1. Information and Communications Technology in the NHS Transforming the Patients Experience of Care European Commission Alasdair Liddell – Kings Fund 20 th July 2010

2. Two studies Fathom Partners for OfCom (March 08) : –What will the health sectors requirement for wireless spectrum be in 20 years time? –Scenario planning project –ofcom.org.uk/research/technology/research/sectorstudies/health/ ?What If! Innovation for the Kings Fund (Nov 08) : –What are the barriers to delivering the best scenario from the OfCom report, and how might they be overcome? –kingsfund.org.uk/research/publications/technology_in_the.html 16 February 2014Alasdair LiddellPage 1

3. Definitions 16 February 2014Alasdair LiddellPage 2 My focus today is consumer-facing technology Technology enables, but the real issue is innovation Innovation = invention, incubation, adoption, adaptation and diffusion The NHS is very good at invention but very poor at diffusion To realise the full benefits of technology, there almost always have to be fundamental changes in ways of working, roles and service models

4. Healthcare is lagging behind other sectors in its use of consumer-facing technology There are significant economic, clinical and quality benefits from greater use of technology But there are also significant barriers to technology uptake in healthcare What needs to be done? Some ideas… But its difficult. What do you think? Key Points 16 February 2014Alasdair LiddellPage 3

5. Other sectors use of technology Shopping Banking Holidays, travel Entertainment Information Social networking iPod apps etc 16 February 2014Alasdair LiddellPage 4

6. Individual – anywhere Home Ambulance Hospital / GP surgery 1. Healthcare technology applications Settings for ICT applications 16 February 2014Alasdair LiddellPage 5

7. GPS location monitoring E-health record access In-body drug delivery SMS pharmacy location Appoint- ment reminders Medication reminders Digital health info including P2P networks Fall alarms 1. Healthcare technology applications Individual – Anywhere Applications 16 February 2014Alasdair LiddellPage 6

8. Triage sensors Paramedic PDAs Video conferencin g The interfacing of a patients record and / or Body Area Network to equipment associated with the ambulance or onwards to a distant location (e.g. hospital) 1. Healthcare technology applications Ambulance Setting Applications 16 February 2014Alasdair LiddellPage 7

9. Home hub and sensors Visiting doctors bag Interactive computerise d therapy Video conferencing 1. Healthcare technology applications Home Setting Applications 16 February 2014Alasdair LiddellPage 8

10. Vital sign monitoring at the bedside RFID tracking Room clean sensors Video conferencing Remote presence robots in-body sensors E-health record access Patient internet access 1. Healthcare technology applications Hospital, Polyclinic, GP Surgery 16 February 2014Alasdair LiddellPage 9

11. Better clinical outcomes Achieved through: Increased patient engagement Better continuity of care Reduction in medical errors Emphasis on prevention and healthy living Health information web sites and devices (e.g. nutritional scanners) help consumers make better decisions about living healthily Telecare and telehealth prevent unnecessary interventions Improved patient experience Improved access to information Administrative and transaction tasks are easier Monitoring and alarm devices can help people sustain an independent life at home 3. Key benefits Benefits of technology adoption 16 February 2014Alasdair LiddellPage 10

12. Benefits to society Improved health in society = more economically productive society More efficient use of resources – benefits health service, patients and society Enables care closer to home Effective use of information and technology brings peace of mind to patients, family and carers Meet challenges faced by the health sector More demand for health services – changing demographics Technology enables more efficient use of resources Clinicians can treat a larger number of patients (e.g. videoconferencing, telecare) 3. Key benefits Benefits of technology adoption 16 February 2014Alasdair LiddellPage 11

13. Product development and marketing Implement- ation Use by consumers Decision to purchase Idea Decision to develop Decision to use Suppliers Commissioners and consumers 4. Technology adoption process Decision pathway for technology adoption Clinicians and consumers 16 February 2014Alasdair LiddellPage 12

14. 4 models for technology adoption Consumer awareness and understanding Consumer concerns Consumer activism and empowerment Demographic changes Internal factors Policy Structures to encourage adoption Procurement and decision making Information sharing Leadership Resources: funding and people Trials and assessment Decision to develop Demand 4. Technology adoption process Factors affecting technology adoption External factors Technology standardisation Engagement between suppliers and NHS Investment case Funding Supply Decision to buy Decision to use 16 February 2014Alasdair LiddellPage 13

15. 5. Barriers to adoption 16 February 2014Alasdair LiddellPage 14 The barriers to adoption Lack of (the right kind of) national leadership Few incentives for clinicians and commissioners to adopt technology The NHS is difficult to sell to Costs and benefits fall in different places Procurement is often least cost, not best value The change management consequences are disruptive

16. 5. Barriers to adoption 16 February 2014Alasdair LiddellPage 15 Case study - Warfarin 1m people on long-term anticoagulation therapy Control of this therapy requires 4-6 weekly blood tests, and adjustments to dosage, requiring visits to hospitals or clinics A self-monitoring device has been on the market in the UK for 16 years, but only 18,000 are in use This means that 98% of the anti-coag population are submitting to hospital/clinic tests Self-monitoring is clinically more effective, more convenient, and probably cheaper

17. 5. Barriers to adoption 16 February 2014Alasdair LiddellPage 16 Why? Not enough focus on the total patient experience? Misguided reliance on push strategies –web-sites and other information sources arent sufficient to ensure diffusion –There is no incentive for inventors to disseminate and sell-in their innovations Pull strategies require system incentives to be in place

18. Our recommendations Leadership from the centre, and locally –Actively to encourage, support, enable and reward –Technology needs to be integral to policy development –Procurement procedures need to be changed –More coordination between national agencies and budgets Convenience is an outcome – measure it! Links with and advice to industry to help them make the compelling case Create consumer demand Target the most likely consumers first 16 February 2014Alasdair LiddellPage 17

19. NHS Financial Context The financial challenges facing the NHS may provide a stimulus for a more entrepreneurial approach to innovation Will the financial pressure be enough to motivate commissioners and clinicians to pull innovations into their own care setting? Will the system allow the necessary tolerance of failure that is an inevitable part of innovation? The key interfaces for maximum benefit are hospital/community, health/social care and patient/system 16 February 2014Alasdair LiddellPage 18

20. What do you think? Alasdair Liddell alasdair@aliddell.com 16 February 2014Alasdair LiddellPage 19