ehealth

Healthy investment It’s taken off in the US and the developing world; now e-health is coming to the UK

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The best medicine

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Drug therapy works best in a virtual world

Bloodless coup

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Will treatment by telephone replace face-to-face consultation

April 2011

BusinessTechnology

Distributed within the Sunday Telegraph, produced and published by Lyonsdown which takes sole responsibility for the contents

Record breaker Will the rise of digital healthcare mean more time with patients and less time chasing records?

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Business Technology

April 2011

an independent report from lyonsdown, distributed with the sunday telegraph

Industry view

Accessing research in real time The BMJ’s evidence base enables doctors to consider the latest research findings in their clinical decisions Around 30,000 new medical studies are published annually, to add to the half a million already out there, and it’s estimated that the average doctor now needs access to two million pieces of information to provide patients with the best diagnosis and treatment.

“The volume of information is so vast that it’s almost impossible for clinicians to keep up,” says Dr Rubin Minhas, clinical director of the BMJ Evidence Centre, one of the world’s leading providers of clinical information services.

“Because of the explosion of scientific research over the last 15-20 years, the traditional approach of doctors reading new research in their spare time is no longer reliable. What’s more, research is now so sophisticated that it’s increasingly difficult for the average doctor to make sense of it.”

Most doctors read only two or three medical journals, and in the consulting room they have an average of just 15 seconds to search for information. Under these kinds of pressures it’s not surprising that many doctors lack confidence in areas outside their specialism, and that patient care can suffer.

A US study found that patients were only getting just over half the care they should have received, partly because their doctors’ knowledge wasn’t fully up to date. And policy-makers are increasingly concerned that much-needed cash is being spent on treatments that have little or no effect on patient outcomes, or on expensive drugs that are no more effective than cheaper alternatives of which clinicians may be unaware.

“Patients increasingly need someone who knows where to find all the answers rather than someone who knows them already,” says Minhas.

Doctors need a way of accessing the latest medical knowledge, in real time, and with relevance to particular patients. The concept is called evidence-based medicine (EBM), and it uses the latest technology to record current medical thinking and make it available to the professionals who need it.

“EBM is very time and resource-intensive,” says Minhas, who is editor-in-chief of Clinical Evidence, the BMJ Evidence Centre’s marketleading EBM product.

The BMJ Evidence centre employs a team of more than 50 people who are experienced at reviewing scientific literature. They analyse every piece of relevant medical and pharmaceutical research from around the world, assessing its quality as well as its results – how rigorously was it conducted, what peer reviews have there been, etc? – before aggregating its findings into the database.

The most relevant research can be aggregated within weeks of publication (before computerised EBM, it used to take an average of 17 years for new research to be put into practice). Clinical Evidence itself is also appraised by

With up-to-date research at their fingertips, medics can prescribe more accurately

a network of experts in clinical peer-reviewing, who validate the BMJ’s procedures and methodology.

Clinical Evidence also sits at the heart of Best Practice, an online decision-support tool from the BMJ Evidence Centre, that covers more than 10,000 diagnoses and 3,000 diagnostic tests in around 250 medical fields.

“It’s intended for anyone who’s not in their comfort zone,” says Minhas. “That could be a non-specialist, or a specialist whose patient has other conditions that fall outside their own area.

“It’s like having a consultant permanently on-hand. And because it’s designed by doctors for doctors, it’s structured and categorised in the way that doctors expect.”

Clinicians can search on a number of criteria, from specific conditions to symptoms and diagnostic tests. The results presented may include a summary of the research to date, hotlinks to original articles and papers, high-level statistics and other relevant information.

The results can be tailored to the particular patient, depending on how their disease presents itself, its acuteness and duration, how advanced it is, and other conditions the patient is suffering from.

Best Practice is now being linked to electronic patient records, so that during a consultation the clinician can be automatically prompted with information that’s directly relevant to the particular patient and their condition.

“We want to help clinicians identify potential gaps in a patient’s care,” says Minhas. The software can already analyse patients’ records to see whether they’re receiving the best treatment. One primary care trust is using it to identify patients with arterial fibrillation (abnormal heart rhythm) who haven’t been prescribed aspirin or warfarin to reduce the risk of stroke. So far 700 have been found: statistically that means around 20 people may have been saved from having a stroke.

Best Practice can also be used on portable computers such as iPads at a patient’s hospital bedside or on home visits, and its iPhone apps are best-sellers. This gives support to clinicians at a time when their access to other information is most limited. Action Sets is a new product from the BMJ Evidence Centre, which goes one step further to provide decision support at the point of care with standardised care protocols.

The use of EBM – the BMJ Evidence Centre’s products are used by more than a million professionals worldwide – is helping to reduce variations in medical practice and raise overall standards of treatment, says Minhas.

“If you can’t measure what you’re doing or compare it with any independent yardstick, how can you tell whether you’re doing it well or not?” he asks. http://evidencecentre.bmj.com

Up-to-the minute advice aids clinical workflow The Royal Free Hospital in London recently completed a pilot using Action Sets in treating upper gastrointestinal bleeding. Action Sets simply provide structured lists of actions for clinician’s to follow that combine the latest evidence and guidelines.

Research has suggested that all patients admitted with upper gastrointestinal bleeding should have a risk assessment score calculated, called a Rockall score, based on simple factors including the patient’s age, blood pressure and pulse rate plus pre-existing conditions such as heart disease.

A second study found that if the patient’s Rockall score is very low, the chance of them dying from their upper gastrointestinal bleeding is less than 1 per cent, so they can safely be discharged from A&E and followed up as an outpatient.

Before the use of Action Sets, no patients admitted to the Royal Free with upper gastrointestinal bleeding had had a Rockall score calculated, so large numbers were admitted unnecessarily. Early results from the Action Sets trial showed that 71 per cent were having their Rockall score calculated on admission and all those with a low score had been safely discharged home, enabling the hospital to make much more effective use of beds.

an independent report from lyonsdown, distributed with the sunday telegraph

April 2011

Foreword

Business Technology

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eHealth – In this issue

Prescription for the NHS The world’s richer countries are facing a triple whammy when it comes to decisions about healthcare. Ageing populations are sending healthcare costs spiralling at a time when slow economic growth dictates belt-tightening on expenditure to rein in budget deficits.

In the US, medical spending per head has nearly tripled since 1990. Here in the UK, the coalition government is making spending cuts across the board and the NHS, which faces major reorganisation, needs to find £20 billion in efficiency savings.

Meanwhile, technology is racing ahead, coming up with new ways both to monitor and diagnose a variety of ailments. The use of technology to deliver healthcare – or eHealth – is sharply in focus for doctors, policymakers and investors as well as individuals.

While technology can be expensive, it can deliver better healthcare as well as huge cost-efficiencies. For individuals, it can mean improved care, savings on time in both transport and diagnosis, and the chance to take more control over their own health, and how to improve it.

In this supplement we look at the extent and way in which we are adopting eHealth in the UK, and at its future potential. We examine telecare services that operate to good effect, helping vulnerable people, and at remote healthcare delivery in Scotland, where distance and access issues provide a convincing backdrop for its benefits.

We also look at developments in mobile diagnostic devices, which could have a significant impact within a few years on the

Human touch: a thing of the past?

treatment of long-term conditions such as diabetes and asthma. The cost of treating asthma alone in the UK is about £2.3 billon a year, and it is a condition that affects about one in every 10 children – but technology is being developed to link asthma detectors to mobile phones.

While innovation remains key to leaps forward in better healthcare, so does the adoption of the infrastructure of technology that enables data to be transmitted from patient to clinician and back, as well as the acceptance of its standardisation across the NHS. And that is where many of the problems lie.

But as we take a look at these exciting new developments in eHealth, it is clear that there are many more on the way, and that they are arriving at a fantastic pace. While today health-related “apps” available for smartphones present data to the user, the next step will be for them to connect in real time and be capable of sending data directly to clinicians.

Technology cannot deliver better healthcare without that crucial ingredient – a human being. As we move towards a world where homes will increasingly be filled with sensors helping us conduct all our daily business, including healthcare, we need to retain perspective on using the technology that is falling in price to best effect. The humble SMS or text message sent on a mobile phone can save administration costs as well as lives by reminding patients to take their medication.

It’s all eHealth – but success will ultimately lie in winning over the sceptics.

Making connections

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Are we seeing a healthcare revolution?

Remote possibilities Scotland pioneers telehealth

Dial the doctor

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In a heartbeat

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On the record

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Test results are just a phone call away

Patients use technology to monitor health

Can medics escape the allure of hard copy

Contributors Publisher Bradley Scheffer brad@lyonsdown.co.uk

Creative Director Martin Nolan studio@lyonsdown.co.uk

Managing Editor Lucie Carrington lucie@lyonsdown.co.uk

Production Manager Sarah Ostheimer sarah@lyonsdown.co.uk

Editor Dina Medland editor@lyonsdown.co.uk

Project Manager Aidan Neville aidan@lyonsdown.co.uk

For more information on any of our supplements please contact us: Telephone: 020 8349 4363 Email: info@lyonsdown.co.uk Online: www.lyonsdown.co.uk

Cover photograph: Heath Korvola/Getty Images

Dina Medland Dina Medland began her journalism career with the Financial Times. She now writes and broadcasts regularly on business issues.

