there's a big buzz about digital and big
data in healthcare
investment in this area has doubled in
the last year and will be five times
more in the coming years Apple launched
healthkit Google's using glass and
analytics in healthcare small sensors
are embedded in medical devices
wearables all creating a vast amount of
new data 78% of people want to use M
health there are literally thousands of
applications involving health available
this is very exciting if especially
exciting for someone who's worked in
this field for so long but the I think
we're missing a point all of the
technology in the world isn't going to
work if we can't connect the data and
use it to change the way we deliver
health care services and engage patients
in understanding their own decisions
around health now professionally I've
been interested in this for 20 years I
started obviously when I was very small
and since the early days of the dot-com
boom I have been fundamentally convinced
that technology can and will change
healthcare personally it's an issue
that's very close to my heart when I was
16 my grandmother died because of an
error in surgery her death and so many
others could have been avoided had the
right information been exchanged we have
literally poured billions of dollars
into healthcare IT and despite the
promise of electronic records the
information we need to manage healthcare
is either missing incomplete or
inconsistent we are significantly behind
other industries in terms of using data
yet the irony is that information lies
at the very heart of healthcare this is
our starting point for digital let's
just be real here okay
all of the exciting technology exists
but here is the starting point this is
the picture of the room where medical
files are stored at a leading Children's
Hospital today well last week each of
these paper files includes vital
information about a very sick child they
have an electronic record and yet it's
easy to see how vital information can
fall through the cracks so what are we
doing about this well as we automate
this pile of paper and as systems mature
we will have new information to
understand what and who causes those
medical errors but even more exciting
will will be that we have electronic
clinical information to do different
types of analysis IBM's Watson and other
computing platforms will take
information from devices images and
clinical records to improve the decision
support for doctors this is exciting
we will also see advancements in the use
of genetics so with it cost of genomic
sequencing declining we will combine
information in clinical practice with
our genomic sequence and we will
understand more how to personalize care
and we will also see advances in
technology such as 3d printing creating
new organs and new bones which replace
failing parts in our bodies now all of
these technologies and the advances in
science are really really really
exciting but it's the data and how we
use it that is the real story we need to
use the data that we have to improve our
understanding of what works and what
doesn't
Kaiser Permanente is a large group of
hospitals in California well known
across the world for their advanced use
of information in their electronic
record by analyzing their clinical data
they could understand
that giving a patient a particular drug
within 24 hours a heart attack patient a
certain drug within 24 hours they cut
the death rate by 50% 50% now this was a
drug that has on the market proven
effective in clinical trials and yet the
impact of clinical practice wasn't known
until they analyzed the data Kaiser
didn't know that they could have doctors
saving more lives so that's the data
that we have but we also need data about
outcomes to understand how we can
improve what really matters now outcomes
data doesn't typically exist in
electronic records it exists in separate
registries for research or perhaps not
even at all there is a significant
evidence base that shows understanding
clinical outcomes improves clinical
practice and understanding clinical
outcomes accelerates this information
accelerates our learning and
understanding of what good looks like in
healthcare walk with me to the martini
clinic here in Germany the martini
clinic is a specialized prostate cancer
facility they have used outcomes data to
consistently improve their clinical
performance over the last few years and
the results are incredible this facility
because they've used outcomes data have
been able to show that a patient after
prostate surgery only has suffers from
incontinence 7% of the time when at the
average German Hospital that will happen
43% of the time guys
I wouldn't take my car to a mechanic
with the poor service rating why would
you take shall we say important
equipment anywhere else
now with improvements in outcomes and
our understanding of outcomes we will
accelerate our understanding of what
improves clinical practice so this is
really exciting we are getting so close
to understanding where in the world
we can get better treatment we are
working with Karolinska Institute
Harvard Business School and 200
providers in 12 countries to create a
standard set of outcomes measure for
important conditions we are so close to
understanding where in the world we can
get the best treatment and I ask you
where would you go if you had to may
have prostate surgery this information
will be part of the TripAdvisor for
healthcare because we will actually
understand it now hospitals
everybody talks about hospitals but
actually 2/3 of our health care spending
is outside of hospitals here is where I
think digital gets really exciting
because we finally have the opportunity
to connect in different ways with our
patients digital will be a real channel
for reaching customers or patients as it
is for retailers for travel for banks
and for any other industry in the future
you will be able to communicate with
your doctor via video chat
you will upload information from your
smartphone to help him with his
diagnosis people in remote locations
will receive important text reminders
and important medical information your
doctor might also accept a selfie at a
certain point to help with his diagnosis
he might use it actually in comparison
to a database of other selfies from
around the world we will we will see
reminders in pills and in pill boxes
that remind you to take your medication
and we will see you going to social
media sites to ask about the patterns of
treatment or the experiences that you
have about your own health care apps in
some cases obviously not all will
replace doctors and pills we have the
first instance of that in the United
States well doc a simple application for
diabetic patients basically it takes
information about diet and exercise
blood glucose readings and provides
regular coaching for people around the
management of diabetes
interesting I'm sure you could think of
a lot of examples it's prescribed by
doctors
it's reimbursed by physicians it's not a
drug it's not a device it's an app so
interestingly all of this stuff all of
those examples exist today in pockets
this is not about new technology this is
about the data that we get from these
applications and how we use it in three
ways
first we will understand more about how
to keep people out of hospital this is
an example a COPD which is a lung
disease it's a chronic condition and it
basically people become admitted to the
hospital on a regular basis an app can
help these people this app could help
people with inhaler technique it could
help people with using their drugs more
regularly it could help them with
exercise it could help them with
stopping smoking with peer support now
these are not your people who are
wearing fitbit's and you know actively
training for a marathon and yet we know
so little about these people if a
retailer if you might have read the
article about target if a retailer can
predict from a customer shopping
behavior that she is pregnant and even
estimate her due date which actually is
well published why can't we in health
care use data to predict and understand
what's happening with these patients
if pharmaceutical companies were to
focus on this understanding people's
behavior and how to influence and how to
keep people out of hospital in addition
to understanding how to use their
inhalers how much more impact could we
make there's another area of impact that
we would have which is around organizing
for around community services now if I
can get a taxi using an app on my iPhone
that connects me with available apps
around the corner how better could we
organize community clinics home care
workers and social workers this is a
significant part of where we spend our
money in health care we don't have to
wait for fully-automated is all-singing
all-dancing records we can use the data
that we have today an interesting
example staying with my COPD example
using existing data is this here we did
an analysis of you know where people in
the northern part of London actually
have COPD more than the London average
which is the brown and where they have
less which is the green and we combined
a different data set which we had to use
an internet search for because from the
Public Health Service we couldn't figure
out where this clinics were and which is
an issue of in itself but actually when
you see there the green dots that's the
location of the clinics that the people
need to stay out of hospital there are
more clinics in the green areas than in
the brown and in some of the areas of
the brown there aren't clinics at all we
can use data to segment populations
understand risk factors and organize our
services in a completely different way
so the title of my talk will do digital
disrupt healthcare or will we die
waiting so it indicates a bit of my
frustration having worked 20 years in
this field about the lack of progress it
also indicates my optimism that we are
finally getting close to a tipping point
of very exciting things that could
happen in healthcare this is not about
technology the technology exists this is
not about fully integrated electronic
records and solving the world's privacy
issues that's so complicated I don't
think it'll happen in my lifetime what
this is about is using existing and new
data and combining that in a way that
will improve the services that we
deliver to our patients and engage
people and patients in their healthcare
in new ways if we can start to figure
this out
with existing data we can start to solve
the problems and less people will die
waiting thank you