What can be done to help rocket boost MedTech into everyday healthcare?

Guest Blog by Dr Michelle Tempest, Partner at Candesic, Health & Social Care Consultancy 

Despite MedTech being central to the future of healthcare, digital implementation often struggles to get into the top 3 priorities of stakeholders who have to contend with A&E four hour targets, delayed transfers between care settings, chronic staff shortages and a savings gap of over £22bn. For those who have invested in a radically changed IT system, such as Addenbrooke’s hospital in Cambridge (who imported the EPIC system from the US) it did not offer immediate success and instead toppled the heads of the CEO and CFO of the NHS trust.

In November 2014, the Government highlighted four elephants in the room that hold back IT healthcare progress:

1) Too much bureaucracy
2) Lack of accountability
3) High cost
4) Concern over data security

However, perhaps there is a fifth elephant? The mother of all the others: the need for pro-active MedTech procurement. Linking IT from home to hospitals is key to unlocking future healthcare. Failing to get systems to communicate with each other is the nail in the coffin for any promising UK MedTech industry.

Reviewing current and developing MedTech products in terms of the ‘home to hospital pathway’ it is clear that there are eleven distinct markets (Fig.3). Taking this a step further and individually analysing over 300 different technologies, less than 1% of products the ability to communicate up and down the care pathway (Fig.4). This lack of inter-operability is an immediate snag to current IT procurement, whose job it is to create integrated and technology-enabled, linked care systems.

Slide3

Slide4

Thus far procurement has oscillated between top down command and control national arrangements, to bottom up ‘letting a thousand different flowers bloom’.  The analogy is that procurement has tried and failed with forced marriage and failed on random selection. So, perhaps it is time for MedTech procurement to be brought into the modern age that it aims to inhabit? One way help navigate and improve procurement would be for a match-making approach – a sort of ‘MedTech Tinder’.   ‘MedTech Tinder’ could proactively use ‘intelligent digital matching’ which could learn to be better at matching than Cupid himself. Indeed such algorithms that match suppliers and consumers was initially the ‘market design’ of Nobel prize winning economists Al Roth and Lloyd Shapley.  This method is no stranger in the clinical setting where Professor Roth’s best known example is the kidney exchange platform that matches donors and recipients which went onto increase the number of feasible life-saving operations. Any new MedTech Tinder matching platform could be as simple as A,B,C:

A. Accountable:  account for all current IT/ digital/ MedTech systems across acute and community settings,
B. Bridge knowledge gap: bridge the information gap across NHS and social care and track progress on communication between systems, aiming to increase inter-operability,
C. Collaborative:  highlight similar issues, proactively keeping purchasers and providers informed, matching innovators to problems and solutions to care organisations.

Such a ‘MedTech Tinder’ platform need not be expensive to implement and would highlight when a solution has already been acquired by one part of the health and social care system and the transparency would help keep costs down.  The Five Year Forward View explicitly requested to unleash “energy and enterprise” and in parallel with high speed broadband and 4G services and Wi-Fi in all hospitals – the stage is set for such an advancement. So, to help MedTech find love this winter, ‘MedTech Tinder’ could prove to be the match made in heaven for the UK export MedTech market.

#Letsdoit #MedTechTinder #MedTechmatch

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The Dynamic Shift: People want to access MedTech at home

Guest Blog by Dr Michelle Tempest, Partner at Candesic, Health & Social Care Consultancy 

One of the most important paradigms in healthcare is the fundamental shift in the doctor-patient axis. The old fashioned paternalistic doctor-patient relationship, where the doctor held the balance of power and only shared information with the patient when they thought it was relevant, has been completely turned on its head by digital healthcare. Now each individual can harness the power of technology to store, measure and monitor pretty much everything about themselves, often innocuously via their mobile phone.  This means that an individual can collect all the information they want and personalise it to measure fitness, wellness, mood, weight, menstrual cycles; there is not much you cannot track about yourself, if you so wish.  In fact there is so much interest in health consumer apps that a central National Information Board has been set up to accredit and kite mark apps, devices and digital services.

This inescapable, irreversible shift to ‘patient power’ means that every person has the ability to become an expert about their own health. Professor Eric Topol in his book ‘The patient will see you now’ describes this paradigm as the death of medical paternalism and the democratisation of healthcare via the ‘quantified self’.

How will medical teams cope with the on-coming tsunami of information?

