Talk on 'How will Technology Shape Care Delivery and Design in Future' for AfH AGM at RIBA Feb 2015.

1. How will digital healthcare shape
future care delivery and design ?
Prof Jeremy Wyatt
Leadership Chair in eHealth Research
Clinical advisor on new technology, Royal College of Physicians

2. Agenda
• What is digital healthcare ?
• Some examples
• Why digital healthcare ?
• Where will care be delivered in future, and what
will happen there ?
– Care outside hospital
– Care in hospitals
– The role of clinical research organisations
• How to judge if this is useful ?
• Conclusions

3. For public:
Trust-marked reference sources
Cancer etc. support forums
Online personal electronic health records
Telehealth to support self care in long term
conditions
Cyber doctor
For health services:
eLearning
Transcription of dictated reports
Remote reporting of X rays, pathology slides
Remote control of surgical robots
What is digital healthcare
“Redesigned services supported by appropriate digital technologies”

4. Instant messaging triage by NHS Direct nurse

5. Devices to support digital healthcare
Helping Hand medicine
reminder
www.medicom.com
Ambient orb to monitor health
status www.ambient.com
Diabetes monitor &
insulin pump

7. Second Life & serious games
Health Info Island - UNC Chapel Hill & Cleveland Public Library

8. Not a new idea,
in fact…

9. Why digital healthcare ?
Old model of care
Focus on acute conditions, reactive
management
Hospital centred, disjointed
episodes
Doctor dependent
Patient as passive recipient; self
care infrequent
Information & Communications
Technology (ICT) used rarely
Technology dominates
New model
Focus on long term conditions,
prevention & continuing care
Integrated with people’s lives in
homes & communities
Team based, shared record
Patient as partner; self care
encouraged & supported
Dependent on ICT & devices
Clinical needs dominate

10. Health care professionals may only interact with people with a
chronic disease for a few hours a year…
the rest of the time patients care for themselves…
Access to health professionals

11. Source: NHS Policy Unit. United Kingdom figures.
Demand for care
Labour supply
Demographic challenges to NHS capacity

12. Questions an architect might ask
Who is the client: NHS, local govt (Manchester);
CIC / SE; commercial (Circle Hinchinbrooke);
person with LTC eg. home dialysis
What does the client want / need ?
What activities must the space support ?
How to know if it’s successful ?

13. Home / community care

14. Active homes
• Sensors to monitor activities of daily living
• Self monitoring medicine cabinet
• Reminders to eat, throw away time-expired food…
• RITA – avatar for people with dementia / frail elderly alone
• Charging zones for wearables, smart phones, measurement
devices
• Home robotics – lifting, stairs, bath, butler robot ?
• Central locking, smart environmental control (Nest)

15. Implanted CardioMEMS sensor & transmitter in distal branch of descending PA
External device sending data to home hub; on screen questions and chart
Telehealth devices

16. Review of
46
trials in
heart
failure –
mortality
Work of Dr Shiva
Sathanandam

17. A future virtual health scenario
Mrs Smith has high blood pressure and wakes
with a headache. She worries that her implanted
drug reservoir may be empty. Her ambient health
orb is a reassuring green, so she turns to her
video wall and asks “Cyberdoc, how is my blood
pressure recently?”
The voice responds “Your drug reservoir needs a
refill in 3 weeks but blood pressure readings are
under control recently and normal today. Your
blood sugar sensor shows normal readings too.
Do you have some symptoms you want to
discuss?”
Meanwhile Mrs Smith’s wall graphs her recent
blood pressure and lists the 20 most common
symptoms in people of her age group locally.
She responds, “No, don’t worry. Remind me to
book my refill in two weeks, please.”
Wyatt & Sullivan, BMJ 2005

18. Some issues
• Privacy in your own home ?
• Connecting in real world to supplement virtual
• Using tech to enable:
– friends & family to connect & participate in care
– elderly contribution to society
• What does a buggy-friendly neighbourhood
look like ? Glide-in cinemas / pubs /
supermarkets ?

