Will an anti-innovation culture in the NHS kill off technological progress?

An an NHS hackday, clinicians and computer software writers layout and publish an app to assist resolve a ‘real-ward’ difficulty. Photograph: Kay Nietfeld/dpa/Corbis

Two many years ago, I came across a great new way of writing healthcare computer software at an NHS hackday. The concept behind a hackday is that clinicians and software program writers choose on an app for solving a “genuine-ward” issue style and compose it within 24 hrs.

This disrupts the conventional way of creating hospital software, exactly where administrators give a series of Chinese whispers to systems analysts in an intergalactic application house potentially on the other side of the Atlantic. The systems analysts transmit even more Chinese whispers to a set of programmers who have no notion what takes place in an NHS hospital. The resulting method overruns by many years, fees millions and proves to be non-implementable by nurses and medical professionals on the ward.

The hackday technique has a greater possibility of good results, since the clinician is at the heart of the design and style procedure. The technique is created to be tweaked if it does not perform, it can be binned, and because it is written in open source, it can be latched on to mainstream systems.

Attracted as I was by all this disruptive contemplating, I was anxious that the youthful chaps creating apps would not realise 3 factors the importance of producing their programmes interoperable, that regulators will demand evidence that the apps are protected, and that offering and advertising and marketing software program in the NHS IT chaos is a nightmare.

To see how these disruptive guys have been acquiring on, I attended the Handi Digital Wellness Spring Symposium last month. Handi (Wellness Apps Network for Advancement and Innovation) assists startups to create apps for healthcare and is the intellectual powerhouse behind the hackday method to writing healthcare application. It believes in open source, quick prototyping, co-manufacturing (clinicians and geeks), crowdsourcing, several platforms – PCs, tablets and smart phones – and disruption, to keep the hospital IT bosses rattled.

At the symposium, I found that the Handi individuals were not just progressive geeks with bright concepts, but had been effectively conscious of the “actual globe”. They have to get via a bureaucratic NHS approval and regulatory method, to have the app registered on the NHS app retailer. 1 speaker claimed that testing could get eight months.

They had to learn how to layout consumer interfaces that are suitable for the consumer. The interface for clinicians, nurses and sufferers would have to be quite different from one one more. The healthcare material has to be “each reliable and engaging”.

They have to cope with an evolving and rather chaotic world of standards: syntactical, communications and semantic. A single speaker claimed that “semantic interoperability in health is impossible”. And even if an app developer conforms to interoperability requirements, they will have to let for fussy hospitals to make hospital-distinct tweaks.

But the actual nightmare is advertising the apps. The developers will have to cope with the NHS’s pervasive NIH (not invented here) syndrome. “Kent may well order your app but Sussex will not.” And it is no great striving to get central support for your app, as the neighborhood degree will reject any directive “prime down” from the centre. And clinicians will demand proof of the effectiveness of your app. They look to consider that proof is the outcome of the sort of RCT (randomised controlled trial) that is employed in approving medicines. The startup software program property would be bankrupt by the time such an RCT were completed. Not a quite helpful setting, then, for apps to flourish.

One fruitful approach would be for developers to associate themselves with hospital trusts or charities, and function with them to produce apps. That curiosity from trusts interested in co-operation of this sort was proven by the variety of delegates from trusts – about a third of the total – who attended the symposium.

An additional target of co-operation is large laptop organizations. Final week, there was a breakthrough. Apple launched Healthkit, a platform on its iPhone, iPad and iMac, to gather “health-associated data from a range of sources”. In the previous, Apple and other developers have created overall health applications, but these have been standalone. Healthkit is “created to give users a large-image appear at their entire overall health profile: exercise, rest, consuming and even metrics like blood strain and glucose amounts”.

Apple is signalling its entry into the healthcare market place. Samsung created a equivalent announcement the earlier week. We can count on the mobile apps market place to burgeon more than the up coming handful of many years, with sensor-laden iWatches and other wearable units.

I hope British Handi-type apps developers will join, or perhaps lead, the gold rush. But the danger is that the fragmented anti-innovation culture of the NHS will destroy them off.

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Will an anti-innovation culture in the NHS kill off technological progress?

Loneliness is not a bug with a technological solution | Ros Coward

‘Anyone who has spent time with elderly people knows the real issues are much more complex.’ Photograph: Paul Doyle/Alamy

In the UK, four out of 10 over-65s do not have internet access. At a time when so much of our lives is conducted online – the payment of bills, access to information – that should be a real source of concern about potential social exclusion.

