Digital Health & Care Institute (DHI Scotland)
The human face of healthcare…
Digital Health & Care Institute (DHI Scotland)
FUNDING: £11 million
The human face of healthcare
The challenge will not go away in a hurry – demand for healthcare services will carry on growing as people live longer, and demand for cost efficiencies will make the situation even worse over time. Technology has helped create the “problem” by improving standards of care, and technology will also have to solve it, with a little help from people. For Scotland, and a lot of its researchers and entrepreneurs, the challenge is a major opportunity, however. We could become a gateway to the European market and a centre of innovation in healthcare, and ultimately this could also translate into happier, healthier people – more gain as well as less pain...
According to the DHI website, “global health and care efficiency must improve by over 35% to maintain current standards of care for increasing numbers and requirements. Scotland’s health and care budget will need to make equivalent efficiency improvements of £3.5 billion per annum.” For Justene Ewing, the CEO of the Digital Health & Care Institute (DHI Scotland) since it was set up in 2013, this is only part of the picture, however. Digital technology will play a major part in “tackling the crisis,” and companies in Scotland stand to benefit from this revolution in healthcare by selling their products at home and abroad, creating jobs and generating revenues, but “it's important not to lose sight of the human dimension,” says Ewing. The DHI is not just about making money, but also about making advances in healthcare. The global digital health market is expected to exceed $1.5 trillion by 2020, and Scotland could earn a significant slice of that income, but how do you value a longer and healthier life?
When My Little One, the first completed project backed by DHI, was officially launched at the Victoria Hospital in Kirkcaldy in November 2014, Ewing experienced something she'll never forget. The project was a collaboration with IC24, working with parents and NHS Fife to develop a tablet-based system which allows parents to view their new-born babies via Wi-Fi and a camera in the cot. But when Ewing saw it in action for the first time in a real-life situation, she didn't just feel satisfaction at seeing the project completed, but experienced a highly emotional moment. “The parents hadn't seen their twins since they'd been born. But when the father saw them on the screen for the first time, he burst into tears,” she explains. “He told us we had no idea what this meant to him and his wife, thanks to this clever device.”
This priceless moment illustrates what Ewing thinks the DHI is really about. The initiative was set up to bring together health, care and third-sector professionals, academics and industry partners to work together, adopting “an agile, demand-driven approach that enables the production and adoption of new products, services and processes grounded in new models of economics and work.” The idea was also for Scotland to “seize the digital health opportunity, to scale its health and care services and company capability to meet the demographic challenge and to strategically position Scotland as world leading in the rapidly growing health and care markets worldwide.” Societal benefit has always been high up on the agenda since the start, along with economic advantage, but sometimes Ewing thinks it’s important for her and her team to remind themselves that people are always the heart of the project.
“On really bad days, when innovation is really hard, uncomfortable and sometimes a lonely place,” she explains, “I jump into my car and visit some of our projects, to check up on progress. And when I see the energy and how much it means to the people involved, and think of the impact the project could have in the future, it reminds me why I’m here and refocuses my passion all over again.”
Ewing also remembers “an interesting question” that helped her to articulate the DHI mission – and why she and her team love what they're doing. “Someone asked me how I felt about taking some of the hardest challenges in life to create commercial gain for SMEs,” she continues, “so I thought for a moment and said if we can help to identify and solve some of these problems (such as isolation and vulnerability), through collaboration between academia, business and healthcare providers, then it must be a good thing – not just for the companies but also for society at large.” It’s good to “make money for all the right reasons,” she adds, and also a “fantastic opportunity” which the DHI aims to translate into concrete results for the people of Scotland.
For Ewing, the biggest surprise since she started her job is that the innovation and healthcare sector in general are not what she expected them to be. There are many different agencies active in healthcare, but in the main they cooperate rather than compete with each other. “The innovation landscape may be packed and very fragmented,” she says, “and the public sector is a fierce environment in some ways, but the various organisations tend to overlap rather than duplicate what they are trying to do – for example, when it comes to diabetes, the different interest groups have been working together when required.”
The DHI, says Ewing, is trying to provide the “glue” to integrate these many different organisations and interests in our field. “We need to inspire lots of activity, but we also need to pull the industry together,” she adds. “That’s why we need a ‘Team Scotland’ approach, combining the strengths of the private, academic, third and public sectors. Sometimes you have to take risks and sometimes you need to be careful, but you have to get on with it – there’s a lot at stake in both economic and health terms.”
