Year Forward View and the National Information Board’s strategy:We need a £40 million investment over the next 3 years in a Million Peer Initiative so that 1 million people each year can participate in peer support.
To take advantage of network technologies, in the way that crowdfunding does, peer support networks need to move online, accompanied by a new suite of digital resources.
There is an opportunity for digital health to quickly leapfrog the kind of matching service offered by crowdfunding platforms. It is not just generic internet technology that is changing healthcare, but also the increasing portability of specialist medical tech.
I wrote earlier this year about a more radical kind of digital transformation for healthcare, following the pattern of change in the publishing or communication industry. Wearable monitoring tech is starting to decentralise healthcare in the same way that the printing press moved from central warehouses into the office and the home. Medical care is increasingly delivered by a range of specialists, well beyond those with degrees in medicine. This is not dissimilar from the way that communication infrastructure is managed by people without engineering degrees.
Two of our Future Shock policy recommendations aim at developing this bespoke technology for a bolder kind of people powered health. The first would fund collaborations between clinical and tech researchers, building on the model of advanced research funding in the USA:A new Digital Health Advanced Research Programme to develop tech and better evidence for how to deliver systemic change.
As John Loder argued in 'Dr Know: A knowledge commons in health', new kinds of data and analytics could transform not just health treatment but health research as well. There are opportunities to understand patients with complex conditions using detailed data about their daily activities. The second Future Shock recommendation pushes for the National Information Board to prioritise support for this kind of research. They need to lead:A review of the potential value of novel kinds of data collection for health research. This should focus on combining sensing data with traditional medical research methods in order to improve our knowledge of how chronic conditions affect individuals.
Digitally-enabled People Powered Health that combines networked peer support with widespread collection of diverse patient data could deliver disruptive change to the way we care for, diagnose and treat those suffering from chronic illness.
Disruptive change is exciting, but there are still a number of digital transitions that need to happen sooner.
Digital finance processes started with basic improvements that changed the way customers interact with their bank. Suddenly, people could walk into a branch in Leeds and find out the balance of an account registered in Brighton. As it stands, a hospital in Leeds cannot access GP records from local patients, let alone if a northerner is rushed into A&E in Brighton.
Headline commitments in the National Information Board strategy include ‘enable me to make the right health and care choices’ and ‘build and sustain public trust’. These are the immediate imperatives for digital health; patients should be able to move their own data around the health system, sharing it with who they want and knowing it won’t be shared further.
The National Information Board commits to giving all patients the right to view their care records and to record their own comments and preferences on their record by 2018. This will create the opportunity for individuals to manage their own personal care record in the future.
A commitment for patients to access their data is the basis for the final Future Shock recommendation. Dr. Mohammad Al-Ubaydli, CEO and founder of Patients Know Best, has written a longer post on what would need to happen for this to be done well, including details of the technical architecture.
Our recommendation includes two details crucial to the success of this scheme. The first is that:This initiative should be accompanied by a well-designed governance framework, safeguarding patient authority over their personal information.
The National Information Board proposes Fiona Caldicott take on the role of a National Data Guardian to scrutinise data management, as well as increasing security standards for data across the care system. These kinds of steps will be vital for a system that truly empowers patients.
The second detail in our recommendation is that the Government commitment to personally managed care records comes good. Viewing a bank account online is not the same as being able to make payments or open a savings account. We hope that soon after 2018:Informed patients may choose to use this to analyse their own condition or donate data for use in medical research.
Government’s intimate role in the healthcare sector means they have the chance now to put in place a framework to support a digital revolution that starts outside the system, in the Apple Health App or Patients Know Best, and make sure it has a willing and ready customer in the NHS when it comes to maturity.
The list of Future Shock digital health recommendations is available here.