But does this mean that by widening internet access, elderly people will feel more socially connected? Or, even, more radically, as a new report suggests, could this be a solution for loneliness in old age?

The centre-right Policy Exchange thinktank makes such claims as part of its forthcoming technology manifesto. It recommends £875m should be spent on training the 6.2 million mainly elderly people who are without basic digital skills.

The report claims these skills would provide older people with a way to stay connected to friends and family, and could therefore ease the isolation of those who live alone, while saving many millions for the NHS and in state-subsidised care home places.

Loneliness among the elderly is certainly a massive problem. Recent research by Age UK has shown that one in three older people are plagued by loneliness, and that this has dire effects on their health.

On first sight, claims about the potential benefit of digital connection for the elderly appear to be backed up by research. The International Longevity Centre recently found that 7.5 million adults have never used the internet – most of them elderly, disabled or poor. Of those who had not been online, 63% often felt lonely, compared with just 38% of those who did use the internet.

But these figures, and their policy conclusions, need to be treated with caution – not least because they may lead to money being invested in a technological fix when the answers are more complex and human. Loneliness in old age doesn’t occur just because older people haven’t learned to use the internet (a problem that will increasingly disappear as a more technologically literate generation ages).

Loneliness among the elderly is also to do with poverty and declining health. On the one hand, financial hardship restricts their activities; on the other, it increases frailty – including the loss of mobility, eyesight or memory, all of which undermine confidence when moving around in the wider community.

It is often these other factors that will restrict access to the internet, even for those who might once have been able to use it. To access the internet, you need money, or skilled neighbours and friends, to fix glitches; you need eyesight to read screens and memory to recall passwords.

Those findings that “prove” that the elderly who are digitally connected are also more socially connected require caution. At first sight, they too appear to be common sense. We have only to think of the incredibly energetic 80-year-olds who are internet savvy, regularly emailing their family and friends, and appearing to gain huge benefit. Yet the truth is that these people are often the ones whose health and financial situation would have kept them socially connected and in the centre of their families and communities, with or without the internet.

Anyone who has spent time with elderly people knows the real issues are much more complex. Of course internet use comes into it. But at its core, loneliness among the elderly still has other causes and effects: missing seeing people regularly, missing casual conversations, missing being able to get out and feel safe. What the elderly value is seeing regular friendly faces, having their basic needs taken care of by real human beings, and being able to walk to places where they can still interact with real people.

It is ironic that these reports highlighting how the internet can solve loneliness for the elderly are running in parallel with reports and academic studies warning young people not to mistake social interaction on the internet with friendship.

This week, research from Australia on loneliness among teenagers showed that the “loneliest” were also the most prone to sharing – or “oversharing” – intimate details on the internet. News stories constantly highlight how teenagers who are suicidally unhappy can be extremely active on social media. Indeed, there are suggestions that internet dependency can be linked to social alienation rather than social connection.

None of which is to say that the provision of basic internet skills for the elderly would be anything other than a good thing. On the basis of social justice alone, promoting universal digital competence is to be supported, and there could be very real and immediate benefits. But we shouldn’t elevate it into something it isn’t – the solution to loneliness and a way of keeping elderly people out of care provision for longer.

It’s a means to an end. The end, in this case, is human contact, human warmth, human kindness. A better way to those ends are services designed to bring about that face-to-face human contact, and communities designed to meet the needs of groups of people who are less mobile and able-bodied than they once were but still crave company.

Loneliness is not a bug with a technological solution | Ros Coward

If NHS data goes on-line, what will occur to the outdated and the bad who cannot entry technological innovation? | Katharine Whitehorn

Katharine Whitehorn: ‘Jeremy Hunt (pictured) trotted out figures, such as that 70% of us buy our air tickets on-line.’ Photograph: Neil Hall/PA

Well being secretary Jeremy Hunt need to have considered he was saying something cheerful when he explained that the NHS ought to learn from banks and airlines, and use engineering to make our care far more personalized. He trotted out figures, such as that a single in five Christmas presents was purchased online and that 70% of us acquire our air tickets on-line.

Definitely individuals who have income in banking institutions, fly away on vacation and have a pc or its equivalent can do all these things. But has not he observed that a wonderful percentage of individuals who are unwell are previous, and many of them poor? They may not even personal a mobile telephone or be fortunate adequate to have someone younger who can cope with such items on their behalf.

Of program there are some who are techies by nature, other folks who have laptop-wise carers here and there some groups are trying to assist pensioners with the web with all the selfless work that used to go into educating the heathen to read. I realize that even now GPs are usually getting to element in the time it will take to pay attention to, and then proper what their younger sufferers have learned on the net.

