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Posts Tagged ‘health care’

And it looks like we are losing the battle. According to “Healthcare expenditure statistics” from Eurostat, “[The] highest share [of total healthcare expenditure] of current healthcare expenditure [related to preventive care] in 2014 was recorded in Italy and the United Kingdom (both 4.1 %), while at the other end of the range, shares of less than 1.0 % were recorded in Romania (0.8 %) and Cyprus (0.6 %).” At the other end “curative care and rehabilitative care services incurred more than 50.0 % of current healthcare expenditure in the vast majority of EU Member States”

It may be that this is the right balance, but allow me to doubt it. And my doubts grow as I focus on the demographic change taking place in Europe. The baby-boomers are getting older and we are not doing anything about it, despite the fact that it is probably a generation ready to embrace a healthier and more active life than previous older generations.

I have been wondering, since I started working for the healthcare and social sectors, why it is that prevention does not get the attention of our policy makers.

Many explanations come to mind. Of course, simply saying “they are stupid” is the easy one but I refuse to fall for it. I strongly feel that anybody who has attained a position of responsibility may have many faults, but being stupid cannot be one of them; they would never have reached that position of responsibility.

The urgency of solving the immediate problem may be one of the reasons; after all, if somebody has an acute illness something urgent has to be done. It is a plausible explanation but, if that were the case, policy makers would never plan for the future building new roads or housing developments since they would be too busy repairing the existing road network or the old houses in inner cities.

I am afraid that highways are built because they make the news. I am afraid that most of the things that our policy makers do are geared towards a 30 second appearance in prime time national TV news. If that assumption is right, then it is clear that the opening of a new hospital (curative and rehabilitative care) is a better news item than the establishment of a prevention scheme that does not require any new buildings, or any new expensive and photogenic equipment. It requires only brains and hands, probably the least photogenic tools of the healthcare process and, probably too, the most ignored by policy makers.

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In 1969, the supersonic aircraft Concorde was the first commercial airliner to replace the traditional and burdensome mechanical and hydro-mechanical flight control systems with the more sophisticated and secure fly-by-wire system. In essence, in a fly-by-wire aircraft the pilot moves the joystick sending messages to a central computer that, once the order has been processed and checked against the rest of the information received from sensors installed along the aircraft, sends an order to the appropriate part of the aircraft, e.g. the engine or the wings.

When fly-by-wire was first introduced, pilots complained that they were not “sensing” the aircraft; they were losing the feeling of how the aircraft was responding. Nowadays more sophisticated algorithms have introduced a feed-back to the pilots, enabling them to “feel the aircraft” like in the old days.

Socio-health care is in the process of going through the same kind of revolution with the same kind of professionals’ complaints. e-Care is introducing a new paradigm into the care process. Many practitioners feel that through long-distance technology, telemedicine for instance, they are losing touch with their patients. Is that true?

Obviously I don’t think so. Haven’t we been using telephone calls as a substitute for face to face meetings since early in the last century? Is not a telephone call effective for solving a myriad of problems that, in the nineteenth century could have resulted even in a war due to the slowness of the response? Think about it: the tools that e-Care puts in our hands are here to solve in minutes what in the old care process would have taken, and still takes, days. Those days are precious when at the other end of the line there is a suffering human being.

e-Care, health or social, is here to help the patient. This is something we should never forget. It is also a tool to help the practitioner to work in a more efficient way. It means the practitioner has to adapt to a new care process, forgetting the old ways in which the patient waited patiently in the waiting room to be seen by the all mighty care professional. That same professional who would explain, in the best of cases in an incomprehensible manner, what was going on.

Today, the patient will demand a clear explanation. A demand full of questions fed by the knowledge, good or bad, acquired on the web. Today the patient will not be patiently waiting, but will be impatiently expecting your to-the-point answers at the other end of the ICT system.

But also today, as a professional you have at your fingertips, or better at your “mouse tips”, more information than you ever dreamed of having. And the combination of general information, together with the much better and accurate information about your patient, puts you on a professional level that your predecessors in the field were never able to achieve.

Do not miss the opportunity, go e-Care! The sooner the better for your patients, and also for you.

