Do you remember when smart was simply to do with setting goals for the team and less about a platform that ensured services were integrated? Maybe we need to bring this definition back and apply it to integrated care and eHealth. Specific, measurable, attainable, relevant and time bound could all be the new hooks for the delivery of a digital platform that truly enables a reform of the health system and links it seamlessly to a smart city.
Ireland is on a journey defined by a realisation that the many understandings of smart have become essential to the delivery of health care. Connected health, eHealth, digital health, smart healthcare and mHealth all point to a similar outcome – an improved health system supported by, not the latest technology, but simply technology from the last decade.
Let’s play back that team-building definition of smart and see where it takes us. The concept of specific healthcare could be a wider definition for personalised medicine in reality. The information you as a citizen provide to facilitate the smart city to know your needs could, with significant care and consideration, be used for healthcare delivery. This information would allow the system to go beyond personalised care and become contextualised care. Not only is the information about you available but the context in which you are in at any given moment in time can be applied to the care delivery and advice you are given.
Contextualised healthcare in a smart city
Imagine as you move through a city that it is able to recommend to you the right restaurant for your dietary needs based on the condition you have made available via your open standards health record. Or the smart city that is able to spot a specific accident that needs emergency services and through traffic control is able to ensure that the right assistance is available quickly from the right type of medic. All of this is technically possible now, and as cities begin to create their own smart fabric it will become easier and easier to interact with.
A key here though is to get the attitude to data openness right. It has to be the choice of the citizen to share data, and not the requirement of the smart city. As cities and governments prove they can take care of personal data and the benefits to the citizen grow, then and only then, will people be more willing to share information and become part of the smartness it can deliver.
A measurable healthcare system in the hands of the citizen
If we are able to make modern healthcare measurable through the use of a smart city fabric then the process of continuous improvement could be made so much more real, more tangible to the citizen. Imagine, as you leave your GP you are asked via a smart device to rate the experience and to provide feedback on the care you’ve had, information, which in turn, can enhance other patients’ decision making. As with the above specific examples, this is now technically possible. What’s needed is not technology innovation, it’s a change in attitude and culture. Is the clinician happy to be rated by the patient, for example, and how does the next patient use that information? These are crucial questions that need to be answered in order to attain a measurable care system that puts the outcomes of the measurement in the citizen’s hand.
Healthcare is challenged regularly to publish more and more open data, and rightly so. The duality of the challenge to publish open data and to also protect data, to the point of removing a citizen’s digital identity where they ask for, needs to be met. The ability of maintaining a measurable healthcare system within this complex requirement is one a smart city can help with. The right to be forgotten has to be part of a smart city fabric as much as the ability to have the smartness support the life of the citizen. Otherwise, the duality of a two tier existence will evolve, as outlined in the book ‘The Circle’ by Dave Eggers. The book describes a world where nearly everyone aspires to be part of the circle; those that don’t receive what is described as a second tier service. Somehow, as we move to a digital fabric for health we have to find a way to be as clear as possible about the benefits of digital health, while also allowing anyone with concerns to not be part of the system but still get a quality of care.
Relevant care driven by relevant data
Making the delivery of healthcare attainable could also be made significantly easier with proper links to a smart city. Many commentators have pointed out that our healthcare system is wrongly titled, it’s not a system for health it’s a system for the sick. Technology could change this. It could enable the citizen to use technology to stay healthy, truly transforming the way in which we deliver care. The ability for a citizen to provide their own information via a wearable device or sensors in the home could ensure that early warning of disease or even fitness could be captured, enabling the whole healthcare system to become more accessible and attainable to everyone. Capturing discrete coded findings without interfering with the patient-clinician relationship could be a huge benefit of a smart city infrastructure.
The ability to make a healthcare system relevant can be achieved through the digital fabric of a smart city and the attitudes of the citizen that this would bring. The shining example of the Tesco Club Card is often used as an example of the citizen being willing to provide information in return for a tangible benefit to them. The healthcare system within a smart city would be able to achieve relevance through cross channel continuity, with citizens willing to provide real time data to systems across the city that, with their consent, could be used for the delivery of a contextualised care plan that is uniquely relevant to the person, the setting and situation.
Smart infrastructure supporting virtual healthcare
The relevance of virtual healthcare delivery supported by a smart infrastructure could also be considered in a city where the system has been created to enable a truly digital approach. A video and voice consultation with a clinician that fits around the citizen’s life is entirely possible with the right technology in place today. The outcomes in countries where this kind of tele-medicine approach has been adopted have been phenomenal: citizens remain out of care settings for longer as they are able to access advice and care planning remotely and in a timescale appropriate to the condition or illness that they have. The parallels to countries that never deployed fixed phone lines and have now adopted mobile-first policies successfully is not to be lost in this arena and is something that Ireland can and should consider for the near term future.
Patient becomes information provider
Last on this analysis of a smart city and the impact on the delivery of eHealth is perhaps the most immediately beneficial in Ireland. How to use technology to ensure that care is delivered in a timely fashion. Smart city analytics that are descriptive, predictive and prescriptive create an opportunity to deliver a superior level of care based in information not data. Health delivery has been considering how it moves from data to insight for a long, long time in many jurisdictions. The ability to provide a unified healthcare information intersection point where, by altering the role of the patient to information provider, the healthcare professional can access insight and deliver pieces of information without the wait currently experienced in Ireland. The smart city allows the patient to add to their record or provide information to the healthcare provider without having to actually come face to face with them.
There is a common and unfair commentary made in Ireland: why do clinicians need out-patient clinics to remind them to look at patient notes? While I strongly believe this is an unfair commentary, if the patient were providing the information, the paradigm this commentary is based on would change completely.
My parents had a different word for smart when I was a child, a ‘bobby dazzler’. I really would like to make 2016/17 the years that we put in place the ‘bobby dazzler’ of eHealth systems that truly set every village, town and city in Ireland on a journey to be able to have a health care system that we can all recognise as smart. Some of the ideas here in this blog may seem like science fiction, and yet the technology for all of this is here now. It’s the investment, engagement and business change that needs to be put in place to achieve it. These are all things we, as citizens of Ireland, can ask for and help to put in place.