The way in which medical and healthcare is delivered is changing. Technology is advanced to the extent that intensive-care unit (ICU) capabilities can be combined with home monitoring facilities; telehealth centres can receive multiple sources of data from large numbers of patients based in their homes and prioritise who needs care – instantly. And with video conferencing and online tools, it is no longer wholly necessary for people to attend appointments at surgeries and hospitals.
Philips HealthSuite, for example, is a digital platform that collects, compiles and analyses clinical and other data from multiple devices and sources. Representing a new era in personalised and connected care for both the public and professionals, it allows patients and their health-care providers to access all manner of data, from the state of an individual’s health through to population trends – all from their PC, tablet or smartphone.
Even without complex technology, data is being collected and analysed to address key challenges. Ian Ireland, chair of the Royal College of Nursing’s e-health group, gives the example of a care home that had a higher-than-average rate of falls. “A graph plotting the time and location of the falls compared to the staff rotas was created,” he says. “What became apparent was that after the evening meal some residents wanted to go to bed. While the nursing staff were busy taking them upstairs, other residents would attempt to go to the toilet by themselves but fall over. Staffing was subsequently rearranged and the number of falls reduced by 50 per cent,” he says.
Many of the skills required by health-care professionals are changing as new technologies come on the market. Indeed, Jeremy Hunt, the Secretary of State for Health, believes that increasingly powerful diagnostic tools will remove the need for GPs (that’s to say, human beings) to diagnose medical conditions.
The idea that technology will render diagnostic skills obsolete is perhaps a step too far. As Dr Taylor, a GP based in the Midlands, observes, doctors frequently don’t make “diagnoses” but “non-diagnoses”, and they do so by applying local context to their decisions – something a computer program can’t necessarily offer.
“Of course technology can be very clever, but there is much more to healthcare than just diagnosis,” Taylor says. “The benefit of visiting your GP is that they can consider the whole clinical picture in relation to family and social set-up. For example, recently I saw a woman who was experiencing knee pain. When I suggested that she have an MRI and arrange an appointment to see an orthopaedic surgeon, she burst into tears. Her husband had left her, her child had been taken into care and to have an operation would have made life even more difficult for her – all of which meant that I had to change my recommendations. A computer program couldn’t have responded to the social context in the same way.”
Equally, not all areas of the country are fully up to date yet when it comes to technology and high-speed broadband, and so many people simply could not access telehealth services even if they wanted to. As such, they will remain dependent on conventional forms of healthcare – at least for now.
All said and done, the digital revolution and the swaths of data that come with it clearly offer many opportunities for the NHS – as long as health-care professionals know how to use them. And there’s the rub, says Neil Mesher, managing director of healthcare at Philips UK & Ireland.
“If you look at how GPs are trained today versus what they will need to be trained in in ten or 20 years from now, it is a very different space. There is so much potential to be found in the data, but GPs need to know how to sift through it, manage it and interpret it,” he says.
The picture for UK medical training in relation to technological advances is currently a little confused. While it has been acknowledged that patients’ needs are changing fast, there doesn’t appear to have been as much discussion of the role of tech skills in helping address this. The 2013 Shape of Training Review by Professor David Greenaway aimed to offer an “approach that will ensure doctors are trained to the highest standards and are prepared to meet changing patient needs. It also offers an approach that will be fit for purpose for many years to come.”
However, only two paragraphs of the 57-page report were dedicated to technological advances. “We considered this review against the backdrop of rapidly changing medical and scientific advances, evolving health-care and population needs, changes to health-care systems and the information and communications technology (ICT) revolution,” the report stated, and then recommended that “a flexible training pathway” be introduced, to enable doctors to take advantage of developments.
In October this year, the British Medical Association (BMA) followed the Shape of Training review with its own publication, Pre and Post Qualification Training and Development of Doctors: a British Medical Association Vision. Referring to challenges such as the UK’s ageing population, expectations of more personalised and joined-up healthcare; as well as rapid advancements in medical and science, it called for training that better reflected the needs of patients, allowing for continuous learning and improved flexibility to accommodate the needs of doctors.
“Crucially, change in medical training should be evolutionary and evidence-based. It should learn from and build upon current and past experience. Training and development must again become integral to services and service planning, specifically and explicitly resourced and based on quality and need rather than convenience,” the report said.
Some medical courses are adapting their curriculum accordingly. The University of Surrey, for example, is one of a handful that are looking to launch an integrated “engineering for health” degree promoting the use of technology in medicine. However, currently such courses are few and far between, although technology and engineering were recognised as important for certain areas of the medical profession. “I think it’s safe to say that big data is not currently driving changes to medical education in the UK,” said the head of clinical studies at the University of Oxford.
Lessons from the US
The United States is one country that is leading the charge on this front. The American Medical Association has launched a $1m initiative,designed specifically to encourage medical schools to change their curriculum. Called Accelerating Change in Medical Education, it is teaching the use of electronic health records, management of patient panels to improve health outcomes, and interpretation of big data on health-care costs and health-care utilisation in order to learn how best to use resources.
“We know it’s time to change. Schools want to change, and we’ve gathered together people who are doing projects that are really making a difference in the way physicians are trained for the future,” says Dr Susan Skochelak, MPH, group vice-president of medical education at the AMA. “Together, the 31 [member] schools will collectively work to quickly identify and widely share the best models for educational change to ensure future physicians are prepared for a lifetime of learning, to lead a team of professionals in delivering care and to explore innovative ways to care for patients, populations and communities in the evolving health-care system.
“By working together, we believe that during the next several years this effort will produce physicians who are not just skilled clinicians, but system-based thinkers, change agents, technology champions and inter-professional team players.”
This is beginning to have an impact across other areas of the medical education community, too. Early this month, the Accreditation Council for Graduate Medical Education (ACGME) announced an initiative called Pursuing Excellence in Clinical Learning Environments, which will be delivered in partnership with the AMA, to facilitate improvement in the graduate medical education system.
We wait to see if the UK will follow suit. Until then, the take-up of tech and data skills is more likely to be driven by health-care professionals themselves.
“Nurses expect timely and accurate information on their patients and yet they don’t always receive this. They also expect access to the technology and training that allows them to use this information correctly,” says the RCN’s Ian Ireland. “I suspect that frustration at not being given the tools they need will help drive more universities and educational institutions to introduce more courses of this nature.”
He adds: “Of course, many nurses are already far more up-to-date with digital and data skills than they think they are, due to the fact they shop and bank online, and use many different apps via their mobile phones”.
Indeed, using in-house skills has already been identified as an important part of the NHS’s tech strategy. Code4Health, for example, is a UK government programme under which doctors, other health-care professionals and even patients are being given training to write basic computer code. They will then be given responsibility fordesigning simple prototypes for tools they think could make the NHS work better.
Members of Code4Health join a growing number of people taking NHS IT into their own hands. “Geeks who love the NHS” is another group of doctors and nurses, together with computer programers and web designers, who organise informal “hack days” when they come up with new apps and other programs. Examples of apps that the group has developed are CellCountr, an app that provides haemotology cell counts, and PatientList, a clinical task list app.
It can be easy to get caught up in all the excitement of new technology. However, if appropriate skills are not delivered to those who need them to use the new tools, then the opportunity to realise the potential of these developments could be lost. As Philips’s Neil Mesher, says: “Over the next ten to 20 years, IT and digital technologies will be providing more and more value to the health service. Having the right information available at the right time is central to allowing clinicians to make better, more accurate diagnosis.” Tech and data analysis skills therefore need to become a priority item on the agenda if the NHS is to remain relevant in the modern world.