But probably there is a great motive hidden in all this: a hope of tackling youth unemployment by hiring them as technical interpreters, to bridge the gulf among the old and sick and the machines with out which, apparently, they could not be cured.

What do you think? Have your say below…

If NHS data goes on-line, what will occur to the outdated and the bad who cannot entry technological innovation? | Katharine Whitehorn

Two Examples Highlight Issues Of Demonstrating The Advantage Of Digital Overall health Technological innovation

We are constantly told healthcare is “ripe” for disruptive innovation, a process of creative destruction enabled by the exciting new technologies of digital health.  Yet, the robust demonstration of almost any substantive benefit (beyond perhaps transient delight and toxic self- absorption) has been slow in coming.

The challenges of moving a health-related technology from promise to impact are illustrated nicely by two recent attempts to carefully evaluate the benefits of intriguing new devices.

The Propeller Health Inhaler Monitor

The first study (NCT01509183) was sponsored by Asthmapolis (now Propeller Health), and sought to examine whether use of the company’s inhaler monitoring device resulted in improved asthma control, the study’s primary endpoint.  Control, measured by the Asthma Control Test (ACT) would be assessed at 4, 8, and 12 months.

The device senses inhaler use – in this study, the use of fast-acting “rescue” inhaler medications, specifically — and communicates data to patients (via an app) and to providers (via reports and change of status alerts), according to MedPage Today.  In this study, asthmatic patients who had experienced a “healthcare utilization event” in the preceding year were randomized into either an active group , receiving the device and associated data, or a group receiving a deactivated device that provided no supplemental information.

As study co-author Bob Quade explains in an email, “the fundamental intervention is information.

At a national meeting last November, interim results were presented.  These data revealed slight improvements in the ACT in the active arm compared to the control arm in both adults and children, differences not statistically significant.

However, additional analysis found subjects in the actively monitored group used rescue inhalers significantly less often than the control group.  Perhaps most strikingly, inpatient days were reduced from 0.225 per person per year in control group to 0.087 in active group; emergency room visits decreased marginally (from 0.141 per person per year in control group to 0.103 in active group) as well.

This reduction in utilization is claimed to be associated with a savings of $ 688.05 per patient (compared to baseline);  subjects  in the control group, notably, were found to save $ 281.95 per patient compared to baseline, suggesting a regression to the mean effect, not surprising given that subjects were selected based on experiencing a healthcare event in the previous year (most asthma patients don’t experience events in any given year).  It’s also possible that simply participating in the study may have contributed to a change in utilization (the Hawthorne effect at work).  Both possibilities were  acknowledged by Quade.

However, the active group still exhibited a dramatic savings (~$ 400 per patient) associated with reduced utilization compared to the control group, despite the lack of significant changes in asthma control as measured by ACT scores.  This presents a real puzzle.

Some, such as wellness guru Al Lewis (author of Why Nobody Believes The Numbers, and more recently, Surviving Workplace Wellness) look at these results incredulously.

“Their own numbers don’t add up,” he asserts in an email.  “First, they say it’s not statistically a significant difference.”

“Even if it were significant,” Lewis continues, the difference reported on the ACT “is something like 2.2% improvement in the score.  Then, they claim an inpatient reduction of 62%. This violates several of the rules in Why Nobody Believes.  First, costs can’t decline that much and second, the cost reduction has to tie to the quality improvement.”

An alternative explanation, however, is that there are improvements in care not reflected in the ACT measure; for example, if the intervention doesn’t prevent exacerbation but catches them early enough to enable them to be managed as an outpatient rather than an inpatient, this could theoretically save significant dollars, yet be difficult to pick up on the ACT.

This study highlights the challenges of rigorously demonstrating the benefit of a digital health intervention that appears to make a world of sense.  It seems logical, even obvious, that improved monitoring of rescue inhaler use, coupled with improved, immediate communication with patients and providers would improve disease management.  As study principal investigator Rajan Merchant points out, it enables the care of asthma patients to transition from episodic to continuous – one of the key ambitions of digital health.

I look forward to examining a peer-reviewed publication once the study is completed later this year, and all data are read out.  My suspicion is that there may ultimately be a cost-savings achieved (vs the control group), and perhaps eventually a small improvement in asthma control.   Whether this economically justifies the use of the intervention will need to be determined, given the cost of the devices and software, and the extra provider time potentially required.

Two Examples Highlight Issues Of Demonstrating The Advantage Of Digital Overall health Technological innovation