Healthcare Challenges in the Context
of the Digital Economy
Stuart Anderson
10/20/2008
Healthcare Challenges Meeting
Context
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Digital Economy Hubs (3 Hubs, £12m per hub, hub and spokes
model, transport, creative industries, healthcare)–
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Blue-sky
Not evolutionary
Not technology
Multidisciplinary
Data abundance
DIY development
Collaborative environments
Work up healthcare as a locus for “transformative
technologies”
10/20/2008
Healthcare Challenges Meeting
Backdrop
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Government
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Citizen
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Business & Organisations
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Intra-government
Interactions with citizens
Interactions with “business”
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Social interactions
Work
Consumers
– Intra-”business”
– Inter-”business”
10/20/2008
Healthcare Challenges Meeting
Economic Significance of Health?
1
2
Life Expectancy and Healthy Life Expectancy
3,4
in 1981 - 2001
Male
At Birth
LE
GREAT BRITAIN
1981
1991
2001
70.86
73.17
75.70
Female
At 65
HLE
LE
At Birth
HLE
LE
At 65
HLE
LE
HLE
64.43
66.14
67.02
9.94
10.84
11.62
66.74
68.57
68.83
11.88
12.97
13.17
12.97
14.15
15.94
76.84
78.70
80.40
16.92
17.91
19.03
•The fastest growing age group in the population
are those aged 80 years and over who currently
constitute 4.5 per cent (2,749,507) of the total
population.
•This age group has increased by over 1.1 million
between 1981 and 2007 (1,572,160 to 2,749,507),
from 2.8 per cent to 4.5 per cent.
•This is mainly a result of improvements in mortality
at older ages over the second half of the 20th century.
10/20/2008
Healthcare Challenges Meeting
What is Value in a Healthcare Context?
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Improving returns on existing investment:
– How do we go from guidelines to improved health outcomes?
• Improved representations, improved support for the generation of
guidelines?
• What about implementation issues? Motivation, adoption, improvement,
linkage to specific contexts
– How do we leverage professional concern to improve outcomes?
• Embedding IT professionals in healthcare contexts
• Advocacy, reuse of information, flexible repurposing
– Acute contexts:
• Improving decisions – high costs per patient – are there issues about
how to frame this work?
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Synthesis issues:
– Can we benefit from synthesis? (inconsistency, incompleteness,
varying quality).
– What are the issues? (Data quality, access, …)
10/20/2008
Healthcare Challenges Meeting
What is Value in a Healthcare Context?
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How do we incentivize the behaviour we want?
– From professionals? (GP contract, improved care, advocacy)
– From patients? (Health benefit from behavioural change, acquiring
new and valuable data, differing ownership models incentivising new
business models)
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How do we capture and exploit modified behaviour?
The role of models? (can be negative as well as positive – nonlinearity, volatile and can modify real economy behaviour)
10/20/2008
Healthcare Challenges Meeting
Value in a Healthcare Context
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Implementation and Governance issues:
– Technology interventions have (highly) unpredictable effects
– Often these interventions can have significant negative impact on
service delivery
– Professionalized communications can inhibit the application of
technologies
– Institutional restraints on innovative approaches to the use of
information – patient confidentiality, issues of ownership and
provenance of data, drive towards quality
10/20/2008
Healthcare Challenges Meeting
Summary
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Digital economy has a heterogeneous notion of value and its
means of production.
The healthcare system offers many loci for the generation of
value in the digital economy.
We have explored how a range of technologies impact some loci
Further exploration to see how technologies (and combinations
of technologies) have transformation impact on the generation
of value in health.
There are significant organisational inhibitors to adoption,
implementation and governance
10/20/2008
Healthcare Challenges Meeting
More Generic Questions
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More people in Informatics here than in Europe
New value created in the digital economy
10/20/2008
Healthcare Challenges Meeting
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Information in healthcare has a lifecycle – capture, analysis,
assembly, application
Decision support – not necessarily effective
Guidelines typically don’t change practice
Guidelines are too generic – more specific guidance required
(who should do what where – more behavioural)
Issues in creation of DSS from guideline – coevolution – issues
with size and specificity – also evolution?
Authoring knowledge base and using text generation to
generate variants of the guideline.
Implementation issues, incentivisation, motivations in guideline
10/20/2008
Healthcare Challenges Meeting
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National Knowledge Service – K is the enemy of disease
Clinical
– Professionalism and development
– Patient Care
– Quality Improvement
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Patients
– Online information
– Service indicators
– Self-care: decision aids, personal health records, telehealthcare
10/20/2008
Healthcare Challenges Meeting
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renal@ed.ac.uk Neil Turner, Richard Phelps
Configurable nephrology system for nephrologists
Evolved in many different directions
Scottish Renal Register - \n\lyse live data fro renal units
Renal units comparing data once monthly sharing of data
Performance of primary care units web pages
Extracting data from clinical systems and making it more useful
by mapping to newer database systems on the web
10/20/2008
Healthcare Challenges Meeting
Distributed vs Centralised
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Grand challenges
Distributed views from different prespectives
10/20/2008
Healthcare Challenges Meeting
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Bonnie
Jeremy
Claudia
Neil
David G
Derek
10/20/2008
Healthcare Challenges Meeting
10/20/2008
Healthcare Challenges Meeting