Devaka Fernando MD FRCP FRCPE MSc FCGPSL ( H on) Consultant Endocrinologist and Honorary Professor

1. Delivering High Quality Care in the 21st Century Consumer World, ehealth,mHealth,Social Networks and Patient Physician Expectations Devaka Fernando MD FRCP FRCPE MSc FCGPSL (Hon) Consultant Endocrinologist and Honorary Professor Sherwood Forest Hospitals NHS Foundation Trust and Sheffield Hallam University Member CCG Board Thanet CCG

2. 21st Century Consumer World • Ehealth, mHealth, Social Networks • Patient Expectations • Physician Expectations

3. The Information Age 1956? • In the United States, the number of people holding "white collar" jobs had just exceeded the number of people holding "blue collar" jobs. • Steady trend away from people holding manufacturing jobs. • An increasing number of people held jobs as clerks in stores, office workers, teachers, nurses, etc. • The Western world was shifting into a service economy

4. The Information Age and Information Technology • The Industrial Age gave way to "the Information Age". • Relatively few jobs had much to do with computers and computer-related technology.

5. Digital age • A term that has been used to refer to the present era, generally beginning within ten years of 1990. • The word digital comes from the same source as the word digit and digitus (the Latin word for finger), as fingers are used for discrete counting. The word digital is most commonly used in computing and electronics, especially where real-world information is converted to binary numeric form as in digital audio and digital photography. • Information and Communication Technology—computers, computerized machinery, fiber optics, communication satellites, Internet, and other ICT tools—became a significant part of the economy. • Microcomputers developed, and many business and industries were greatly changed by ICT.

7. Operational Efficiency Efficacyof Care Patient Safety CQI/TQM Patient Financial SystemsDepartmental Clinical Systems 1980 1990 2000 2010 2020 TODAY Institute of Medicine (IOM) report Eras of IT in Health Care ANALYTICS CONTINUOUS IMPROVEMENT Process IntegrationWorkflow Transformation Data Integration: Patient-Centric View Clinical Decision Support – CPOE Technology Infusionfrom Other Industries

8. Using Databases for research

10. Its not as complicated as many would think!!!!!!

11. Evolution? H. Australopithecus H. industroservicialis H. erectus H. sapiens Million years 50 years

12. Patients are highly influential in treatment outcomes Importance of Convenient Therapies Low High DiabetesObesity Consumer High CardiovascularDisease Ultimate decision-maker concerning the nature and extent of therapy Required Behavior Modification for effective therapy Asthma TB Low Physician Cancer Hypertension Osteoporosis Infections Acute Chronic Nature of Illness

13. Industrial Age £ Tertiary care Encouraged Secondary care Primary care Discouraged £ Self care family/friends Encouraged Self help networks Professional as teacher Discouraged Professional as partner Information Age Professional as authority £ Inverting the Power Pyramid (from Ferguson T, Consumer Health Informatics 1995

15. Men and their trousers • 50% of men wear their trousers too tight • only 10% admit to it • 40% identified their own image • 20% women identified their man’s image • 45% of men thought they were overweight • 30% hated their stomach most of all Prof Steven Gray, NTU, 1999

17. Population approach

18. Paradigm of NCD Prevention, Control and Health Promotion

19. The continuity of care model Registration of services Diagnoses Problem lists Healthy Population Hospital care Progression Risk Factors Terminal care Disease Palliative care Tertiary prevention Treatment and rehabilitation Medical intervention and secondary prevention Primary Prevention: High risk groups Primordial Prevention: Population

20. Strategic Scenarios

21. http://www.ibtimes.co.uk/healthbook-app-revealed-apples-big-play-health-fitness-market-1440664http://www.ibtimes.co.uk/healthbook-app-revealed-apples-big-play-health-fitness-market-1440664 NHS Local showcase Florence the NHS Telehealth system Florence, helping COPD patient Chris Cartlidge. Chris uses her mobile phone to interact with a new intelligent NHS Telehealth system which sends reassuring messages and advice to her and even alerts her Community Matron if she needs medical attention.