The development of this personalised digital explosion poses the frequently quoted data quandary of the 3 V’s: Volume, Velocity and Variability. Such vast data quantities will soon reach Exabytes amounts. To put this in context it would take a single doctor several lifetimes to read this amount of information, let alone process it.  So, ‘Artificial Intelligence’ learning algorithms will naturally come into play employing parallel computation and parallel processing. Medical teams will want immediate access to ‘what has changed’ or ‘what is an outlier’, whilst healthcare consumers will want to link their own personal data feeds to help with early diagnosis. Similar such feats are already emerging in financial technology (FinTech) by linking professionals and customers more directly to banking algorithms.

The doctor of the future will have to be more like Sherlock Holmes rather than his associate, Dr Watson, who was frequently sent to check up on one variable at a time.  Future Sherlock’s will need to build up pictures of data to help solve medical riddles.

As yet clinical teams and IT systems are not set up to do this, so how will they succeed?

One current stumbling block is that data is stored in siloes with little inter-operability. Data is collected in a linear fashion as if it is preparing to help solve a 2D puzzle. But Sherlock Holmes would never have found ‘who done it’ unless he had developed a 3D way of problem solving. To solve such riddles there is a journey that is yet to be taken.

It is actually a similar journey that is currently underway across the rest of the health and social care setting, where separate, siloed disciplines of: Specialist, hospitals, mental health, community, care homes and care-in-the-home need to be integrated.  Data should be at the forefront of this journey and as care moves from being reactive to proactive, the same step change has yet to happen in MedTech.

#Letsdoit #MedTechTinder #MedTechmatch

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2016: The Year for UK Medical Technology (MedTech)

Guest Blog by Dr Michelle Tempest, Partner at Candesic, Health & Social Care Consultancy 

Technology is everywhere. Your mobile phone is probably close at hand ready to break down the physical barriers of bricks and mortar. Technology rapidly advances in accordance with Moore’s law, which states that processing power doubles every two years.

Applications in healthcare are growing exponentially and the market develops with every blink of an eye (fig 1).  So how can decisions in purchasing technology ensure that they are ready for the market of tomorrow?  Currently procurement decisions across the MedTech spectrum are made in isolation. This article highlights the complex environment facing procurement and the weight resting upon the shoulders of people who do this important job and calls on the English Government to develop a pro-active matching scheme for MedTech to help the UK win the global race in the development of integrated IT, with interoperability from home to hospital and back home again.

Slide1

Overview
We are living through an age where mobile telecommunications and digital services have changed everything, well almost everything.  The pace of change in robotics, the Internet of Things, data analytics and other disruptive trends have created increasingly accurate predictions, even of consumer spending habits. In health and social care, it is perhaps understandable that the rate of adoption has been much slower due to security, acuity, risk and multiple stakeholders.

The post digital Brave New World is a far cry from when the NHS was born in 1948, and an enlightened NHS MedTech baby has yet to be born. Other sectors have managed to keep pace alongside the Internet age, where more than 80% of UK adults use the internet, and almost as many carry a smartphone. In banking over 22 million people use online banking and each week 18.6 million use their mobile phone to make transactions. This has helped cut costs by 20% whilst customer satisfaction has soared.  In the airline industry, 70% of flights are booked on-line and the paper boarding ticket has almost disappeared with most people choosing digital e-tickets.  Compare this to the NHS: 2% of consumers report any form of digitally enabled interaction.  Sadly the experience remains stuck in the days before the Internet or smart phones.

The NHS has a chequered history when it comes to technology. The infamous NHS National Programme for IT, part of the Connecting for Health catastrophe, cost the taxpayer around £9bn over 10 years and delivered virtually nothing. So 2016 must be the year for the NHS to embrace MedTech, else other countries will reap the rewards.  The USA is so eager to win the global MedTech race that digital health spend has sky rocketed from £0.7bn in 2011 to £2.8bn in 2015 (Fig 2).

Slide2

#Letsdoit #MedTechTinder #MedTechmatch

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Patients are right to expect high risk procedures to be performed by regulated professionals

Guest blog by Amanda Casey, Chair of the Registration Council for Clinical Physiologists

Imagine I told you that you needed to go into hospital for a heart bypass. You’d know instinctively it was major operation, with considerable risks. But no doubt you’d be reassured by the fact that thousands of such procedures take place every year, that a majority of patients make full recoveries, and that you were in the safe hands of qualified and regulated healthcare professionals.

Now imagine I told you the doctors and nurses performing the operation were unregulated. At the very least, your confidence would be shaken. Most likely, you’d be angered and fearful – questioning the ability of the people in whose hands you’re putting your life.

That scenario wouldn’t happen. But tens if not hundreds of thousands of highly sensitive investigations and procedures are performed on patients each year by unregulated practitioners. Yet patients have the same expectations as if they were undergoing a heart bypass. Namely that they’re putting their health in the hands of professionals subject to rigorous regulation and scrutiny.

