Professor George Crooks - ECO 19: Care closer to home
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Presentation by Professor George Crooks, Chief Executive Officer, The Digital Health and Care Innovation Centre at ECO 19: Care closer to home on Tuesday 9 July at Deepdale Stadium.
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Professor George Crooks - ECO 19: Care closer to home
- 1. The Digital Health and Care Institute Scotland’s national innovation centre for digital health and care
- 2. Our vision is that innovation in digital health and care will help Scotland’s people to live longer, healthier lives, create sustainable services and help Scotland’s economy grow. COPYRIGHT – DHI Scotland
- 3. Vision and focus SHIFTING THE BALANCE OF CARE COPYRIGHT – DHI Scotland
- 4. Integrating Innovation Service model innovation Technical/Digital innovation Business model innovation Acceptedservicemodels DEMONSTRATING INTEROPERABLE READINESSTOADOPT/SCALE COPYRIGHT – DHI Scotland
- 5. Communities and technologies are getting smarter IOT 5G/6GLORANET WEARABLE S SENSORS OPEN DATA CLOSED DATA SMART TECH AIDATA SCIENCE CONSUME R DATA SMART infrastructur e SMART meters COPYRIGHT – DHI Scotland
- 10. Chronic conditions Lack of health professionals Financial unsustainability Health inequalities HLY vs LE Ageing society
- 12. What is it that we do?
- 14. • Increase Inpatient mortality by 20% • Increase Inpatient Length of Stay by 1-3 days • Increase likelihood of errors • Increase complaints and litigation Which environment will do the following?
- 17. • a 15% reduction in A&E visits • a 20% reduction in emergency admissions • a 14% reduction in elective admissions • a 14% reduction in bed days • an 8% reduction in tariff costs • a 45% reduction in mortality rates Which environment produces:
- 19. Long Term Conditions – Prevalence Projections Macro Trends
- 20. Projected prevalence of Chronic Disease
- 23. 0 200 400 600 800 1000 1200 1400 1967 1972 1977 1982 1987 1992 1997 2002 2007 2012 Publications in… > 11,000 publications (1967 – 2014) > 2,000 about chronic disease management > 180 RCTs > 130 systematic reviews Telehealth Publications
- 24. We identify health and care-led problems where digital innovation can provide the greatest impact. We will then match these with the right capabilities and solutions providers, with the emphasis on quality, depth and real-world application.
- 25. We bring together right people and capabilities and provide them with the means to identify, design, evaluate and invest in new solutions to the country’s priority health and care priorities. Our unique needs-led approach is an essential link between the Scottish Government’s national priorities and the wealth of talent across different sectors and communities in Scotland.
- 26. Doing this creates better digitally focused health and care services whilst providing opportunities for innovators, entrepreneurs and enterprises to develop proven, scalable solutions that are commercially viable for use across Scotland and can be exported to other markets.
- 27. Examples of current activities
- 28. Stroke reduction by digital atrial fibrillation detection
- 29. Transforming gastroenterology services through camera pill colonoscopy
- 30. Next generation diabetes management
- 31. Development of modern outpatient services
- 33. Next generation asthma care utilising 5G capabilities
- 36. A purpose built environment demonstrating: - Service model innovation - Technical and digital innovation - Business model innovation Bringing technology, service and business innovation together
- 37. Art of the possible
- 38. What will it do? 1) Build trust in the distributed collection and use of data 2) Develop citizen centred communication methods to support co- management 3) Use automated risk assessment to develop both ‘preventative’ and ‘management by exception’ care models 4) Develop decision support infrastructures that support the best possible decisions by all parties.
- 39. ? Integrated Service ModelsProduct Management All Markets Health & Care
- 40. Chute & French, 2018 Visual Credit: Angela Tulloch Care 4.0
- 41. Previous Model Personal Care, reablement, family, link workers all form part of the circle of care. They all have their own siloed records systems or none at all. Fall alarms, fire alarms and other safety services are siloed and reactive. Alerts are analogue – i.e. sent through phone lines. There is not broader data shared, nor any two way communication build into telecare systems. An alarm receiving centre receives many of the alerts and handles the calls and escalations. Many people are conveyed to hospital after an adverse incident. GPs and pharmacies deliver healthcare face to face in community practices. Long term condition monitoring and medication prescription, dispensing and review are all handled on site.
