Technology adoption in health – is the NHS ready? martin wakeley

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Technology adoption in health – is the NHS ready?


BackgroundMartin Wakeley

Experienced NHS Leader Lead CEO lead for SPFiT Part of the PwC team that introduced the independent sector to the NHS Executive Director of Circle – opened their award winning hospitals and led the

acquisition of Hinchingbrooke Siro of the largest NHS investment in BI in the UK Turnaround director across numerous hospitals and CCGs Co-founder of Nth Dimension

Nth Dimension are backed by Tech MahindraSet up to innovate and disrupt in HealthcareSet to create joint ventures across the NHS and universitiesFocus on interoperability and data exchangeCreate new markets


AI and HealthcareTechnology and AI is growing at a rapid pace in healthcare

AI spend in USA healthcare is projected to increase from $660m in 2014 to $6 Billion in 2021 and that’s probably a gross underestimation (Frost & Sullivan)

The number of companies utilising machine learning algorithms in healthcare is growing rapidly.


The pace of innovation is exhilarating

Google Deepmind is collaborating with London hospitals such as Moorfield's

IBM Watson and Medical Sieve are gathering significant momentum

Sense.ly and Babylon are changing the face of AI

Atomwise is accelerating compound research

Zorprisma Publiek know more about the efficacy of clinical practice in the Netherlands than the physicians do

Berg Health is beginning to understand why patients survive


Worldwide healthcare demand is increasing

Africa

Rest of Americas

South East Asia

Europe

Eastern Mediterranean

Western pacific

0 20 40 60 80 100 120 140 160 180 200

Population and healthcare resource

Median Age % > 60 Doctors per 10,000 Nurses per 10,000

The median age in Africa is 19, in Europe its 39

In Africa the % of people over the age of 60 is 5%, In Europe its 21%

The UK population is projected to grow by 9.7 million over the next 25 years

By 2039 8% of the UK population will be > 80 yrs.


There are not enough qualified staff to meet growth

AfricaRest of AmericasSouth East Asia

EuropeEastern Mediterranean

Western pacific

0 2000000 4000000 6000000 8000000

Clinical Staff

Actual Nurses Actual doctors

Africa

Rest of

America

s

South E

ast A

sia

Europe

Easter

n Medit

erra

nean

Wester

n pacif

ic0

2000

4000

0%

100%

200%Per Capita spend growth

Per capita Spend 2002 $ Per capita Spend 2013 $Growth

There are over 7 million nurses in Europe for a population of 906 million

There are just under 3 million doctors in Europe

The OECD reports that 36% of UK doctors were born overseas

Spending in South East Asia grew by over 130% in 10 years

Spend in Europe grew by 98%

Western Pacific spend grew by 172%


The NHS is under considerable pressure

The NHS faces a £16 Billion shortfall in its funding by 2020

Existing productivity gains cannot meet the gap

The deficit in 2015 was a record £2.5 Billion and its not improving


Social care is in a similar positionTo meet current demand the budget for social care will need to double in the next 15 years

The largest area of spend is in physical support for the over 65’s


Interesting developments?

Artificial intelligence can automate significant elements of how healthcare can be delivered

IBM Medical Sieve can triage thousands of images and direct the radiologist to the image requiring their attention

Remote monitoring can observe patients and take action more more effectively than a human being

Avatars can engage with patients and anticipate events and take preventative action. Recent studies suggest that patient are more open with Avatars than real people

Genomics and other initiatives are pushing ahead the precision medicine agenda along with anticipatory medicine


Where could AI help?NHS 111 receives 33,000 calls a dayEach triage call takes an average 15 minutes61% were directed to primary care

GP Out of Hours recorded 5.8m interactions in 2013/143.3m were face to faceEach patient cost £7.50

In 2013/14 there were 41.1m imaging examinations of which 22.6m were x-rays

NHS choices recorded 583 million hits in 2015

Of 95 million OPD visits less than 100k were via telephone


Off the shelf solutionsSolutions such as Sense.ly and Babylon can replace some of the services provided by 111 and NHS Direct. They can also link into OOH services, linking patients to providers or services without the need for human intervention.

IBM Medical Sieve could provide on-line automated triage of plain film x-rays 24/7, freeing up staff to focus on more complex tasks

AI can provide routine follow up and monitoring services for patients post operatively or replacing face to face follow up assessments


The NHS has to adopt new solutionsDemographic pressures and the impact of reduced availability of clinical staff from overseas will force the requirement to explore non-human modes of delivery.

The productivity requirement for the NHS to deliver against its targets is at a level higher than any other comparable healthcare system has ever delivered.

The process to schedule and deliver care is based upon a model that has hardly changed since its inception in 1948

The ’do-nothing’ option is not an option and plans are already in place to adopt technology


However?The NHS has a poor track record with the adoption of technology

The current situation means that cash for transformation is in short supply

There is a shortage of technology advocates pushing solutions at a national or local level

Procurement often requires reference sites but where are they in the UK?

Confusion around patient data and consent defaults to ‘do nothing’


Why is adoption slow? • Who is going to pay for the technology?• Product or service?• Who is going to benefit from the technology• What are the procurement and governance and regulatory

issues that need to be addressed?• Who is responsible for adoption?• How do you identify and address professional

parochialisms?• Identifying and managing across inter organisational

tensions• Working with patients and getting their support• Clarity on risks and benefits and who takes what• Preparing for failure from commencement


There are emergent opportunitiesGP federations are becoming new providers and they don’t have legacy business models or investments that prevent them from innovating.

Interoperability solutions will gather pace and will generate longitudinal data sets at massive scale supporting AI adoption and accelerated innovation

New care pathways are dependent upon real time data collection and analysis to direct patients towards digital solutions

Patients and their carers are demanding change


Rose doesn’t seem to be eating

Rose – We’ve been alerted by the NHS to your fall - We’ll send

someone to help make your home safe for you

Shared Data

Rose – We’ve let our colleagues know in

Social Care that there could be some side

effects to your medication...

Rose is anxious after her fall

Can you tell the Fire Service that Rose now stores oxygen bottles at home...

Can you alert your staff to the aggressive dog that lives next door to Rose...

Rose – The hospital has alerted us about your

recent fall. Your GP will be in contact soon after

your discharge.

Rose – The NHS have alerted us to your

disability. We’ll issue a blue badge and a bus pass automatically....

Rose – Your daughter, who lives in Australia is now able to apply, order

and pay for services directly for you...

Rose – your blood pressure seems to have gone up overnight – is

everything ok?

2

3 6

4 5

8

7

1

10

9

This is possible now


What next?Lets get doctors and nurses excited

Lets get patients and their relatives excited

Lets create business propositions that make sense to the people who pay

De-risk failure but reward success

Identify the top 10 advocates and adopters

Be flexible


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Technology adoption in health – is the NHS ready? martin wakeley

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