Entediada na escola, falta às aulas, em desigualdade com os seus pares: Esta criança pode vir a ser uma empreendedora, diz Cameron Herold. Na TEDxEdmonton, ele defende o modelo de educação parental e escolar que ajuda os possíveis futuros empreendedores a prosperar — como crianças e como adultos.
EUROPE Paul Timmers, a director in the European Commission’s department responsible for managing the digital agenda, backs an open market for innovative eHealth and wellbeing products and services
Europe’s healthcare domain is facing an uncertain future. While our healthcare systems are starting to feel the strain of an ageing population, today’s young people are projected to be the first that will have a lower life expectancy than their parents due to the negative health effects of physical inactivity. This unhealthy scenario is compounded by an economic crisis which is forcing many health authorities in Europe to meet mounting challenges with declining resources.
While the challenges are significant, they bring with them an opportunity that must be seized. Currently, healthcare lags a decade behind virtually every other sector in the EU when it comes to implementing digital technologies. Now is the time to embrace smart innovation which will revolutionise healthcare and open up a whole new market.
To do so, we need to acknowledge that, to remain viable in the long run, healthcare systems need to become more efficient – responding to broader societal trends that all European countries are facing, including an ageing society and an increasing desire of patients to become actively involved in their care processes.
This does not mean reinventing the wheel. We can already see excellent examples from across Europe of how digital technologies are enhancing citizens’ health and wellbeing. Scotland is reaping the benefits of implementing telecare solutions on a wide scale. Some 6,600 unplanned hospital admissions were avoided over four years. In 2013, we expect to see a body of new evidence to emerge on the benefits of telehealth solutions for chronic disease management, from the pan-EU Renewing Health telehealth pilot.
Of course, no single solution will ever suit every EU country, healthcare system, hospital or patient. However, much can be learnt from the experience of others. For this reason, the European Commission, through initiatives such as the European Innovation Partnership on Active and Healthy Ageing, is bringing together partners to share best practice and research, as well as innovate and invest in solutions with the aim of increasing the average healthy lifespan of European citizens by two years. This approach means that successful technological, social and organisational innovation can thrive without the risks of venturing into uncharted waters. In the area of integrated care, for example, we have managed to attract partners who together committed more than €1 billion of investment.
Let’s not forget that patients are not only being empowered to manage their conditions, but also to take a proactive approach to illness prevention. Already there is clear evidence of people wanting to be in the driving seat. In the UK, the NHS Choices website gets up to 11 million visitors a month, and there are more than 13,000 health and fitness-related apps for the iPhone alone.
This desire to take action and interact with technology provides real opportunities for businesses to innovate for the future health of Europe’s citizens, and to make widespread availability and use of eHealth a reality. Now is the time to act and seize the opportunities that citizens are demanding and which are offered by European partnerships.
Going forward, the European Commission will work to foster an even better performing and open market for innovative eHealth and wellbeing products and services. This will mean addressing the needs indicated in the recent report of the eHealth Task Force: unlocking health data while ensuring strong safeguards, improving digital health skills among health and care workers and citizens, and ensuring that we connect so everyone can benefit from a real digital healthcare revolution, wherever in Europe they may be.
Paul Timmers is director for sustainable and secure society, within DG Connect at the European Commission, and was previously at the University of North Carolina and United Business Institute, Brussels.
From RECOUNTER by Paul Timmers
PROGNOSIS As the UK population ages and more people live with illness, provision of healthcare must adapt to meet the new challenge, writes Lilian Anekwe
The way that healthcare is provided and how people expect it to be delivered has changed. There are more demands on healthcare systems as we get older and more people live with chronic illnesses.
Last year researchers at the University of Dundee wrote in The Lancet that “radical change” would be needed for the NHS to cope with the rising number of people suffering chronic illnesses. In response, the Department of Health said technology would be key among these changes. Specifically, the department singled out greater use of telehealth to “help people care for themselves and manage their conditions better”.
Telehealth is an example of connected healthcare, technology-enabled health management initiatives that deliver care outside the traditional medical settings of the hospital and the doctor’s surgery.
Brian O’Connor, chairman of the European Connected Healthcare Alliance, a collaborative of commercial, academic and government stakeholders, says approximately 20 per cent of the population cost more than 80 per cent of the total spend of healthcare services.
“Many people who have chronic diseases are the biggest users of beds in acute hospitals and ambulances, but once they are stable in hospital all they need is monitoring,” he says.
“The big innovation is remote monitoring. If someone in their own home takes their own readings every day, these can give an early indication of possible problems and interventions can be made to prevent that person going to hospital. You can see the benefits to the individual and to the health service.
“Some technologies, such as smartphone apps, are already being used to connect patients and doctors, and by those without chronic diseases who want to manage their own health.”
Marco Mohwinckel is partner at Janssen Healthcare Innovation, a division of Johnson & Johnson tasked with using technology to modernise healthcare delivery at the company. He warns that, though there are clear opportunities for connected health technologies, we should also be wary of “hype”.
“There’s a lot of hype and perhaps confusion around technology, and what it can or cannot do,” he says. “Technology by itself is not necessarily the answer to all problems. It is a valuable tool and an enabler that should be deployed to solve real needs of real people. The key issue around connected healthcare – telehealth, telecare, m-health, all these buzzwords – is that the business models are not clear. Who pays for often unproven technologies at a time when everyone is looking to cut back cost?
