Putting health into context (and context into health) final

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1. White Paper Jan 2015 Freddie McMahon - Director, Strategy and Innovation Putting Health into Context (and Context into Health) How Context Brokers and the Quantified Self will Transform Global Healthcare 2. Anomaly42.com2 Overview The size of the opportunity page 4 A new approach page 5 Quantified Self page 6 Introduction page 3 Fighting Disease with Data page 3 References page 13 Hidden in plain sight page 7 3 Vs of Big Data page 7 Data Security page 8 Towards a healthcare data ecosystem with the context broker page 9 Paradigm Shift page 10 Context In Practice page 11 Conclusion page 12 Rethink Global Healthcare page 10 3. Anomaly42.com3 Introduction The global healthcare system looks increasingly broken. If its not already in a state of crisis, most observers agree it will be soon. Its a crisis that affects us all. In many developing countries, we have yet to achieve basic levels of care, with social and economic problems hampering the evolution of reliable and sophisticated health services. In developed nations, meanwhile, the cost of healthcare is spiralling out of control and the returns on that investment are diminishing rapidly. Even worse, many of the health issues now confronting humankind are self-inflicted the obesity crisis in the US, for example, is adding $190bn a year to the countrys healthcare budget, according to Cornell Universitys John Cawley in a research paperi . We should know better. And today we can know better. Fighting Disease with Data In the digital age, there is no shortage of data available to develop a healthcare ecosystem capable of transforming outcomes for people in need, both today and tomorrow. This data is key to both tackling preventable disease and dealing with disease that has not been prevented. But there is a problem. None of the existing stakeholders in the healthcare ecosystem have yet confronted the task of managing data on a holistic, system-wide basis for the common good for creating what we might coin a health wealth. Unfortunately, the ability to attain system value within healthcare is inversely related to the level of system fragmentation. The challenge, then, is to build a healthcare data ecosystem that aligns the different needs of those stakeholders, eliminates data fragmentation and siloism, and above all delivers better outcomes for the people of the world. Enter the context broker. 4. Anomaly42.com4 Global healthcare spending is currently on a stunning scale around $6.5 trillionii a year and rising. The US alone spends 44% of the worlds health budget on just 4.4% of the worlds population in 2012 its outlay was the equivalent of 17.9% of its GDP while the equivalent figure in the UK was 9.4%iii . But the richer nations are getting neither value for money nor value at scale at the level of the individual. For one thing, wastage is enormous: in the UK alone, $500m is spent annually on unnecessary prescriptions; in the US, meanwhile, the Institute of Medicine estimates that unnecessary tests are costing a mind-boggling $750bn each yeariv . Moreover, even though a significant proportion of global healthcare spend is accounted for by a relatively small number of non-communicable diseases (NCDs), including cardio diseases, cancers, diabetes and mental health, we are failing to effectively tackle these conditions. Cardio diseases, diabetes and cancer account for 44% of total US healthcare spend, while 60% of deaths worldwide are due to NCDsv . Whats very clear is that throwing money at the problem does not work. The US, which spends more on healthcare on a per-capita basis than almost any other country in the world, had an infant mortality rate of 6.14 infant deaths per 1,000 births in 2010vi . The size of the opportunity This is well above the average of four deaths per 1,000 births among the member countries in the Organisation for Economic Co-operation and Development (OECD). NCDs, to put it bluntly, do not care whether you are rich or poor. Faced with the wholesale indifference of disease, we need to think differently and at a scale that matters. 5. Anomaly42.com5 A new approach How, then, do we fight these diseases more effectively and efficiently? The answer is twofold. Firstly, we need smarter ways to evolve diagnoses and treatments for those who have already developed an NCD. At the same time, we need to become more skilled at preventing people falling prey to such diseases 80% of the risk factors identified for common NCDs can be mitigated by lifestyle changes. These are not unrealistic goals, for the information required both to develop better treatments and to promote healthier lifestyles is widely available. It exists in pockets all around the global health ecosystem in hospitals and pharmacies, in research labs and universities, and in both the public and private sectors. The second way to fight disease more efficiently is for us all to tap into, and learn from, the