- 42. Long term condition monitoring (telehealth) products are being used sporadically to help people co- manage their own care from home. Current State Consumer devices are emerging that are low cost and appealing to use. These often focus on convenience and wellbeing but do not play a meaningful role in the co- management of care because they are not trusted and do not integrate. The model is mainly predicated on clinicians providing equipment and then monitoring the outputs in addition to the normal appointment based service model. These struggle to demonstrate favourable cost / benefit.
- 43. Best Practice - Estonia PHARMACIES AND FAMILY DOCTORS X-Road, ID-card, State IS Service Register HEALTHCAREBOARD -Healthcareproviders -Healthprofessionals -Dispensingchemists STATEAGENCYOFMEDICINES -CodingCentre -Handlersofmedicines POPULATIONREGISTER PHARMACIES 2010january BUSINESSREGISTER HOSPITALS 2009 FAMILYDOCTORS 2009 SCHOOLNURSES 2010september ANONYMIZED HEALTH DATA FOR STATISTICS 2013NATION- WIDE HEALTH INFORMATION SYSTEM 2008 december PRESCRIPTION CENTRE 2010 january DOCTOR PORTAL 2013 X-ROAD GATEWAY SERVICE 2009 PATIENT PORTAL 2009 v1 2013 v2 SOCIAL INSURANCE BOARD PORTAL 2012 HEALTH INSURANCE FUND REGISTER X-ROAD GATEWAY FOR EMERGENCY SERVICES 2014 STATISTICS PORTAL 2013 EMERGENCY SERVICE MOBILE WORKSTATIONS The Estonian approach: 1) Understand interoperability is built at four levels: political, organisational, semantic and technical. 2) Think beyond health and care 3) Stop digitising existing paper processes 4) Develop an mandate a common approach to identity as a method of enhancing citizen ownership and transparency 5) Develop and mandate use of a single data exchange layer
- 44. Best Practice - Finland Finland’s approach As the Estonian model (1-5), plus: 6) More social care data integration 7) Development of an modular personally held record 8) More automated and analytics driven decision support and workflow
- 45. Current State + Many vendors offer local government commissioners proprietary products and platforms for ‘digital telecare’ that still focus on reactive safety models Many vendors offer primary care commissioners proprietary products and platforms for long term condition remote monitoring – often specialising in management of one condition only. Consumer self-management products and ecosystems focus on convenience, wellbeing and prevention. However these are largely untrusted due to lack of evidence, regulation and control. These services remain superficial because they can’t be used to support co-management of care. Attempts are made to create more generic and open platforms to allow multiple long term conditions to be monitored through one service. Market immaturity around changing medical device regulation makes this difficult to achieve in the short term.
- 46. Future State (Our View) A public sector data store and exchange unifies the key health and social care data required for professionals to deliver co- managed care. Centralised services streamline user engagement with public sector services – e.g. appointment booking and a directory of services. A managed service is developed – moving beyond provision of devices and data and into the overall orchestration of person- centred services. This is designed to provide an end to end service for those who want simplicity and a core service only for users wishing to control and add new services. Data storage and exchange capabilities will exist outside of either public or private sector control, providing a ‘trust broker’ role using asset locked, ‘zero knowledge’ community interest company models for maximum privacy and user control. The managed service holds responsibility for regulated and stable safety / medical device related hardware in the home. A multitude of businesses using ubiquitous consumer technologies can support user choice and empowerment in the way they self and co-manage. While the user may still deal with many proprietary products, suppliers will be required to connect to open platforms using recognised standards – meaning that the data can still be used effectively.
- 48. Final Architecture for DHI DSE Phase 1b DHI EXCHANGE PHR SERVICE PERSONAL DATA STORE FRAILTY APP BLOOD PRESSURE APP HEALTH & SOCIAL CARE PORTAL PLATFORM SCI STORE DOCMAN APPLE HEALTHKIT CONNECTOR APP BP HEART RATE STEPS SLEE P RESPIRATOR Y CALORI E INTAKE PEAK FLOW HYDRATIO N APP CERT PLATFOR M DOCUMENT SERVICE CONDITION SERVICE APPOINTMENT SERVICE OBSERVATION SERVICE MULTI-CHANNEL DECISION SUPPORT Open Market DHI procurement 3rd party resourced KEY
- 49. Next Generation Increased user readiness, concern about privacy and strengthening trust broker roles allows the citizen to be the ‘point of integration’. This allows the user to ‘tell their story once’, curating their own data from all sources, and then use this data to activate service on their own terms. Citizen consent, open standards and trust brokerage allows service providers to work from hardware, avoiding duplication / waste and creating a more seamless user experience. This allows the user to involve their circle of care more effectively and use their data collectively with others to power new types of service. This personal data store is ‘whole of life’ – i.e. useful beyond health and care service delivery. For example to be available with consent to auto- populate a benefits submission or insurance form. This newly aggregated data, shareable by the empowered user, can stimulate new types of services that we cannot conceive of in the current model.