Sometimes there are also “cultural barriers” to innovation, says Ewing. For example, healthcare professionals can be very protective about the NHS, and often tell the DHI at meetings “what they think we want to hear,” rather than talk about really difficult problems. “Understandably, nurses and doctors are proud of their organisations, but they also have to grasp the opportunity to change things for the better, and feel empowered and safe in their roles to do so,” she says. And to get people talking, the DHI creates a “safe” environment for open discussion – which hopefully will lead to life-changing innovation in future.
The production line
Since October 2013, the DHI has been involved in over 80 projects – developing everything from animations, videos and augmented reality tools, therapeutic games and electronic people locaters to bereavement apps and social media tools for breastfeeding mothers and eczema sufferers, as well as digital solutions for strokes, diabetes, brain injuries, back pain, dementia, colitis and cancer. Every project has an academic partner, as well as involvement from healthcare professionals and industry partners. The ideas come from every direction and one of the challenges faced by the organisation is how to identify those with the greatest potential, then evaluate the projects with a view to commercialisation. The size of projects varies from the very small to national and international projects which promise to have a huge impact (e.g., Scotland-wide programmes for diabetes and cancer). “Some projects may seem highly targeted and very modest,” says Ewing, “involving only one academic and one SME, but all could have enormous long-term impact.”
For example, the “Tele-ventilation” project could transform the lives of many patients with chronic lung disorders by making it possible to monitor their condition (breathing and oxygen levels) and also provide ventilation at home – freeing up hospital beds and improving quality of life in the process.
Another project highlighted by Ewing is a mobile ECG (electrocardiogram) solution developed by AliveCor of the USA, now being tested at 20 general practices and five NHS health boards in Scotland. According to Ewing, this innovation could have a huge impact in detection of atrial fibrillation (AF), an irregular heart rhythm which affects many otherwise healthy people over 65 years of age. AF is the most common preventable cause of strokes in Scotland (increasing the risk of a stroke by a factor of five), and can be treated with anticoagulant drugs such as warfarin – as long as it is spotted early on. Using a simple adapter which converts a smartphone into a portable ECG (electrocardiogram) recorder, using two sensors, nurses and doctors can identify patients with AF when they go for annual health checks, simply by taking a fingertip reading for just 30 seconds. An estimated 100,000 people in Scotland have been diagnosed with AF, but as many as 30,000 people may have the condition without even knowing. A successful trial – screening up to 10,000 people in the course of a year – would not only help to save lives and produce better outcomes for patients, says Ewing, but also save a huge amount of money in healthcare (over the last 20 years, admissions into hospitals because of strokes have increased by 60%), as well as in lost earnings. And the device is now available at prices starting from only £75.
More flexible approach
According to Ewing, the original business model drawn up for the DHI four years ago has gradually evolved since the centre began operations, adopting a more flexible approach to proposals and industry demand. For example, eight different organisations with interests in improving diabetes care came forward with project ideas, and instead of selecting just one, the DHI suggested it would work with all eight of them as part of a national programme. This should ultimately lead to progress for all and fits in very neatly with Government targets.
Ewing also believes that NHS Scotland has a “unique selling point” in this arena, trialling innovative nationwide projects by taking advantage of its integrated patient information systems and its world-class research base, as well as its wide variety of geographic, economic and demographic conditions. The Scottish Government already has an extensive innovation and entrepreneurial agenda to support all of this. “It's something we should shout about,” says Ewing, “and a great asset.”
Another way in which the DHI helps SMEs and public healthcare providers is through “pre-commercial procurement” approval. This means that when an individual health board or NHS Scotland partners with an SME and a research team to develop a novel solution, the buyer does not necessarily have to go through procurement procedures all over again when the new product is delivered to market, saving time and money for the healthcare provider, as well as making sure the SME gets future sales. “The process is designed to be very open and fair, as well as neutral,” says Ewing, “in line with our mission to make innovation easier for everyone.” Many SMEs have struggled in the past to compete with multinational rivals, but now there is a much more level playing field – and greater opportunities to break into markets which used to be closed.
