Healthcare in the 21st century will require a much higher degree of connectedness and mobility of information, knowledge, processes, devices and people.
For many years, IT in healthcare has been treated as a poor investment in relation to other investments with budgets frequently cut to fund treatments or pay rises or increased demand for care. However, there are emerging signs that the value that IT can deliver in health & care is being recognised, though the difference between standalone “e” health applications and those that support the patient’s journey through care is also being recognised, and the value of truly Connected Health solutions is becoming apparent. The connections must bridge time, organisations, clinical disciplines and the yawning gap between health and social care, especially for ageing populations suffering from chronic diseases. While healthcare industry is in the process of recognising the potential of IT, other factors are driving potentially greater divisions in the patient’s journey—for instance the fragmentation of medical specialities as treatments become more complex, the movement to care in non-traditional environments like the home or workplace, both introduce a risk of more “unconnected” journeys. To make matters worse, in the wider world outside healthcare, technological advances are accelerating, offering more opportunities and also a greater need to coordinate and connect processes, information, knowledge and patient journeys.
The Technology Avalanche
The rate of technology advancements—storage, processing, communications, and connectedness of information—is exponential and will have a profound impact on the way people work, live, learn and play in the next 20 years. Consider the progress made in wireless technology for example. In the 1980s, a mobile phone was considered innovative if it was smaller than a car battery. In 2001, the first telephone call was made from space when shuttle astronauts used a Cisco® IP SoftPhone communications application (a software programme used on a PC or laptop) to call home instead of using a radio. Today, phone calls are increasingly made from computer devices for free over the Internet.
The scale of the technology avalanche is staggering. For instance, in 2003 alone 6.5 exabytes of data was created worldwide, enough to fill the U.S Library of Congress 500,000 times over.
Profound implications for the world of healthcare arise from the power of the new communications enabled by advancing storage, infrastructure and computing power. These new capabilities might be one of the only ways in which we can collectively deal with the rapidly growing demand for care generated by an ageing, chronically ill population. Further, the power of the new technological capabilities will enable new ways of working rather than automating current practices—changing the governance, control and distribution rules for information and knowledge in healthcare. The next generation of internet solutions is enabling a “human network” to evolve, rather than computer to computer transactions.
The Impact of the Human Network on Connected Health
While healthcare is facing huge challenges influenced by ageing populations increasingly suffering from chronic disease, the rules for interactions between organisations and especially between individuals are changing dramatically. Traditional producers of content—from hospital performance information to health knowledge—are facing new competition from sources that as little as three years ago did not exist. Patients now find it easy to create websites themselves (such as www.patientopinion.org.uk) to capture information about a disease or a hospital’s performance.
Such content usually has little of the traditional quality-assurance process applied to it but is accessible and quickly updated. Large organisations, especially those in the public sector, can take years to create a new service for patients, yet patients or small private organisations can use innovative Internet tools to design online services in a matter of days. “Mashups,” which combine content from multiple sources, are powerful examples of these new services (see http://whoissick.org/sickness/). Similarly, modes of distribution are being multiplied by the increasing number of connected devices, and by delivery technologies such as WiMAX, YouTube, wikis and blogs. These content avenues are making an abundance of health information and services widely and easily available to patients and citizens. Yet, the very flexibility and freedom that create these choices also make it hard to assess the quality, competence and reliability of such services and knowledge.
The impact of this technological change, combined with healthcare’s need to respond to sociological change with more prevention, efficiency, higher-quality care, and delivery of more complex treatments, is leading to four emerging themes in many healthcare systems:
e-health becomes connected health
The term “e-health” emerged in the late 1990s as healthcare organisations noticed that the advent of Internet technologies added new information technology tools for sharing data and communications. E-health is still very much a part of the healthcare industry’s language and culture because it helps ensure that important tools are peripheral to care, rather than intrinsic. Healthcare in the 21st century, however, is evolving; it is no longer just about e-health but more about connecting healthcare—creating a collaborative industry among clinicians who have multiple specialties and cooperating across professional, organisational, and budgetary boundaries. Unless a plan arises for connected health, the opportunities currently available will pass, as will the benefits. New tools are beginning to offer true connected health capabilities, such as the Map of Medicine (www.mapofmedicine.com), developed in the United Kingdom, which combines best practice patient journeys, clinical evidence and public and private health knowledge.
The divorce of health and care
As the world’s population ages and chronic or long-term disease becomes more prevalent, traditional models of health and social care will need to change. Today, all too often the responsibilities for chronically ill people moving in and out of hospitals are split between local government, social care and healthcare organisations. At the boundaries of this infrastructure lie significant problems with continuity of care, funding, and case management. For example, in Europe, a hospital has discovered a way to support patients at their homes using remote medical devices and video monitoring. Patients leave the hospital up to 10 days earlier than normal, but as soon as they are discharged, the hospital ceases to be paid for the patient’s treatment.
Furthermore, the healthcare system will not be able to afford to treat all diseases from which the ageing population might suffer. Prevention must become the norm—not only through preventive treatments, but also through education to help people change unhealthy lifestyles, such as smoking, that lead to disease. These changes are fundamental to the organisation of care and to the information tools used to help citizens take responsibility of their health.
Increasingly, as we focus on health and prevention, the degree to which individuals can avoid disease will be driven by the services available to them, or that they can afford. In the future, more and more devices and information-based services will become available to help people avoid or manage disease, including wearable or implantable devices and smart clothing to monitor body functions.
The availability of services to health consumers will again change expectations regarding service levels people should receive from their care organisations when they move from health to care. This will dramatically increase the pool of available data on which their care can be planned. There will be far reaching implications, however, for having so much information about an individual’s health. For example, today, if someone suffers a sudden heart attack on the street, the ambulance and hospital do their best, on very short notice, to treat and save the patient. In the future, however, caregivers may have four to six hours notice of an impending heart attack—and, as a result, expectations of success will be significantly higher. The systems for notification, coordination of professionals, communications with the patient, and liability for failure in the care chain are still to be explored.
A lack of young people to care for the elderly is a major concern among healthcare organisations in much of the developed world. This concern, combined with the increasing cost of healthcare continues to erode the gap that already exists for critical resources. In addition, finding the right resources is also a significant challenge. For example, paramedics and nurses sitting in the back of an ambulance with a patient showing unusual symptoms often have to resort to paper-based lists of specialists and phone numbers when calling for help. As an example of how Connected Health might address this problem, the Map of Medicine is being further developed to contain an Expert Network capability that will potentially address both problems: locating resources and scaling their expertise. The Expert Network, accessed via the Map of Medicine on PC or mobile device, has the potential to link clinicians across organisations and professional boundaries so that the right skills are available for a given patient at the right time. Such developments will not only improve access to care, but will also reduce the cost of care, stretching the impact of skilled resources beyond the normal geographic or organisational boundaries.
The future potential of the human network and Connected Health is vast. However, the biggest challenges will occur not at a technical level, but in supporting the process, cultural and behavioural changes required to take advantage of these technological possibilities.