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James Barlow Constructing Excellence

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James Barlow Constructing Excellence Powered By Docstoc
					From centralised care to distributed care:
building the new value streams
Professor James Barlow

Chair in Technology & Innovation Management

Innovation Studies Centre, Imperial College London
Aims of talk

• Drive to create new healthcare
  facilties: PFI, LIFT, Procure 21
• Predict and provide focus: more
  bedspaces, more facilities
• But before building new facilities,
  what are the new services and
  what are the value stream
  implications?
 Agenda

• Context: care system pressures
• Enabling distributed care: emerging ICT
  based services
• Developing the service chain
• Delivery implications
• Future scenarios
• Conclusions
 Changing demands on health care provision

• Demographic and social change
• Rising cost of care delivery
• Demand for better quality services,
  infrastructure and customer focus
• Staff shortages, particularly in the
  social care sector
• Ageing population of informal
  carers
 Government concerns

• Cost containment
• Reduction of
  pressures in the
  acute sector
• Widening choice
  over the location of
  care
  The need for ICT

• The back end: innovation in
  administration and management
• The front end: innovation in the delivery
  of care – greater use of home care and
  other community based models
 Policy drivers

• Sustainable communities – local access to
  services
• Social inclusion, embracing diversity and choice
• At least 12 major policy reports have argued for
  the introduction of telecare since 1998
• Home ‘telehealthcare’ to be available in 100%
  of homes requiring it by December 2010
• Within this context new telehealthcare
  services are beginning to emerge as real
  possibilities …
 Agenda

• Context: care system pressures
• Enabling distributed care: emerging ICT
  based services
• Developing the service chain
• Delivery implications
• Future scenarios
• Conclusions
But what exactly is ‘telehealthcare’


• Telemedicine is a ‘B2B’ service –
  between health professionals
• Telecare is a ‘B2C’ service – between
  the patient / client and the care system
                         Environmental monitoring, e.g.
 Telecare services       Bath overflowing, gas left on, door
                         unlocked


                                                               Mitigating risk

 Social inclusion

                                                                     Personal monitoring:
                                                                     • Physiological signs e.g.
Information &                   The individual in                       COPD, symptom
communication, e.g.                                                     change, oxygen
                                their home or                           saturation, weight and
health advice, triage,
access to self-help             wider                                   temperature
groups                          environment                          • Activities of daily living
                                                                        e.g. detecting falls,
                                                                        room occupancy, use of
                                                                        appliances




         Improving
         functionality
                         Electronic assistive technology,
                         e.g. environmental controls, doors
                         opening/closing, control of beds
    Personal & environmental monitoring: service model

                                              Sensors, equipment in home
  Events            NHS CRS
  record




Record event

               Response       Alarm !
                protocol                        Response: home visit,
                                                 emergency services,
                                                   remote change
                              Check status

                                             Response
                  Contact                    provider:
                  centre                e.g. neighbour, relative,
                                        ambulance, GP practice
                                        nurse, HCA, fire, police
 Agenda

• Context: care system pressures
• Enabling distributed care: emerging ICT
  based services
• Developing the value stream
• Delivery implications
• Future scenarios
• Conclusions
NHS?
What are the infrastructure needs?

• Buildings: not just new healthcare facilities
  but how far and at what cost can we adapt
  existing healthcare buildings and people’s
  homes?
• ICT: what are the in-home and external
  network needs, what are the data storage /
  retrieval / distribution needs?
• Organisational: how can we create the right
  structures, how will new organisations
  integrate with existing care system?
   Home care value stream: roles and activities

  Data providers          Service providers         Infrastructure providers      Device suppliers


       Patient                                              Buildings
       data &            Management     Response            and                     Hardware
      protocols                                             network
                                                            provision




• Providers of          • Responsible for          • Telecoms and              • Manufacturers of
  relevant individual     monitoring end user        other network               devices for
  patient information     interface and              and access                  monitoring
  including response      managing the               providers                   patients
  protocols               response using
                          patient information      • Providers of
• Key activity is                                    physical facilities
  consolidation of      • Responsible for
  patient information     integration of
  from different data     activities along
  sources                 value chain

                        • Responsible for
                          coordinating
                          telecare with other
                          health & social care
                          services
   Telecare value stream: possible players

  Data providers        Service providers         Infrastructure providers      Device suppliers


