Healthcare is a growing sector for all parts of the IT industry. Dell has been piloting a project called Mobile Clinical Computing which is being trialled in 11 hospitals, three of them in the UK. And of course, the technology is powered by Intel.

The project is designed to respond to the different computing needs of clinicians - the need for data security, the mobility of staff within a closed environment, and medical archiving.

I spoke with Nigel Leaney, from Dell, who has been looking after the project.

In his 1996 book Only the Paranoid Survive, former President and CEO of Intel Andy Grove, described the concept in business of a strategic inflection point – that is a time in the life of a business when its fundamentals are about to change. I believe that point is rapidly approaching when we look the changing demographics that are happening all around us. At the beginning of the 19^th Century the average life expectancy was below 50 years of age whereas today, largely thanks to advances in medicine and quality of life, people can expect to live into their 80s. This is leading us to an interesting situation where it is estimated that by 2045, the global population will have more people over the age of 65 than children under the age of 5. Another way of looking at this is that in the UK, someone is turning 50 every 40 seconds, while in the US this is happening every 7 seconds.

This demographic change has profound implications on society as a whole in terms of healthcare and service provision, but more importantly it also provides us with an amazing opportunity for new businesses and products, designed explicitly for this section of the population. Let’s look at some of the economic facts – older people have a greater proportion of societal wealth than any other age group, estimated at in excess of €3tr when looking at Europe as a whole. In the UK 50-plus households spend around £350B annually, accounting for over 40% of national household spending.

You would expect that this would cause a significant percentage of products to be aimed at older people, yet almost all marketing of products is targeted at the under-40s. There are opportunities here though not just for marketing but also for service development and product design. As people grow older, their needs change, requiring new services and products that specifically address their requirements. This could be anything from wealth management, to healthcare products or household appliances. A number of white-goods manufacturers now produce washing machines that are specifically designed to address the challenges of ageing. These products have a tilted drum to enable loading and unloading without as much need to bend down and larger controls to address a reduction in dexterity. When Ford designed the Focus car, they encouraged their designers to wear a special suit that restricted their movement and caused reductions in sensory abilities. This helped to design a car that addressed some of the needs of an ageing population. Similarly, the design of the Intel® Health Guide, an in-home chronic-disease management platform took many of these factors into account by providing a large touch-screen, and simple software user interface.

Next month a conference will be held in Dublin to discuss many of the elements described here. The event is called The Business of Ageing and it plans to equip attendees with the basics needed to develop and accelerate their understanding of the 50+ market and learn from those who've already targeted this market, successfully and won.

What do you see as the biggest product gaps in this market or what mistakes have you observed?

(Background information sourced from www.businessofageing.com )

A recent post on a Harvard Business Review blog by Patrick J. Skerret, discusses the potential for remote health monitoring at work.

Many companies (including Intel) offer the option of voluntary health check-ups and fitness programmes but not many go to the next stage by extending the offering to include remote health monitoring. The HBR article refers to a programme called Smart Beat that was developed by Center for Connected Health in Boston, and is offered to employees of certain large companies. It provides monitoring and assistance to people with hypertension, diabetes or weight management difficulties. According to one of the participating companies, EMC, it brought significant improvements to the blood pressure levels of the volunteers who participated over the 6-motnh period.

So what is the motivation for a large company in offering this type of programme to its employees? For many years, progressive companies have been concerned about the health of their employees. A healthy workforce is more productive, thus benefiting the overall profitability of the company, while in parallel improving the quality of life of their employees. Of course, if the employer is also responsible for the cost of health insurance, then there is an added incentive to having healthy staff. Some insurance companies even offer reduced premiums for members who can prove they regularly attend the gym or undertake some other forms of exercise.

With an estimated 17.5 million people in Great Britain living with a chronic disease, these types of remote monitoring and health management programmes cannot be too far away for most people in the workforce. In fact, I would speculate that over the next five years, these programmes will move from being optional for employees to becoming a compulsory part of employment contracts.

Is health monitoring available from your employer and if so, do you participate? If it was compulsory, would it change your opinion on taking part?