Notes de l'éditeur
- Scotland has a strong tradition for innovation, and have an equally strong ambition to create sustainable services and grow the economy – so as yesterdays Dr Marvel pointed out, we also need to embrace this for not just the benefit of Heath and Care, but for wellbeing and economic development purposes
- So we all know how this world has looked in the past, with unsustainable resource being consumed in treating ill citizens Less attention has always been given to help prevent and allow folk to live independently……… The DHI vision is about shifting the balance of care and integration is at the heart of that…….
- But this can only be realised if you start to merge the innovation streams,,,,,,,,,,,,,in my experience which is over 12 years working in this domain – my realisation is that the service needs much more attention to ensure they are ready, able and willing to change! And once they are we also need to be aware that the business model to purchase such as service also needs to be in place and ready to integrate into the system seamlessly. So the interoperability and integrations is not just a technical challenge – in some respect that is the easy bit!
- Along with this shifting focus Communities, citizens and places are getting smarter and at yesterday plenary a question was asked about Smart cities and urbanisation is an enormous movement with over 70% of popn living in cities by 2050…….so keep that in mind as I speak later about data integration and how IOT and new communication technology like 5G will start really enabling us to do things that we thought years ago would be impossible……
- We identify health and care-led problems where digital innovation can provide the greatest impact. We will then match these with the right capabilities and solutions providers, with the emphasis on quality, depth and real-world application. The further implication of this is that DHI is no longer broadcasting in search of a wide variety of opportunities; it is focussed behind core demand-led priorities and engaging with the relevant audiences specific to those priorities.
- Our networks, reach and capabilities are able bring the right people together and provide them with the means to identify, design, evaluate and invest in new solutions to the country’s priority health and care challenges. Scotland’s public sector, academia, charities and industry need a place to co-design digital solutions to some of our country’s biggest health and care challenges. We bring these groups together, allowing them to imagine and create new ways of working, services and products. Our unique needs-led approach is an essential link between the Scottish Government’s national priorities and the wealth of talent across different sectors and communities in Scotland. This creates opportunities for innovators, entrepreneurs and enterprises to develop proven, scalable solutions that are commercially viable for use across Scotland and can be exported to other markets. That also helps Scotland to be at the forefront of the growing global digital health and care economy by developing the right workforce, infrastructure and policies to attract investment and new jobs.
- Doing this creates opportunities for innovators, entrepreneurs and enterprises to develop proven, scalable solutions that are commercially viable for use across Scotland and can be exported to other markets. That also helps Scotland to be at the forefront of the growing global digital health and care economy by developing the right workforce, infrastructure and policies to attract investment and new jobs.
- Stroke reduction by digital atrial fibrillation detection Trials have found that new digital technology could make atrial fibrillation reduction more accessible. Background Research has found that new digital technology – using special devices linked to mobile phones or tablets - could make atrial fibrillation detection more accessible, allowing more people to be identified and treated with medication to reduce the risk of stroke. Work was needed to assess the effectiveness and benefits of various digital options that allow for screening and management in the community. We have explored these options and have conducted a health economic analysis to compare the efficacy of these devices in current practice. Detection of atrial fibrillation is a priority for the 'Stroke and Heart Disease Improvement Plans for Scotland'. The work we have undertaken seeks to support the national improvement plans and to improve the treatment of atrial fibrillation in Scotland, helping to prevent strokes. We're working with the Scottish Government, NHS Lanarkshire, University of Strathclyde and Edinburgh Napier University, in partnership with companies who provide monitoring tools that monitor and dectect atrial fibrillation. Work to date Supported by Scottish Government we’ve funded trials across six health boards - NHS Lothian, NHS Fife, NHS Tayside, NHS Greater Glasgow and Clyde, NHS Ayrshire and Arran and NHS Grampian - involving twenty GP practices and over 1200 patients. The trials used a simple hand-held electrocardiogram (ECG) device developed by Kardia, which is compatible with mobile phones or tablets. It costs around £70 per unit, and allows detection within GP practices and immediate access to medical treatment. ECG recordings from the trial were sent by secure email to a cardiologist to assess if atrial fibrillation was present. Patients with a provisional diagnosis had a more advanced test carried out to confirm is atrial fibrillation was present, resulting in being referred for further treatment. Of the 1805 patients, 92 (5.1%) were identified to have atrial fibrillation.