She remains a regular contributor to the FT. Sade Laja Sade Laja writes for The Guardian’s healthcare network. Her main areas of interest are informatics and workforce issues in the health sector.

Cath Everett Cath Everett is a freelance journalist covering business, technology and skills-related issues.

She writes regularly for The Guardian.

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Tracey Caldwell Tracey Caldwell is a freelance business technology journalist specialising in healthcare and biometric technology.

She is a regular contributor to Guardian Healthcare Network.

Michael Cross Michael Cross specialises in public policy, particularly where it concerns technology, healthcare and the law. He was on the launch team for The Independent and writes for The Guardian and the British Medical Journal.

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Business Technology

April 2011

an independent report from lyonsdown, distributed with the sunday telegraph

Telehealth

Is remote medicine the best cure?

As the NHS adapts to increasing financial challenges and new patient needs, the digital revolution could be just what the doctor ordered Leading the way – Charles Gutteridge is boosting informatics

By Dina Medland

The jargon can be confusing, but the message is straightforward. Whether you call it telehealth, eHealth or health telematics, it is about the remote provision of healthcare services with the use of technological innovation.

Worldwide the phenomenon is gathering pace, with growing investment from organisations and individuals looking for equity returns. But in the UK, there remain significant barriers to overcome, and the picture across the board is far from uniform.

Between 1.6m and 1.7m people in England currently benefit from telecare services, or continuous, automatic and remote monitoring of patients to allow them to live independently, according to healthcare charity the King’s Fund. But there are only about 5,000 users of telehealth – the remote exchange of data between an individual and a healthcare professional – and they are part of a pilot programme costing £30m.

In a move aimed at providing more clarity around the use of health information systems by the NHS and to make the system work better, Dr Charles Gutteridge was appointed national clinical director for informatics in January 2010.

According to Gutteridge, formerly medical director at Barts and the London Trust: “Informatics tries to bring together the idea that information about your health and the use of systems is a way of really changing people’s health – essentially it is about making the connection between the technical bit and the information bit.”

Telehealth, he says, is only part of the wider concept of digital health – in some cases it can simply be about streamlining the records process. “About 99 per cent of GPs in

this country, when they see a patient, record all information that patient gives them on an electronic system. That’s a store of information available to everyone in theory, including the patient. Some leading GPs even give patients access to their records in the surgery, or even at home,” he says.

“It means that if you have diabetes or hypertension, for example, you can begin to see whether you are getting better.”

On the NHS Yorkshire and the Humber’s website, a set of videos explains clearly the many ways in which digital health is becoming a routine part of healthcare delivery. For example, telecare has helped in the care of people with terminal diseases, aiding them to live well and be cared for in their own home.

Telehealth is extremely useful in chronic disease management, where the role of the doctor is often one of dose adjustment once the patient has begun treatment.

Unsurprisingly, where distances are great and access to doctors and hospitals is difficult – in parts of Scotland, for example – there have been greater advances in using machines and video screens to supplement the work of doctors.

But even in Scotland, where the Scottish Centre for Telehealth has been conducting project-based work on a variety of fronts, translating project work into mainstream delivery remains one of the challenges.

Dr Andrew Buist is a GP at Blairgowrie and deputy chair of the Scottish General Practitioners’ Committee. He has reservations about the effectiveness of telehealth, also known as telemedicine. The community hospital in Blairgowrie has assessment equipment for the minor injury unit – with the accident and emergency unit 15 miles away in Perth – which he concedes is “quite useful in a very practical way”, but he adds: “As

clinicians we like to be able to lay our hands on patients.” In other words, there is no substitute for the professional human touch in diagnosis.

“Telemedicine has a useful part to play, but it is far more limited than some people would like to suggest,” Buist says. “The cost is unlikely to make any revolution feasible as you need healthcare professionals at both ends to actually conduct tests.”

The UK has its fair share of sceptics when it comes to the use of gadgets rather than people in the field of healthcare delivery. Yet new diagnostic devices are created every day and the latest Healthcare Innovation Expo in London in March saw a wide range of exhibi-

done remotely. When the patient’s result comes up, Gutteridge uses secure software to send it to her and conduct a dialogue about what to do next in terms of prescription. This is still leading-edge in the UK, he admits.

The barriers to overcome in embracing telehealth in the UK are also financial. Over the next four years, the NHS has to make £20bn of efficiency savings. “Communications technology is here and available and being taken up by professional groups who get it because it makes a difference to their working lives.

However, the market in medical software is still very expensive,” Gutteridge says.

But the use of better information communication technology in the NHS is definitely

The eHealth phenomenon is gathering pace, with growing investment from organisations and individuals looking for equity returns tors including big players such as BT, which has a major investment in both devices and in hosting software.

Perhaps inspired by Telefonica’s activities in Europe, BT clearly believes that there will be a convergence of services and technologies in telehealth and telecare.

To counter the sceptics within his profession, Gutteridge cites his own experiences with patients in his care. “The most important thing first is to establish trust and a relationship with the patient,” he says. “If the patient does not trust you as a physician, then digital technology is not going to work.”

He gives the example of a haematology patient who comes in to have blood taken, with the rest of the communication and diagnosis

gaining ground, and he believes that within the next 10 years, telehealth will revolutionise the way we deliver healthcare.

It’s already started. Globally, the widespread use of mobile phones has been particularly helpful in developing countries for delivering healthcare. The UK has always been besotted with its mobile phones and as smartphones grow in popularity, so does the number of healthcare apps giving help and advice on everything from exercise to quitting smoking.

As healthcare information and education is increasingly delivered using new technology which empowers the individual, winning the battle for hearts and minds – and increased investment – seems bound to follow.

an independent report from lyonsdown, distributed with the sunday telegraph

April 2011

Business Technology

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Telehealth

Going the extra mile Distance and access issues have led healthcare professionals in remote parts of Scotland to develop alternative treatments

By Sade Laja

Matthew Cole has multiple sclerosis and diabetes. The doctor who monitors his illnesses is based more than 170 miles away in Aberdeen.

Before his local health board NHS Orkney, the smallest in Scotland, started using telemedicine, the distance between patient and doctor was a big problem. In Cole’s case he would either have to go all the way to Aberdeen to see his doctor or the doctor would travel to Orkney to see him.

“Before I would have to go to a clinic and there would be hundreds of people to see the doctor and I would only get two or three minutes with him,” Cole explains. “But now there are only three or four other people waiting to

Remote possibilities Renfrewshire residents of all ages are benefiting from the council’s telecare service

James Ferguson believes patients prefer virtual consultations

see the doctor and I get 10 or 15 minutes with him.”

The 44-year-old visits his local hospital in Orkney and sees and talks to his doctor through a web camera and screen, while a nurse is on hand to make sure his vital signs are fine.

“It has made things a lot easier. It’s no different from talking to the doctor face to face,” he says.

James Ferguson, clinical lead at the Scottish Centre for Telehealth, believes the majority of patients would rather have virtual consultations than physically see a doctor.

“Patients don’t like coming to big hospitals.

They can’t park, there’s MRSA – it’s horrible!” he says. “Most people would far prefer to be

managed in their community or closer to home if they can.”

However, telemedicine is not about distance, Ferguson says. “It is easier for healthcare professionals and organisations to accept the use of telehealth when there is a physical distance involved because there is no alternative, but you could apply exactly the same system in the middle of a big city to improve the delivery.”

Whatever the drivers for the use of telemedicine by public bodies, the tool appears to be helping to improve the care delivered to vulnerable people.

Asked what he would say to patients who were dubious about using telehealth, Cole declares: “I would tell them that it’s brilliant and that it makes life so much simpler.”

Renfrewshire Council estimates that more than 3,000 vulnerable people are able to live at home thanks to its use of home-monitoring technology in its Care 24 service.

Since the service’s launch in 2008, the local authority has used telecare technology such as sensors to continuously monitor a person’s home for real-time emergencies and changes in personal habits which could indicate problems.

These sensors are placed around a service user’s home and detect any environmental risks such as smoke, floods and gas, as well as personal risks such as falls.

Telecare is often thought of as a service for older people, but Renfrewshire Council uses it to help younger people too. Children with learning difficulties or mental health issues can be monitored through door sensors – reassuring for parents who know they will receive a call to alert them if their child wakes up and starts moving about the home.

A rapid response team is also available to provide personal, domestic and housing support in the event of an emergency.

According to Renfrewshire Council, one of the main aims of the service is to avoid unnecessary admission to hospital. It wants to shift the balance of care from hospital to community-based resources, while improving the quality of life of service users.

The project has also generated efficiency savings – with the potential for more. One resident was able to live independently for an extra two years, saving about £42,000 in residential care costs.

