May 10, 2013

Stop Saving the NHS: new book

Stop Saving the NHS cover (small).jpgWell I have done it. My book Stop Saving the NHS and Start Reinventing it has been published in Kindle and paperback. It's aimed at NHS leaders and managers, but will probably interest anyone who is interested in the shape of 21st century healthcare.

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December 15, 2006

Admiring the Heights, Gazing into the Chasm?

Mountain ViewIn the last month or so I have attended a couple of conferences as a speaker and a chair. What caught my attention were the number of opportunities for using technology in healthcare--particularly in remote monitoring and diagnosis--and how this contrasts with the situation of UK healthcare ICT.

At the BCS eBrochan conference in Glasgow (brochan means porridge, apparently) Prof. Frances Mair, Professor of Primary Care Research, at the University of Glasgow, talked about the real application of telecare and telemedicine, stressing the importance of having clear aims and of adequate preparation and reorganisation. Too often such projects are tacked on to existing practice, which often means staff have to do their day job and manage the pilots.

I chaired the recent Mobilising the Clinician conference where talks ranged from making better use of the PDA to remote monitoring and diagnosis using wireless and GPRS. On the second day, Professor Istepanian of the Mobile Information and Network Technologies Research Centre (MINT) described an array of applications some using GSM or the faster GPRS for monitoring vital signs; for example, transmitting ECGs, blood oxygen saturation and blood sugar levels. Ultasound scans have even been taken remotely in Cyprus.

Dr Omar Aziz works in Professor Sir Ara Darzi's unit at Imperial College in London. He described the possible use of body sensor networks (BSN) in mobile health (m-Health). BSN could be applied widely in healthcare; for example, in monitoring vulnerable patients and post-operative recovery.

Lest we lost touch with reality at these rarified heights, Jon Holmes, Informing Healthcare Project Manager at Gwent Healthcare Trust in Wales, told us about the challenges of implementing wireless computing on wards, which allowed nurses to record Admissions, Discharges and Transfers in real time.

In the UK, 21st Century ICT must be implemented in a 20th Century healthcare system. Benedict Stanberry of Avienda suggested healthcare IT is on the brink of the chasm referred to in Geoffrey Moore's book Crossing the Chasm. The chasm is a void on a notional curve that spans the phases of technology adoption. Moore's chasm opens up between the phases of early adoption (comprising the enthusiasts) and early majority (the pragmatists), because expectations are distinctly different.

The illustrious Royal Society also suggests UK healthcare's adoption of ICT is dilatory. Its report Digital Healthcare covers familar ground for readers of FHIT. As well as looking at the view from the top, it suggests more can be made of existing systems and that even applications like mobile phone SMS messaging still offer unexploited footholds.

Hmmm. When it comes to integrating ICT into healthcare, scaling the peak will be an achievement and the views will be fantastic--but there's a lot of abseiling and climbing still to do.

November 13, 2006

Long Term Care Demonstrators

Hand holding a walking cane.That will teach me to ask rhetorical questions at the end of posts.

In a previous post on management of chronic conditions I asked where remote monitoring appeared in the vision for the NHS and in its NPfIT. The DoH has announced its intention to fund up to three Whole System Long Term Care Demonstrators covering a population of one million. The pilots will run for up to two years.

It will be interesting to see how the pilots are organised and their technical solutions. The DoH wants the NHS and Local Authorities to partner. The workings of such partnerships--which could include contributions from the primary and acute care in the NHS as well as the private, voluntary, charitable and private sectors--will be key to their succeess. And where will organisations like NHS Direct fit in, I wonder? All in all, we should gain insight into the structure of future healthcare and the technical, human and organisational dynamics needed to support it.

Partnerships will be able to draw upon offerings from 15 suppliers from a pre-competed Telecare National Framework Agreement.

November 01, 2006

Healthcare on Wireless Waves

Toumaz device being used.My previous post discussed the reality of remote health monitoring. I noted the high compliance of study participants monitored using large arrays of stick-on sensors. Such discomfort may now be unnecessary.

