Digital health matching the best solutions to the right problems Dr Charlie Davie, Interim Managing Director, UCLPartners 1 UCLPartners Quality Forum 9 June 2017
The partnership Higher Education Institutes & Research Networks 1. Anglia Ruskin University 2. Central and East London CLRN 3. City University 4. CLRN for Essex and Hertfordshire 5. Institute of Education 6. London Metropolitan University 7. London School of Hygiene and Tropical Medicine 8. London South Bank University 9. Middlesex University 10. Queen Mary, University of London 11. University College London 12. University of East London 13. University of Essex 14. UCLBusiness 2 Acute, Community & Mental Health Providers 1. Barking, Havering and Redbridge University 2. Barnet and Chase Farm 3. Barnet, Enfield Haringey Mental Health 4. Barts Health 5. Basildon & Thurrock University Hospitals 6. Camden and Islington 7. East London NHS Mental 8. Great Ormond Street Hospital for Children 9. Hertfordshire Community NHS Trust 10. Homerton University Hospital 11. Luton and Dunstable Hospital 12. Mid Essex Hospital Services 13. Moorfields Eye Hospital 14. North East London 15. North Middlesex University Hospital 16. Royal Free London 17. Royal National Orthopaedic Hospital 18. Southend University Hospital 19. South Essex Partnership University 20. Tavistock and Portman 21. The Princess Alexandra Hospital 22. University College London Hospitals 23. West Hertfordshire Hospitals 24. Whittington Health
UCLPartners aim: to bring together leaders to translate cutting-edge research and innovation into measurable health and wealth gains for the population Information Education How will we achieve it? Work with our partners to: Discover new treatments and methods for improving health Develop discoveries through clinical trials Population Implement changes at scale across the partnership Evaluate how the system is working and what can be done next Educate the workforce and develop capabilities Use information to its best effect throughout the system 3
The global challenge Growing and aging population Multiple long-term conditions Increasing costs 4
Our overarching goal should be to improve value of care for patients and families, as defined by patients 5
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Put the patient at the centre of everything It s not What s the matter? It s What matters to you? 9
Patient engagement insights report 10
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Improve patient experience 1 2 3 Net promoter Score Level of engagement More time at home 4 5 6 Create district nurse champions Annual neurology review (NICE) Better conversations 12
Make variation transparent and do something about it Using national and regional data to effect change: NHS Atlas of Variation Percentage of people known to have atrial fibrillation (AF) who were prescribed anticoagulation prior to a stroke by CCG (2013/14) 13
Linking data: the key to seamless care 14
Healthcare is becoming increasingly data intensive Internet and cloud provide connectivity to every corner of the globe Smartphone: 2 billion users; 80% of adult population by 2020 Socialome: the digital data harvested for health and wellness Quantified Self: Non-invasive biometric sensing, Tricorder wearables. Apple Research Kit Exposome: Pervasive environmental sensing will bring new knowledge to public policy decisions about creating a healthier physical environment, and $1000 genome (genome, microbiome, transcriptome, lipidome, proteome, metabolome, multiome/panarome) Stem Cell and Genetic Tx (2000 + trials) EHR data: exponential growth of phenome from Electronic Health Records Predictive Analytics (Machine learning, A1, and Visualisation). Prediction: Ten X more new knowledge from research in silico over RCT by 2020 Persuasive Technologies: Behavourial and motivational sciences 16
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The NHS landscape 18
Digital: The solution to the challenge? Whilst there is a strong heritage in research and idea generation there are often problems with achieving scale. The problems include: a lack of commercialisation skills shortages of IT and analytical capabilities difficulties in funding challenges with accessing a local revenue stream in the NHS. Monitor Deloitte Digital Health in the UK September 2015 19
Overview of the future digital landscape Imison C, Castle-Clarke S, Watson R and Edwards N (2016) Delivering the benefits of digital health care. Research summary. Nuffield Trust 20
NHS Innovation Accelerator (NIA) supporting 26 innovations AIM to help create the conditions and cultural change necessary for proven innovations to be adopted faster and more systematically for patient benefit Selects: annual call for Fellows representing high impact evidence-based innovations via a robust multi-stage selection process Offers: Bespoke support through a range of mechanisms to accelerate national uptake Progress at 18 months for the first 17 innovations: 460 additional NHS organisations 20m funding secured 9 selling internationally 21
A number of the innovations directly empower patients to self-care: Complete online self-management for COPD patients Expertise normally provided by the health professional delivered at time & place to suit patient Also has a MyPulmonary Rehabilitation - comprehensive 6-week PR class delivered online Nurse led, technology enabled model of care for people with Multiple Sclerosis Offers expert assessment and advice to people at times when it matters most to them By phone, patients can discuss physical, mental & social care needs, agree plans & share info Fully automated cognitive behavioural therapy (CBT) programme, delivered via web or mobile Users receive proven techniques from a virtual sleep expert through weekly tailored sessions In a placebo-controlled trial Sleepio was shown to be comparable in effect to face-to-face therapy, but is available instantly at a fraction of the cost. 22 Website and mobile app that brings all the information about a person s breast cancer together with tailored insight and support Patients can write into the app about their treatment, side effects and emotionally how they are feeling that can be shared with health professionals