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Why is it so difficult to convince older people to adopt gadgets and new behavioural patterns that are meant to make their lives healthier and richer? A person who has not ever read will find it difficult to enjoy reading when turning 65. Behaviour is one of the most difficult things to change; ask any smoker or drinker. And it gets more difficult as we age. Habits form our core identity. As we age we tend to rely more and more on our way of doing things and tend to confront any change with the utmost suspicion.

This behavioural inertia is also ingrained in society. Almost every socio-health care system is based on a pattern of attending social and health problems. Care systems are traditionally designed to repair our ailments. If you have a problem we will take care of you. Don´t bother us if you just feel that probably you will have a problem in the near future; we don’t have time for it!

The combination of both behavioural patterns, personal and social, results in a rejection to adopting anything that means to change our old ways. Change then comes forcefully, meaning we have to change because there is no other way. Any change is, then, a public proclamation of some kind of unavoidable evolution in our system. If I am using a walking stick, it means that I am now frail. I am telling everybody that now I am frail, everybody assumes I am going downhill. Outcome: I will not use that dammed walking stick even if I fall!

If walking sticks became fashionable, as they were in the last century, my ailments would be stealthy; I would be using the walking stick just like everybody else, only I really need it.

If care systems insist on putting all their efforts into solving problems – tackling mainly acute problems-, there is no chance that we can incorporate new habits into the population. I know that for years there has been talk about the need to introduce prevention into our care systems. I know also that very little has been done. If you are in doubt, compare the amount that any system is investing in obesity induced illnesses and the amount spent on preventing obesity. I recognize also that the opening of a new acute hospital makes headlines with a nice picture of the Minister of Health, while a program for changing eating habits in children in an out of the way school does not make even a tiny article on page 45 of the local newspaper. Nevertheless, we all know that prevention is the only way to face a brighter future.

Prevention means that, as soon as possible in the person’s life, the system will help to change habits in order to avoid future complications. With that in mind, we will be able to introduce say, healthy eating apps that will be assimilated into our everyday life. The person will rely on the app when feeling at loss for ideas for tomorrow’s lunch. The odd search will become a habit, and the app will start recording what food is chosen, and letting the person know when he/she is eating more meat than necessary.

Compare this process with today’s. Today, I would go to the doctor when I felt sick, he will spot that I am eating a very unhealthy diet and recommend a complete overhaul of my eating habits. He may recommend an app to help me keep track of what I eat. I will struggle to follow the diet and will not use the app. My mind is telling me that I have been eating a lot of meat ever since I was young and I have enjoyed every minute of it. I will keep it that way till the grave, even if it means the grave closes nearer.

I think that the only way to success is to be able to induce a behavioural change in our target population. We know that behavioural changes are easier the younger the person is. We should then aim at incorporating as soon as possible into daily life those elements that will contribute in the future to a longer and healthier life. Get your walking stick today; do not wait for when you really need it. Or in a more up-to-date fashion, start getting acquainted with apps and other ICT gadgets today, before you really need them and feel old and battered.

From the developer/entrepreneur point of view, your customers are the social-health care systems; convince them that only by prevention will they have spare resources to attend the ageing society; change their behavioural pattern from solving acute problems to preventing problems. I know it is a long and burdensome process but it is the only way that your products will make it to the market, to those who need them.

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e-Health has been around for a long time; we could even say it is an old feature in today’s world. But yet, who is really using e-Health today? Do you know of a friend, a neighbor, a relative using any of the many gadgets that are part of e-Health? Don’t focus only on the internet, that is not e-Health by itself. The internet provides information, albeit a lot more information than what we used to have at home. Certainly a lot more, and up-to-date, than the classic “Our bodies, ourselves” which probably a lot of my readers haven’t even heard about and that, by the way, has moved to the www.

Let´s go through the process that has brought us to this point in the history of e-Health. The first push came from the R&D organizations. More specifically, the European Commission, through its many R&D programs, has been financing research for years into what we know today as e-Health. Millions of euros have been lavished all over Europe to make e-Health a reality. As always, in the USA the private sector has been the driving force behind this endeavor. The result is a myriad, I could safely say even a milliard, of what is known as Personal Health Systems and other types of gadgets and integrated e-health systems.

