The Cit itiz izen Perspective for Dig igit ital l Healt lth - - PowerPoint PPT Presentation

The Cit itiz izen Perspective for Dig igit ital l Healt lth

Julia Manning BSc(Hons) MCOptom FRSA Chief Executive, 2020health

About 2020health

• Mission

2020health is an independent, social enterprise think tank whose mission is to “Make Health Personal”. Through research, evaluation, campaigning and relationships we aim to both improve individual health and create the conditions for a healthy society.

• Vision

Making Health Personal means: Sustainability – individuals and their communities are essential foundations of and participants in maintaining affordable healthcare. Sharing – empowering people through technology to build confidence and knowledge, and participate in managing their health and networking within communities. Shaping – designing healthcare that reflects the needs of the individual and enables them to function within their environment.

2020health’s track record...

Our health records…

Problems for clinical judgement: 2. Obtaining a reliable past medical history

Neglecting the past medical history can cause a physician inadvertently to discontinue important medications, prescribe an incorrect dose of chronic medications, duplicate a low-yield diagnostic test, neglect an earlier directive or disrupt plans made by previous clinicians.1 Problems may become further compounded given that some of the hardest patients to treat are also those with the most complex past medical histories. This article reviews classic observations from psychology that are relevant when taking a past medical history. The patient case in the introduction describes a situation that contains each of the 8 specific traps: telescoping effects, sequencing effects, false memories, inhibition of memory, halo effects, persistence of beliefs, self-presentation and context dependency. Such biases may explain why one of us (D.A.R.) missed the correct diagnosis for this patient who eventually was admitted to hospital because of domestic

• violence. More generally, problems related to a patient's failure of

comprehension, recall, evaluation and expression cause mistakes when a physician is taking a past medical history.

Problems for clinical judgement: 2. Obtaining a reliable past medical history Donald A. Redelmeier, Jack V. Tu, Michael J. Schull, Lorraine E. Ferris, Janet E. Hux

• CMAJ. 2001 March 20; 164(6): 809–813.

Brief history of political promises

• In 1995/6 a new NHS number was issued to all patients on GPs' lists. These

numbers were the basis or electronic patient medical records. By 2001 it provided on-line access to over 60 million records.

• electronic patient records in all Primary Care Trusts by 2008 (NHS Plan 2000)
• Wanless Report in April 2002 which criticised NHS IT as piecemeal and

poorly integrated. In July 2002 Delivering 21st century IT support for the NHS promised: NHS Care Records Service (NHS CRS) containing basic patient information and health details so people would be able to access their record and all their health information and be involved in making decisions about their own care and treatment.

• Patients have the right to ask their GP to correct any factual errors they see

in their medical records, according to the new NHS Constitution. (2013)

• £1 billion to help A&Es and NHS staff access medical records in hi-tech

hospital revolution - This new funding will help deliver the government’s commitment to allow everyone to book GP appointments and order repeat prescriptions online by March 2015, as well as give everyone who wants it

• nline access to their GP record.(2013)

The digitally enabled patient

Why it’s so important…

Table 1. Projection of partial sight and blindness (<6/12) by disease type, UK (people), 2010 to 2030 (Source: Access Economics 2009: 45-47) Total cases Age Related Macular Degeneration Cataract Diabetic Retinopathy Glaucoma Refractive Error Other 2010 n = 1,857,062 16.8% 312,789 13.7% 254,417 3.4% 63,140 5.3% 98,424 53.3% 989,814 7.4% 137,422 2020 n = 2,262,124 17.9% 404,920 14.0% 316,697 3.2% 72,388 5.2% 117,630 52.2% 1,180,828 7.4% 167,397 2030 n = 2,875,392 19.6% 563,576 14.5% 416,931 2.8% 80,511 5.2% 149,520 50.4% 1,449,197 7.4% 212,779 20-year 55% % increase

• f cases

80% 64% 28% 52% 46% 55%

Chil ildren and young people le: th the case for PHR

• The current estimate of prevalence of Type 1 diabetes in children

and young people under the age of 19 in the UK is one per 430 – 530

• 6–8 % of children have a proven food allergy
• By 2025, asthma will represent the most prevalent chronic

childhood disease and result in one of the highest causes of health care costs

• 50% of mental illness first occurs before the age of 14 and one in

ten children are affected

• 7 young people are diagnosed with cancer every day in the UK

….children and parents flying blind

Refs https://www.teenagecancertrust.org/?gclid=CMbC3Lyn7swCFTUz0wode8YNpQ https://www.diabetes.org.uk/Documents/About%20Us/Statistics/Diabetes-key-stats-guidelines-April2014.pdf https://www.allergyuk.org/allergy-statistics/allergy-statistics

Wider society - behaviour change…

• A. Devices and diagnostics – public access to information outside NHS

setting

• B. Keeping up with information – only the public can? And the public

most motivated to ‘care’? JAMA McManus 2014*

• C. Personal investment – individual to NHS spend on digital is 10:1
• Should be no more them and us with this investment leveraged
• A. Regulation lag – e.g. online refraction USA June 2015 (18-40yrs)

*Self-monitoring of blood pressure with self-titration of anti-hypertensives (self-management) results in lower

blood pressure in patients with hypertension

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 Communication and education  Prevention and early intervention  Treatment and correction  Independence and self-care  Interdependence and partnership working  Recreation and lifestyle  Ophthalmology advances

Technology driven behaviour change

Follow the trends...

• a third of people aged over 55 use diagnostic technologies (blood pressure

monitors, blood sugar level monitors and mole checkers) compared with just an average of only 12 per cent for younger people (aged 35-44)

• nearly 1 in 4 (23 per cent) over-55s would be willing to have a microchip

placed under their skin containing medical information that could be accessed by healthcare professionals if they needed medical care, compared with 1 in 5 of younger people (20%)

• a quarter (25 per cent) of 18-24 year olds already own and use fitness

related smartphone apps – up from 16 per cent of the same age group saying that they owned and used such apps in the 2014 State of the Nation Report

• the percentage of 18-24 year olds keeping personal electronic health

records, such as diet and fitness notes, rose from 6 per cent in 2014’s State

• f the Nation Report to 10 per cent in this year’s survey.

AXA PPP – 2020health – Design Museum Health Tech & You ‘State of the Nation’ Survey. YouGov October 2015

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What has to change….

• Professional attitudes – welcome PGD, accelerate sharing of data, public

awareness of better practice

• Professional promotion – how many GPs have promoted benefits of PHR?
• NHS endorsement – national campaign (admitting the disconnect…)
• Culture of partnership – participatients – professionals taught from day one

/ professional expectations

• Wider culture – Making Health Personal: information, understanding and

confidence

• Children

Taught in school to request access, be given information and on wellbeing Harness the easier wins e.g. Mindtech / Gamification of healthy behaviours

Thank you

www.2020health.org

Juliamanning@2020health.org 077 2020 6910