andy wilkins presentation iot midlands oct 2014

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Digital Health: Understanding the healthcare and technology challenges Andy Wilkins Independent healthcare consultant 1

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Page 1: Andy Wilkins Presentation IoT Midlands  Oct 2014

Digital Health: Understanding the healthcare and technology challenges

Andy Wilkins

Independent healthcare consultant

1

Page 2: Andy Wilkins Presentation IoT Midlands  Oct 2014

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

Page 3: Andy Wilkins Presentation IoT Midlands  Oct 2014

Agenda

1. Background

2. Healthcare market size and trends

3. Digital healthcare challenges

4. Key opportunity areas

Andy Wilkins – Health 2.03

Page 4: Andy Wilkins Presentation IoT Midlands  Oct 2014

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

Page 5: Andy Wilkins Presentation IoT Midlands  Oct 2014

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

Page 6: Andy Wilkins Presentation IoT Midlands  Oct 2014

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

Page 7: Andy Wilkins Presentation IoT Midlands  Oct 2014

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

Page 8: Andy Wilkins Presentation IoT Midlands  Oct 2014

“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

Page 9: Andy Wilkins Presentation IoT Midlands  Oct 2014

Understanding what patient experiences to create is not easy….

What?

Who?

When? 9

Page 10: Andy Wilkins Presentation IoT Midlands  Oct 2014

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

Page 11: Andy Wilkins Presentation IoT Midlands  Oct 2014

Modifying behaviour is harder than the technology!

11

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

Page 12: Andy Wilkins Presentation IoT Midlands  Oct 2014

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

Page 13: Andy Wilkins Presentation IoT Midlands  Oct 2014

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

13

Page 14: Andy Wilkins Presentation IoT Midlands  Oct 2014

Opportunity Areas

Andy Wilkins – Health 2.0

1. Aged Care2. Outpatient care

14

Page 15: Andy Wilkins Presentation IoT Midlands  Oct 2014

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

Page 16: Andy Wilkins Presentation IoT Midlands  Oct 2014

• 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

Page 17: Andy Wilkins Presentation IoT Midlands  Oct 2014

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

Page 18: Andy Wilkins Presentation IoT Midlands  Oct 2014

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

Page 19: Andy Wilkins Presentation IoT Midlands  Oct 2014

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

Page 20: Andy Wilkins Presentation IoT Midlands  Oct 2014

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

Page 21: Andy Wilkins Presentation IoT Midlands  Oct 2014

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

Page 22: Andy Wilkins Presentation IoT Midlands  Oct 2014

2222

Thank you…..

Andy Wilkins

+44 (0) 7713 266626

[email protected]

Andy Wilkins – Health 2.0