Technology Enabling Care Integration Professor Michael Rigby Emeritus Professor of Health Information Strategy Keele University, UK Adjunct Professor,

Technology Enabling Care Integration

Professor Michael Rigby

Emeritus Professor of Health Information Strategy Keele University, UK

Adjunct Professor, Dublin City UniversityVisiting Professor, Imperial College London

Meet a 21st. Century Older Person

Prof. Michael Rigby: Technology Enabling Care Integration - Dublin Castle, October 2015

… something about Mary

Aged 79 yearsLives alone (family

home)Arthritis (legs and

hands)Long-standing digestive

problemMitral valve leakageSmall mental lapses - ?

TIAs


Mary’s Health Support

General Practitioner – uninterested, repeat meds., nothing curable

Cardiologist – medicationOrthopod – undecidedNeurologist – unsureGeriatrician – peace

makerHome nurse – monthlyRespite care – annuallyNo coordination – family have to broker


Mary’s Holistic Needs for Health

Nutrition supportMobility supportShoppingBathing supportSocialisation opportunity

Without all of these, her health will suffer


… and her Informal Support

No childrenStepson, niece; each 90

minutes away; working

2 sisters – equally dependent, do not drive

Neighbours – elderly couples aged 70+, each husband with history of cancer


Who Manages her Health?

Health seriously compromised if not helped holistically

Health care and Social care need harmonising

Fit for ‘independent living’

Potential major risksDisease monitoring not

relevant


Test of Person-Centred Integrated Care in modern society

Mary’s Technology

Pendant alarm Safe in cupboard in case

she needs itBank card Does not use – who gets data?TelephoneCannot cope with automated menu response

How will Health IT help Mary?


Proliferation causes Problems

GP

CommunityNurse

Hospital

Care/Nursing Home

Physiotherapy

Pharmacy

Laboratory

DentistOpticianSpecialist Clinics

HealthCare

Personal Support

Housing

Community ServicesHome Safety

SocialCare

LearningNeeds

Leisure

Voluntary Services

Private sector support

Diagram after P. Hill

Chiropody


Current Organisation-based View

Provider 1

Provider 3

Patient A

Patient H

Patient Z

Patient G

Patient B

Patient C

Patient D

Patient FPatient E

Patient T

Patient V

Patient U

Patient X Patient W

Patient Y

Provider 2


Current Organisation-based View

Provider 1

Provider 3

Patient A

Patient H

Patient Z

Patient G

Patient B

Patient C

Patient D

Patient FPatient E

Patient T

Patient V

Patient U

Patient X Patient W

Patient Y

Provider 2


Holistic Client-Centric Vision

Patient U

Provider 3

Provider 1Provider 2

Electronically brokered and re-presented


Care Supported by Information

• Care is primarily given by People• They need Processes• Information supports processes

• Care teams (formal and informal) must feel integrated• Information and ICTs can be the glue


Siren Calls on ICTs for Integ. Care

1. Remote Sensing and Monitoring- Needs service change; risks electronic silos

2. Lifelong Electronic Medical Record- Has not been scoped; would swamp users

3. Trendy Wishful Thinking e.g.Review of Nursing Homes Support Scheme A Fair Deal 2015 (p65)

“Telecare services and the use of technology have been developed for some years now and may facilitate and support new approaches to care. A range of technologies and services are available. ….. Remote monitoring of health indicators, particularly when effectively linked with appropriate healthcare professionals and supported by more direct intervention when necessary, can allow various conditions to be safely managed in new ways.”

- No evidence, context or costing - pure buck-passing


Once there was Family Support


But Society has Dispersed

Smaller familiesThird level education Better skillsEconomic migrationLifestyle choices

Dissipation of the physically cohesive family


The Care Force of Modern Ireland


The Achievable Vision: E-Enabled Care to Look like This

Rules of Governance

Families

Friends and Neighbours

Health and Care practitioners

Voluntary Agencies

Private Care Providers

Consent


‘As Needed’Key Data

IntegratedPersonal Care

Mary’sE-Enabled


Are ICTs the Answer ?