Screen Shot 2016-02-02 at 13.07.05A recent poll by ComRes, which was commissioned by The Whitehouse Consultancy on behalf of the , found that 81 percent of Britons expect assessments to support the diagnosis of neurological disorders such as strokes and epilepsy to be performed by regulated practitioners. Nearly 80 percent expected pacemaker assessments to be undertaken by staff subject to statutory regulation. And three quarters assumed heart ultrasounds were performed by professionals overseen by an organisation with similar powers to the British Medical Authority.

It’s perfectly reasonable to expect these types of procedures and investigations to be undertaken by staff who can be disciplined or even struck off by a regulator if they do something wrong. Yet, despite whatever the public might think, these and many other interventions are performed by practitioners who are at best subject to only voluntary registration.

There is a fundamental difference. A statutory regulator like the British Medical Association or Health and Care Professions Council can investigate errors and take action to ensure they don’t happen again. That might mean sanctioning or striking off an incompetent practitioner. Quite simply, it confers a far greater level of accountability and ensures the processes are in place to weed out incompetent practitioners.

Voluntary registers have no such powers. They have limited powers, can’t compel practitioners to report incidents or give evidence, and can’t issue sanctions when necessary. Their registrants aren’t even subject to the Government’s much heralded ‘duty of candour’. The result is far less accountability and ability to prevent incompetent practitioners continuing to work with patients.

That’s not to suggest all unregulated disciplines should be regulated, or that standards amongst the majority of practitioners are not extremely high. But there is a need for some professions to be regulated. Clinical physiologists are amongst them. And without regulation we’ve seen examples of patients dying as a result of poor practice, but the individual responsible being able to continue working.

There is an imperative for action, and unless this glaring deficiency is rectified, patients will continue to be put at needless risk. The Government has been reluctant to regulate the unregulated, but in the case of clinical physiologists ministers can and must make an exception. The public clearly expects it, and the NHS and patients will benefit from it.

After all, it’s not unreasonable to expect the person checking your pacemaker is working, is regulated.

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Do you ‘Breakfast’ like a King?

Modern life means we all have demands on our time.  It might be getting the kids up, dressed and to school on time, an early morning visit to the gym before work, or a long commute  – meaning there’s little time to make and eat breakfast before heading out of the house. That shouldn’t mean that breakfast gets forgotten so we have a mission for you, should you choose to accept it! For Breakfast Week (24 – 30th January 2016), we’ve teamed up with UK dietitian Nichola Whitehead to bring you a new Mission Breakfast Guide’ to help you eat a healthy breakfast every day. 

Screen Shot 2016-01-20 at 14.38.51Nichola says: “It’s widely known that breakfast is regarded as the most important meal of the day – it gives you the energy for the day ahead.  But according to research, a staggering 45%¹ of people admit that they skip breakfast at least once a week, which can result in low energy², feeling grumpy³ and struggling to concentrate(4). Our mission is to get everyone to rethink their morning routine and my ‘Mission Breakfast Guide will help you do just that and choose the right healthy breakfast for you – no matter what your morning routine.”

The guide highlights the benefits of a number of staple breakfast ingredients, as well as healthy suggestions for different morning scenarios including:

  • Samantha: a young professional faced with the grind of the morning commute
  • Kelly: the busy mum trying to keep the whole family happy
  • Tess: the gym bunny looking to rebuild energy levels post workout
  • Caitlin: looking for a weekend brunch to impress her friends
  • Linda: the recent health convert keen to get back in shape

Screen Shot 2016-01-20 at 14.48.57


The full guide, with breakfast suggestions and recipes, is available at 
shakeupyourwakeup.com. Further breakfast recipe ideas and nutritional information can also be found on Nichola Whitehead’s website: www.nicsnutrition.com
Breakfast Week is now in its 17th year and aims to raise awareness of the importance of eating breakfast and is organised by AHDB Cereals & Oilseeds on behalf of UK cereal farmers and producers.

Join the breakfast conversation on Twitter using #BreakfastWeek or follow us @breakfastweek facebook at ShakeUpYourWakeUp

If you enjoyed this post, why not see some of 2020health’s research on diet management in ‘Careless Eating Costs Lives?