Putting the patient in the driving seat SystmOne has been driving the NHS forward for over a decade, delivering proven IT systems across a range of healthcare settings The recent White Paper, Equity and Excellence: Liberating the NHS, highlighted the need for a patient-led NHS where choice and quality of care are paramount. Yet while the industry has been busy over the past decade trying to convince clinicians of the efficiencies IT can bring, the rest of the world has moved on. These days, technology plays such a large part in our lives that it’s no longer a surprise when life is made easier by the touch of a button or the click of a mouse – it’s simply what we expect.

We can obtain a quick credit check or explore years of bank statements – surely viewing our own medical data should be just as simple?

The patient has, like in every other area of life, become a consumer. We expect flexibility, variety, excellent service and most importantly, readily available information. Patients want to be in control of who cares for them and how that care is delivered. So what’s the

easiest way to both empower patients and improve ways of working?

The answer is simple. Engage with an IT system that works across the board. SystmOne from TPP has been designed from the outset with the patient in mind.

When we phone our car insurance company, we expect them to have all the relevant information to hand just by confirming our name and registration number. It’s quick and efficient, it makes sense. So why settle for any less when we make a visit to A&E, or see a new doctor? Doesn’t it make sense for clinically relevant information to be at the caregiver’s fingertips? Wouldn’t that provide better, more professional care for the patient?

With SystmOne, shared care is the most basic yet crucial concept. It really is simple: by connecting the NHS through IT, clinicians can offer the best, safest and most efficient patient care.

SystmOne can work elsewhere to give patients better control. We’re used to ordering groceries over the internet, or paying an electricity bill over the phone. Shouldn’t our healthcare be as accessible? Patients should be able to securely order prescriptions 24 hours a day, or book or change an appointment over the internet.

When we get a home visit from a doctor,

nurse or midwife, that health professional should be able to access our patient record and provide us with the same level of care we’d expect in the surgery via simple remote technology. With one single IT system, you can do all of these things.

When the patient asks about their care, they expect not only fully informed clinicians but also full access to their own electronic patient record. These days, we can obtain a quick credit check or explore years of bank statements – surely viewing our own medical

data should be just as simple? eHealth is about making our lives easier, not more complex. By investing in systems that actually work – in every area of healthcare – the NHS can rebuild the relationship between patient and clinician, dramatically increase efficiency and, crucially, put the patient firmly back in the driving seat.

Dr John Parry is clinical director at TPP www.tpp-uk.com

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Business Technology

April 2011

an independent report from lyonsdown, distributed with the sunday telegraph

Industry view

Charting a course to cost-effective care An ageing population and extreme pressure on costs mean health services must take a more focused approach to their use of IT As global populations age and the prevalence of chronic disease rises, it is increasingly clear that no country can deliver higher-quality, affordable healthcare without significantly reforming the way health systems function financially and improving co-ordination among all those who care for patients.

This approach requires secure, shared access to accurate clinical information. As such, it needs the Department of Health, NHS and other organisations to continue to design and implement a new information infrastructure that can deliver the right data to the right stakeholders in ways that improve clinical outcomes and lower the cost of care.

Twenty-first century healthcare requires more intelligent care delivery where the patient is at the centre of care, and Intel provides an architecture that offers increased access and encourages innovation across the system.

Four trends From Intel’s perspective, the needs of the NHS are shaped by four trends or requirements that must be addressed by any information architecture. We call them the four Cs. The first is complexity. Healthcare systems are being asked to manage an environment that encompasses patients with more complex illnesses and co-morbidities. In addition, they are dealing with ever more complex data types and information streams and an

increasing number of people involved in care management.

The next trend is co-ordination. To support the move to team-based models of care, healthcare systems must accommodate the information and workflow requirements of each and every individual and organisation involved directly or indirectly in patient care.

Collective responsibility is our third “c”.

Alternative payment schemes will become more prevalent, pushing groups of healthcare professionals to share end-to-end responsibility for the collective health of large populations. They will be paid collectively for quality-based results.

Finally, community-based care will become increasingly important, as greater emphasis is placed on wellness and caring for patients in the most cost-effective locale that is suitable for their needs. Care capacity will rest on a growing workforce of community health workers who must be trained, monitored and evaluated, and whose workflows must be supported with mobile tools and information.

Start now Embracing these enabling technologies requires changes in behaviour and culture.

Careful attention must be paid to workflow redesign, workforce development and business process to ensure this is a lasting fix. Reform and innovation must become embedded

Managing patient care is becoming more complex

within healthcare culture, and both process changes and infrastructure development must be ongoing and iterative.

For more than a decade, Intel has worked with healthcare leaders around the world to design and deploy robust IT solutions for healthcare, and we continue to do so. We provide on–the-ground support in dozens of countries to help healthcare organisations identify the workflow changes and information infrastructure needed for optimal care and efficiency.

Integrated care delivery is a response to unavoidable demographic and cost trends, but it does now represent a tremendous opportunity for healthcare leaders to truly lead; to get ahead of changes that are inevitable and chart a course to higher-quality, more accountable, and more cost-efficient care.

Alex Gledhill is UK healthcare manager at Intel Corporation www.intel.com/healthcare

Managing medicines with First DataBank Whether on the move or in consultations, the innovative FIRSTLight system offers health professionals vital drug information, wherever and whenever they want it

Drug data at your fingertips

Established more than 30 years ago, First DataBank is best known in the UK for its medical drug knowledge base.

Multilex Drug Data File (Multilex DDF) is used by the majority of primary care practices in the UK as part of their patient-administration system, providing clinical decision support to GPs at point of prescribing.

First DataBank has also successfully moved into the secondary, mental health and community care settings where Multilex DDF provides fully integrated medicines management information including eDischarge and ePrescribing.

First DataBank is based in Exeter, Devon, and employs more than 70 staff, including a highly skilled editorial team drawn from clinical, pharmacy or other healthcare backgrounds.

In 2010 it launched an innovative product, FIRSTLight, which offers the breadth of First DataBank’s trusted medicines information as a web-based tool, accessible on demand from any point in the clinical workflow, in consultations or on the move. A unique stand-alone resource, FIRSTLight delivers comprehensive drug information that empowers clinicians and supports safer, faster clinical decision-making.

First DataBank managing director Darren Nichols says: “FIRSTLight is a tremendously

exciting industry innovation which we anticipate will take the healthcare profession a significant step closer to eliminating adverse drug events. FIRSTLight has been developed specifically for electronic search and display, making it very easy and very quick to find what you are looking for – which will save clinicians valuable time.

FIRSTLight delivers comprehensive drug information that empowers clinicians and supports safer, faster clinical decision-making “The key benefit that FIRSTLight will provide to clinicians is a one-stop-information-shop about how and when to use, or not to use, a medication. As importantly, it can be used by nursing staff, technicians, pharmacists and doctors to answer instantly a range of medication queries in a wide variety of care settings.

The versatility of accessing FIRSTLight from your desktop computer or when on the move

via an iPhone and iPad could dramatically reduce medication errors that arise when treating patients in the absence of appropriate information about a drug,” he adds.

“We realise not all hospitals have fully integrated clinical systems in place, leaving clinicians resorting to paper-based references or mainstream search engines. FIRSTLight offers a trusted resource that is researched and authored by our team of clinicians and health informatics specialists. With a modern, intuitive user interface and powerful search functionality, it really is very easy and very quick to find what you are looking for.”

Ethan Richardson, product manager of JAC Medicines Management at Mediware Information Systems, leading provider of clinical systems into secondary care facilities, reviewed the new tool. He says: “FIRSTLight has an innovative information architecture which ensures clinically authored drug information is easily accessible at the point of care.”

Interested clinicians can sign up via the FIRSTLight website for a free trial where they can view the content and get a feel for the user interface and search functionality. The full launch follows later in 2011. www.firstdatabank.co.uk/firstlight

an independent report from lyonsdown, distributed with the sunday telegraph

April 2011

Business Technology

7

Industry view

No place like home Technology can be the clinician’s best friend in providing quality care at home to help patients return to health Given a choice, when our health is suffering, there’s no place like home; it is where we can relax, and feel safe.

Dr Jean Challiner, chief medical officer at Clinical Solutions, agrees. “In my experience as a clinician, this rings true with the majority of patients,” she says. “Whether recovering from surgery, receiving treatment for a long-term illness or caring for a new baby, the majority of us will want to be at home, with our family and in our own familiar space.”

In a recent article on thisisnottingham. co.uk, which identified plans for replacing immediate care beds with home services, Councillor Stuart Wallace, deputy cabinet member for adult social care and health, supported this view. “By moving to providing these services in people’s homes, where we can, we will be able to provide better, more tailored and personalised care and support,” he says.

The government is committed to investing in re-ablement – helping people back to health by providing quality care in the home or community – so reducing the time that patients spend in a secondary care environment such as hospital. It is clearly more cost-effective for patients to receive support at home, rather than unnecessarily taking up hospital beds.

A recent article in Health Service Journal stated that “care in the home under the (British Red Cross care in the home) schemes has been shown to prevent ambulance call-outs and resulting two-day hospital

No need to go to hospital

A reassuring voice at the end of the phone

admissions in 75 per cent of cases, and reduce length of stay”.

