1. Are our roadmaps going in the right direction? A Physician’s Perspective Dr Roy Harper Consultant Physician & Endocrinologist The Ulster Hospital Visiting Professor, School of Mathematics and Computing The University of Ulster

2. What about heading to a place where? Use ICT to support patients, healthcare delivery and healthcare personnel - making it easier - making it better - making it safer

3. Systematic Review: Impact Of Health Information Technology on Quality, Efficiency, and Costs of Medical Care. Chaudhry et al., Ann Intern Med 2006;144:742-52. Improving Safety with Information Technology Bates and Gawande. N Engl J Med 2003;348:2526-34.

4. Timeline for Health Computing (Informatics) in Health and Social Care in Northern Ireland (1999 – Present) – A Personal View Regional EHR Research Group Established Wireless Carts Emergency Care Record Pilot Goes Live Tablet PCs and remote access PatientCentre Appointed as Physician in UCHT HPSS ICT ‘Vision’ HPSS ICT ‘From Vision to Reality’ First COM 723 at UUJ NIPACS 2009 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 RPA Pilot ECR NI BCS HIF set up Roll out of PCs in all OPD Consulting Rooms Diamond Diabetes ECR installed Di@L-log Local PACS ECCH set up Start of H&C Number roll out

5. “Information technology is no longer perceived as just a supporting tool, but has become a strategic necessity for developing an integrated healthcare IT infrastructure that can improve services and reduce medical errors” Source: Le Rouge, Mantzana & Wilson, European Journal of Information systems (2007) 16, 669-671

6. What about? Using ICT to support patients, healthcare delivery and healthcare personnel - making it easier - making it better - making it safer

7. ECCH launched January 2008 To promote health improvement through the use of new technologies First project is to establish a large-scale remote monitoring service

9. Remote telemonitoring Patients record data on an agreed set of parameters at a remote location Data is routinely communicated to a monitoring centre Data is analysed and feedback given as appropriate to support patient self-care Incoming data outside of ‘limits’ triggers an alert and ‘response’ Data is used to support ongoing clinical decision making

10. Home (self) monitoring technologies can transform episode driven health services into a relationship based continuum of care E A Balas 1999 Does it work in diabetes care?

11. Transformation from Industrial Age Medicine to Information Age Healthcare Industrial Age Medicine Information Age Medicine Individual Self-Care Transformation Through Cost-Effective Use of Information & Communication Technologies Friends and Family Person Community Networks Community Professionals as Facilitators Primary Professionals as Partners Secondary Professionals as Authorities Tertiary Source: Adapted from Malaysian Telemedicine Blueprint

12. Patients increasingly need (and demand) ready access to feedback on their progress with advice from HCPs Ongoing Information & Support Regular Feedback on Progress

15. Remote telemonitoring JMcM JB

16. And so RTM may help those: With diabetes (and co-morbidities) experiencing repeated hospital admissions With type 2 diabetes starting on insulin / GLP-1 agonists Pregnant or preparing for a pregnancy With type 2 diabetes and suboptimal blood sugar or blood pressure control Preparing for major surgery With type 1 diabetes

17. Remote home-based telemonitoring – what have we learn’t Useful for a wide range of patients Patients like it Amazing amount of incoming data Positive outcomes Initial triage by someone else is helpful Safety limits (4-16) are not always relevant Software could be better Requires a dedicated weekly virtual clinic session Permits frequent treatment adjustments Promising in terms of improving blood sugar control

18. Conclusions Home-based remote telemonitoring (RTM) can be used to support and motivate patients with diabetes improve their self-management skills and their diabetes. Clinically relevant improvements in HbA1c were seen in patients using RTM for 12 weeks. Patients readily accept RTM. Significant changes to working patterns and a redeployment of resources will be required for RTM to become widely used and accepted by clinicians.

19. Sort of solutions available Patient web portals Call centre type approach Mobile phone-based support solutions Remote home-based telemonitoring Voice activated RTM solutions (e.g. Di@L-log)

21. Demonstrate the advantages (NHS context)Can it work? to Will it work? Patients Safe Acceptable (and used) Better Outcomes HCPs As above Improves Efficiency Healthcare System As above Cost-effective

22. Innovation Self-monitoring technologies with regular feedback and support can transform episode driven health services into a relationship based continuum of care supporting self-careE A Balas 1999

23. And so ‘connected health’ Has little evidence in our health economy Limited potential Increases workload Lots of ancillary (superfluous) data which is hard to interpret and out of context Not another system! ….And so little clinical engagement

24. What about? Using ICT to support patients, healthcare delivery and healthcare personnel - making it easier - making it better - making it safer

25. Problems around the way we record and use clinical information

26. Very much a paper-based world

31. The problem is in accessing key information Many disparate clinical systems Multiple log-on’s to lots of different password protected systems Only access to a single clinical domain or service Ever increasing amounts of clinical time devoted to locating information Preventing effective and timely decision-making

32. The answer – a NI-wide ECR Key information from various disparate legacy clinical information systems brought together effectively and collated within a secure regional electronic care record (ECR) Quite feasible

33. Here’s what’s happening HSC supported a proof of concept study Pilot ECR is up and running Running for >12 months Very positive evaluation Case made now for regional ECR

39. Northern Belfast Others Western GP’s Western Southern Before ECR G P H&C PAS A&E PACS Renal Comm Labs South Eastern

40. With ECR Patient Access to Personal Health Records Northern Single sign-on, Security, Auditing, Business rules Belfast Virtual Patient Record Southern Southeastern GP’s Western

41. What do we need Continued investment in HSC ICT infrastructure Support and long-term investment to deliver a Regional ECR for the population of Northern Ireland Support healthcare workers with the information tools they need Quantum leap in efficiency, quality and patient safety

43. Effective ‘Connected health’ approaches Copy letters to patient Use the telephone Use SMS E-mail On-line contact ….via a web-portal

44. Purpose built

45. Innovative

46. Need to find the right interface device

49. Summary Current and emerging technologies will transform healthcare Demand new ways of working Connected health is about enhanced communication Solutions must support patients and healthcare personnel Use our data and information optimally Integrate data from RTM solutions into ECR Opportunities here

50. Are our roadmaps going in the right direction? A Physician’s Perspective Dr Roy Harper Consultant Physician & Endocrinologist The Ulster Hospital Visiting Professor, School of Mathematics and Computing The University of Ulster