The Royal Society of Medicine’s Telemedicine & eHealth Section held its annual conference at the end of November, on the topic of how technology can help people age well. As the organiser I was not able to be in every session, so the following are the highlights of what I was present for. Many people commented that the quality of presentations was extremely high; feedback was very good.
Baroness Masham of Ilton opened the conference describing loneliness as one of the challenges of ageing well.
Jon Rouse, Director General for Social Care, Local Government & Care Partnerships, Dept. of Health, continued the theme explaining that older people will increasingly want to continue earning money and play a full role in society: the antidote to loneliness. He mentioned that an increase from 8m to 14.5m of people over 65 will increase government spending on those 65+ to some £25b by 2020. His overall presentation themes were: prevention, information, integration, research & housing. He was concerned at underrepresentation of older people in mental health provision including IAPT. He ended by throwing out a challenge to the conference: “How can technology simultaneously empower the patient and support the care worker?”
Dr Alfa Sa’adu, Consultant Physician, Dept. of Medicine for Older People, Ealing Hospital NHS Trust, gave a very accomplished and humorous presentation on the challenges of ageing well.
Dr Mary Baker, President of the European Brain Council, began by quoting Peter Peterson: “probably 2/3rds of the people in the world who have ever reached 65 are alive today”. One particularly alarming statistic she quoted was that 62 of 90 prescription medications ordered online were found recently by the MHRA to be counterfeit.
Dr Martin Johnson, Director of the Thalidomide Trust, explained that the cost of a hospice inpatient bed is £4000/wk., whereas the cost of hospice at home & telemedicine is £700/wk., & the gap is widening: the conclusion is obvious. Hospices need to continue innovating, deploying technology and respecting patient preferences, “or die”. His colleague Elizabeth Horak, Consultant in Palliative Medicine, Hillington Hospital, said they were looking at the introduction of telehospice as a tool. They need to shift the philosophy of End of Life care such that it is much more home-based.
Halima Khan, Director of the Public Services Lab, NESTA, explained that the three main steps to using technology to help people age well were first to change the system from fighting infectious diseases to managing long term conditions, then to introduce technology, and finally to socialise that technology. The different types of innovation that emerge from systems thinking can be categorised as product/service, market, political, cultural – we need to think about them all. We can see health systems through different lenses: networks (using the power of social networks), as social relationships (collaborative scripts), and as knowledge.
In identifying how best to help people with dementia, Prof June Andrews, Director, Dementia Services Development Centre, University of Sterling, offered three levels of evidence: proper research, extrapolation from sensory/physical impairment, and international expert consensus. People with dementia move faster on smooth, unpatterned, surfaces – as many patients have dementia, all hospitals should be dementia-friendly. She stressed that the unwillingness of NHS England (vs other parts of UK, dramatically illustrated with a coloured map showing relative percentages) to diagnose dementia meant that it is harder to prioritise management. Most important is to help people with dementia to stay in their familiar environment – if there is a carer at home, the probability of someone with dementia being institutionalised is reduced by a factor of seven.
Professor Clive Bowman, School of Health Sciences, City University, London, quoted some research done at BUPA care homes that had found that whilst the temperature in their homes is kept constant throughout year, deaths in their care homes are closely inversely correlated with external temperatures. In discussing how technology can help, he explained how tools like uMotif can promote a different way of delivering care. He sees a huge opportunity to use telesurveillance to manage home-based and care home care as staff represent some 65% of total care cost. “We must move from just doing what’s always been done differently to doing different things, particularly in ageing”
Dr Richard Genever, Consultant Physician & Movement Disorders Lead, Chesterfield Royal Hospital, gave an excellent summary of the many technology resources available to help people with Parkinson’s, including both applications and social media. He observed that over three quarters of Parkinson’s forum posts are about connection with others suffering similarly (the remainder requesting information). (GMC & BMA guidance is not to accept patients as Facebook friends – professionals should point them to their professional online presence if they have one.) Finally he stressed the importance of patient information providers updating Wikipedia to ensure it is relevant and correct.