¹The Grocer – 10 things you need to know about breakfast (August 2015)
² The Causal Role of Breakfast in Energy Balance and Health, Bath Breakfast Project, published in The American Journal of Clinical Nutrition, June 2014
 ³The Effect of Breakfast Prior to Morning Exercise on Cognitive Performance, Mood and Appetite Later in the Day in Habitually Active Women, Northumbria University, published in Nutrients July 2015
(4)The glycaemic potency of breakfast and cognitive function in school children. Kings College London, published in European Journal of Clinical Nutrition, September 2010 / Cognitive Drug Research, in conjunction with HGCA (2004) (former name of AHDB Cereals & Oilseeds)
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Ignorance of #obesity in #Mexico driving me nuts!!

When you know a little about something and a host of people who know nothing about something make loud claims about that something, it gets pretty frustrating.

That something is #obesity in #Mexico and their junk food (note NOT sugar!) tax

Mexico – the fattest country in the world –  implemented a national strategy for the prevention of overweight and obesity in 2014 and part of that was introducing a tax of one peso per litre on soft drinks on Jan 1st of that year. Sales dropped by 6% in the first year. However the context for this success is critical.

  1. Mexico has a major problem with drinking water:
  2. Most Mexicans do not trust or drink the tap water. More than 10% of the population have no access to running water[1]. The city’s giant 1985 earthquake burst water pipelines and sewers, increasing waterborne diseases, and officials blamed water supply systems for a spread of cholera in the 1990s. Mexicans consume 69 gallons (260 litres) of bottled water per capita each year compared to (116 litres) in the USA[2] – more than anywhere else in the world.
  3. Coca-cola was – and in many places still is – cheaper than water – it’s what families drank morning, noon and night[3]. Bottled water can be found at a cheaper price than soda[4], but when I was in Mexico in December, outside of supermarkets, bottled water was still more expensive.
  4. UK tap water is safe to drink. Average per capita UK bottled water consumption is 40 litres[5].
  5. Other taxes:

At the same time as the obesity law, to encourage people to drink water, another law was introduced in Mexico City officials to force 65,000 restaurants install water filters with health inspectors able to impose $125 to $630 fines to those not complying. Encouraging Mexicans to drink water is a massive issue for the government.

As well as the SODA tax (NOT SUGAR), an 8% tax on junk food[6] was also introduced on non-essential foodstuffs of over 275 calories per 100g[7]. In addition, Mexico did try to put other OECD suggestions in place[8] on labelling, education and marketing but most of these have been undermined – mostly, it is claimed, by industry.

The other thing I noticed there in December was that apart from diet coke, there were NO diet sodas in any of the shops, cafes or road-side stalls.

YES Mexico has a soda tax (NOT a sugar tax); YES consumption of soda has dropped a little; there is NO evidence that there has been any impact on obesity; Mexico CANNOT be held up as the global example of a successful sugar tax. I am just saying.

[1] http://blogs.ft.com/beyond-brics/2013/09/04/mexicos-bottled-water-addiction/

[2] http://phys.org/news/2014-01-mexico-city-law-habit.html#jCp

[3] http://english.periodismohumano.com/2013/03/05/the-coca-colization-of-mexico-the-spark-of-obesity/

[4] http://www.numbeo.com/cost-of-living/country_result.jsp?country=Mexico

[5] http://www.statista.com/statistics/283766/bottled-water-consumption-per-person-in-the-united-kingdom-uk/

[6] http://www.nytimes.com/2013/11/01/world/americas/mexico-junk-food-tax-is-approved.html?_r=0

[7] http://www.internationaltaxreview.com/Article/3299441/Companies-will-have-to-collect-new-Mexican-taxes-to-combat-obesity.html

[8] http://www.oneillinstituteblog.org/the-devils-in-the-detail-mexicos-broken-obesity-prevention-campaign/

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What have junior doctors and Norman Lamb got in common?

Quite simply, it is an understanding of the need for politicians to consider a realistic funding settlement for health and care services, delivered by high quality professionals, that the public expect and a civilised society should provide.

This afternoon Norman Lamb MP will propose a cross-party commission to review future funding and structure of health and care services in England in the House of Commons.

We welcome this proposal and consider it vital that politicians are engaged in the questions on the future of funding health and care, which to date, most have them been avoiding. Meanwhile thousands of junior doctors are planning to strike over the terms of the government’s proposed new contract, the crux of which is expecting more of them under increasingly pressured conditions at the same price. (We wrote about this further here).

NHS funding has been the subject of study, speculation and analysis for decades as the demand for healthcare has continued to rise. Social care has likewise been on the receiving end of both reviews and ever more demand, but being means tested, ever tighter criteria have been applied for state-funded care. However there has been no cross-party review of the ability of the NHS to cope with future demand, or a fresh deliberation of the options for funding and for sustainable, equitable health and care services. Policy makers need to be involved in consideration, scrutiny and the devising of proposals for a comprehensive NHS fit for the 21st century.

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