Whilst other NIA innovations enable greater patient empowerment Health Coaching Training programme to provide clinicians with the skills and techniques to empower patients to become more active participants in their care HealthCoaching helps time- poor clinicians manage difficult conversations, and demand through reduced prescribing, repeat appointments and tests One of world s largest support networks for health with over 4million visits each month Connects patients, caregivers and health advocates safely online with guidance from leading credible health organizations Partnership with Macmillan will see all cancer patients provided with a personalisable online care plan delivered by HealthUnlocked Patient controlled record enables patients to hold all their medical information in a single record owned by them. Patients are able to invite anyone they wish to view their record and so can construct a strong and comprehensive care network best suited to them 23
Web-based applications for the self-management of chronic obstructive pulmonary disease The Problem 835,000 people are diagnosed with chronic obstructive pulmonary disorder each year in England This leads to 122,000 hospital admissions and 23,000 deaths each year Each admission costs an estimated 1,590 per patient and results in total of 778,000 bed days overall per year in England Almost every COPD intervention is delivered face to face apart from a few telemedicine programmes, which do not tackle the issue of education about the condition MyCOPD is an NHS Innovation Accelerator innovation now part of the Innovation and Technology Tarrif MyCOPD is an online system empowering patients to manage their conditions and share information with their care team MyCOPD also includes online pulmonary rehabilitation (PR) which costs 20 per patient for the life time of the patient vs. a traditional six-week face-to-face course costing 200 per patient How to purchase: G Cloud or direct at: https://mymhealth.com/ 24
One STP estimated savings through adoption of MyCOPD COPD admissions cost on average 1,590 per patient STP annual # of COPD diagnoses Annual # of hospital admissions (based on diagnosed COPD rates) Cost of all admissions per year ( 1590 per patient) MyCOPD has been shown to reduce admission by 30%: # fewer admissions 22,007 3,215 5,112,382 965 1,533,780 savings of avoidable admissions by implementing MyCOPD Total Estimated savings in 1 STP: 1,533,780 25
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Data linkage driving efficiency in clinical trials > 24,000 volunteers 6,228 volunteers enrolled in dementia studies (about ¼ of all UK recruitment) 451 NHS, University and commercial research organisations 335 research studies 29
Trends: Direct-to-patient 30
But you don t have to be Apple In March 2014 Recruited over 2,600 patients with long term conditions within 24 hours as part of a survey for The Institute of Public policy and research 77% said that more of their healthcare should and could be managed independently at home BUT a lack of support and information was holding them back from doing so People wanted a named contact for day to day queries 57% wanted this person to provide telephone support 61% felt peer support and or coaching would be helpful 20% used devices to monitor their health or maintain their independence 24% thought condition specific apps would be helpful 31
32 DigitalHealth.London Building the Global Digital Health Capital - together
In the first five months of the DigitalHealth.London Accelerator programme, our cohort of SMEs has secured 12 pilots and 24 contracts. Applications for cohort 2 being evaluated 33
40% more outpatient appointments attended 34
14 to 2 outpatient visits due to home monitoring : 35
Care City Innovation Test Bed 36
A Learning Health System 37
Discovery a learning health system for east London A collaboration between four boroughs: Newham, Tower Hamlets, City and Hackney, Waltham Forest and two hospitals, Homerton and Barts Health Pop 1.3 million: 200 general practices and 700 GPs, two hospital trusts..strive to become learning health systems by making clinical data research grade and lowering the cost of data acquisition and knowledge generation Victor Dzau. Transforming Academic Health System for an uncertain future (2013) Every consenting patient s characteristics and experience is available to learn from Best practice immediately available Improvement is continuous This happens routinely and efficiently This is part of a culture Charles Friedman. Toward Complete & Sustainable Learning Systems (2014) 38
National Context Target Architecture: Towards a Learning Health & Care System The Discovery East London programmes is aligned with national principles: Establish local learning health and care systems with a focus on local priorities and direct or individual care innovation in the context of population health. Establish a diameter of trust for citizens to share information supporting direct care, inform service redesign and to support research Leverage scale to track and manage patients across complex pathways, to enable organisational service redesign across the STP footprint. In conjunction with Academic Health Science Networks and testbed sites, take collective responsibility for driving national adoption and proven innovations. Link and share data across boundaries for service redesign and promote research including life sciences research strategies or larger cohorts. 39
Local Geography for Discovery East London Phases I / II Possible options to expand project following this may include engagement with Hertfordshire (Pop. ~0.6m), West Essex (Pop. ~0.3m) & the broader UCLP footprint Phase II Pop. ~0.8m 40
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For more information please contact: Dr Charlie Davie Charlie.davie@uclpartners.com www.uclpartners.com @uclpartners 44