Any newcomer to the world of remote health will undoubtedly be challenged by the variety of different names and labels used to describe the technology. These include Telehealth, Telecare, Telemedicine, eHealth and Connected Health and depending on who you talk to, you will get different interpretations of these.

So here’s where I stand on these:

·         eHealth (or Connected Health): Health services, information and education delivered or enhanced through the internet and related technologies. This is the broadest of the labels used and eHealth encompasses all of the methods listed below.

·         Telecare: The continuous, automatic and remote monitoring of real-time emergencies and lifestyle changes over time in order to manage the risks associated with independent living. Social alarms such door sensors, smoke alarms, flood detectors and personal alarm pendants (PERS) all fall into this category.

·         Telehealth: Using communications networks to provide, access, and manage any type of health information or service. This name is commonly used to describe remote chronic disease management, with solutions such as the Intel® Health Guide.

·         Telemedicine: This is a type of Telehealth and is often used to describe the activity performed specifically by a doctor, who uses IT and the Internet for the diagnosis of a patient in another location. This term is often applied to a specialist providing a remote consultation or a second opinion to a doctor somewhere else in the country or the world.

To add to the confusion, the European Commission use the term Telemedicine to cover the delivery of and healthcare services at a distance, through the use of Information and Communication Technologies. Additionally, another term – Telehealthcare – is starting to emerge blurring the lines between Telehealth and Telecare. For all of these reasons, it is very important to understand where all parties in a discussion on these topics stand so that some of the confusion is eliminated.

In a recent customer meeting, the fall-out of all of these different labels became blatantly clear to me. This person was interested in deploying a Telehealth solution for the purposes of chronic disease management. Her challenge however, was that she didn’t have a budget line item for Telehealth (or any other tele- or e- activities), and that she was constantly getting frustrated with new labels being applied to solutions that effectively just improved existing service delivery activities. Her recommendation was that industry should stop using new labels to describe these technologies, and rather position them as enhancements to current care delivery, allowing for much easier procurement by healthcare providers.

An interesting argument indeed – but do you agree?

More information on remote health in the UK is available in this White Paper – Chronic Care at the Crossroads

In this morning’s opening keynote at the Partners Connected Health Symposium, Dr Jason Hwang, co-author with Clayton Christensen of the Innovator’s Prescription spoke about the application of disruptive innovation on the healthcare industry.

Disruptive innovation describes a process by which a product or service takes root initially in simple applications at the bottom of a market and then relentlessly moves ‘up market’, eventually displacing established competitors. This disruption allows new consumers to begin to use the technology whereas in the past it was inaccessible to them. This can be seen in the computing industry where the technology has moved from mainframes to mini-computers to PCs and to smart-phones, which has also moved the location of the technology from a central location to being accessible anywhere it is required. This decentralization through disruption leads to increased accessibility but it is important to note that companies often add functionality through innovation faster than consumer wants or needs the technology

In healthcare this same move to centralize everything, can be seen with the co-location of multiple services and technologies all under the same roof in a big hospital. The emerging trend however is to move this care provision from a central location out into the community and into the home. This also means that different people will be able to deliver the care such as nurses and empowered patients themselves, supported by new technologies.

This in-turn requires us to look at the dominant business model in healthcare where everything is centralized on the general hospital. This implies that many different types of technology and specialities in one location. The business model then has to support all of these resources but with the number of hand-offs that result, it can be prone to error and forces increased costs to maintain profitability.

Hwang asserted that hospitals are expensive conflations of three specific types of business models:

1)      Solution shops – typically very dependent on people offering diagnostic and intuitive activities on a fee for service basis

2)      Value-added process businesses – typically process dependent where a certain task is repeated enough times to where it becomes possible to accurately predict the outcome, for a fee.

3)      Facilitated Networks – where users, both providers and patients, transact and interact with one another on a fee for membership basis.

As disruption occurs in the healthcare industry, Hwang believes that a number of changes will occur to these business models

-          Specialist hospitals will emerge to address the solution shops model, bringing together a number of different specialties to reach a diagnosis sooner

-          Treatment centers focused on a particular procedure, e.g. heart by-pass, where technicians can be involved in delivering the treatment, rather than doctors, as they have been specifically trained on parts of the procedure and repeat it on a daily basis

-          Social networking through sites such as PatientsLikeMe, empowering individuals to do more for their own care delivery

Dr. Hwang concluded however, that each of these new propositions will require new value networks to gain traction in the market and for this to happen, having the right partners will be key to success.