The second lever for securing a wide permeability of e-Health is the people, i.e. the patient or the primary user. The use of ICT technology by the population is increasing by leaps and bounds. The older population, probably the strata that could most profit from the use of ICT tools to maintain their living standards, is changing radically. There is very little in common between the older population of today, and the future older population coming out of the baby boomers of the post-war. A recent study in Spain by Fundación Telefónica reveals that the population older than 55, is using internet for productive proposes (e.g. banking or filing taxes) at the same level as the rest of the population. And it is in these population strata in which the use of smartphones applications is having the biggest boost.

The secondary end user, the socio-health professional, is obviously an important lever for spreading the use of ICT socio-health applications. Although maybe a little dated, PwC released a study in 2012 on m-Health concluding that “Healthcare’s strong resistance to change will slow adoption of innovative m-Health”. A closer look at the study reveals that it is the skepticism of the professionals that hinders the extensive use of m-Health in particular and e-Health in general. Because I believe that unless professionals prescribe e-Health gadgets with the same confidence that they prescribe today a medicine or a treatment, e-Health will not take off.

But for that to happen, the fourth lever has to act. This is no other than the socio-health care system; in Europe led by the public sector. It is very telling that while one branch of the public sector is pouring money into R&D, the other branch is simply ignoring the fact that ICT tools could save a lot of money in taking care of the socio and health ailments of the population they are covering. Is it so difficult for the politicians responsible for R&D and those in charge of the socio-health system to talk to each other? Apparently so, but I would appreciate your views on the subject so that among all of us we could find a path to a better and more e-Health world.

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We are familiar with too many good ideas that never make it to the market and less frequently, brilliant marketing strategies selling a flop. A proper balance between the product and the business plan rarely occurs. That is probably why there are few companies like Zara or HM; only the chosen few can find the Holy Grail. But we all struggle to do our best and come up with the right balance that puts our product or services in the right spot in the market. The belief that that is achievable is what bring us together every time there is a gathering like this one. And the reason for this exposition is because we, the partners of AiB, believe that we are on the right track. First, let me go through briefly how the ideas that my colleagues have already explained can become a sellable thing. To start with, you may have gathered already that AiB has two heads, kind of like a Hydra.  The difference is that this one has only two heads, its breath is not poisonous but sweet, and its blood, instead of being deadly, heals. One of the heads of our friendly beast represents a service. AiB has been designed as a care service with the objective of detecting the risk of falls in the individual being cared for by a care service provider. Corresponding to that view, AiB as a service offers a complete software-hardware package that allows the care provider to screen the population under its care for a set of signs that will prompt the system to raise alarms. If this is the case, care professionals will perform a pre-evaluation of the person to double-check if the user should be included in the risk-prevention programme or if this is a false positive. Once the inclusion is decided upon, a multidisciplinary team will perform a complete check-up of the user and decide upon a personalized care plan for the user to follow. The care plan is a comprehensive set of neurological and physical exercises included in the system library, as well as any other action that the care professional decides, such as pharmacological therapy or dietetic recommendations. The system will request certain information by the user, mainly about environmental conditions, and prompt remedial actions to counter its risks. Once the personalized care plan is designed and introduced in the user terminal, the user will be asked to follow it by means of an agenda, reminders and so forth. Continuous follow-up of his or her performance will be recorded by the system, triggering alarms to the care professionals in case of deviation from the care plan or changes in the vital signs of the user. These events will allow the care professional to modify the personalized care plan accordingly. It will be obvious by now that AiB as a service is directed to socio-health organizations that can take advantage of the system to reduce the rate of falls in the population they cover, with a clear saving in the overall cost of care, which I am not going to go into since we all are aware of the cost of a hip replacement, for instance. The second nice head of our Hydra corresponds to the product that we envisage to earmark for the individual. In a nutshell, AiB as a product is a self-contained package for individual use by those concerned with their health, probably because they have already fallen or have seen their relatives fall. So it is for people who are aware of the personal cost of a fall in terms of days and/or health lost. The AiB product comprises a self-evaluation that will prompt a care plan, although obviously not at the level of the service care plan. The care plan includes a set of remedial actions that can be made in the environment, as well as physical and neurological exercises. A system of alarms will suggest the user refer to a care professional when deterioration in the performance of the user is detected. How does this translate into a business model? We have chosen the Business Model Canvas because it is as good or as bad as any other model but has the advantage of being simple and clear cut. I will concentrate on only two of the boxes of our model. First the customer segment, in the Canvas jargon. As you can see, we are targeting two completely different markets:  the professional care market and the individual, with basically the same body of knowledge.  Again our friendly Hydra comes to mind with two heads but only one body, and guarding against the perils of falls instead of the entrance to the Underworld. Second, the key activities. We have discussed a lot among the partners on how to proceed from here. We have been able to produce a thing, system and product for the prevention of falls, without killing each other.  A thing that is the sum of the efforts of very different organizations, from health care, to users, to ICT companies, to process designers, even an economist (myself). The result cannot be broken into parts so that each one takes its bit and markets it independently. So we arrived to a solution that has been in use for many years: the European Economic Interest Grouping. This legal figure is governed under European Community (EC) Council Regulation 2137/85. It allows us to continue collaborating while preserving the individuality of the members and separating the AiB undertaking from the other business of the partners. The use of the EEIG will allow the AiB partners to go on to the next step of industrializing our output. That will be our way forward. I am sorry I could not attend the event in person, but if you have any questions, feel free to ask either my colleagues present or contact me at the e-mail address shown on the screen. Thank you very much for your attention.