Toumaz Technologies has developed new, small, low power, wireless sensors that can be attached to the body with sticking plasters. These devices enable non-intrusive, continuous monitoring and analysis of ECG, temperature and at least one other vital sign, such as respiration or activity level. Vital signs are transmitted to a PDA or mobile phone and monitored with software that includes an arrhythmia detection algorithm for real-time monitoring of ECG.

You may also be interested in an article I wrote for an IT innovation magazine about real-time remote health monitoring (well, everyone likes to back a winner sometime) though I was thinking of a wristband.

Visit the Toumaz site for more on their device.

October 29, 2006

Telemedicine and Self Care

Worker with a PC.jpgPhysician, heal thyself with the support of remote monitoring, suggested Dr. Paul Johnson, Director of the telemonitoring service Xenetec last week at the International Healthcare Innovation Congress in London.

He pointed to a pandemic in lifestyle-related diseases exacerbated by growing levels of obesity in Western countries (in the UK 23 percent of us are now classed as obese—the highest level in Europe). As a consequence, incidence of chronic diseases—like asthma, coronary heart disease and chronic obstructive pulmonary disease—is increasing. In the UK, chronic disease apparently accounts for 65 percent of the visits to Accident and Emergency departments.

With such a pandemic, it's fortunate advances in IT and communications make 24-hour health monitoring a reality. Vital signs like respiration and heart rate are useful indicators. A healthy heart rate has a high degree of variance, showing as a spikier trace than an unhealthy one. In addition, nocturnal breathing disorder is often a co-morbidity in asthma, COPD, hypertension and heart disease. Close monitoring of such signs could assist sufferers to manage their conditions and carers to pre-empt crises.

Dr. Johnson said that multi-centre trials in Europe show such monitoring is practicable. Patients in the trials had worn a cluster of electrodes on their chests stuck on with adhesive tape that reminded me of the spaghetti at the back of my aging HiFi system—yet compliance was high. This is a good sign. If patients can tolerate being wired up like that then compliance with newer, wearable equipment should be at least as high (see future posts).

Supported by monitoring centres, self-management of chronic illness is real option. As an example of its possibilities, Dr. Johnston referred to work by Dr Dean Ornish et al on the effect of diet, exercise and stress management on heart disease. Dr. Ornish's work assessed the power of a rigourous risk management regime to arrest—or reverse—the progression of atherosclerosis.

If it's practicable (inevitable maybe), where does remote monitoring figure in NHS plans, or indeed in the NHS National Programme for IT (NPfIT)? Do the operational vision for the NHS and the technology planned to support it need revision?

October 04, 2006

Closing on Remote Care

The US Defense Advanced Research Projects Agency (DARPA) seeks to investigate and exploit promising technologies for use in the defence industry. Its Trauma Pod program (see article and animation at bottom of the page)--an outgrowth of earlier telepresence surgery R&D--seeks to meet the military’s need for trauma care and autonomous surgery by 2025. It is part of the Army’s goal to remove medical personnel and all hospitals from battlefields.

This program supports immediate diagnosis, therapy and evacuation of casualties. Deliverables include advances in teleoperation and surgical procedures, mechanical movements, directed energy, software development, miniaturization and the automatic management of medical supplies in theatre.

Since 2004, DARPA principal investigators have designed and prototyped novel systems. Commercial use of Trauma Pod technologies could lead to greater medical efficiency and the better use of specialist staff.

DARPA Advanced Biomedical Technology Program.

Thanks to Lance Manning for this entry. Lance is a business consultant providing client support in research, development and implementation of emerging health care technologies.

January 26, 2006

Telemedicine: changing the way healthcare meets

telemedicine.jpeg I did not know it was so isolated. The nearest referral centres to the north, south and east are more that 2 hours drive away. To the west the nearest is across the Irish Sea in Dublin. But Bronglais General Hospital in Aberystwyth, Wales overcomes distance with telemedicine.

At a seminar in Slough, UK on Tuesday held by Multisense Communications Ltd. clinicians from Bronglais described (online, of course) how they manage cancer cases at the hospital using multi-disciplinary teams (MDT) and virtual consultation. Telemedicine combines live video with diagnostic data, images and even access to the Web.

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