The second keynote this morning was from James Mongan, MD, CEO of Partners Healthcare.

Within a few months there will likely be a bill signed on healthcare reform but Mongan believes that it will not have realised everything that was set out to be achieved. He asserts that the work on reform will continue for a number of years afterwards.

Despite the fact that there are huge numbers of uninsured, most still receive the treatment they need. What doesn’t happen though is that treatment for chronic conditions is not delivered in a preventative manner.

One proposal in the reform legislation is to introduce an Individual Mandate but Mongan asserts that this appears to be a new tax with another name. There may be restrictions on who actually pays this mandate but it doesn’t address the core need for insurance reform.

But what about the issue of controlling healthcare costs? Barriers to cost include the way costs are reimbursed and the lack of integration of the provider systems. With most items that you buy, you benefit immediately, but with healthcare payments you benefit later

It is likely that any new legislation will blend taxes, employer payments and individual payments but the key issue is the fairness of financing – who pays and how much? In Mongan's opinion, it needs to be a balance between individual liberty and justice for all.

Last week Adam Bosworth, one of the founders of Google Health and previously involved in many other successful ventures, launched his new company – keas. This is quite an interesting development as the goal of keas is to help you understand what your health data means and how you can use it to be as healthy as possible.

Keas works by getting you to complete a basic health questionnaire and to answer some questions about your family history and your wellness goals. It then assigns certain care plans to you, which, in theory, enable you to either manage your condition better or assist you in achieving your wellness goals. These care plans are designed by experts but do not constitute medical advice, diagnosis or treatment.

What makes this proposition interesting is that you can upload your medical data to the system from other services, such as Google Health, or enter details of clinical tests that you may have undergone. Keas will then attempt to provide an interpretation for you and assist you in dealing with possible next steps. This is one of the first sites to pull all of these different elements together to offer you comprehensive advice and guidance.

It sounds simple but in fact this can be a challenging area from a regulatory and a privacy perspective. Many clinicians are reluctant for data to be stored outside their country (and sometimes even outside their offices!) despite the fact that many countries have implemented stringent data privacy regulations. Additionally, providing care plans that are useful, while not crossing the line of delivering medical advice could be quite a challenge.

Keas is backed by a strong management and advisory team, and it will be interesting to see how it delivers over the coming months.

One of the fundamental tenets of healthcare delivery is to “first, do no harm,” but what happens when clinicians are inadvertently putting their patients at risk by transferring infection from one place to another? When Intel developed the mobile clinical assistant (MCA) reference design a number of years ago, infection control was one of the key considerations taken into account.

The mobile clinical assistant is a computing platform specifically designed to meet the challenging needs of healthcare professionals by incorporating a number of features designed to be of benefit to patients and clinicians alike. These include built-in barcode and RFID tag readers to help with patient identification and medication management, configurable quick-launch soft-keys for easy application launching and integrated digital camera useful for wound management. However one other feature of importance is the fact that the unit can be easily disinfected because of its sealed design, significant for controlling the spread of hospital acquired infections, such as MRSA, and in minimizing the transmission of illnesses, such as Swine Flu. But how effective is it?

I was involved with a pilot at Salford Royal NHS Foundation Trust, one of the first hospitals in Europe to use the MCA. We ran the trial with its energetic team of phlebotomists and designed it around their daily workflow. We found that using the MCA resulted in a reduction in paperwork, ensured positive patient identification and eliminated unnecessary blood draws. All of this was enabled by the delivery of the right information to the right person at the right time using the MCA. Additionally, after each use, the phlebotomists were able to quickly disinfect the units, simply by wiping them down with alcohol wipes, thus minimizing the risk of transferring infections between patients.

I strongly believe that appropriate technology design can help with solving many of the problems encountered in our daily lives – this is just one example.

The MCA reference design has since been brought to market by a number of manufacturers including Motion Computing, Philips and Panasonic. Further information on the product and additional case studies are available at www.intel.com/healthcare/ps/mca.