Foundations for growth
The DHI now has a team of 48 people, including 20 who spend most of their time in the Experience Laboratories (see sidebar below for details), focusing on “experiential learning” by testing ideas in conditions as close to real life as possible, as well as on rapid prototyping and development. Another 20 people are described as “project support staff,” evaluating opportunities and focusing on business development.
Even though she is proud of her team, Ewing strongly believes that the DHI should take full advantage of existing organisations to develop its projects and identify partners. For example, the DHI works very closely with Interface, which helps connect companies with academic researchers. “Coming from industry, my instinct is to be competitive,” she says, “but by collaborating effectively with these other agencies, we avoid replicating what they do. There are lots of people and organisations already involved in this space, and we want to utilise everyone's strengths, so that everyone wins, and mobilise Team Scotland.”
Ewing says the main aim of the DHI is “creating capacity,” rather than expressing it in terms of saving costs or improving efficiency, or even technological advances. For example, if a patient can go home instead of having to be cared for in a hospital or nursing home, that is a great gain for the healthcare provider as well as the patient, because it frees up beds and other resources. Similarly, patients having more say in their treatment, and being able make informed choices are major advances.
“There are hard facts we cannot ignore,” Ewing says, “but what price life and what price better quality of life? That is why building capacity matters.”
Health education also has a key role to play in the future of healthcare, including making all of us aware that we should also take responsibility for our personal health and make the right choices, based on the right information. Why is it, asks Ewing, that people in Canada spend the last ten years of life in illness, while people in Scotland spend their last 20 years in illness? Predictive analytics, education and empowerment may be the answer.
The DHI is learning fast and moving with the times. It knows that “making innovation easy” is a challenge in more ways than one – the new technology itself is probably the easiest part. When it comes to changing traditional methods of service delivery and introducing new devices, there must be a balanced approach. For example, if you give people new tele-healthcare devices, you have to “take something away” in order to make a real difference, for both patient and healthcare provider.
Ewing also expects that the DHI’s next phase will see a reorientation of basic objectives. Digital healthcare technology will continue to radically change through the years – gathering more real-time data from easy-to-wear smart devices, incorporating new and much more powerful predictive analytics. The “Internet of Things” will soon be taken for granted, connecting different systems and devices, including health and fitness apps which soon will seem part of our bodies. More homes will be designed as safe environments for people with special needs, such as dementia sufferers, so they can be more independent and free to ‘live life.’
The technology will gather momentum, but policy and attitudes will also need to change. “We have already proved we can collaborate and create cohesion, but in the future we will have to be more focused on the strategic priorities of Government,” says Ewing, “including the Education, Digital and Health and Social Care Directorates. We will also need to encourage the development of more open, more connected digital platforms, and have a more international perspective, bringing in more multinational partners to engage and partner with SMEs, at the same time as boosting our exports, and establishing Scotland as the International digital health and care gateway to Europe.”
> Improve cost effectiveness of health and social care in Scotland
> Improve health performance and patient experience
> Improve quality of life for the citizens of Scotland
> Build the global reputation of Scotland as a centre of innovation for digital health
> Engage with more than 200 companies and establish 210 innovation
> Release up to 140 new products and services with societal benefits from within
> Create a Doctoral Training Centre in Digital Health and Care
> Generate educational benefit by investing in PhD, Masters, CPD and skills
The DHI has developed a three-pronged approach to drive innovation:
1 The Digital Health Exploratory engages a wide range of national and international
organisations to develop priorities for action, running activities to stimulate the
development of ideas and deliver opportunities.
2 The Experience Laboratories provide a safe environment where users (service
users, carers, clinicians, practitioners and third-sector partners), businesses and
researchers can collaborate and rapidly prototype in response to health and care
challenges. Experience labs provide a creative and innovative environment
(replicating real-life practice), using design to carry out rapid cycles of experience
trialling of new ideas, including new technology, new services and roles and
behaviours (often the biggest barrier to successful innovation implementation)
which may become candidates for further research, development and
3 The Digital Health Factory helps DHI members progress known solutions much
closer to market and deployment. It offers a facilitation and resource platform,
including access to expertise and test environments, business mentoring support
and facilitation to source funding. The Factory works with industry, health and
care partners, third sector and university partners to develop commercialisable
solutions to real-life situational challenges that can make a difference in clinical,
professional or user-based settings.
Visit the Digital Health & Care Institute website at: dhi-scotland.com