However, the need to save cash and balance the books is the biggest challenge facing NHS managers right now, according to a survey by the NHS Federation. The government has told the NHS to find between £15bn and £20bn each year in efficiency savings over the next three years from 2011 to 2014. However, it’s not just a matter of cutting costs or services, but about maintaining and improving the quality of service at the same time.

For the NHS it’s not just a matter of cutting costs or services, but about maintaining and improving the quality of service Re-ablement is about returning patients to health by taking the most expensive care into a less expensive setting. It means that healthcare professionals are managing the delivery of services in the home – services that would traditionally be delivered within a care setting where peer support and advanced care are available. However, for re-ablement to be effective, home workers need the right tools to support them.

This change in focus is not without its challenges. “The shift towards increasing levels of re-ablement is not a straightforward one,” says Challiner. “But it is my belief that technology can help to address some of the challenges. Care can range from something as simple as having someone who knows the patient on the end of the phone to give the right advice, to software which helps clinicians manage their patient interactions through workflow management, supporting

decision-making and providing information.”

Clinical Solutions is in a position to see this first hand. Its solutions serve more than 100m people across the world and the company has worked with publicly funded and insurancebased organisations in the UK and in other countries including the US and India. The clinical algorithms and scripts that power the solutions have been proven safe in more than 60m clinical transactions.

“Technology enables healthcare providers to deliver care traditionally reserved for hospitals outside that setting,” Challiner says. “It can help to facilitate remote and face-to-face care. Assessment tools within the applications support the clinician working in the contact centre or with the patient in their home and help in the process of returning the patient to health, avoiding unnecessary or costly referrals, and saving bed days, through supporting early discharge and preventing readmission.”

For those with long-term conditions, monitoring devices in the patient’s home (telehealth and telecare) can alert clinicians to a change in the patient’s condition even when they are not with the patient. This offers an early-warning sign that can be acted upon before it is too late and admission becomes inevitable.

In practice, Clinical Solutions software provides a means of communicating with and recording encounters with patients. Its Hospital At Home application provides telephone triage, structured history taking, structured physical assessment, care advice and prescribing facilities in the context of the patient’s medical history and current health problems.

These capabilities combine to simplify the process, putting patients at the centre of their care – informing and empowering them, and advising the healthcare professional delivering services.

Challiner says: “Our solutions are private cloud based. Wherever and whichever device and communication channel the clinician

or the patient uses, they can access and synchronise their information, when they need it. Our Hospital At Home mobile device allows them to remain in touch with all the information they need from the patient’s bedside at home. The ability to link to the web means that we have a world of information at our fingertips, that we wouldn’t have had even 10 years ago. We should be better exploiting this way of accessing information; why should health be any different from other markets?”

A key advantage is using technology to rapidly create a detailed record of the encounter and the actions taken by healthcare professionals. This provides an audit trail which enables clinicians to reflect in detail on the quality of care provided.

“This ability to audit actions at every stage of the process offers accountability and clinical governance for those delivering the services. And the patient (and their family) has peace of mind that they are receiving responsive, consistent, high-quality and safe patient care.”

Challiner adds: “Re-ablement, or a move towards delivering care in the home to prevent admission or readmission to hospital, is about delivering complex care in a safe way. We should let technology take on the more complex aspects of care. In doing so, we reduce the risk to patients and provide healthcare professionals with a technical best friend to support them and their patients in their day-to-day roles. This improves the patient experience and quality of care and as an added bonus reduces the cost of care as well.”

To find out more about how Clinical Solutions’ technology can help deliver healthcare in the home, please call +44 (0)1256 337 300 or e-mail enquiries@clinicalsolutions.com. www.clinicalsolutions.com

8

Business Technology

April 2011

an independent report from lyonsdown, distributed with the sunday telegraph

Industry view

Intelligent systems cut costs Ensuring back office systems are accurate and up to speed is helping the NHS to reduce costs but not quality It is widely known that the NHS needs to find up to £20bn of efficiency savings by 2014 just to stand still but how many people fully understand why these savings are so important? We have an ageing population and providing for the future care needs of our people represents an immense challenge. The UK population is predicted to rise to 71.6m by 2033, an increase of 17 per cent over the next 20 years, while the number of people aged 85 will reach 3.3m.

The solution is to drive efficiency in all areas of the NHS, maximising use of financial and human resources, and moving the delivery of care out of hospital into the community and nearer to the home. Delivering care in the community is not only in line with patient preference but is more cost-effective than traditional institutionalised care. Wider use of information technology is the key to meeting these objectives and Advanced Computer Software Group is central to that agenda.

Advanced is a leading provider of back office and management information systems to the NHS including out-of-hospital solutions. Supporting both health and social care providers in the community, Advanced has IT solutions targeted specifically to help the NHS meet its prime objectives of reducing spending, increasing safety and improving the patient experience and outcomes for all.

Solutions can also be deployed efficiently and safely via the Advanced Application Cloud to reduce the cost of managing essential IT functions.

Doing more with less The key is to understand the requirements of commissioners responsible for purchasing care, and of the providers responsible for

All at the touch of screen

delivering that care. Their focus is improved efficiency and the ability to deliver effective outcomes for care that will be increasingly delivered in the community setting. To achieve this, both commissioners and care providers require better information about patient needs and the resources available to serve them. This is where Advanced is helping the local NHS. In 2010, NHS Wakefield District invested in a business intelligence solution from Advanced. One of NHS Wakefield District’s biggest IT investments to date, the solution provides valuable insight into how the primary care trust (PCT) is performing in relation to the health needs of its population. Health in the Wakefield District is generally poorer than other parts of England, which provides the PCT with considerable challenges and a requirement to measure needs and performance accurately. Since implementation, thousands of pounds of savings for NHS Wakefield District have been realised through improved operational efficiencies and more streamlined procurement.

In addition to business analysis and measurement tools, Advanced can provide the business systems required to support the NHS back office function and has supplied multiple NHS customers with Advanced Financials. These systems underpin efficient delivery of finance, procurement and HR functions and proven savings of £5.2m have been realised at the Countess of Chester Hospital NHS Foundation Trust,while the Royal Berkshire NHS Foundation has realised savings of £500,000 as a result of their effective deployment.

Going mobile Most of us have come to depend on and expect mobile technology as part of our day-to-day lives but within the NHS it is surprisingly underutilised. Advanced believes that mobile working and mobile technology generally have the potential to deliver transformational benefits for health.

Mobile solutions are undeniably a means to gain substantial efficiency savings. They also provide good quality and essential clinical data at the point-of-care, enhancing patient safety by making key information available to clinicians and removing the need for confidential health records to be carried in paper form.

Advanced mobile solutions deliver core patient data securely and accurately via a variety of mobile solutions. This data capture can be configured to include access to the national Summary Care Record and may include end-of-life preferences.

Advanced recognises the need to provide solutions appropriate to the nature of the service being delivered and offers mobile solutions on laptops, smartphones, mobile phones, tablet PCs and digital pens, which can all be integrated with national clinical systems.

Moving to mobile working will allow clinicians

Mobile technology could transform healthcare delivery

to deliver more and better quality care by eliminating the time they currently spend performing lengthy administration functions and reducing travelling costs and time.

Adding capacity iNurse, one of Advanced’s clinical mobile devices, is a patient management system that enables community nursing teams to record and communicate patient care data using handheld mobile devices. iNurse is proven to save each nurse a minimum of one hour per working day. For example, if the product was used by a team of 300 nurses, saving only half an hour per day, the results would be the equivalent of adding 18.7 full-time nurses per year at a salary cost of over £748,000. More importantly, this would translate into an additional 28,500 patient visits per year. With this kind of return on investment there is arguably no reason for a health provider not to embrace technology and, specifically, mobile technology as a way to drive down costs

and improve patient care.

A similar mobile product from Advanced for the social care market is iConnect, an intuitive and revolutionary point-of-care solution designed specifically for providers delivering home care, extra care and supported living.

This product frequently results in efficiency savings of over 20 per cent. If all 111,700 local authority care workers achieved a 20 per cent efficiency gain, an extra 34.4m visits per year could be delivered. If all private providers followed suit then a further £112m of savings for local authorities could be delivered.

Ultimately the task of the restructured NHS will be to reduce costs while protecting the frontline to deliver the best possible patient-centred care. The Advanced approach is to work with all providers and the widest range of technology partners to deliver robust, innovative solutions to help the NHS in delivering its objectives. www.advancedcomputersoftware.com/ahc

an independent report from lyonsdown, distributed with the sunday telegraph

April 2011

Business Technology

9

Mobile technology

Ringing the changes on healthcare Using the phone isn’t just about calling the doctor – mobile health monitoring could transform the way patients receive the care they need

By Tracey Caldwell

It’s called mHealth, and using mobile phones for health data collection and providing healthcare information is well established in developing countries and North America but in the UK and Europe use of the technology is still in its infancy.

However, mHealth could make a real difference to both patients and healthcare providers facing increasing challenges.