      Patient                                             Buildings
      data &           Management     Response            and                     Hardware
     protocols                                            network
                                                          provision




• Primary and acute   • Community alarm          • Vodafone,
  care                  providers                  Orange, BT etc            • Tunstall,
• Social services     • Westminster              • Construction                Shorrocks,
                        Healthcare, BUPA,          industry                    Chiltern Inverdex,
                        Nestor                                                 Possum, SRS
                      • Kaiser, United                                       • Siemens, Hewlett-
                        Healthcare                                             Packard,
                      • Housing                                                Honeywell
                        associations
                      • Utilities
                      • Home insurance /
                        security
                      • BT, Orange, Nokia
  … but there are unanswered questions

• How much of the infrastructure is already in
  place?
• Which services does each party wish to supply?
• How much of the value stream does each
  participant wish to be involved in?
• What capabilities are needed and what skills
  need to be developed?
• Who will be the systems integrator for new care
  services?
 Agenda

• Context: care system pressures
• Enabling distributed care: emerging ICT
  based services
• Developing the service chain
• Delivery implications
• Future scenarios
• Conclusions
   Service design implications

• Service requirements
  must lead technology
  requirements
• Early involvement of all
  relevant stakeholders in
  development phases
• Need for clear ownership
  and leadership
 Procurement implications

• Mix and match approach to avoid
  technology silos

• Care providers don’t have skills
  base for systems integration

• Need for local single point
  responsibility for procurement,
  working with systems integrators
  and within national framework
Value stream implications


• There are several possible ways of
  “cutting the cake” – different value
  stream models …
                                             Sensors, equipment in the home
  Events               EPR
  record




Record event

               Response        Alarm !
                protocol                          Response: home visit,
                                                   emergency services,
                                                     remote change
                             Check status: VDI

                                         Response
                  Contact                service provider:
                  centre                 HCA, neighbour, relative,
                                         ambulance, GP practice
                                         nurse, fire, police
                                           Sensors, equipment in the home
  Events               EPR
  record




Record event

               Response        Alarm !
                protocol                          Response: home visit,
                                                   emergency services,
                                                     remote change
                             Check status: VDI

                                         Response
                  Contact                service provider:
                  centre                 HCA, neighbour, relative,
                                         ambulance, GP practice
                                         nurse, fire, police
Business model implications
• Business models need to consider:
  – Infrastructure procurement, financing and
    revenue arrangements
  – Organisation of maintenance, continuing
    support & upgrading technologies &
    infrastructure
  – Relationships between care providers,
    technology providers, infrastructure
    providers (telecoms, construction /
    facilities management)
It’s not the technology!
 Agenda

• Context: care system pressures
• Enabling distributed care: emerging ICT
  based services
• Developing the service chain
• Delivery implications
• Future scenarios
• Conclusions
Future scenarios

                    A: ‘NHS Direct to You’
                    • Basic services to all              D: ‘Whole health
                    • Existing social                      system’:
 Increasing scale



                      alarm systems                      • Generic services to
                    • Locally or nationally                all, but customisable
                      integrated                         • Big bang approach
                                                         • Fully integrated




                                C: ‘Niche by niche’:
                                • Priority user groups
                                  – eg diabetes,                   B: Case by case’:
                                  asthma                           •Individualised – very
                                • Locally integrated               disabled or at risk
                                                                   •Few suppliers, need to
                                                                   mix and match
                                                                   •High cost
                                                                   •Locally integrated



                                         Increasing scope
‘Make or break’ issues

• There are some critical influences on
  deployment of new models, whatever
  the future policy environment:
  – standardisation: need for standard care
    protocols, as well as standardisation in
    construction systems
  – evidence of system-wide impacts of new service
    models is needed, as well as individual care
    outcomes
  – business case needs to be demonstrated
 Agenda

• Context: care system pressures
• Enabling distributed care: emerging ICT
  based services
• Developing the service chain
• Delivery implications
• Future scenarios
• Conclusions
Conclusions

• The ‘hospital of the future’ won’t just involve
  new facilities – intermediate care, hospital at
  home, telecare etc will change the
  requirements for the location, space and
  layout of buildings
• The construction industry needs to
  understand how the underlying conditions for
  value creation in care are changing
• Rapid change is a challenge in making
  decisions about what buildings to provide
  and how to future proof them, and what
  business models to adopt

				
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