knowledge that is now available and which, moreover, is being created at an exponential rate. In his book, The Decision Tree: Taking Control of Your Health in the New Era of Personalized Medicine, former Wired executive editor, Thomas Goetz, demonstrated that individuals actively engaged in their healthcare decision-making have significantly better outcomes. Increasingly, information is held by individuals themselves, within devices and apps generating a stream of data that is growing at an exponential rate. We are now witnessing the phenomenal growth of healthcare apps linked to wearable devices. These wearables range from wristbands that monitor the number of steps taken each day by the wearer to more sophisticated kit that replicates the equipment that was once the preserve of healthcare professionals monitoring blood pressure and the activity of the heart, for example. 6. Anomaly42.com6 Quantified Self This is the age of the quantified self, in which individuals have the power to constantly monitor their bodies and the data they produce. We can keep an eye on the exercise were taking, the sleep were getting, our dietary intake, our stress levels and a multitude of other lifestyle factors. Even better, we can monitor in real time the impact of making changes to our lifestyle, in order to enhance our health and well-being. The quantified self depends on apps and the Internet of Things. Essentially, wearable devices rely on connected sensors that feed information back to apps that process the data and provide it to the individual user. But the loop does not have to be a closed one: an aggregation of the anonymised data generated byhundredsofmillionsofquantifiedselvesoffers an incredibly rich and continuously updated database that has the power to deliver answers to some of our most fundamental questions about health, including NCDs. Dont underestimate the scale of the data being generated by wearable devices. Over the year to March 2014, 3.3 million Americans bought fitness bands from Nike, Fitbit or Jawbone in a market that grew 500%vii in each of the three previous years. With the likes of Apple, Google, Microsoft and Samsung now moving into wearable technology, itisnotdifficulttoforeseeaworldinwhichseveral billion users are simultaneously monitoring their health and well-being using such devices. On some estimates, 30% of smartphone owners will be using healthcare apps by the end of this year. These will be clinical trials the likes of which the world has never seen before. The scale of the opportunity is immense. This is our chance to transform the way we diagnose, treat and prevent the NCDs that are killing so many people around the world and costing such enormous sums. We will do this not by devoting more resources to the battle against these NCDs, but by harnessing the power of something far more effective than hard cash - data. The smartphone will become the primary source for healthcare applications and thus is positioned as a disrupter technology to global health Smartphone user base in 2015 (millions) 30% of total smartphone users will be using healthcare apps by 2015 TOTAL SMARTPHONES TOTAL HEALTHCARE USERS 1400 500 7. Anomaly42.com7 Hidden in plain sight If the opportunity is clear, the path to realising it is less so especially without the necessary leadership, data-brokering and management of vast data ecosystems. The reason for this is that, while vast amounts of healthcare data are now becoming available, and are growing by the day as wearable devices become ubiquitous, this data, in itself, has no value. Instead, it is the stories within the data the insight it is possible to generate from all that information that will reveal new advances in healthcare. Yet finding those stories is the digital equivalent of finding a needle in a haystack: the value of data is hidden in plain sight. One issue obscuring that value is the way in which the healthcare sector has developed in distinct silos. This is an industry with a diverse cast list. It includes pharmaceutical and life science companies, hospitals and clinicians, charities, academic institutions, carers, specialists in individual NCDs and third party service providers the list goes on and on. And to that cast we must now add the mobile healthcare sector: the developers of the devices and apps that enable us to monitor our own health and which promise so much. All of these players operate in isolation, generating and managing their own data. Each holds a piece of the jigsaw, but no-one is able to imagine the full picture, let alone see it clearly. 3 Vs of Big Data It does not help that most of these players would find it difficult to share data directly with one another even if they wanted to. The healthcare sector suffers from data illiquidity an inability to easily exchange information. The volume, velocity and variety of data the so-called 3 Vs of Big Data is simply too much for most organisations active in healthcare, whether in the private or the public sector. Estab