For example, up to 80 per cent of healthcare costs are spent on treating people with chronic illnesses at a time when the pressure on healthcare budgets is focusing minds on the high and rising costs of treating these conditions. Reducing the costs of GP visits and unplanned hospital admissions has become a priority.

Technology could be the answer. Many chronic conditions can be monitored by patients themselves in their homes and mobile phones can be a convenient, user-friendly way of capturing health data and sending it in real time to healthcare providers. They in return are able to respond and advise the patient by mobile phone.

The European MHealth Alliance (EuMHA) was established last June to promote mHealth in Europe, which lags behind the US and Canada. Analyst firm Juniper Researchers have forecast that, globally, revenues from mobile health monitoring will

mHealth in the UK Adherence Science – based in London and Derby. Offers personalised patient education and scheduling of medication by mobile phone. http://adherence-science.com Regpoint – Canterbury-based SME Regpoint offers the Pocket mobile service to facilitate data transfer between patients with chronic conditions and health authorities and care providers. http://regpoint.eu Intelesens – Belfast company Intelesens’ Wireless Vital Signs Platform may be connected via Bluetooth to the patient’s mobile. www.intelesens.com iPlato – London-based iPlato Healthcare offers mobile services for people with diabetes, hypertension, epilepsy and HIV. www.iplato.net SIMpill – this is an interactive pill bottle that communicates with a patient’s mobile phone.

The SIMpill bottle is programmed with a patient’s medication schedule and sends an SMS reminder if the patient forgets to take medication. www.simpill.co.uk OBSMEdical – OBSMEdical has its headquarters in Oxfordshire. Its mPRO collects electronic patient reported data through the mobile phone. www.obsmedical.com

Drug alert: text messages remind patients to take their medication

reach $1.9bn (£1.2bn) by 2014, with heart monitoring in the US accounting for most early mobile monitoring, followed by other chronic diseases such as asthma, diabetes and epilepsy.

In the UK, mHealth pilots have tended to focus on getting information to patients rather than a two-way communication. Londonbased iPlato Healthcare is involved in a mobile

Mobile phones can be a convenient, user-friendly way of capturing health data and sending it in real time to healthcare providers patient support service in partnership with the National Hospital for Neurology and Neurosurgery (NHNN). More than 50 epilepsy patients have signed up to the service, which began in early 2010 and helps patients keep to

recommended treatment by sending reminders to their mobile phones.

It’s a service that, according to the NHNN’s Professor John Duncan, could save money and free up resources if, by taking their medication more regularly, patients have fewer seizures and therefore have less need for health services.

Information can also be sent to healthcare providers by mobile phone. For example, health data may be captured by body-worn sensors or breath sensors, or by apps that collect data entered by users.

Currently, smartphone apps tend to supply data to the user rather than send it directly to the doctor. One example is the iTMP Digifit system for the iPhone. It includes the app and sensors such as heart-rate monitors – the app collects data from wireless sensors in chest straps which measure heart rate and sends the results to an iPhone for display and tracking by the user as an aid to fitness.

The next step is to connect apps in real time to clinicians – and that capability is certainly available. One company offering the technology is Belfast-based Intelesens, which supplies a wireless vital signs platform designed to communicate with mobile phones via Bluetooth in order to transmit cardiac information to clinicians.

The future is out there – and it could be mobile.

Asthma monitoring by mobile phone Asthma costs £2.3bn a year and about 12.7m working days are lost to the condition, according to Asthma UK. And in addition to the cost to the NHS and the economy, there is also the human cost to the patient and their families.

It’s a big problem but Applied Nanodetectors (AND) is one firm looking to new technology to help the care of asthma patients. It has developed a breath analysis diagnostic test using nanosensor array technology which can be interfaced with a mobile phone.

The breath analysis detects carbon dioxide, nitrogen oxides and ammonia, produced when inflammation begins in the airways before asthma symptoms even develop.

Initially the company was looking at ways of monitoring air pollution, one of the triggers for asthma patients. Managing director Victor Higgs says: “This led us to understanding a more effective way to help the patients would be to look at breath analysis, which has been around for about 4,000 years. Hippocrates speculated that by smelling people’s breath you could diagnose disease.”

As asthma affects one in 10 children in the UK, the challenge was to come up with a way to get children and teenagers to comply with a regular testing regime.

“We realised that to get the benefits of this type of breath test you really need to monitor your condition every day,” says Higgs.

“For children, the key enabler was that most have mobile phones. If you could have a technology that interfaced with your mobile phone, not only is it a more efficient way to improve your condition but it is a better delivery.”

Asthma patients are encouraged to monitor their breath every day when cleaning their teeth. The test data may then be transmitted to a remote database, which can be reviewed by physicians or GPs. Feedback from the physician could then come by SMS or email.

The chip can go into a Bluetooth component that interfaces with a mobile phone or potentially be integrated with a mobile handset. This sensor array can be integrated with mainstream semiconductor processes and manufactured at high volume. So far, AND has licensed the technology to as-yet-unnamed mobile phone handset manufacturers and is working with GPs and healthcare providers to bring the technology to market.

Data collected via the sensor and mobile phone is transmitted in real time to AND’s database, but the key will be integrating that with healthcare systems and providing a mechanism for clinicians to respond to the data and communicate with patients.

“The challenge is the infrastructural issue.

GPs have their own systems for capturing data, different to what is in the hospitals,” says Higgs. “With the advent of personal healthcare monitoring, it is really important that this would have to be a standardised process.” www.applied-nanodetectors.com

10

Business Technology

April 2011

an independent report from lyonsdown, distributed with the sunday telegraph

Industry view

3G Doctor Healthcare in your pocket? There’s a quiet revolution going on which means expert medical advice is closer than you think, says 3G Doctor

Located in a remote corner of Ireland, Dr Fiona Kavanagh is no ordinary country doctor. In addition to her rural practice, she’s an adviser to 3G Doctor, launched in 2006 to provide members of the public with 3G video consultations with informed, registered doctors.

As the world’s first service putting an informed doctor in your pocket, 3G Doctor is a leading example of how mobile phones are rapidly changing the way we engage with healthcare services.

Mobile healthcare, or mHealth, is a rather general term that refers to the use of mobile devices and network technologies by patients and their carers. You’ve probably already experienced it in the form of convenient text message appointment reminders from your GP or dentist, but the market is moving quickly as consumer appetite grows for the latest video mobiles and touch-screen tablets from brands such as Apple, Nokia and Samsung.

Smartphone subscribers can access tens of thousands of health and wellbeing apps to help count their steps, track their fitness, monitor their sleep, plan their diet, securely access their health records, motivate them to exercise more or simply help them unwind and relax.

Doctors have always been quick to adopt new communication technology and most in the UK are already using smartphones as critical work tools to securely access their e-mail, look up medical information and even place orders for prescriptions. So bear that in mind next time you see a GP staring into a small screen: it’s probably not a Facebook update, SMS or game of Snake!

Sometimes the health benefits of mobiles are obvious to everyone. If you’re a parent you’ll know how stressful it can be waiting for a child to arrive home, and the relief of receiving a text telling you why they’re delayed.

At other times, the health benefits are a little less obvious and hard to evaluate – what’s the value of knowing you are always within arm’s reach of a connection with your friends and family if you’re one of the seven million who live alone in the UK, for example? Is there a

GPs are quick to embrace technology

positive health outcome in this scenario?

It may be challenging but it’s also an opportunity for mobile operators to increase their appeal and profits by better connecting patients with healthcare information. Vodafone has made a £5m investment to set up the mHealth Alliance, a collaboration with the United Nations Foundation and Rockefeller Foundation to help grow the use of mHealth in emerging markets. Closer to home, O2 has created a new branded division called O2 Health, offering a whole range of new services.

These brands are hopeful that they’re in the right place at the right time, as care providers are increasingly looking to remote home care as a way of keeping our ageing population active and independent.

mHealth is about how mobile phones are rapidly changing the way we engage with healthcare services While these initiatives haven’t yet made it into the high street, they are already selling directly to healthcare providers wanting to remotely manage patients’ vital signs via wirelessly connected peripheral sensors such as ECG monitors, spirometers, weighing scales, temperature sensors, blood, glucose and pressure monitors, and pulse oximeters.

Research has found that patients tend to perceive mHealth very differently to the prescriptive eHealth services that have suffered from a lack of adoption despite massive government investment. One example is the NHS’s Patient Portal, which has so far been used by less than 0.06 per cent of eligible patients. The key factors seem to be the affinity and reliance patients already have for their mobiles and the additional control and empowerment that they enjoy when using a tool that is already carried, unshared and belongs to them.

As the impact of patient access to quality health information continues to emerge, personal mobile video content is perfectly placed to be used by patients, healthcare providers and communities to transform health education and motivate individuals to change their behaviour and maintain healthier long-term lifestyle choices.

The private sector has taken the lead and 3G Doctor has been working with some

of Harley Street’s leading clinics to launch services that enable specialists to send useful mobile video to their patients.

