Sunday, 5 May 2019

Poetry in Motion: shining a light on your health care


I had a lightbulb moment last week. I don’t mean one of those occasions where you suddenly have a great idea or gain an understanding over something that up until that point had eluded you. No, not that kind of lightbulb moment, I meant I had a real lightbulb moment, which involved a real lightbulb. The new house needed an outside lamp over the front door. Most outside lamps are either very pretty, but don’t have motion sensors, or are utilitarian, and whilst they do have a motion sensor they lack aesthetic appeal. Despite this, I had opted for the pretty type of light and bought a motion sensor to use with it. I had even found an electrician to fit the lamp. Just as we were leaving the store, J saw something claiming to be a motion sensor lightbulb. Although I was slightly dubious about such a thing, I was persuaded to buy it. 

The electrician came to fit the lamp. The bad news was he told me we couldn’t connect the lamp and the motion sensor together without chiselling out some of the rendering. This was not something I really wanted to do. So, it was back to the motion sensor lightbulb. The lamp was fitted, bulb inserted and hey presto the thing only went and worked. Unbelievable, but true. Someone had invented the perfect solution to a tricky problem. Well not quite. The light bulb switches on 24 hours a day at the slightest movement detected, and its range is extensive, and it appears to be highly sensitive. A leaf, floating gently to the ground from a nearby tree, sets it off. The bulb lights up, stays on for 60 seconds and then switches off again, before repeating the same action at the next movement detected. J did ask if we could alter the lightbulb settings, but I guess that will only be possible with the next generation of lightbulb…

However, even with its shortcomings, it is still a very useful technological development. Unlike the so called WaitLess app trumpeted to the world last week by our Secretary of State for Health and Social Care, the ever-enthusiastic technology advocate Matt (the app) Hancock. Gleefully announcing that the WaitLess app would be good for patients and good for clinicians, he believes it will relieve pressure on A&E departments (or EDs as the rest of us like to refer to them), as patients could look to see which hospital had the shortest waiting time. Talk about lighting the proverbial blue touch paper. That day Twitter lit up with tweets ridiculing the suggestion, or suggesting that more doctors were needed, we should pay nurses more to retain them, and that our GP surgeries needed to be open for longer hours and so on. 

There were also many, many tweets reminding Matt Hancock that all patients coming to the ED are triaged and those who present with the most urgent needs are seen first. My favourite comment about this announcement, asked would we now see Tesco producing a WaitLess version for their till waiting times, advising customers that the till queues were shorter at Asda, or Waitrose? Personally, I think the app might be a good idea, but like my motion sensing lightbulb, it’s not quite the complete answer just yet.

And that has been the problem for the NHS and the social care sector and its adoption of new technology. The Taxpayers’ Alliance reported at the end of April that the NHS could save billions of pounds each year if it made greater use of robots and artificial intelligence (AI). Their research posits that the widespread use of digital apps could transform care, and they note that 90% of people now prefer to use automated systems to book appointments, order repeat prescriptions and so on. It estimates that such approaches save a staggering £12 billion a year in staff time. Millions of patients are already being supported by automation technologies in areas such as diagnosis and treatment as well as logistical service administration – much of this support is unseen by most of these patients. 

However, it is in the area of predictive data analysis that the greatest gains are likely to be found. Many EDs are still not hitting the 95% of patients seen and treated within 4 hours target. The main reason for this is accurately predicting patient flow, and the exponential growth in complex presentations. Advanced AI-powered data science are used by the likes of Tesco in understanding customer preferences, shopping habits and responses to environmental and other contextual factors. The NHS should adopt these technologies to predict patient flow and demand for emergency services.

We are already seeing such approaches being used in different parts of the UK to help support the so called ‘frequent flyers’ of health and social care services. Indeed, the current review into scrapping the 4 hour target is predicated on using such data analytics. Instead of the crude 4 hour target, which lead to perverse target chasing, data analytics now allow for more sophisticated measure's. For example, determining the time patients are seen, assessed and treated, using the so called ‘rapid care measures’ to achieving individual patient-centred care. EDs will be measured on their overall average waiting times for all patients. However, those patients with heart attacks, sepsis, stroke or those experiencing a mental health crisis will now be expected to receive their care within 1 hour.

Of course, data analytics per se will do nothing in terms of helping people to help themselves when it comes to health promoting choices or choosing where to go when they need health or social care. Much more needs to be done in these areas, but new technology, particularly digital technologies, can help bring about the changes in behaviours and expectations required. Let’s hope they are more successful in action than my motion sensing lightbulb! 

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