Innovation in healthcare

IMG_9701Last week’s Cardiff University Innovation Network at Heath Hospital’s School of Medicine promised a tour of healthcare innovation. Interest piqued, I went sightseeing.

“… real innovation will not be about new healthcare technology. It will be how the medical community rewires the way it works and collaborates by innovating business models with streamlined organisation, processes and automation.”

Health, Technology and the Forgotten Stepchild of Innovation: John Nosta & Faisal Hoque; Forbes, 26/01/2013

Given as the header-quotation in a promotional email, this further intrigued. Real innovation is not about new healthcare technology. No? Was this a disguised way of promoting safer organisational change?

Energetic chairman of the evening was Professor Keith Harding, the Director of the Institute of Translation, Innovation, Methodology & Engagement (TIME) at Cardiff University School of Medicine. (Prepare for epic medical titles that beg to be skimmed).

Translational research is defined as the “effective acceleration of medical research for societal benefit or impact.” The evening’s aim was to give an 8-part tour of 5 minute innovation ‘nuggets’, all speakers threatened with Professor Harding’s water pistol, should they run over their allotted time.

1. Innovation & Translation in the School of Medicine

ageing populationFirst up, Professor Lars Sundstrom, Director of Severnside Alliance for Translational Research framed the weighty issues at hand. In the UK there are more people over 60 than under 16, with the latter figure soon rising to 25. Costs are rising throughout the EU and we simply can’t afford the current healthcare system. It’s a time-bomb.

Selecting Alzheimer’s to illustrate his point, although he said he could have chosen many conditions, Professor Sundstrom explained that its treatment cost £25 billion per year. At the current rate, it would cost 50 per cent of the total healthcare budget by the year 2050.

Hence the need for genetic research, open innovation and distributed expertise. The Health Technology Challenge harnesses all of these and strongly depends on crowd-sourced solutions. Following a selection process, the best projects win funding.

One of these is a biosensor developed to detect Urinary Catheter blockages. It demonstrates an example of translational research and the importance of building relationships, according to Professor Harding. His presentation ended under water pistol threat with the line: “Innovation is never obvious until it’s obvious”.

2. Innovation in Cardiff and Vale University Health Board

Andrew Lewis, Director of Innovation & Improvement at Cardiff & Vale University Hospital Board, spoke of continuous improvement and “propelling change”. His presentation contained lengthy bullet-point lists about R&D’s power to improve service quality and generate income through developments and enablers.

As an example of technology in action, he cited eDischarge, which led to time-savings and efficiencies. eDischarge involved making patients’ discharge letters electronic and moving away from time-consuming handwritten forms. Not a staggeringly inventive innovation, but apparently an effective one.

Mr Lewis’s parting gift was that there is “no recession in innovation”.

3. MIST Clinical Trial

Cedar is a combined Cardiff & Vale UHB / Cardiff University research group led by Dr Grace Carolan-Rees. It evaluates medical technologies for the National Institute for Health & Care Excellence (NICE) and supports decision-making on medical devices, diagnostics, interventional procedures and service configuration.

Illustrated by the evening’s first few grisly images, Dr Carolan-Rees explained the various pains of Venous Leg Ulcers, the treatment of which annually costs up to £198 million. Following a study commissioned by NICE, new ultrasound therapy MIST is hoped to significantly reduce those figures.

4. Health Modelling Centre Cymru

quick responseNext came Professor Paul Harper from Cardiff School of Mathematics.

To quickly dispel surprise at a remarkably straightforward title, he’s also Professor of Operational Research and Head of the OR Group; Director of the Health Modelling Centre Cymru (hmc2), a pan-Wales centre for modelling in healthcare; Director of Innovation and Engagement for Mathematics; and a few other things but his impressiveness is tiring. His links: profpaulharper.com / hmc2.org.

He spoke about mathematical modelling, computational biomedical modelling, systems and design. Work has been applied to WAST (Welsh Ambulances Service Trust) response times, incorporating external open sources such as Google Maps and Met Office data into simulation models and designs.

5. Teledermatology – Improving GP Education in Dermatology and through Triage and Waiting List Management

GPs receive virtually no training about Dermatology despite skin disease being the single most common reason for visiting a GP. Dr Richard Motley, a consultant in dermatology and cutaneous surgery at Cardiff School of Medicine, talked of a Teledermatology solution implemented largely thanks to the development of digital photography.