19. Community health hub
• Analogies: rural telehubs; office space by the hour
• More likely now councils taking increased role, ageing
population
• Could house telepresence, haemodialysis,
chemotherapy infusion equipment

20. Not this…

21. On the road… ubiquitous healthcare
• Connected car
• ECG sensors in seat back
• Support for self management in diabetes,
asthma ?

22. Hospital care

23. Trial of teledermatology to prevent GP referrals
With Depts. of Medical Informatics and Primary Care, AMC Amsterdam

24. Closing the clinics ?

25. A new kind of workforce ?
• More junior staff
supported by decision
support systems,
protocols
• Telepresence robots
• Domestic / delivery
robots

26. What must we do in real world ?
• History taking (tele-presence ?)
• Clinical examination, palpation (kiosk with haptics ?)
• Psychotherapy (computer based behaviour therapy)
• Taking blood etc. specimens (blood / saliva self
testing, lab on chip)
• Invasive procedures, surgery (kiosk with robot?)

27. The potential of home based self
management in LTCs
1. Agree therapeutic objectives
2. Provide education about the early signs of
deterioration
3. Elicit their own warning signs
4. Capture disease activity information
5. Give people their own information in usable form
6. Support adherence with drugs, appointments
7. Provide a safe envelope – and appropriate actions
when patient moves outside it
• (Wyatt & Wyatt, in preparation)

28. Some implications
• Hospitals get more specialist
• Extensive use of VC facilities + data analytics
• “Hospital discharge” is not about leaving the
building – RCP Future Hospital Commission
report

29. Research centres:
potential influence of citizen science
and patient controlled research ?

30. Citizen Science – CRUK
Cell slider
• Your Contribution Matters
• 2331103 images already
analysed
• Join thousands of others
giving time to Cell Slider and
become part of our
worldwide collective.
• Each and every click adds to
our totaliser above. You can
make a real difference.
30/24

31. Crowd sourcing: potholes & cyclists
http://thepotholegardener.com/page/2/
www.potholes.co.uk – funded by
Warranties direct

32. Asthmopolis

33. • Photo of airbus A380

34. Quantified Self studies
• QS: 28 founder members in SF 2008, 5524 in 42 groups early
2012
• Butter Mind study – RCT with 45 people, showed that eating
60g of butter / day improved speed of calculation. Methods
unclear, no controlling for IQ / education etc. Reported in blog
2010
• Blueberry study – running since 1999, hundreds of
participants, said to show 1% increase in online word recall
exercises. Pub online / conf posters.
34/23

35. Summary - benefits of digital healthcare
• Allows patients and carers to do more
• Responsive to user needs:
– “Disintermediation” – talk direct to specialist
– Delivery anywhere (mHealth), anytime (global)
– Mass customisation – the long tail
• Greater patient control, eg. over data (Mydex)
• Better data improves quality, research
• Access to a wider market – health tourism
• Lower cost of delivery (?)

36. Financial benefits
£8.60
£5.00
£2.83
£0.15
£0
£1
£2
£3
£4
£5
£6
£7
£8
£9
£10
Face to face Letter Telephone Digital
Costin£perencounter
Mean public sector cost per completed encounter
across 120 councils
Source: Cabinet Office Digital efficiency report, 2013

37. We can fly airplanes remotely – but should we ?

38. Holistic health service ?
• Risk of a “Great Revulsion” (Muir Gray), eg GM foods
• In Cheltenham people already spend as much on
complementary therapies as NHS spends on community
services
• Those who can, might opt for old fashioned, face-to-face,
holistic care

39. APEASE criteria for success in HC
Affordability
Practicality
Effective, cost effective
Acceptable
Safety, side effects
Equity
Source: Michie et al. The Behaviour change wheel, 2015: 22

40. Some conclusions
• Clients for health architecture will become more
diverse
• Healthcare will become (much ?) less centralised
in hospitals
• The type of activities carried out in hospitals will
change; some staff may even work from home
• Homes will need to adapt, too
• Community health hubs to support people with
long term conditions