Statistics show there are as many people aged 50 or over with an iPhone as there are under 25, so smartphones are no longer used just by the young and healthy, but are increasingly capable of improving the healthcare experience. The concept of doctors prescribing an “app for that” is a great way to engage patients and a good opportunity to control the spiralling healthcare costs and loss of productivity that result from poor health and lifestyle choices. The impact of mHealth will be to use the most underutilised individual in today’s paternalistic sickcare systems: the patient.

As well as the impact of mobile video, we are also set to witness an incredible convergence of medical technology to the mobile device similar to the development of consumer devices led by Nokia in the last decade.

Similarly to how an obscure Finnish brand became the world’s biggest manufacturer of

cameras (displacing established brands such as Minolta and Canon), calculators (TI and Casio), watches (Timex and Seiko) and music players (Sony Walkman), the next 10 years will see Moore’s law bring ever more powerful technology to our fingertips and into our pockets.

Already we have basic phones that can send SMS to emergency services or share our accurate location with emergency response services. Increasingly, we have smartphone devices being adopted across all sections of society which are capable of helping patients carry in their pocket a tool they can use to securely share their information, connect with an informed doctor or access a comprehensive medical video library/biomonitoring tool. In the future there are even more exciting opportunities – check out the blog at mHealthInsight.com, or experience a mobile video consult at 3GDoctor.com The Doctor Can See You Now. www.3GDoctor.com

an independent report from lyonsdown, distributed with the sunday telegraph

April 2011

Business Technology

11

Mobile technology

Getting to the heart of the matter It looks like a timepiece, it feels like a timepiece, but for Suzan Bloom, her arrhythmia monitor is the answer to taking back control of her health

By Catherine Everett

“Because of my heart arrhythmia, I’ve used all sorts of technology and had all sorts of technology used upon me, but the ECG watch is phenomenal. It’s not uncomfortable and you can get on with your life as normal,” says Suzan Bloom, who wore the mobile diagnostic device for a week after experiencing chest pains.

Arrhythmias, or palpitations, occur when the heart races or slows down without warning, either occasionally or on an ongoing basis. They may result from a number of underlying conditions such as heart disease or high blood pressure, and symptoms can include dizziness and fainting.

Electrocardiograms, which measure the electrical activity of the heart, are one way of understanding how well it is functioning. Until recently patients had to visit their local hospital or GP surgery to be wired up to electrodes for testing purposes whether their symptoms were presenting at that time or not. Now, with the help of technology, there’s another option – the arrhythmia watch.

The device, which is about the size of a diver’s timepiece and can record up to five episodes, has one major advantage, according to Bloom: “It gives you back control because you are the one in charge of when to record what feels like a pain.”

Other benefits include the fact that the device is unobtrusive and does not “get in the way because it’s like wearing a watch and

there are no electrodes or wires attached”, she adds.

When not in use, the watch displays the time and date, but on feeling chest pain or discomfort, users simply press a red button located where a winder would normally be and the letters “ECG” pop up on the screen.

After three seconds, a beep indicates that the patient needs to press down on two small metal plates at the top and bottom of the watch’s face for 45 seconds using their thumb and index finger.

“The ECG watch is phenomenal. It’s not uncomfortable and you can get on with your life as normal” – Bloom “The back of the watch has to touch your skin and you have to keep your left arm very still to create a circuit so that it can record your heart’s activity. Now that’s what I call technology,” Bloom says.

After five days of wearing Broomwell HealthWatch’s device continuously, she

returned to St Gabriel’s Medical Centre in Prestwich. A nurse downloaded the data on to a PC using a wireless USB stick and both an ECG graph and Bloom’s pulse rate appeared on the screen. The information was double-checked by her GP, Dr Jonathan Lieberman, who confirmed that her condition hadn’t worsened and she didn’t need

any extra care.

“You don’t have to be a brain surgeon to use it and you don’t have to wait weeks to get the results, which could save lives,” she says. “You also don’t have to go back and forth to the hospital, which is no joy as it’s time-consuming, the parking is bad and it’s expensive.”

Managing your healthcare by mobile With the help of developing technology, healthcare professionals are looking to longterm solutions to help manage the care of patients with chronic conditions Within the next three years, patients in the UK with long-term conditions such as diabetes and asthma can expect to start using mobile applications to help them manage their health more effectively.

Although it is early days, about 1,000 small-scale pilot projects are under way globally to test how effective the technology is as one element of broader programmes of care.

In a nine-month t+ diabetes Think Positive trial 240 diabetics will be supported by the London Borough of Newham’s diabetes specialist nurse team.

Patients will be divided into two control groups, one manually recording their blood glucose readings, how much insulin they have injected and any subjective symptoms, and the other using OBS Medical’s mobile electronic diary application. The information from the second group will be sent instantly

to a central server to enable both patients and clinicians to view trends based on historical data. The aim is to understand whether the technology improves users’ health, quality of life and perceived control over their condition.

These are two small pilot projects, but according to Keith Nurcombe, Telefonica’s global director of healthcare and managing director of O2 Health UK, the use of such technology is likely to increase over the next few years.

It will especially help patients with chronic diseases that need to be monitored and managed, he believes.

“There are 15m people with long-term conditions in the UK, ranging from diabetes to asthma. So about a quarter of the population is using 60 per cent of health resources,” he says.

Nurcombe believes that the biggest innovations will be seen among peripheral devices such as blood pressure machines and blood

sugar monitors, which will in future either become mobile devices or be able to communicate with them.

The mobile device will send data to centralised monitoring centres staffed by clinicians who can analyse it in real time and alert other medical professionals, carers or patients themselves if there is a problem.

“Today, you can manually enter results or use Bluetooth, but devices are fixed,” Nurcombe says. “The technology exists for linking everything together to deliver an endto-end capability, but it requires fundamental change in the way people manage health.”

For example, the way that people are referred for care would have to change, and 24-hour monitoring centres would need to be set up, run either by the NHS or the private sector, depending on resources.

Souheil Marine, head of ICT applications and cyber-security at the United Nations’ International Telecommunication Union, agrees that much work needs to be done before the dream can become reality.

“Above all what is needed most is the glue, that is, the political will to develop a national mobile health strategy enabling all of the necessary actors to interact,” he says.

12

Business Technology

April 2011

an independent report from lyonsdown, distributed with the sunday telegraph

Industry view

Doctor, the patient will see you now Telehealth puts the patient in control – and keeps them out of hospital. Now it’s up to healthcare providers to think about technology in new ways A patient turns on a video screen in their living room. Moments later, their doctor appears. Then their scans, X-rays or test results appear. Next, patient and doctor talk through the options for treatment. This is all using equipment running over standard broadband, all with the same privacy as the consulting room – and all without the patient having to get out of their favourite chair.

Is this future-gazing? No. It’s about to happen in the Western Isles, where O2 Health and the NHS are trialling a system called Side

By Side which could make a significant difference to healthcare.

To see specialists and get treatment, Western Isles patients often face a flight or ferry crossing to a hospital on the mainland.

That’s inconvenient enough, but the trips are often cancelled because of bad weather. More frustration and delay for the patient, more administrative headaches for the trust.

But Side By Side means patients could soon have to travel just once – for treatment itself.

It also means that consultants can share data securely, allowing them to get specialist input immediately.

Such a system is already up and running in Spain. O2 Health and parent company Telefónica ran a six-month trial between the mainland and the Canary Islands, drastically cutting the number of return flights. And the signs in the Western Isles are good. “There’s a real appetite to change and use the technology,” says Western Isles NHS medical director Dr Jim Ward.

Time for technology It’s the kind of technology whose time has come, says O2 Health managing director Keith Nurcombe, who is also Telefónica’s global director for telehealth. “The NHS has to get more efficient and make resources go further,” he says. “But because the population’s ageing, there are more and more patients with chronic conditions. That’s putting more pressure on the system just when it’s feeling the financial strain.”

Telehealth offers a way round the problem, he adds: “The whole healthcare system benefits from using technology to move information between clinicians and patients reliably and securely. Patients get a better experience because they spend less time waiting. Hospitals free up much-needed capacity and staff get to help more patients. Everyone wins.” eHealth isn’t just about keeping patients and consultants in touch. It can have a role right at the heart of mainstream care, says

Back to the future: patients can access their test results from home

Nurcombe. “Already, a simple idea such as text message reminders has cut the number of missed appointments by 40 per cent for Portsmouth Hospitals Trust. And community midwives there can now spend more time with expectant mothers because digital pens have halved the admin that results from each appointment.

˝If we at O2 Health save money and make systems work better, it’s because we’ve made things better for the patient˝ – Nurcombe, O2 Health “Before, midwives made notes, gave a copy to the patient, then entered the same information on a computer back at hospital. Digital pens mean the information goes securely into the system straight away. So they only have to write it once.”

In Bradford and Sheffield, O2 Health is involved in another trial with 30 nursing homes.

Telewound management is a more efficient way of treating wounds that can develop with slow-healing conditions. During the trial, half the homes will provide their normal care. In the other half, nurses will use mobile

phones to take pictures of wounds and upload them securely to an NHS server, and record symptoms using digital pens. Specialist nurses will study the photos and information. Then they phone or e-mail their counterparts in the homes with instructions for treatment.

