SBA

IT’s Good For Our Health

Really? As you throw the computer out of the window in a red-faced apoplectic fit of rage, pulse racing, blood boiling, frustrated by the latest Microsoft updates which are taking forever to install, and berate the poor sap on the IT helpdesk once again, and this fool Burrows is telling you that IT is good for our health? Really?

Health has been in the news muchly of late; rising costs, over budget, chronically understaffed, new health Minister, long waits to be seen at A&E. It’s not just the Isle of Man, the UK NHS has similar issues and many folk who have lived in both nations will tell you that service from the Manx NHS is notably better than the UK one. The reality is that the current model of UK-style NHS is broken, and given that UK taxes are notably higher than those on the Isle of Man I suggest that simply raising taxes to give the NHS more money is not going to cure the NHS disease (Manx or English).

Healthcare is a people industry - it employs huge amounts of intelligent folk to diagnose and treat our ailments. Personally I know very little about treatment, but I am a trained diagnostician - I was formally instructed in procedural and heuristic diagnostics to fault-find very complex large mainframe computer hardware as part of my early career - and I learned very quickly that there is no excuse for delay. Until you have diagnosed the cause of a problem its consequences and repercussions are likely to get increasingly worse - “a stitch in time saves nine”. Urgent diagnosis is therefore crucial to eliminating extra labour, harm and cost (waste) - whether one is repairing a computer system or a human being.

This is where IT steps in, and particularly Artificial Intelligence (AI). Ultimately most diagnostic processes are about pattern recognition - if a given set of conditions / circumstances / anomalies / symptoms are exhibited then the problem is likely to be (insert your own ailment here). The first iteration of diagnostic process may take us straight to the problem, or merely lead us to the next, more granular set of conditions to test in order to refine the diagnosis - OK, the patient appears to have the symptoms of a hepatitis - now what type of hepatitis? Artificial Intelligence is really, really good at pattern recognition and sieve (filtering) processes - and at learning which symptoms are actually most important in making an accurate diagnosis. Like the self-learning pattern recognition processing used by the Artificial Intelligence programs which have recently come to dominate complex games such as Go and Chess, beating the best of human players, new AI technologies are being applied to medical diagnosis. 

One application which has particularly caught my eye is the analysis of radiology images and other diagnostic data sources - EHR, X-ray, CT, MRI, ultrasound, mammography, ECG, EEG, blood/urine/stool/CSF tests, histology - to identify the presence and significance of conditions. For example, does this image of the patient’s lungs show a tumour, and if so where, how large, and the likelihood of malignancy. Radiology is one of the most crucial diagnostic tools in modern healthcare, the imaging equipment and the specialists who interpret those images are both very expensive, and most patients have to wait for this step in the diagnosis of their condition unless it is believed that treatment is very time critical - during which delay they are both suffering and likely becoming more ill.

Wouldn’t it be wonderful if we could double the productivity of a hospital radiology department without needing extra consultant Radiologists? Reduce the delay and cost of diagnoses, and the associated downstream harm and waste caused by current resource constraints? New Artificial Intelligence technologies offer the opportunity to significantly reduce the human effort involved in diagnosis for primary, secondary and tertiary care - and they’re coming soon. Google has been working with the UK NHS for some time on experimental projects controversially analysing patient health records, and a Russian company has developed and is seeking to trial in the UK NHS a system, Botkin.AI, which claims to do exactly as I have described above - take a lot of the analysis burden from the shoulders of very scarce and expert consultant radiologists and make the computer do the legwork instead. A high proportion of patients passing through Nobles hospital need Radiology; new healthcare technologies will enable the medical profession and the taxpayer to focus more on fixing people instead of spending a fortune trying to work out what’s wrong with them.

Enough with the AI diagnostician. The potential for good is enormous, but what about when we’ve been repaired and are growing old and grey because the medics cured us of whatever ailment would have killed us?

There has been much noise in the Manx media lately about Meals on Wheels and the axing of a £159,000 contract with charity Age Concern to provide the meal delivery service to a few hundred primarily infirm, vulnerable or elderly citizens. The Government claims that there are commercial providers who will deliver ready-to-heat meals at similar cost to the homes of those who use the Meals on Wheels service - and whilst this claim may be true it misses the point.  One of the long understood benefits of the Meals on Wheels service, as operated in both the UK and the Isle of Man, is that the recipients are regularly visited by someone who will be concerned and raise the alarm / provide assistance if the recipient appears to need support - which is a significant level of care above and beyond what one would normally expect of a food delivery driver - let’s call it “extra care”.

The benefit of this extra care, to the state providers of health and social care, and to the other carers looking after the frail and elderly who remain in their own homes instead of being herded into an institution, is the knowledge that somebody is checking and will report if the vulnerable person has a problem - fails to answer the door for their regular delivery, appears to be confused, showing signs of injury following a fall etc. - meaning that the frail and elderly can enjoy more independence at home without the need for regular intrusive (and costly) supervision. 

I can’t make the judgement as to whether the eliminating the extra care dimension of the Meals on Wheels service will save or cost the state in the long term - although I have heard that accidental deaths are very expensive for the state to investigate and I know that accident prevention is usually cheaper than remediation. What I can say is that, again, IT has something to contribute, not only to the frail, but also to those in robust bodily health but suffering from dementia. 

Extra-Care is one of the terms given to describe technology which assists care providers by minimising the need to visit the stay-at-home frail and elderly, and thereby reduces the cost of care in the community, reduces the intrusion of care visits to those who are vulnerable but not incapable, and defers the need for residential care. The most basic of extra-care technologies is the assistance button - a dongle typically worn around the neck with a panic button to summon help if needed. More modern extra-care concepts include more sophisticated assistance dongles or bangles which may incorporate activity monitoring, fall detection, location reporting, pulse detection, and body temperature monitoring along with two-way voice communication in addition to the panic button. If all that sounds rather intrusive the other major technological support approach to extra-care or assisted-living is the smart home, in which sensors detect occupation, movement, use of kitchen and bathroom etc. to ascertain that the activity levels of the occupant are normal for them.

I’ve written about the Isle of Man’s opportunities to exploit Extra-Care technologies previously - at the start of the current parliament - in order to reduce the escalating workload and cost to the state of providing adequate care in the community to our elderly. The technology is there, the opportunity is there, to use technology to replace some of the domiciliary support mechanisms - not just for those who use Meals on Wheels, but for all of our vulnerable who wish to remain living in at home in their community but need some small degree of supervision in order to do so without major mishap.

I’ve also previously written about the opportunities for us to better exploit telehealth / telemedicine - especially relevant as we live on a small island. As Tynwald today discusses the matter of approving the nine and a half million pounds over-spend incurred by the Department of Health and Social Care for the current fiscal year, and the Treasury Minister requests the commissioning of “an independent review to determine change options for service delivery and funding to provide a modern, fit for purpose healthcare system for the Island”, let them and us remember that some options to use technology to do more for less are already available, and have been on the table for several years. What is needed now is Government bravery to get on, show leadership, and take these opportunities - one day the healthcare technologies I’ve written about will be the norm globally, but the Isle of Man has a problem today.