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Copyright © 2015. All Rights Reserved. l Nth Dimension Confidential.1
Technology adoption in health – is the NHS ready?
Copyright © 2015. All Rights Reserved. l Nth Dimension Confidential.2
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
Copyright © 2015. All Rights Reserved. l Nth Dimension Confidential.3
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.
Copyright © 2015. All Rights Reserved. l Nth Dimension Confidential.4
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
Copyright © 2015. All Rights Reserved. l Nth Dimension Confidential.5
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.
Copyright © 2015. All Rights Reserved. l Nth Dimension Confidential.6
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%
Copyright © 2015. All Rights Reserved. l Nth Dimension Confidential.7
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
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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
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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
Copyright © 2015. All Rights Reserved. l Nth Dimension Confidential.10
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
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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
Copyright © 2015. All Rights Reserved. l Nth Dimension Confidential.12
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
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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’
Copyright © 2015. All Rights Reserved. l Nth Dimension Confidential.14
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
Copyright © 2015. All Rights Reserved. l Nth Dimension Confidential.15
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
Copyright © 2015. All Rights Reserved. l Nth Dimension Confidential.16
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
Copyright © 2015. All Rights Reserved. l Nth Dimension Confidential.17
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
Copyright © 2015. All Rights Reserved. l Nth Dimension Confidential.18
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