Unplugged: Why tech is good for your health

Monday 22 October 2018

If you were going to spend £466m on something, wouldn’t you want to know a fair bit about what it will actually do? Where you will put it and how you will pay for it are clearly important – but do they rank above the actual purpose of it?

Much of the focus so far on Jersey’s planned new hospital has centred on the location, with far fewer words being expressed on the actual services which will be delivered there, many of them using technology which isn’t possible in the current site.

With demographics meaning there’s likely to be an increase in people needing medical services in the future, and government budgets looking tight, it is technology which seems to offer the best solution.

Jersey’s full fibre broadband network has just been completed, at the time the island is planning the biggest shake-up of health services in generations. Express asked  Bernard Place, Project Director for the new hospital, what the opportunities are...

Bernard Place: Patients, carers and staff have a relationship with the hospital, and people understand what the relationship used to be like; the future, enabled by digital technology allows us to have a different relationship with the hospital. For example, historically people have had to physically come to the hospital to access services, to meet staff. 

The future allows us, in some cases not all, to have a relationship which is much more physically remote. So, for example, tele-health and tele-medicine means that we can do lots of things that help patient care, and importantly health, without patients needing to come to the hospital.

Pictured: Project Director for the new hospital Bernard Place says "digital technology allows us to have a different relationship with the hospital." (Gary Grimshaw).

That has lots of implications. You can think about how that will give you a better, more efficient use of ambulances and patient transport. It would have an impact on traffic, where people are now coming to the hospital, making journeys which don’t necessarily have to be made.

You can see a completely different relationship emerging where a lot of the health and well-being of patients can be over-seen, monitored, managed without patients physically having to come to the building.

Express:  What difference does that make in terms of your planning for the new development? 

BP: We need to have sufficient band-width. We need to have the capability, technically, to have that kind of conversation with patients. We also need to have a model of care which actually emphasises that patients and relatives and carers will have an increasing responsibility for their own self-care, monitoring their health, engaging in health-supporting behaviours, outside of the physical building.

Pictured: Mr Place told Express how digital health is sculpting plans for the Future Hospital (Gary Grimshaw).

On a practical basis, having rooms in the hospital where tele-medicine and tele-health can occur, and that is not just having particular rooms. Every bed in the hospital will be wireless, so anybody bringing in their phone, or their iPad, or whatever their device is, will have the ability to be talking to people both outside the hospital, and within the hospital. That’s not just patients, that’s staff as well.

That will require a very different kind of relationship whereby some of that communication will be physical, it will be people together in the same room talking; but the beauty of technology is alternatively, they could be one metre away, or a thousand miles away, but have the ability to access services and advice from across the world. And for a place like Jersey that is really important. We are relatively isolated geographically, but technologically, we are part of a much more connected world.

Express:  Will patients have access to a broader range of skills, advice and services?

BP: That’s right, we can start with our immediate neighbours in Guernsey, and Southampton. Technology allows us to collapse geography, physical space but also importantly collapse time. The world is working on a 24-hour cycle. You know we are very fortunate in the Channel Islands to have major health systems which are awake earlier in the day, and major health systems that are awake later in the day.

So that notion of providing care on a 24/7 basis, it opens up the possibilities for that as well. That is something that all major health economies are considering at the moment, because time is critical to patients who are ill. You can do much more for patients, if you understand what’s happening in the early part of their illness.

Pictured: "Technology allows us to collapse geography, physical space but also importantly collapse time."

So, technology collapses geography and time. It also begins to have an interesting relationship between the power relationships, if you can describe them that way, between staff and patients.

We are seeing many more patients empowered in their information gathering, coming better prepared to the kind of interactions which, historically, have been: the doctor says this, the patient does that.

Now that is in a stage of development at the moment, but you can imagine patients accessing artificial intelligence or clinical decision-making software, which will be available outside the hospital and coming to understand what their drugs do, what their condition is, what the side effects might be.

And therefore, they are not presenting themselves as experts, but as informed patients, and that will lead to a much more intelligent discussion between patients and healthcare staff. I think that is a really fantastic change where patients and their families are much more informed.

Express: Is there also the opportunity for actual surgery, or other services, to be provided by technology, remotely? 

BP: Yes. What we are seeing now is increasingly the notion of surgery which is less invasive.