- Diagnosis and treatment for digestive health Demand for gastroenterology services is on the rise, putting pressure on capacity and resulting in an increase in waiting times. Background A further option to conventional endoscopy being explored is a camera contained in a pill that can be swallowed, avoiding the need for more invasive procedures and allowing for the timing of any investigations to be more flexible. Whether from conventional or new cameras, there is an opportunity for improvements in how images are interpreted. This is a specialist skill that is usually carried out but this option allows those images to be interpreted remotely, potentially negating the need to attend hospital outpatient appointment for this service. This work is being evaluated in a remote and rural setting and in an urban environment to address potential waiting list initiatives. This work is in using video conferencing, via a typical PC web browser in the Highlands and Islands area to carry out consultations with patients and GPs, to avoid the time and travel involved in such outpatient appointments. We are working with our partners to combine these approaches into a comprehensive service that will allow for more localised provision of gastroenterology services, supported by central virtual analysis and specialist consultation service. The first phase of this will be to assess the experience in the NHS Highlands and Islands area against needs across the rest of Scotland to develop a model that could be adopted nationally. The partners include NHS Highland, NHS Scotland and the Scottish Government. We are also working with Highlands and Islands Enterprise on identifying commercial opportunities. Private sector partners include: video-conferencing provider Attend Anywhere; Corporate Health International, an SME based in Inverness and Open Brolly, an Elgin-based enterprise that has supported secure data exchange. Work to date We have facilitated and funded the evaluation of an NHS Highlands and Islands project that used an external analysis service to streamline the process of assessing these images to improve service and patient outcomes. Separately, some GP practices have experimented with remote consultation using video conferencing, supported by NHS Highlands and Islands.
- Diabetes management Diabetes is continuing to grow year on year across Scotland. The way that treatment and support are provided is not sustainable. Background The prevalence of diabetes is continuing to grow year on year across Scotland. The demand for services is such that the way treatment and support are provided is not sustainable, and it is widely recognised with the healthcare system that transformational change is required. One practical implication of this is that patients, their families and carers will need to be more actively involved in prevention and management of the condition. There is a growing body of international evidence that this can effectively be supported by technology, while also improving patient satisfaction with their care. At DHI, we see that there is a major opportunity to take existing activities and join these together to create a complementary and integrated suite of digital tools and services. We're working with the Scottish Centre for Telehealth and Telecare (SCTT)on the use of Attend Anywhere video conferencing for virtual clinics. We are also supporting an existing self-management web platform to attract commercial interest that will help the web platform to develop further. Work to date Scotland is already recognised as an international leader in diabetes management and experienced in the use of digital solutions in diabetes. The Scottish Care Information – Diabetes Collaboration, provides a central data store of all diabetic patients in Scotland and the My Diabetes My Way web platform helps patients to manage their own care. There have also been significant advances in digital solutions to support self-management for glucose monitoring and control, proper medicine use and lifestyle management. Virtual clinics have been trialled in Scotland and several health boards are using home and mobile health monitoring solutions for the day to day management of diabetic patients.
- Development of modern outpatient services The current design of hospital outpatient services cannot cope with increasing demands Background It is widely recognised that the current design of hospital outpatient services cannot cope with increasing demands, both from initial referrals and follow-up appointments. The underlying service model needs to be transformed. Our role is to help the Scottish Government and other partners to better understand the scale of the challenge and what it might entail. To make the task manageable, our work will focus on individuals who have multiple long-term conditions which currently require regular interaction with outpatient services. We are supporting the Scottish Government and NHS Scotland on identifying what the service might look like in future, with a focus on the use of digital tools and services to improve healthcare provision, while also better managing growing demand. Work to date The Scottish Government has led work on modern outpatient services, with various initiatives over the last decade aimed at supporting NHS boards and local healthcare providers. Much of this has focused on steps to improve or even optimise the current service as it is delivered today.
