A trio of September meetings

AAL/Bucharest, The Guardian and Kings Fund

As previously highlighted on Telehealth & Telecare Aware, last week was indeed the week of connected health events. This editor made it to three:

AAL/Bucharest

As very much of a supporting act – presenting to researchers on how to do business with the different health organisations across Europe – my principal challenge was getting to the city after the ‘information’ kiosk in the airport told me the hotel I was booked into didn’t exist. Thankfully they were wrong. What I saw of the conference looked good, though there were some bizarre rules on who could have free WiFi.

The Guardian

Wednesday evening brought the Guardian information sharing event which proved especially interesting. The official write-up is here. Top of the bill for me was Adam Steventon who as one of the key researchers working on the WSD has seemingly had an endless supply of cold water to pour on hopes of good positive outcomes. This time though his tune had changed, and he stressed the complexity of technological interventions and the shortcomings of the assessment methodology. Mark Davies of Medeconomics gave an excellent presentation too in which he stressed that the NHS needed to bring together the two streams of information it currently keeps separate, on clinical and financial outcomes, in order better to develop a coherent approach to delivering excellent yet affordable healthcare.

Kings Fund

On then to the first day of the Kings Fund International Digital Health & Care Congress which was afternoon-only. Most notable was the presentation of an app to improve information transfer in hospitals on handover. Clearly very well thought through, though still at the design stage, this app demonstrated vividly the importance of organisations such as DHACA (of which this editor is Managing Director) which are seeking to share information on what is already being developed, as this must be at least the fifth such patient handover app I have had presented to me over the years.

On the second day, when there were many more delegates, I sensed both a different audience and a different tone at this year’s renamed event, compared with last year. Many of the traditional  suppliers appeared to be absent – Medvivo, Docobo, Tunstall. etc. Where there was a presence, it was often without a stand and sometimes brief (eg Safe Patient Systems, Welbeing). At the same time there seemed to be many more clinicians around and a focus on the hard stuff of proven outcomes. The quality of presentations continues to rise – even the unashamedly commercial breakfast presentations by main sponsors Medtronics (disclosure: in which this editor holds a few shares) and Philips (on the third day) were extremely informative and of very high quality, particularly the latter, in which Prof Stan Newman gave an outstanding presentation on lessons from the WSD (see below).

Standout presentations included:

A trio of three excellent presentations on Technology Enabled Care Services, moves towards a paperless NHS, and dallas by Cathy Hassell, Paul Rice and Hazel Harper/Marilyn McGee-Lennon respectively got the second day off to a great start. Prof Chris Ham, summarising, commented that there is a challenge for evaluators when medical technology is advancing so rapidly: the danger is of only measuring by looking in the rear-view mirror

Dr Kathleen Frisbee of the Department of Veterans’ Affairs gave a most interesting account of attempts to alleviate the burden on veterans’ carers using a suite of apps which initially failed to show a significant benefit. One intriguing comment was that spouse caregivers were 2.4 times more likely to use the apps than non spouses. Particular issues were the short time for the trial (three months) and a combination of problems many people had using iPads or accessing the apps. Thankfully they are persevering as this felt to be very worthwhile.

Sian Jones, Head of Service Improvement at Bristol CCG, presented very well on the challenges of achieving a large scale telehealth rollout – clearly the CCG considers it a success as they have just extended Safe Patient System’s original three year contract for a further year. Nothing was a particular surprise in the challenges encountered, although the opposition by clinical staff did at times take one’s breath away. As the person who prepared the original business case for the project (as a private contractor), it gave me the satisfaction of seeing proposals I made delivered, and forecast outcomes largely achieved; a great treat.

On the third day, Prof Stan Newman’s breakfast presentation was one of the high points of the conference, as the approach to the WSD he took was very different from before – for example he began by saying that had future decisions as to whether heart transplants should be carried out been made on the basis of the outcome of the first heart transplant (where the patient very sadly lived for only a few days), then heart transplants would not be the life saver they are today; likewise remote patient monitoring should not be judged solely on the outcomes of the WSD. “Does telehealth work?” is not the right question he said, because it is often a small part of the overall change in the way care is delivered.

Tantalisingly he again showed a slide giving a breakdown of the outcomes for the three diseases covered by the WSD which, colleagues confirmed, has not yet been published. In terms of hospitalisations avoided, this shows a significant benefit for CHF, a lesser benefit for COPD and nothing significant for diabetes. However careful analysis of the diabetes results does show a very significant although small improvement in HbA1c which if maintained for more than the year of the study should result in a significant reduction in complications in future years. In other words the outcomes for all three diseases were good, although not directly additive.

Let us hope that this new framing of the WSD will continue in the report that is to be delivered to the DH this autumn and in the three remaining WSD papers that, if I heard right, are still being peer-reviewed prior to publication.

In the plenary sessions, Ali Parsa gave another outstanding & entertaining presentation on Babylon, and in the breakout session I chaired, both Rowan Pritchard-Jones (Mersey Burns & other apps) and Tim Knowles (Imperial) gave fascinating presentations.

The day ended with an excellent presentation by Ray Hammond, a futurologist, who suggested that there were five major forces that would affect healthcare in the next 15 years:

1. Genomics/DNA profiling – resulting in much more personal medicine, and individual treatments for diseases involving DNA damage;
2. Stem cell – enabling the repair/growth of spare human organs that no longer require immunosuppressive drugs for transplant;
3. Nanoscale interventions – for example to deliver drugs to a specific spot, or to effect a change;
4. Mobile/digital healthcare – the topic of this conference
5. Robots – such as those able to perform diagnosis, determination of best treatment plan and monitoring, taking over a significant portion of a current GP’s role.

On the mobile/digital healthcare theme, he suggested that as with wireless sets and horseless carriages, calling communicators ‘mobile phones’ immediately limited the imagination. He saw them getting more and more powerful and smaller and smaller – for at least another 20 years, to the point where they became implantable and able both to monitor our bodies (‘bodynets’) and to communicate with the outside world, providing, for example, real-time translation of other languages. He suggested that prompted by such devices, at least 40% of the population would be prepared to take much greater responsibility for their own health.

He mentioned Ray Kurzweil and the concept of the coming singularity, after which the rise of machine intelligence above human intelligence would render all predictions meaningless, as mentioned previously here. He ended his presentation by posing the linked questions: “If there came an indication from deep space that there was a fleet of aliens that were expected to arrive on earth by 2040, would not all governments in the world be getting together to decide how to deal with their arrival? Why therefore is no one taking this approach to what will essentially be our home-grown aliens following the singularity?” (Note Ray puts arrival of the singularity at 2030, so even less time).

A more detailed summary of the proceedings at the Kings Fund is here, and Mike Clark has done a brilliant job producing a full Twitter transcript here.

Meanwhile, in the press

It’s good to see that telehealth has now reached the status of being the target of The Onion, as reported by MedCity News. The supreme irony of their take-off of course is that there are apps, using CBT, that can be sent down the line electronically that can reduce the impact of pain – you don’t have to take drugs.