22. At-risk individuals and groups General population Known Disease Interventions with a socio-economic & POLITICAL FOCUS Interventions with a CLINICAL FOCUS Interventions with a PREVENTIVE FOCUS • Lipid lowering drugs • Antiplatlet agents • Beta blockers • ACE-inhibitors • Appropriate revascularization • Identifying and treating individuals with high cholesterol or hypertension (by behaviouraland lifestyle modification or drugs) • Smoking cessation in a smoker • Taxing tobacco/alcohol/Sugar • Subsidizing healthy foods • Health Education • Promote Physical activity (e.g., mandatory physical activity programs in schools)

23. The Chronic Disease Care Model Community HealthSystem Resources and Policies Organization of Health Care Develop and implement policy to improve health Self-Management Support Information systems DeliverySystem Design Decision Support Create Supportive environment Strengthen community action Productive Interactions Informed, Empowered Patient and Family Activated community Prepared, Proactive Practice Team Prepared Proactive community partner Health Improved Population health and clinical functional Outcomes

24. Innovative care for chronic disease framework Positive policy environment • Integrate policies • Promote leadership • Promote advocacy • Promote consistent financing • Develop competency • Deploy human resources • Strengthen partnerships • Support legislative framerworks Community Prepared Health care organisation • Raise awareness • Reduce stigma • Encourage better outcomes through leadership and support • Mobilise and coordinate resources • Provide complementary resources • Support self management and prevention • Provide continuity and coordination • Encourage quality through leadership and incentives • Organise and equip health care teams • Use ICT • Support self management and prevention Community partners Health care team Motivated Informed Patient and family Better outcomes

25. The 'Ideal' ‘Patient’! I feel confident to monitor my condition and recognise when I can deal with it my self and when I need to see the doctor/nurse I have a personal care plan which I have agreed with my nurse/doctor I know and understand my test results and how I can improve them I understand my condition and how to manage it when it gets worse I am living my life to the full I feel happy and in control of my condition I understand how to take my medication, how it works and the side effects I can make choices to improve my health and know where to get the help I need to meet my goals I have a plan in place for when I need more help

26. Our patients with long term conditions are encouraged to have a personal care plan and set collaborative goals The 'Ideal‘ service! Patients with more than one long term condition attend one LTC care planning appointment We share results with our patients ahead of their care planning/review appointment and we copy all letters to patients Patients with long term conditions are encouraged to self care and are referred to appropriate education resources Patient have a named contact at our practice should they have any queries about their condition Our staff are trained in care planning and self care Evidence based information and signposting for patients to self care is readily available at our practice Patients have regular medication reviews and know where to go to ask questions about their medication Patients have a plan to manage exacerbations of their condition We encourage our patients to set the agenda at appointments using agenda sheets/bubble maps

27. Clinical Decision Support • Giving clinicians, patients, and others relevant information in context, that helps them make better decisions, prevent errors, and improve care quality and outcomes • CDS interventions include guidelines, alerts, order sets, tools to interpret patient data • ‘‘any measure designed to help health professionals make clinical decisions, deal with medical data about patients or with the knowledge of medicine necessary to interpret such data’’. • These DS tools can be classified into: • tools for information management • tools for focusing attention • tools for patient-specific consultation

29. Expectations 1 • Use the process of systematically reviewing, appraising and using research findings to aid decision making on the best method of delivering optimum clinical care to patients. • Such decisions should be based on strength and weight of scientific evidence on clinical effectiveness when allocating resources • Assurances on Safety: As to disease, make a habit of two things – to help, or at least do no harm- Hippocrates, Epidemics (book I Chapter XI) c 400 BC

30. Expectations 2 • ICT systems are a health care intervention. Does it do the job? Meaningful use? • Clinical Governance and Information Governance are both important • Systems for evaluating their efficacy and safety should be as robust as those evaluating other health care technologies. • An integrated approach by consumers of health care technology and providers of technology required. • A corporate culture of evidence based critical appraisal is required • Consequent corporate buy in from developers, providers and purchasers of IT solutions in health care is required. • Preferences to mix and match? Interoperability? • Database Studies: New Paradigm for research?