The Central Statistics Office estimates the proportion of people aged over 65 will increase two-fold in the next 30 years. In the future, frail older people are less likely to be supported by family. This will stretch services, pensions and healthcare budgets. We need to re-imagine health and social care models. Part of the solution may lie in the field of connected health.
If we allow it, the digital revolution will enable us leverage technological innovations to better respond to patient needs. Technology has transformed other industries but has had limited impact on healthcare. Part of the reason for this is the sense that innovation in healthcare is driven by technical possibilities rather than the real needs of patients and healthcare professionals.
Younger patients value speed, efficiency and flexibility. They will demand the same responsiveness from healthcare. They will want to participate more in their own care. Older people wish to remain well in their own homes for as long as possible. Carers want to care, but feel isolated. People want services designed around their needs, but see systems and services often designed to suit professionals.
‘A National Survey of Chronic Disease Management in Irish General Practice’ highlighted weaknesses in chronic disease management (CDM) in Ireland. Only 5.5% of surveyed GPs thought the current system worked well. While there seems to be a consensus that the best place for chronic disease management is within primary care, it needs to be within an alternative version of primary care, which is appropriately funded, and where primary care teams function properly, unhindered by bureaucracy.
The term ‘connected health’ describes a technology-enabled model of healthcare delivery. The key stakeholders – patients, GPs, specialists, public health nurses and pharmacists – are connected through a health portal ensuring efficient flow of information. Through remote monitoring, patient data is collected, stored, analysed, monitored and transformed into pertinent actions, allowing the physician to proactively manage the patient, intervening earlier, and more simply, preventing acute decompensations and avoiding admissions. The patient is at the centre of this.
They access the health portal, and participate in their management. Through education and feedback on their health status, we enable patients to make healthier lifestyle choices and to take better care of themselves.
Remote monitoring is a key element of connected health. Data collected will include results of biomedical tests, and subjective reports of symptoms or health-related behaviours. Advances in wearable, mobile and ambient sensor technologies means passive harvesting of large volumes of data. Analysis and interpretation of these large datasets will underpin future proactive chronic disease management, and inform policy.
Irish general practice is beginning to engage with this development and includes work carried out by Prof Andrew Murphy and Dr Liam Glynn at NUI Galway as part of an international trial providing sustainable healthcare to rural areas through use of video-conferencing and internet/smartphone based self-management.
A further Irish GP example of this is the use of machine language to analyse verbal clues in telephone surveillance of very frail elderly patients, feeding this directly back to GP surgeries via their co-op – the PaJR System in K Doc.
Key issues need to be resolved. Are we in general practice going to remain in professional mourning for the Celtic Tiger economy, or are we going to put ourselves at the edge of technological change for the benefit of our patients?
Questions include: who ‘owns’ big data and controls the health portal? A patient-controlled portal may mean that we would be invited to access the portal. How would this sit with our position as custodians of patient medical records? In such a system, who would vouch for data accuracy? Should patients have access to doctors’ notes on the portal? Will connected health improve outcomes?
A study on these issues is being carried out at Applied Research for Connected Health (ARCH) centre at Nexus UCD, the UCD industry partnership centre. The ARCH team is implementing and evaluating a connected health solution in the dementia care pathway as part of a pilot project. GPs in the catchment areas are selecting patients for inclusion. The aim will be to evaluate usability and acceptability of Connected Health for each of the stakeholders.
People are now more informed about their own health, and we must support this, facilitating access to their medical records, directing them towards reliable information, and encouraging their participation in tailored online programmes. Timely sharing of pertinent information between primary and secondary care means more time is spent talking, reassuring, directing, explaining, anticipating and examining. Delegating more to technology means more time for us to do what technology can never do.