Digital Health: Understanding the healthcare and technology challenges
Andy Wilkins
Independent healthcare consultant
1
My health Background Highlights
NHS• Co-authored “Digital First” report for NHS England
• Co-authored “The Future’s Digital” mental health report for NHS Confed + NHS England
• Co-authored mHealth report for NHS England
• Innovation model recommendations for NHS/private sector collaboration
• Patient Experience research & innovation report for Royal Free Hospital
Private Sector• Diabetes Patient & clinical needs research & report for Sanofi Aventis
• Health market assessment & recommendations for O2 Health
• Interim head of eHealth strategy for Bupa– Corporate employee health & wellbeing service design (behaviour change) - Bupa
– Market needs analysis for pregnancy and early stage motherhood – Bupa
– Market opportunities analysis for aged care – Bupa Care Homes
Andy Wilkins – Health 2.02
Agenda
1. Background
2. Healthcare market size and trends
3. Digital healthcare challenges
4. Key opportunity areas
Andy Wilkins – Health 2.03
Healthcare $6.5tn – welcome to biggest show on earth!
Total spend on healthcare is almost 10% of OECD GDP!
• Around 70% of health costs are due to preventable conditions
• Controlling healthcare costs is one of the biggest challenges for 21C!
Andy Wilkins – Health 2.04
Why are health costs continuing to rise?
1. Rise in Chronic disease (Lifestyle related)
• Obesity (26%)
• Diabetes (5.5%)
• Heart disease (4.4%)
• Cancer
• Mental health
2. Aging populations
• Longer life spans
• Changing demographic mix
3. Rise in medical costs
• Medical technology
• New treatments
Andy Wilkins – Health 2.05
Today most healthcare spend is focused on sickness..
Healthy/low risk At risk
High risk
Chronic Disease early stage
Acute Disease
Chronic Disease
Progression
End of Life care
Healthcare Cost
CostValue
20% of population generate 80% of healthcare costs
Healthcare Status
Preventing sickness Treating sickness
Andy Wilkins – Health 2.06
Wholescale business model change is required…
350m consults/yr£50/consultation
£25/consultation
Nursing care
Innovation needed to transfer diagnostics & treatments to lowest cost point of delivery
Increasing cost & finite resources
42.5k GPs 358 NHS hospitals356k Nursing/Healthcare visitors
80m consults/yr£250/consultation
60 Million People
Traditional healthcare Primary care
Secondary care
Digital healthcare
mHealth Opportunity• Telehealth• Monitoring• Personalised
medicine• Preventative care
Smartphones & IoTMonitoring Devices
Electronic Health Records & Care Pathway workflow
Andy Wilkins – Health 2.07
“You‘ve got to start with the customer
experience and work back toward the
technology - not the other way around.”
Steve Jobs
Technology as an enabler not a solution - Apple
Andy Wilkins – Health 2.08
Understanding what patient experiences to create is not easy….
What?
Who?
When? 9
Designing Digital healthcare solutions
Understand the ecosystem context
• Who are the players and what does good look like for them?
• How will they measure success?
Understand the Patient’s context
• What value will they get from the solution (could be different from clinician’s)
• In what contexts will this be used?
• Do you understand the patient journey – physical, cognitive and emotional
• What usability issues need to be considered
Understand the clinical context
• What are the outcomes that define success?– Clinical outcomes
– Care pathway measures
– Economic
– Technical
Wellness Prevention (at risk)
Diagnosis Treatment
Healthcare providers & Regulators
Healthcare Payers & InsurersLifestyle, Fashion & Wellbeing
brands
Health Service Providers
Andy Wilkins – Health 2.010
Modifying behaviour is harder than the technology!