You can also whach the presentation at http://youtu.be/QZtK6AyvfN0

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This is a real story of a real person in a real country that, I am afraid, can be replicated across many other countries in Europe. It is a story about cuts in healthcare services and its real influences in overall expending for the Government and for the people.

Mr. XXX is a manual worker whose job implies using his arms to move thing around. After several months of feeling that his right arm was hurting, he went to visit the primary care doctor. The diagnosis was clear: a strong tendinitis that prevents him from performing  his duties until he is properly treated. So the primary care physician sent him to the traumatologist for consultation and further treatment.

And here the nightmare starts. Due to cuts in healthcare personnel, the waiting list for traumatology is such that Mr. XXX receives an appointment for 90 days from now. What are the implications? First, Mr XXX cannot work and he will be on sick leave for at least the next three months. He will be paid  by the social security a percentage of his salary, with a complement by his employer to make up for the basic 100% of his salary. Secondly, his employer will have to employ another person to fulfil Mr. XXX duties.

So the outcome is that, by cutting back on personnel disregarding the actual demand, the health service has prompted an increase on the social security budget and at the employer’sexpense, while Mr. XXX lies in bed weighing to be taken care of!

Are these the savings that we are aiming for? I certainly doubt it.

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If demographers are correct, an ageing population is coming and will put mounting pressure on social and health services. The pressure is already here and the response of most governments has been to make it more difficult to access them, reducing the population covered, or to cut the provision of services, reducing the coverage offered, or any combination of both. In other words, look for a quick fix and postpone the problem.

So much talking about structural changes and all our governments are coming out with is cutbacks in the services they provide, without looking at the way they are provided.

Social and health services have to be redesigned. This is so obvious that I am not going to talk about this aspect of the redesigning effort. The only thing that is needed is a political push in that direction. A political push that needs to interiorize that a certain investment has to be made before reaping the benefits.

I will focus on another aspect of the redesigning effort; namely the need to redesign keeping in mind the primary end-user i.e. the patient.

We may have achieved the most efficient work flow, with the possibility of reaching a level of efficacy not known till now, yet despite all our efforts neither that level of efficacy nor the expected efficiency is reached. The problem, I think, lies in the interface between the user and the system. Have we taken care of the lay-out of the system? Have we made it user-friendly not only for the ICT literate but also for those ICT illiterate so that no one feels bored or stressed? Have we considered the cultural differences not only among nations but also within a nation? A carefully designed process needs a carefully designed interface that allows the primary end-user to feel comfortable and at ease when using the service, from the screen in his or her smart-phone to the colour of the walls or the seating arrangement in the care centre. Not reaching that level of integrated design is at the root of so many good ideas gone to waste.

We all have experienced communication problems between process designers and ICT developers, but to that we have to add a third group of professionals, those in charge of making everything look amiable and user-friendly. If we tackle this problem from the beginning, we will have working towards the same objective the expertise of the socio-health professionals, the use of the latest ICT technology providing more efficient care processes, and the end user vision of their real socio-health demands.

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