Dr Alf Collins, Consultant in Pain Management, Musgrove Park Hospital & National Clinical Lead, Co-Creating Health, the Health Foundation, gave some evidence from Somerset that inpatient costs rise exponentially with the number of comorbidities, whereas social care costs rise far less dramatically. Health coaching is about an attitude – we need to tap into the patient’s view: usual care is self-care
On the second day, Dr Adam Darkins, who established the largest telehealth programme in the world for the Dept. of VA, although here speaking in a personal capacity, commented that many technologies such as video are old & have yet to make the changes in care treatment expected – they will! He emphasised that Interoperability must cover technology AND clinical process. He commented that the increasing technological ability to deal with acute events in the home creates new challenges of whether/how to do. The importance of mHealth is that everyone is a node on the network, receiving device agnostic services using their hardware of choice, and apps. Better networking combined with big data will greatly enhance the effectiveness of remote patient monitoring. The ability to look at the natural history of diseases, and ageing process, through large scale data collection will improve understanding. One of his most important conclusions was therefore that knowledge management will result in a different type of, larger, organisation delivering care; the devices used will be less important.
Dr Mohammad Al-Ubaydii, CEO & Founder, Patients Know Best, offered his experience that older people have better IT skills than middle-aged people, including doctors, who can project their own lack of skills on to others. He dismissed the “autocratic approach” of each older person having a named GP: it did not scale 10 years, will not scale now. He suggested that the only way of scaling up integrated care is to use patient controlled medical records.
Lord and Lady Swinfen, Directors of the Swinfen Charitable Trust, gave an excellent presentation on using telemedicine to connect sick people in developing nations to medical specialists. They had some very heartening (and some very sad) tales to tell.
Gerard Bowden, Clinical Facilitator, Coordinate My Care (“CMC”), The Royal Marsden, spoke about how CMC encourages professionals to coordinate with each other to share a single palliative care plan. It is web-based, so there is no need for additional software. Currently they use N3 for security, though a non-N3 version is being developed to involve more professionals. CMC drivers include an advance care plan for more patients, & support for preferred place of dying.
Andrew Canon, Managing Director, BUPA Care Services explained that people are postponing entry to care homes vs previously so they come in with more serious conditions. BUPA is using technology to liberate care home staff from bureaucracy to provide better care. Where EHRs have been introduced in BUPA care homes, it has resulting in many more frequent, smaller, updates – relatives perceive more staff being employed, though there has been no actual change. He highlighted the business case challenges to make technology mainstream – must change previous ways of working. (During his talk, a person in the audience tweeted that: “BUPA Telecare pilot done with only 30 people. Very similar to NHS pilots, benefits won’t be seen unless they’re done at scale”).
Dr Frank Miskelly, Care of the Elderly Section, Dept. of Medicine, Imperial College, London, quoted the use of telemedicine by trained technicians to prioritise attendance at dermatology clinics. He also remarked that “nearly all radiologists work from home now” because of high quality networks/telemedicine.
Jonathan Burr, CEO, Intelesant, explained that big data analyses are a major challenge in health because of restrictions arising from eg the IG Toolkit and data ownership
Professor Jonathan Kay, Clinical Informatics Lead, NHS England, commented that “We’re not so technology limited as we are organisationally limited”
Terrence Lewis, Associate counsel, University of Pittsburgh Medical Centre & Chair of the Centre’s Enterprise Telemedicine Oversight committee talked about how the law is behind practice. The best example of this is the need for many national & international licences to practise cross-border telemedicine
Dr Martin Vernon, Clinical Director, University Hospital of South Manchester, observed that over 1m people 65 or over are still working in UK: age alone is a poor measure of burden. We can use technologies to reconfigure the way we deliver care in order to respect the person better. Exercise is the best intervention if you can catch people early enough in their frailty progression
Rabbi Yehuda Pink gave an excellent, humorous, talk on recognising the spiritual needs of ageing and emphasising the benefits to aging well of people having a purpose in life, & exercising. He commented that material needs and spiritual needs are inseparable. “If we feel we have a purpose in life, then old age is a blessing” if not, old age can become a burden. Other quotes include: “Research suggests that attention to religious & cultural needs…can contribute to their wellbeing”; “A key element in enabling a person to age well is ensuring they feel needed”; and “Technology is God’s gift to humanity to improve our quality of life”
Robert Madelin, Director General for Communications Networks, Content & Technology, European Commission kindly closed the conference by video: talking about the importance of experimentation he warned “Be careful not to regulate the future as the past”
Note, except where a presenter specifically refused to give permission, every presentation was videoed. These videos will be viewable via the Telemedicine & eHealth Section’s microsite on the RSM’s website when processed.