Historically, for example, an abdominal operation required the whole cavity to be opened, and the operation to occur in a large hole. Now what is increasingly happening, is that that kind of surgery can be performed through a small hole in the abdomen, and you can visualise the internal abdomen on the technology.

You can have ‘assist devices’ which are connected both locally, and more remotely, and there are loads of things that you can do with that, and part of that is to understand what you can do safely.

Pictured: Mr Place envisages a new hospital which can welcome new technological innovations in digital health (Gary Grimshaw).

A lot of robots are robotic assists, rather than robotics doing the job. And I think, for Jersey, we have to take a really clear view about we can do in a relatively small general hospital, one that actually for a population of 104,000 people provides an extraordinarily rich range of services, but, nonetheless, the kind of surgery we would be doing in this island isn’t the kind of surgery you see in a tertiary teaching hospital.

Technology allows us to attend to the kind of procedures we would want to do here. For example, a good illustration for that is that our surgeons maybe don’t do so many of a procedure that might be seen in another hospital, and can have somebody remotely helping, supporting, assisting them, and at the same time visualising the procedure in real time.

Now those kinds of things are happening already across the world. Jersey currently is relatively immature for that. And you have to think, why is that? It’s not because we are not committed as an island. We are very sophisticated in terms of our digital health and digital Jersey. A lot of that is our current facilities don’t support that kind of technological innovation.

One of the things we are doing in the hospital is we are going to have what is called automated guided vehicles, which will be relatively innovative in hospitals.

They are the robots that take the stores and take them up through the cores, and then deliver the stores into the areas. That is something that the hospital will be enabled to do.

Express:  What are the challenges?

BP: Part of what we are addressing is legacy. An illustration for that is we are not designing a hospital with lots of rooms to store lots of paper records; but our legacy systems are paper-based so there is a whole process of how do we turn those paper-based records to digitise them and how, when the new hospital opens, are those records available electronically? The first stage is to deal with the legacy.

The second stage is to recognise that the hospital occurs within the context of a wider health economy; so we talk about the need for an electronic patient record, and that is important when the patient is in the hospital, but that also has to be part of an electronic health record, because most people’s healthcare, most people’s lives, are lived outside of hospitals, and health is something which is a 24/7 business.

And the vast majority of people’s healthcare is delivered in primary care by GPs in the community, by voluntary and community organisations, by their families and by themselves; and so technology allows all of that to be integrated.

Pictured: Mr Place is having to plan for the process of transferring hospital records into a paperless archive.

And then when patients are in the hospital, we have to consider things like, so if that electronic patient record is part of our way of working, and it is in the design because we have not provided the storage space for paper notes, then how is that going to be used?

Now that is not so much a technological issue, the technology is currently available, it is old technology, it is tried and tested; it is about the change of management of how staff work.  It is the sharing of information, it is about the permissions to share information, it is about how that data is turned into information, and used to improve safety.

And the critical thing for technology is it can, used correctly, used well, address one of the fundamental issues that drives patient safety: communication.

When it’s good, safety improves; when it’s poor, when there are hand offs, when there are mis-transcribing or mis-communication, patients fall between the cracks, and so technology allows us to do those things.

And I think the risk always for a project like this is people see the building as the thing that makes the change, rather than something that actually consolidates and embodies the changes which are already made.

Express: Is the objective also to reduce health budgets? 

BP: The key driver is we are facing an increasingly elderly population. Technology can help with that, and we can see, for example, where lengths of stay could be reduced if we are able to discharge people earlier; we are able to discharge people earlier, if we are able to follow people up, if we are able to get services co-ordinated around the patient, so everyone has a common record, again in real time and importantly mobile.

One of the things that the hospital will do, is that it will create a wireless environment and that allows us real-time, mobile, instantaneous information about a patient to be shared, and that will allow us to bring greater efficiencies and therefore improve costs.

Pictured: Mr Place says that health technology in the new hospital "will allow us to bring greater efficiencies and therefore improve costs".

I don’t mean it will be less expensive than it is now, it is just it will be better value. What we have got to do is ensure that every pound we spend on that, we have got the best value out of that. And that is what technology does, but it isn’t a panacea.

My background, I have been a registered nurse for 35 years, is about patient care, and it is no use having all the tools, if patients don’t get a sense that that is helping them feel better cared for and; ultimately it starts with safety. It’s then about effectiveness and then it’s about money. Money’s the tool, it isn’t the purpose in what we do.

This article originally appeared in Connect magazine. Read it in full here.