A solution no more sophisticated than an email attachment of a photograph accurately showing a skin condition has relieved a massive burden, allowing 80 per cent of cases to be handled remotely. As well as helping patients, Dr Motley told how the solution educated and empowered and could be used as a key teaching resource.

6. Electronic Handover

burden of careAssistant Director of Innovation & Improvement at Cardiff & Vale University Health Board, Maureen Fallon co-leads MAGIC (Making Good Decisions In Collaboration).

Poor communication between teams and inefficient handovers are responsible for 13.5 per cent of adverse patient outcomes. Her talk concentrated on improving communications between teams and the introduction of e-handover training, all supported and managed by an updated desktop software solution.

7. Prognosis of CLL

Dr Chris Pepper’s 17-year research career has concentrated on chronic lymphocytic leukaemia (CLL). He is a Reader in the Institute of Cancer & Genetics at the School of Medicine, where he manages a research team and provides a high-speed cell sorting facility.

In possibly not the most accessible of presentations (Dr Peppers have history in being misunderstood), he spoke of high resolution telomere length measurements, and how finding correlations led to a new prognostic tool. This tool provides superior risk stratification together with the identification of novel therapeutic agents. Potential calculation of a universal biological threshold also holds implications for personalised medicine.

8. Removing Polyps and Fibroids in the Outpatient Clinic Instead of Theatre

Richard Penketh is a consultant obstetrician and gynaecologist at Cardiff & Vale University Health Board. At the end of 2011 his team won the MediWales Innovation Award for a project that moved gynaecological surgery from the operating theatre using general anaesthetic, to a new outpatient clinic using local anaesthetic.

Here was an example of effective procedure change using new technology and ‘vocal local’ support from staff. As well as having lower costs than all alternative treatments, live on-screen video gives patients full procedural visibility.

At the end of this talk a video was played of a procedure, a video taken using a patient’s volunteered iPhone. Throughout the talks, mention of the mass-market mobile technology which has enjoyed such an explosion in recent years – whether it be smartphones or laptops – was conspicuous by its absence.

Whether it’s considered to be a consumer technology, or the idea of holding private data on portable devices is seen as too much of a risk, was unclear. It seemed that many of the solutions cited were, by 2013 standards, fairly basic: email attachments, desktop software, digital photography, electronic forms. Arguably not even of our decade.

How “IT” was used as a term, and even that IT was used so broadly, might hint at a level of institutional datedness. My impression was that IT certainly seems to mean fixed solutions, not portable ones. Which isn’t to say that there aren’t opportunities for technology providers, especially OEMs and manufacturers capable of producing specialised equipment and devices. Flying in the face of the opening quotation, there clearly is an appetite for informatics solutions, devices and diagnostics; an appetite for new healthcare technology.

This was reflected in the following Q&A session with all the speakers, breezily couched along by Professor Harding. It was also suggested that new forms of investment might grow, with more private companies commissioned to produce solutions.

Other Q&A bites included an admission that the NHS was “good at plans, poor at implementation”, one speaker endorsed the power of “disruptive behaviour” (hard not to raise an eyebrow), while it appeared there was on-going contention over the difference between Service Evaluation and Research. A newly appointed NHS Head of Innovation present in the audience indicated that there would be a more commercial appetite focusing on fewer areas.

Not to applaud the innovations and advances showcased here would be unfair. But it’s equally worth recognising that these were largely sensible, logical, rational baby-step solutions – as Dr Pepper conceded to me over a spicy bhaji after the event. These are mostly conservative changes made within a highly risk-averse, some might suggest highly paranoid organisation.

These are all emotive issues about which many rightly feel passionate. Clearly, nobody wants to make a mistake that costs a life. But in an organisation often accused as being ‘top heavy’ with handsomely paid senior members of staff, and with the ageing population threats underlined at the start of the evening, could it be time for a few of them to buckle up and take some risks?

More details about the event and the Cardiff University Innovation Network can be found here:
http://www.innovation-network.org.uk/events/innovation-in-healthcare-wed-17-apr-2013.aspx

Images © Mark Hawkins 2011-2012

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