- Citizen-centred data sharing The Scottish vision is that citizens will be able to access, add to and share a personalised view of their health and care information. Background The Scottish Government wants citizens to be able to access, add to and share a personalised view of their health and care information. This ‘portal’ would also allow individuals to communicate securely with health and care providers, book or change appointments, order repeat prescriptions and access ‘virtual clinics’. If this can be achieved with the necessary privacy, security and consent controls, then it could offer major benefits, such as greater convenience for patients and lower running costs for the NHS. Two models are currently being looked at. One is to have centralised data accessed through a single, closed point of entry. A second is to have a more open IT infrastructure that allows different methods to be used to access the data, that would again be stored centrally. Although the first option is likely to be simpler, it also severely restricts citizen choice and the ability to develop more personalised services. We're working with the Scottish Government on the next steps towards developing the necessary IT infrastructure that could work for the second model. This work will involve Scottish SMEs, charities and other groups with an interest in a more open, distributed and citizen-controlled model of data sharing. Work to date Some work has already been carried out to scope out the steps necessary for proving the concept of a national patient portal. In parallel to this, we ran a two-year development project called Next Generation Digital Records with Scottish industry, academia and the Scottish Government.
- Next generation asthma care There is no consistently reliable way to understand the frequency and effectiveness of inhaler use or the adherence to prescribed treatment plans. This makes improving asthma care much more difficult. There is hope that emerging 5G technology could create a smart asthma inhaler that is truly independent of any other device. Ultimately, such an inhaler could benefit users by allowing healthcare services to create more personalised and effective treatment plans and even provide early warning of an imminent asthma attack. We are working with the Scottish Government, and Edinburgh Napier University to co-design the service model for asthma enabled by 5G technology. Work to date Manufacturers of inhalers are working on the strategies to address the existing service problems, but these depend on the availability of real-time information derived from systems such as internet-connected asthma inhalers. There are existing prototypes, such as using Bluetooth enabled inhalers connected to mobile phones. However, these suffer from significant limitations, including their effect on device battery life and the security of Bluetooth signals.
- Risk-free –the DE provides this capability in a space that can model live systems without any risk to the real-world systems or individuals. Technology interoperability – enables a consortia approach where technologies can come together, integrate with broader infrastructure to develop service models that are adoptable. Open to industry – it is a place for innovators to learn, develop and demonstrate their capability as part of DHI initiatives that have the buy-in of the key H&SC partners procuring them. Focus on innovation – bringing innovation alive for H&SC, academic and industry partners securing opportunities for both industrial and H&SC partners. Co-location – a one-stop shop and focal point for H&SC, industry, and academic partners alike developed conceptually from the ground up to demonstrate specific digital opportunities in H&SC. An investable facility that will attract a broad range of partners offering the necessary resources and skills to support a national facility.
- The ‘Art of the Possible’ – providing a safe place to play with emerging technology – to build confidence in new tools collaboratively with industry, academia and public services
- 1) Build trust in the distributed collection and use of data Build trust in citizen or non-statutory (distributed) sources of data. Allow a citizen to build their own digital footprint, depicting their unique context once. Empower the citizen to build their own consent model. 2) Develop novel citizen centred communication methods to support co-management Create new citizen centred communication channels. Create ways for the citizen to use their data and wishes to activate proportionate levels of service. Use a citizen’s data and consent model to better balance clinical risk versus overall citizen wellbeing. 3) Use automated risk assessment to develop both ‘preventative’ and ‘management by exception’ care models Move to a preventative model powered by the citizen’s data. Automate remote monitoring based risk assessment to standardise detection at a far earlier stage. Use citizen centred consent models to make anonymised data available to service planners & researchers. 4) Develop decision support infrastructures that support the best possible decisions by all parties Better curate quality assured content / knowledge and make it available via open APIs. Create infrastructures that allow easy development of context specific decision support tools. Provide communications infrastructure to allow timely access to professional to professional (P2P) advice.