It’s a screening method to decide whether patients need to see a GP or go to hospital. It’s also a way to pick up problems early, avoid complications later, monitor patients over time and help them recover faster.

Problem first, technology second The NHS White Paper Equity and Excellence: Liberating the NHS talks about putting patients at the heart of the NHS through an information revolution and greater choice and control. This includes new ways of providing care using technology. But technology alone isn’t the solution, according to Nurcombe.

“The most important thing is understanding what patients and their carers need,” he says. “So that’s where O2 Health starts. When we talk to healthcare organisations, we ask them to tell us what they want to achieve and how. Then we help introduce technology to make that change real for the community. It’s bespoke because what we do has to reflect the community we work in.”

Looking ahead, he adds: “In five years large numbers of people with long-term conditions will be monitoring these from home. For the NHS, face-to-face contact is the most expensive and difficult to provide. For patients, it’s the most disruptive. In the future, telehealth will mean it’s only for the patients who need it most.”

However, Nurcombe says technology and innovation can only help if healthcare

organisations change how they work. “They must make a huge mental shift from secondary care by specialists in hospitals and clinics to community-based care,” he says.

That’s happening in Berkshire with another O2 Health innovation. Home Physio lets patients go home earlier after surgery and monitor their own rehabilitation. Berkshire East Community Health Services has been trialling it since January.

Like Side By Side, it’s already being used in Spain, with several Madrid hospitals using it with patients after knee operations. Patients attach sensors to their knees and follow exercises from a computer screen that tells them if they’re doing the exercises right. The system sends data on performance and pain to a consultant or physiotherapist, then they decide if the patient needs a personal visit. Additional exercises can be sent to the Home Physio system, depending on how the patient’s doing.

Berkshire East’s director for business and strategy Siobhan Melia sees Home Physio as a way to keep up with increasing demand for physiotherapy despite squeezed budgets. “It also creates a patient-centred approach, which was one of the other reasons I was really keen to pursue it,” she says.

That echoes Nurcombe’s view that the right result for patients always comes first: “If we at O2 Health save money and make systems work better, it’s only ever because we’ve made things better for the patient. Technology is just the enabler for change.” www.o2health.co.uk www.wihb.scot.nhs.uk www.telefonica.com www.berkshire-eastchs.nhs.uk

an independent report from lyonsdown, distributed with the sunday telegraph

April 2011

Business Technology

13

Industry view

An office in your pocket Mobile technology is helping nurses and other medics working in the community to maximise their time with patients and away from the office admin Many healthcare professionals see their patients in the field, a long way from an office computer or medical network. But they still want to give them the best possible care in the most efficient way, and that means having up-to-date information and the support of colleagues, as well as minimising wasted time and effort.

Here’s the story of Jane, a typical community nurse: “The thing I love most about my job is that no two days are the same. The patients change, the cases are always different. And luckily for me the technology I use is changing. So I start the day by reaching for my BlackBerry smartphone.

“Even the really simple things, like being able to access a completely up-to-date calendar with all my appointments, make all the difference. Things change so quickly, and not having to go to the office to update my schedule means I get to spend more time with my patients.

“With GPS on my BlackBerry smartphone I always know where I’m going, with doorto-door directions for all my appointments. I even get to know when there are traffic jams so I can make all my appointments on time.

“Once I arrive I always give the patient a quick call to check they’re at home – and make sure they get the kettle on before we start!

“Because I can access up-to-date patient records directly from my BlackBerry smartphone I know exactly what I’m going to be doing during the visit. And I can make notes

during the appointment which go straight into the patient records database.

“I can’t tell you how much this has helped us to improve patient care. Previously I’d have had to carry case files around with me or call the office to deliver or receive updates. It used to take up to three weeks for handwritten notes to be updated onto a patient’s record, and sometimes things got mistyped.

“As I’ve been using my BlackBerry smartphone more and more, I had the idea of setting up a BBM (BlackBerry Messenger) group for my team, so when I need a bit of advice or a second opinion I can contact them all together in one hit. We’re almost never at our desks so we find this is a great way of keeping in touch.

Even when I’m out visiting patients I stay connected to my team.

“Because I’m out of the office so much it used to be difficult keeping on top of all the administration. I’ve now halved my admin time by using a digital pen and forms to record the patient visit. I can complete assessment forms by simply running the pen over the relevant barcodes on the form and writing up any other notes freehand. It even recognises my handwriting.

“I like doing this with my patients, as they seem to find it a useful recap of what we’ve spoken about during the visit. Best of all, the assessment form and notes are instantly added to the patient’s record and can be viewed by any of my colleagues.

“As I’m out and about all day my own personal well-being is really important to me

and my employer. Working as a nurse and carrying medicines around with me I need to feel that I’m safe. So before I begin an appointment I switch on my loneworker application and set a time for the appointment duration. If there are any problems I can raise a silent alarm at the press of a button, or if an appointment’s over-running I get a call back from my team making sure I’m okay.

“When you’re dealing with confidential patient information, security is critical.

I have real peace of mind that my BlackBerry smartphone can only be used by me. I lock and unlock it with a password PIN and my organisation uses smartcards and readers for extra security.

“I simply insert my ID card in the reader before I leave the house. If my card and BlackBerry smartphone are more than five metres apart I get a message warning me that it’s about to lockdown the device. So my BlackBerry smartphone would lock automatically if it was ever lost or stolen, and the IT guys could even wipe it remotely from the office.

“Being able to work remotely has been the most positive change in my job over the past couple of years. I’m a community nurse after all, and having a BlackBerry smartphone means I get to spend more time in my community, visiting patients.”

Further information healthcare@rim.com www.blackberry.co.uk/healthcare

The fruits of BlackBerry

Jane may not be a real person, but thousands of healthcare professionals just like her are helping real people every day. Giving them access to key information at the point of need has many benefits: • Improved decision-making Users can confront issues as they emerge, refer to existing records, and confer with colleagues before taking the appropriate action.

• Increased responsiveness Quick communica tion between colleagues and with patients enables mobile staff to stay in touch with live issues and respond faster. By making better use of time spent away from the office, mobile workers can make considerable efficiency savings using mobile solutions.

• Reduced administration time BlackBerry solutions enable busy mobile healthcare professionals to manage their time more effectively and cut down on administration time by allowing them to record data and respond to communications while away from their desks.

• Improved service and capacity Putting key information in the hands of mobile health care professionals empowers them to perform their duties in the field with greater speed and precision, resulting in improved organisational performance, capacity and patient care.

Giving patients key information when they need it

In short, equipping mobile healthcare workers with a BlackBerry smartphone makes sense for them, their patients and their employers. For patients, it means faster access to their records, reduced waiting times and the reassurance of a more informed decision.

For the healthcare workers, it gives them access to systems and improved collaboration with colleagues, enhances their personal safety, cuts travelling time, and lets them reduce their admin burden and spend more time with patients.

And for healthcare organisations, BlackBerry solutions help improve care quality through mobile access to information at the point of care, reduce unnecessary admissions and increase patient satisfaction.

14

Business Technology

an independent report from lyonsdown, distributed with the sunday telegraph

April 2011

Industry view

Caring about efficiency GPs can save money and time by embracing the potential of technology when it comes to patient data The government’s spending review has placed healthcare expenditure firmly in the spotlight.

GP practices and hospitals are facing even greater pressure to be more responsive to patients’ needs – at a time when every penny that is spent is being vigorously scrutinised by those who hold the purse strings.

The current financial landscape therefore dictates that budgets have to be spent even more wisely and the results have to be even more impressive. Dr Andrew Whiteley, a GP from Warwickshire, says: “The current challenges facing primary and secondary care mean GP surgeries and hospitals need to be working hand-in-hand with their acute trusts to maximise key efficiencies.

“One of the issues at the centre of this efficiency drive is the safe and reliable transfer of patient information. If a GP practice or hospital can get this right, it has a big impact on the smooth delivery of patient care further down the line.”

It is therefore surprising that a huge number of UK healthcare sites still rely on analogue dictation systems to handle and transfer vitally-important patient information.

“At a time when healthcare is focused on maximising key efficiencies, it’s staggering that 30-year-old technology is so widely

used,” Whiteley says. “How can that be efficient when tapes degrade, secretaries lose vital time searching for dictations, playback sound quality is poor, batteries need replacing and tape machines need investment to stop them breaking down?”

It seems there has never been a more compelling case for change. Whiteley recognised the need to embrace the latest dictation technology more than a decade ago and his company, Lexacom, has been at the forefront of digital development and innovation ever since.

“When healthcare is focused on maximising key efficiencies, it’s staggering that 30-year-old technology is so widely used” – Andrew Whiteley, GP Today, Lexacom supplies all-encompassing digital dictation software to customers across the UK and is the exclusive digital dictation software supplier to the LMC Buying Groups

Going digital: it’s all about efficiency

Federation, an organisation that represents 4,500 GP practices in the UK. As a practising GP, Whiteley leaves no stone unturned in the battle to uncover efficiency improvements and the results of a recent audit illustrate how big an impact a digital dictation system can make over analogue technology.

