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| Ask the Midwife - 'appy days |
These tech-connected times are stirring things up in British healthcare.
Home-life has changed in the digital age: my transport and the UK taxi industry have been shaken up by Uber and sat-nav, eReviews have changed the way I shop, and around the world e-banking on mobile phones has made huge waves. Likewise, the strong currents are shifting the creaking and oil-tanker-like NHS with all this available data, processing power and communication.
Nottingham & Derby hospitals now have flashy iPhones and iPads on most wards for recording vital signs and alerting the docs, as shiny as the First Aid apps on my phone. But there's a general sense of disillusionment with IT in the hospitals, technology's Sisyphean burden being forever to labour but to always have more work to do - the shortcomings are always more apparent than the functionality. Our ward desktop computers are renowned for their outages, for electronic medical records clunkier to search through than paper files, and for technology that lags far behind service changes and so forces juniors to be entering seemingly unnecessary data multiple times. The paper backup alternative is undoubtedly flexible, and fortunately budgets haven't reached the point of paper outages, yet.
So, to try and give some balance, here are six of my favourite ways in which freely available data has developed our healthcare.
(1) Symptom checkers and clinical decision support tools
Many free public symptom checkers are available, including the one behind the 111 NHS direct service, as well as big names like MayoClinic, Isabel and iTriage. The last of these reports 50 million hits a year in the US, and has a funky avatar if you like pictures. While widely used, don't ditch the professional yet: primary diagnosis by symptom checkers is currently correct in 34% of cases, and triage advice about whether to attend GP/hospital/self-care is correct in only 57% of cases (the algorithms tend to be risk-averse). This in contrast with seeing a physician where diagnosis is typically 72% accurate using the same vignettes. So - still some ground to cover, but the potential is growing (Semigran et al., 2015; WSJ review). A major challenge is for these to be integrated into existing healthcare workflows so more successes (e.g. alerts on GP systems about drug interactions) can be achieved.
(2) GP - delivered quick (GPDQ) and Ask the Midwife
Too busy to go to your GP? For £120 per 25 minute consultation, mobile doctors can be alerted and will come out to your workplace/hotel/home at your convenience (average turnaround - 90 minutes). Currently available in London and Birmingham, with sister products out there in Australia and likely elsewhere. Pricey, but nice if you can afford it. And if you or someone you care about is with child, in need of a registered midwife, and you want some quick answers from the professionals, AsktheMidwife - for £15 you can have a detailed messaging chat within the hour with them. Could make a good gift, that.
(3) Radiological image sharing (PACS)
This is one for the medics. The digital radiology images service is one of the most successful parts of the £11bn 2002-2011 NHS technology programme. PACS enables images to be stored and viewed sequentially for each patient - meaning doctors can compare, for example, current and prior breast images to check for development of signs of cancer, or more acutely, whether an internal bleed is progressing and needs surgery. Saves a lot of trips to the radiology basement archives. Alongside PACS we now have electronic lab test results, e-prescriptions directly to the pharmacy, patients able to choose their dates for referral appointments and broadband across the hospital estate (although the programme didn't manage to implement the single patient record it hoped for). PACS is the most visible of these though, and we may all be grateful for it someday. As may your consultant who could be reporting on your image from a screen on the far side of the planet...
(4) Choosing your doctor based on their results
Worried about an upcoming operation? You can now browse surgical mortality and revision data by consultant (apparently about 25% of procedure information is on there so far); and through the same site can review the Care Quality Commission's inspection reports of your local GP practices/hospitals, which may be slightly more helpful than reading the ludicrously polarised patient-submitted feedback through NHS choices. Transparency, while perhaps risky in the hands of those who aren't good at interpreting it (and likely to breed cautiousness on the part of surgeons not taking on difficult cases), certainly adds to competition. Anna Powell-Smith and Ben Goldacre's OpenPrescribing has also now made it possible to review the prescribing patterns of your GP practice, in case you're curious.
(5) Devices communicating wirelessly, e.g. pacemakers and pillboxes
A pacemaker antenna sends a message to a home bedside base unit (e.g. at 3am), this logs alerts which are then flagged to the medical team as required. This significantly reduces check-up visits for pacemakers (Burri & Senouf, 2009). The communication tool has also come to market as the MedFolio pillbox (retailing at $160 per device in the US) - a study found low-cost, portable, user-friendly devices improve takeup (Hayes et al., 2006). Just don't believe the hype about most of telehealth yet, it doesn't offer bang for its buck, so we're not going to see this on a major scale, yet.
(6) Accessing your own electronic medical records
98% of NHS patients can already electronically access their GP summary care records of medication, allergies and adverse reactions they've had, and the government intend patients by 2020 to be able to access all their test results, including hospital data, and also add to their own notes (!). If we are to empower people to take ownership for their healthcare, there's much sense in this. Despite confidentiality concerns expressed in the media, patients' NHS healthcare data has been analysed for service planning, research and epidemic-spotting since 1987 (see CPRD) - only 1 in 50 people have opted out, so with increased transparency we can expect the patients to take more control of their own data.And that's not to mention the many devices enabled by the processing power, from CT/MRI scanners to robotic surgery. For skeptics who are still groaning on about the good old days of the NHS, before all this modernity when matron ruled with an iron fist, I commend Monty Python to thee...
"But what have the Romans ever done for us...?"
Thanks to George Palmer of SendOwl for review and links to AsktheMidwife and OpenPrescribing