- This slide outlines the way industry 4.0 is conceived for factories (top left), looks at how it has expanded into full ‘value chain’ business models in the context of a consumer broader needs (top right), and then looks at medical use cases aligned with Health 4.0 which largely follows the top town product management thought process (bottom left) and then an identified gap where no one has yet conceived of how new service and business models can emerge in the context of the users lived experience (bottom right). Top left – Industry 4.0 "The First Industrial Revolution used water and steam power to mechanize production. The Second used electric power to create mass production. The Third used electronics and information technology to automate production. Now a Fourth Industrial Revolution is building on the Third, the digital revolution that has been occurring since the middle of the last century. It is characterized by a fusion of technologies that is blurring the lines between the physical, digital, and biological spheres. There are three reasons why today’s transformations represent not merely a prolongation of the Third Industrial Revolution but rather the arrival of a Fourth and distinct one: velocity, scope, and systems impact. The speed of current breakthroughs has no historical precedent. When compared with previous industrial revolutions, the Fourth is evolving at an exponential rather than a linear pace. Moreover, it is disrupting almost every industry in every country. And the breadth and depth of these changes herald the transformation of entire systems of production, management, and governance. The possibilities of billions of people connected by mobile devices, with unprecedented processing power, storage capacity, and access to knowledge, are unlimited. And these possibilities will be multiplied by emerging technology breakthroughs in fields such as artificial intelligence, robotics, the Internet of Things, autonomous vehicles, 3-D printing, nanotechnology, biotechnology, materials science, energy storage, and quantum computing." https://www.weforum.org/agenda/2016/01/the-fourth-industrial-revolution-what-it-means-and-how-to-respond/ Top Right – new ‘washing machine as a service’ business model. The current way we purchase washing machines it highly unproductive and offers poor experience for users and lack of sustainability for businesses and nations. A properly efficient, robust and environmentally friendly washing machine costs £100s if not £1000s. People don’t want to commit to a big outlay up front or even on finance, and so often purchase a cheap model that wastes energy, increases their costs and breaks down easily. Instead of purchasing a £1000 machine that lasts ten years, it may seem more expedient to buy a new £200 machine every two years. The new business model is that a company will offer a contracts to an individual on a monthly or ‘per wash’ subscription. The agreement would state cashback to the consumer if the company fails to provide a working machine at all times. This subscription rolls up the hardware, energy consumption differential, and repair costs, and then prices in the value of a guaranteed functional machine at all times. It may come out to equal or less than what it would cost the consumer. The important thing is that the model shifts the risk to the supplier. The consumer has piece of mind and does not need to ‘administrate’ the machine, worry about getting it serviced, or fear that it will break down. The business can now make or lose money depending on how well they keep the machine functioning. The company is incentivised to use their engineering and service expertise to put a really efficient and robust machine into the home. At this point prevention of fault is cheaper than repair, recovery or replacement – the more the business knows about the live operation of the machine via IOT capabilities, the lower the risk of costly fault. This is the true value of a ‘smart’ washing machine within the Industry 4.0 mindset. Bottom Left – Hospital IOT Value Chain Health 4.0 is currently using the technologies, but not necessarily the service or business models that ‘4.0’ enables. It also focuses primarily on the vertical relationship between a healthcare consumer and a clinical service. For example the hospital consultant gives someone a remote monitoring device (e.g. BP cuff) that feeds data back to the clinicians to that they can provide better or more cost-effective clinical services. Typically this only yields minor improvements because it does not fundamentally evolve the service or business model. Research and market analysis work focuses on trends of wearable and app adoption and the potential impact for these simple vertical relationships. https://dzone.com/articles/connected-healthcare-internet-of-things-examples-I Bottom Right – Gap in Thinking What is the health and care integrated service model? How can it capitalise on 4.0 capabilities to scale?
- Industry 4.0 principles and capabilities are increasingly applied to ‘vertical services’ between a person and their clinician. Health 4.0 manifests in medtech, medical, pharmaceutical, big data and other innovation forms. There may be some consideration of ‘horizontal’ service add-ons that give some degree of choice and feedback to the service-user – but overall the Health 4.0 application to date has been organisation-centric in nature. DHI proposes an alternative application of Industry 4.0. Care 4.0 focuses on an person-centred, assets based and community oriented model that looks first to the horizontal capabilities and connections – prioritising life’s context before looking to clinical considerations. The combination of both health and care paradigms will lead to a more proportionate response to needs. Resourcing for Care 4.0 will act as a counterbalance to a tendency to focus on medical innovation, and will create a more conducive environment for person-centred, integrated health and care service innovation. The overlaps between the spheres in the diagram above - marked with a (?) – will be the subject of further investigation by DHI and partners – to understand the overlaps and gaps between these models through service design and implementation activities. Connectivity Trust (both ways) Privacy / Consent Control Security
- A next generation asthma proposition need to: Able to anticipate and not just react to issues, and allow the citizen to self-manage to avoid escalation. Balancing risk management (system) and convenience (user). Build trust in the consumer device data the citizen generates and consents to share into the system. Develop open, cross-cutting methods of connecting devices and sharing data Capitalise on these methods with digital services that enhance the convenience to the consumer and derive insight for the health and care system
- A next generation asthma proposition need to: Able to anticipate and not just react to issues, and allow the citizen to self-manage to avoid escalation. Balancing risk management (system) and convenience (user). Build trust in the consumer device data the citizen generates and consents to share into the system. Develop open, cross-cutting methods of connecting devices and sharing data Capitalise on these methods with digital services that enhance the convenience to the consumer and derive insight for the health and care system