After gathering data at Appletree Medical Practice in Belper, Derbyshire, for a month, Lexacom’s digital dictation software was shown to reduce urgent patient referrals from 31 hours and 42 minutes down to one hour and seven minutes. And when processing routine referrals, Lexacom software took an average of 26 hours and 48 minutes compared with 98 hours and 17 minutes with analogue technology.

Statistics like this point to big cost savings on administration time and a proven increase in productivity and efficiency. Digital dictation technology gives complete transparency and visibility to all work practices and workloads, ensuring that patient information is processed faster and more reliably.

Lianne Burke, IT/data manager at Appletree Medical Practice, says: “I think if I was to tell the staff that we are going to take Lexacom away, they would all hand their notices in the following day. That’s how much of an impact this digital dictation platform has made in the practice.” www.lexacom.co.uk www.lmcbuyinggroups.co.uk www.appletreemedical.co.uk

The power of the machines With M2M wireless technology, providers can deliver quality healthcare wherever patients live, without compromising on either cost or security

Wireless technology: a walk in the park

In a changing and challenging world, healthcare professionals are increasingly turning to wireless technology to significantly improve practices around the world. National healthcare systems are facing challenges in prevention and in how to provide efficient medical care to an ageing population with growing incidence of chronic diseases.

The delivery of healthcare through mobile technologies (mHealth) can provide an answer. Remote wireless health monitoring will play a vital role in the development of new strategies aimed at improving access to and continuity of healthcare while controlling costs at the same time.

A key technology to facilitate wireless health monitoring is cellular-based machineto-machine (M2M) communication. With the patient’s prior consent, M2M solutions enable mobile health devices to remotely monitor, connect and communicate the patient’s health status to a medical specialist over the air.

Thanks to this technology, patients can benefit speedily from specialised services, wherever they are, especially in remote areas.

Complementing face-to-face visits, M2M technology establishes an additional communication channel between clinicians and patients, removing geographic barriers and enhancing the quality of service delivery.

Unobtrusive and easy to use mobile health devices can suit a variety of telehealth purposes. This includes monitoring a patient’s medication compliance (pill reminder); managing elderly patients through wearable

health monitors (assisted living); and helping chronic disease patients such as diabetics by providing assistance to bring blood glucose levels back to a normal range (chronic care management). Remote monitoring devices can automatically call for help (social alarms), enabling emergency services to react more quickly – and ultimately save lives.

M2M technology establishes an additional communication channel between clinicians and patients, removing geographic barriers to good healthcare It’s all about delivering the best care. Consistent and real-time monitoring of vital parameters or behaviour allows for early detection of a deterioration of a patient’s condition, enabling timely intervention to help reduce expensive emergency situations and hospitalisation. It also encourages more frequent interactions with patients based on medical data gathered in real-life situations, improving the continuity of care.

Crucially, patients’ electronic health records have to be strictly confidential, so how can healthcare providers ensure data is protected?

Security is indeed a key requirement for the

adoption of electronic health records, with strict regulations controlling access to the content of an individual’s online medical record.

The answer is safe M2M wireless technology, which allows for automatic and secure transmission of medical data from sensors straight into a patient’s record, delivering a clear and complete picture of all aspects of a patient’s health without compromising the privacy of the patient.

With more than 15 years of experience in digital security, Gemalto provides technology which enables healthcare devices to communicate over wireless networks in a highly secure fashion. Data transmission is based on the latest encryption technologies and security mechanisms inherent in modern cellular networks.

In addition, Gemalto also supplies healthcare providers with smart badges and strong authentication solutions to securely access patient records, ensuring only authorised personnel can retrieve sensitive patient data.

Combining M2M technology, smartcards and other solutions, Gemalto and Cinterion can significantly improve end-to-end security in wireless networks, safeguarding patient information and meeting regulatory requirements.

Axel Hansmann and Manfred Kube, specialists in M2M healthcare solutions at Cinterion (a Gemalto company) www.gemalto.com www.cinterion.com

an independent report from lyonsdown, distributed with the sunday telegraph

April 2011

Business Technology

15

Electronic records

Putting the record straight Giving patients access to their medical records is a key part of health policy – putting computerisation back at the top of the NHS agenda

By Michael Cross

Greater Manchester GP Dr Amir Hannan has an answer for anyone who says ordinary patients are not interested in computerising the NHS – 1,140 of the patients in the practice, a 10th of the entire list, now have access to their personal medical records via the internet.

Hannan’s practice at Haughton Thornley Medical Centres is one of only a handful in the country to offer patients the chance to view their complete, unexpurgated records.

He’s been giving patients that access for five years, according to the GP, “with not a single problem”.

Patients have to attend the surgery to apply for a log-in code, which they receive after filling in an online questionnaire dealing with issues such as how they would react to finding alarming information in their records.

Hannan says that giving patients access to their records encourages them to take more interest in their care – to the benefit of patient and doctor alike.

The government agrees. Giving patients control of their health records is a central part of Health Secretary Andrew Lansley’s plan to reform the NHS in England. Under plans for an information revolution in healthcare, patients will have access to their own health records, as well as swathes of data about the performance of hospitals, general practices and individual doctors.

According to the Department of Health, access to health records improves relationships with clinicians, and means patients are better informed about their care and medication, and are able to correct errors and omissions. It also increases people’s ability to manage their own healthcare and their confidence to do so.

However, the revolution will not happen until medical records make the leap from paper to electronic format. All over the world, health services have lagged behind other industries in adopting IT. Even in the US, only about a fifth of hospitals have fully electronic medical records.

There are several reasons why healthcare has proved more resistant to information technology as compared with, for example, banking. Health records contain messy collections of information, including images and notes made for a doctor’s own reference.

And, until recently, computer hardware was not portable and robust enough to be carried by doctors on their ward rounds or in operating theatres.

Paper trail: will our health records ever be full electronic?

The NHS’s track record in going electronic is notoriously patchy, too. While most GP practices are computerised (systems received a hefty subsidy as part of the last Conservative government’s “fund-holding” scheme), progress in hospitals has proved trickier.

The NHS in England has been committed to electronic records since 1998. However, progress stalled when the last government launched its now-notorious £13bn national programme for IT.

Medical records must make the leap from paper to electronic format. All over the world, health services have lagged behind other industries in adopting IT While some systems were transformed – X-rays are now presented on computer screens rather than on photographic films – the implementation of hospital-wide systems became bogged down in acrimonious disputes. (The NHS in Scotland and Wales took a less aggressive stance, and in some ways the organisations have achieved more computerisation.)

In fact, the first NHS hospital to announce it had gone entirely paperless was working outside the English national programme. St Helens and Knowsley Teaching Hospitals Trust in Merseyside has computerised its records with a £1.2m document-management system which handles electronic versions of conventional patient notes, and a patient-

administration system which records administrative data.

According to director of informatics Neil Darvill, the trust did not go electronic for the sake of it, but to be able to run a better service.

“Lost records were generating 30, 40, 50 complaints a year,” he says.

The electronic system was implemented over 22 months, and more than 500 clinicians and 130 medical secretaries are trained to use it. So far, 135,000 records containing more than 41 million pages have been scanned in.

The notes appear on the screen as they would on paper and clinical staff can add information with a keyboard or a hand tablet. The trust now plans to close its medical library in 2014, saving at least £3.2m over five years.

The government’s information revolution is supposed to empower other trusts to follow suit with their own locally-specified technology, in contrast to the centralised approach of the national programme.

However, two obstacles loom. One is cost: at a time of budget cuts it will be difficult for trusts to find the upfront investment for IT. There is also the cultural challenge of going electronic. In its response to the information revolution consultation, the British Medical Association raises concerns about letting patients take control.

“The cultural change of enabling patient access to their complete records is significant,” it warns. Allowing patient access “should be a gradual process which will require piloting and, if successful, a staged implementation”.

The BMA also warns: “At this time of financial restraint, there should only be investment in this area if an evaluation provides evidence of patient demand and clear benefits.”

It is clear not every doctor is an Amir Hannan.

Do electronic records improve patient health An early claim for electronic medical records (EMRs) was that they could save lives in emergencies by allowing doctors to look up blood groups or allergies.

This is questionable. If you have a chronic condition or life-threatening allergy, it is safer to carry a recognised token such as a MedicAlert bracelet rather than to rely on emergency teams identifying you on a computer system.

But what electronic records can do is greatly ease the frustration of more routine journeys through the NHS. Benefits of computerisation include: • No need to repeat the same information to receptionists, nurses and doctors.

• Fewer appointments cancelled because medical records have not arrived.

• X-ray images being instantly available. Also, because an electronic image doesn’t get lost, EMRs should mean fewer potentially harmful re-examinations.

• A reduction in prescription errors: systems can spot mistakes in doses, and combinations of drugs which could produce harmful side effects.

• Faster hospital discharges, with beds no longer blocked by patients awaiting paperwork.

A potential downside of EMRs is a loss of privacy but those in favour of the change argue that computerised records are more secure than paper because they record who is calling up what information. However, as with any computerised data, they can be tempting targets for systematic attack.