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Mental
Physical
Environment
Financial
Social Life
satisfaction
Intellectual
Behavio
ur
Change S
trate
gie
s
Personal
Wellbeing • Diet & nutrition• Exercise• Substance abuse• Disease management• etc
• Mental health• Stress• etc
There is now compelling evidence to show that people do not make rational decisions
to improve their health & wellbeing…. mHealth providers need to use new techniques
MINDSPACE
Messenger We are heavily influenced by who communicates information
Incentives Our responses to incentives are shaped by predictable mental shortcuts such as strongly avoiding losses
Norms We are strongly influenced by what others do
Defaults We go with the flow or preset options
Salience Our attention is drawn to what is novel & seems relevant to us
Priming Our acts are often influenced by sub conscious cues
Affect Our emotional associations can powerfully shape our actions
Commitment We seek to be consistent with our public promises and reciprocate acts
Ego We act in ways that make us feel better about ourselves
Andy Wilkins – Health 2.0
The explosion of wearable sensors will create a revolution through passively recording and monitoring health & physiological data
Primary Care
A&E
Secondary Care
Nursing Care
Health information
Public Health
Pharmacists
Social Care
Health Insurance
3rd Sector Support
Fragmented data held by health system silos
The transactional patientThe quantified selfHealth & Wellbeing Behaviour Tracking
Physiological Tracking
EHRMy
data
Andy Wilkins – Health 2.012
There are ecosytem barriers to widescale adoption…
Wellness Prevention (at risk)
Diagnosis Treatment
Medical device, pharma & content providers
Developers & ICT industries
Digital Health Solutions
Healthcare providers & Regulators
Healthcare Payers & InsurersLifestyle, Fashion & Wellbeing
brands
Lack of mHealthskills
Health Service Providers
Constraints & Enablers
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Opportunity Areas
Andy Wilkins – Health 2.0
1. Aged Care2. Outpatient care
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Senior person
Their family & support network
Aging Journey End of life
Their medical provider
Self sufficiency
Reliance on supporting services
Living at home Support at home Assisted living Care home
Digital & Telehealth service opportunities
Market opportunity – 10m 65+
2. Medical Support – managing my condition
3. Wellbeing Support – living well
1. Care Support – looking after myself
There are huge opportunities in aged healthcare
Andy Wilkins – Health 2.015
• The Royal Free Hospital serves 500k outpatients per year• They new their patient experience was poor• We were asked to research the patient journey & make recommendations
The Royal Free Hospital in NW London
The Royal Free has an ambition to become a world class hospital
Players in the healthcare system are now aware they need radical change in order to achieve their objectives
Andy Wilkins – Health 2.016
Deep dive patient research which enabled us to identify over 400 needs along a structured customer journey
Backstory Appointment journey
How they felt about their experiences
What else could make a
difference
Patient Interviews1. Conduct patient interviews & observations
ContextsFunctional
needs
Emotional
needs
Wider support
needs2. Interview analysis to extract
needs & experiences
Contexts
Functional
needs
Emotional
needs
Wider support
needs
Contexts Functional
needs Emotional
needs Wider support
needs Contexts Functional needs
Emotional needs
Wider support needs
Contexts Functional
needs
Emotional
needs
Wider support
needs
Contexts Functional needs Emotional needs Wider support needs 3. Collate multiple interviews to
build end to end outpatient experience journey
4. Analyse patient experience needs to create solution ideas
Over 400 needs
Andy Wilkins – Health 2.017
Research revealed that the patient journey is broken with many disconnected experiences – lots of opportunity!
PRE-CONSULTATION POST CONSULTATIONCONSULTATION
Referral DischargePre-appt Travel Arrival Clinic time
travel Post-appt
Visit a GP due to health issue
Obtain a referral Find out more about my condition
Prepare for my appt Travel to my appt Arrive at hospital
Determine location, proceed to clinic
Arrive at clinic, register for appt
Wait for appt
Meet doctor for appt
Test / procedure
Obtain advice / follow on appt
Onward travel Manage condition Obtain a discharge
Significant numbers of patients are being referred unnecessarily clogging up the system
Patients need and want more information to help them plan & prepare for their appointment visits
There are multiple issues around directions, travel planning & parking that cause significant frustration & difficulty to patients who are ill
First impressions are chaotic and unwelcoming and hospital navigation is confusing
Waiting is key frustration for patients with many clinics offering a dingy, overcrowded & poor experience
Testing & consultation procedures often involves more waiting & queuing
Consultation templates of fixed lengths often lead to rushed appointments & patients feeling unable to express themselves or unclear on doctor explanations & instructions
Limited information & support for ongoing patients leads to poorer condition management & outcomes + greater readmission rates
Inconsistent discharge procedures lead to unnecessary follow ups that further clog the system
Overbooking leads to significant delays in availability and appointment choices impacting patient outcomes and convenience
Andy Wilkins – Health 2.018
Research from Kaiser Permanente shows that outpatients spend 0.01% of their time with doctors & 99.99% on their own
PRE-CONSULTATION POST CONSULTATION CONSULTATION
Referral Discharge Pre-appt Travel Arrival Clinic time travel Post-appt
My Life
1. Visiting the hospital
2. Managing with a medical condition
Patients receive minimal support at the time they most need it!
This is where health happens!
Andy Wilkins – Health 2.019
PRE-CONSULTATION POST CONSULTATION CONSULTATION
Referral Discharge Pre-appt Travel Arrival Clinic time travel Post-appt
My Life
1. Visiting the hospital
Understanding & ownership of
my condition
• Understanding my condition/ treatment• Personalising my care plan• Taking ownership of my condition/
self management
Managing my treatment & my
condition
• Support for managing my condition• Obtaining support from family for managing my condition• Support from other patients for managing my condition• Monitoring my condition
Obtaining support from my
doctor & care team
• Communication access to my doctor & clinic teams
Carrying out tests &
obtaining supplies
• Undertaking repeat tests & procedures
• Obtaining repeat medical supplies
Support for medical queries
and emergencies
• Medical queries• Emergency support
Managing & coordinating my
appointments• Coordinating & managing my hospital appointments
Huge “white spaces” exist in the patient’s world where personalisedinfo & tools would provide significant help & improved outcomes
2. Managing with a medical condition
Andy Wilkins – Health 2.020
I will leave you with an important medical tip…
“Never under any circumstances take a sleeping pill and a laxative on the same night.”
Andy Wilkins – Health 2.021