• Technology can– Bring data together– Bring patient and carer into visual contact– Facilitate organisation

• Technology cannot– Make a cup of tea– Change a dressing; put you to bed– Give a hug or a kiss







2012

Learning from these Examples

• The ideas are not new• Technology has progressed• What is missing is the follow-through• The ICTs are stronger and widespread

• It is the people and process issues which no-one is tackling






Prerequisites to ICT Support

• Unique Patient Identifier– Identifies the patient – now agreed as

policy

• Data standards / semantic inter-operability– Makes sure shared data have common

meaning

• Messaging and / or Broker– Delivers, or seeks, key data to agreed

format

• Regulated Portals– Records data can be viewed or

transferred safely

• Universal Broadband / 3G– Needs to be seen as a utility like

electricity / waterProf. Michael Rigby: Technology Enabling Care Integration - Dublin Castle, October 2015

Next Step - Listen to Care Teams

• Who needs what information, when?

• Patient and Carer Choice• Plans for care, based on need and

carer need• What terms and presentation are

useful?• Balancing confidentiality, care, and

safety• Time planning (repair services can do it!)

and hours• Observation messages; urgent

messages• Acceptable and available platformsProf. Michael Rigby: Technology Enabling Care Integration - Dublin Castle, October 2015

So Why the Inertia?

• Social Science issues• Service Inversion issues• Lack of Stable Market (design and purchase)

• Need for Shared Vision, Shared Risk – – IT supplier and service provider


Three Further Challenging Points

• Must cover public and private care– There can be no partition within

Integration

• Must cover mental and physical health– Persons with chronic mental and

physical health– Mental health issues caused by illness /

caring

• Must cover children with complex needs– Parents and formal systems need

support– Conditions can be changing– Risk of normal child health care being

overlookedProf. Michael Rigby: Technology Enabling Care Integration - Dublin Castle, October 2015

Governance and Societal Issues

• Third party advocacy for citizens not able to manage their affairs or electronic systems.

• Ensuring those not digitally enabled or empowered are not disadvantaged.

• Third party issues and rights• Governance models and rules.• Education, awareness, and training

programmes.


Older People are often Troubled

• Aware of increasing limitations– Cannot do what they used to (in home, social)

• Lonely, and sometimes angry– Family have moved on; friends died or left

• Feel life has left them behind– Don’t understand modern world

• Nothing to look forward to– “It’s not getting any better”– “Not what I envisaged when I was younger”

• Bewildered, sometimes frightened– “What is going to happen next?”


The New Phone Era

• Phone apps were mini web pages• Now a new era of applications is emerging• Intuitive• Recognise user from saved log-in• Anticipate likely questions• ‘Click down’• Range of presentations and input to suit• Examples – airlines; hotel bookings


Booking.com

• Simple location / date enquiry

• From List, one click to Map

• Available (blue)• Bargains

(symbol)


Booking.com

• One click – top level information

• In natural formal

• Click another or• Click for details


Booking.com

• Nearly all items ‘clickable’ for more detail

• Slide up for more details – continuous item


Booking.com

• Click down for detail

• No technical thinking


Now Think Outside the Box

• Care partnership with informal carers

• Lead health professional as mentor / coach

• Shared key information• Secure mobile system, easy drilled

down– E.g. next appointment; report to key

worker

• Easy communication / reporting• Neither patient nor carer is alone• Data still controlled, structured,

authoredProf. Michael Rigby: Technology Enabling Care Integration - Dublin Castle, October 2015

The Achievable Vision: E-Enabled Care to Look like This

Families

Friends and Neighbours

Health and Care practitioners

Voluntary Agencies

Private Care Providers


IntegratedPersonal Care

Mary’sE-Enabled


‘As Needed’Key Data

Rules of Governance

Next Steps from Here – Innovation for Integration

• Collaborative analysis and Design• Informal Carers as People and

Partners• Partnership with IT providers• Plurality – no single answer yet• Try different ideas – active

prototyping• New governance will be needed

• Go Boldly – design 21st Century Caring !


The Final Word – from our President


The political and technical

decisions that are to be

made over the coming

months may be complex,

but ultimately the great

challenges of our time are

ethical and intellectual

in their nature.21st. July 2015, Paris, Climate Change Summit

Documents

Technology Enabling Care Integration Professor Michael Rigby Emeritus Professor of Health Information Strategy Keele University, UK Adjunct Professor,