“We have tools directed to patients and consumers that allow them to manage and monitor their health and disease better, analytic tools that help manage and put meaning into big healthcare data, devices and apps to encourage connectivity between healthcare professionals and patients, and technologies to improve workflows and processes in and out of hospitals.
“As an industry we have to move away from being product-focused towards being patient-focused and that means delivering outcomes through integrated solutions.”
Investment is desperately needed, says Mr O’Connor. “One of the biggest obstacles is lack of funding. But until we start looking at spending on health as an investment rather than a cost, we will not overcome some of these problems.”
This is beginning to happen in Northern Ireland, he says, while the Department of Health in England has launched its 3millionlives campaign, which is a commitment to bring telehealth and telecare to three million people over the next five years.
Meanwhile, in the United States, the “Obamacare” health reforms have provided $27 billion in incentives for the “meaningful use” of electronic health records. Industry analysts Accenture have highlighted computerised clinical decision support systems, and electronic prescribing alerts and reminders as potential areas of such meaningful use.
The potential for meaningful use of technology in UK healthcare is undisputed.
SELF-MANAGEMENT Telehealth is transforming lives and the government has plans to roll out the technology to three million patients, writes Rowenna Davis
Many people with cardiovascular disease and other long-term illnesses live with symptoms that don’t warrant hospital admission, but still cause worry. Some suffer in silence and leave themselves at risk; others spend too much time in hospital waiting rooms.
Telehealth, technology that uses telephone or internet-enabled devices to monitor people’s health, may offer a solution. By putting patients in charge, this technology promises to let people regain a sense of control over their health.
Mike Worden, head of healthcare advisory services for the telehealthcare provider Tunstall, has a clear notion of the role these companies can play. “What we’re offering is self-care. There are lots of examples of lives being saved, and there is also an impact on carers and families. Both parties don’t have to worry so much. It’s life-changing for them,” he says.
One Tunstall device, My Medic, takes patients’ blood pressure, weight and oxygen levels, and sends them to a monitoring station staffed by nurses. Patients can call for advice if they notice any significant changes and feel more confident about going out if they don’t. Landlines and mobile phones can be set up to deliver prompts, while follow-up health conferences with doctors can be arranged over the internet via Skype.
Until recently, the British have remained skeptical of the telehealth revolution. While private healthcare companies have been pushing a wide uptake in the United States, experts say that less than 10,000 people use telehealth in the UK. Why?
“The reason telehealth hasn’t been picked up earlier was there was no evidence,” says Maureen Talbot, senior cardiac nurse at the British Health Foundation. “Companies were plugging it, but clinicians just didn’t know the evidence. Nurses had the traditional view of being proud to see and talk to patients. Machines weren’t going to replace nurses. But, now more studies have been done, that attitude is starting to change. We’re beginning to see it can be very cost-effective.”
The Department of Health has carried out the largest telehealth evaluation. Recently published in the British Medical Journal, the Whole System Demonstrator pilot involved more than 3,000 patients. It found that telehealth reduced hospital admissions by 20 per cent and cut deaths by 45 per cent. At a time when the NHS is pushed for funding, this evidence base is winning people round. The Department of Health now aims to roll out telehealth to three million people in the next five years.
But academics remain cautious. Adam Steventon, senior research analyst at the Nuffield Trust, who helped lead the study, says that, although emergency admissions were reduced, there was a spike in admissions in the comparison group when the equipment was taken away. This could mean that telehealth increases anxiety when it is taken away as people become psychologically dependent on it. And, although there were cost savings, the admissions that were prevented were generally minor and less expensive, and the start-up costs of the devices were high.
“On the basis of this trial, we’re still not sure whether telehealth saves money,” says Mr Steventon, “The cost of implementing it is quite substantial and could outweigh the benefits, although the cost could come down with economies of scale.”
However, telehealth is not for everyone. It is not suitable for patients with emergency or critical conditions, and works best for people who are motivated and able to take charge of their own health. Overall, Ms Talbot is confident that telehealth will offer growing benefits.
“What the information is showing anecdotally is that patients feel better monitored,” she says. “They have people watching and checking them on a daily basis, and they say they feel they have control over their treatment. Most significantly, they can see now that they are being admitted into hospital less. That’s a great freedom.”
‘Monitoring made me feel safe’
June Smith-Parker, 68, from Dunnington, York, uses a telehealth device to monitor her blood pressure, pulse, oxygen levels, temperature and blood sugar.
She says: “Last summer I was taken to hospital with what I thought was diabetes and the doctor said I could have a heart attack in days. He said the right ventricle of my heart was damaged and that meant my oxygen levels were 68 when they should have been close to 100. I just wanted to sleep all the time and water retention meant that I could hardly walk.
“Telehealth helped a lot. The NHS installed a device in my house that let me take my own measurements every day. I used the little gadget to check what I should and shouldn’t do. If I was walking too far, standing too long or trying to hoover, my back would start to ache, then I’d get a rapid heartbeat and I’d know I needed to stop.
“It’s a marvelous thing. It gives you independence over monitoring your own health. And, of course, all the data also gets sent to a centre and, if they don’t like what’s happening, they can ask you to take another measurement or contact a doctor.
“I don’t think there are any downsides. I did make a mistake once – I put my arm through the wrong bit of the machine and it said I had a blood pressure of over 300. I thought I was going to explode. But you can ring the people at the centre any time and they can help.
“It’s been very good for my health. I’ve slowed down a bit and spend more time with my family. For the first time I could go and visit my daughter in Holland and my grandchildren, because the constant monitoring made me feel safe. I’m going again this October – and this time I’m driving.”