By Accountable Care Journal-
Healthcare is about knowledge: Patients who know more tend to live healthier lives, and professionals who know more, care better for patients.
With a knowledge-differentiating condition such as diabetes, those who learn about weight and blood sugar can live rewarding lives. Those who don’t, fill a disproportionate number of hospital beds, risking peripheral neuropathies and sight loss, while their families face untimely losses of loved ones.
Diabetes research is knowledge-based for drug and technology combinations that capture better data and deliver real-time medication. As a result, type one diabetes no longer hampers one’s career and even Mrs May, for example, was able to pursue a full, if somewhat brutal, lifestyle as Prime Minister.
In the Twentieth Century, health information exploded beyond belief. Grainy pictures of bones became images of minute tumours or videos of thoughts flickering across someone’s brain. Biochemistry caught the first stirrings of disease and we decoded the genetics of who would suffer from what, and which treatments would work.
Our therapeutic knowledge tracked these diagnostic developments and the great killers of earlier centuries (except malnutrition and war) retreated before antibiotics, massively and minimally invasive surgery, and a cocktail of smart drugs and devices.
Now, think about stroke. At first, this looks like the diabetes story since there are many healthy lifestyle choices that cut the risk of stroke. Moreover, highly specialised care is needed to diagnose and treat the initial insult and there is often a period of ongoing care afterward.
However, two critical differences between diabetes and stroke open our eyes to another type of information. First, the stroke patient is at greater mercy of the system: Someone else must spot the symptoms and someone else must reach the patient. Second, unless there is a rapid-response system, the outlook is poor. Delay is lethal, leading to disability or death.
A stroke care system must process patients in intricately coordinated ways and under extreme time pressure, 24/7 and at scale. Coordination and timing at scale is the new Twenty-First Century challenge – medical logistics. While what we know in medical science determines the best we can deliver, our medical logistics knowledge determines what we deliver to most people.
Information systems for medical science are all about records and machinery that deliver numbers: Electronic patient records, path labs, biochemical labs, sequencing labs, radiology services, pharmaceutical dosages and side effects. Information systems for medical logistics are about people, places, resources and time: Where a 999 call comes from, where the ambulance is now, how many beds are available, where each member of staff is, and what machines are ready, now. More broadly, we need health population statistics to distribute our resources accordingly.
We make both types of information work in combination when a stroke victim in Kent is airlifted to Kings College Hospital within the golden hour. However, the information needed above the helipad is very different to that used in the neuro-OR just below it.
Our Twentieth Century success gives us ever better medical science information systems, increasingly augmented with advanced artificial intelligence (AI). The best we can do keeps getting better.
Importance of data
However, our inattention to the logistics of care means that the average service we deliver across the country is a long way behind. Worse still, logistics data is confused with audit data. Armies of people in the UK collect data about services, much of it of dubious quality and a vast majority of which is never used to alter patient care.
We argue that such data collection has become dangerous. Firstly, because the data driving government statistics rarely help to make a single decision to speed a patient through the system. Audit therefore skews data selection away from its use in care delivery. Secondly, audit enjoys priority over operations and people are fired when the audit numbers are wrong. This is inevitable in a state run, top down, unitary healthcare system.
The alternative, point of care access to logistics data for health professionals to better manage patient care and the flow of individuals, has fewer and weaker champions. Thus, audit data displaces logistics data as well as skewing it.
Healthcare depends upon two data types; the clinical determining the best we can do and the logistics that limit what most people will get. Right now, our best is diverging alarmingly from our average and, until we invest in the logistics of health, this trend is bound to continue.
Professor Terry Young worked in industrial R&D before becoming an academic and is now Director of Datchet Consulting. With over 30 years' experience in technology development and strategy, health systems, and methods to ensure value for money, his current focus lies in designing services using computer models and he set up the Cumberland Initiative to support healthcare organisations wishing to develop their services more systematically. Three of his downloadable papers are:
Using industrial processes to improve patient care (2004, with Brailsford et al., British Medical Journal)
Performing or not performing: what’s in a target? (2017, with Eatock & Cooke, Future Hospital Journal)
Systems, design and value-for-money in the NHS: mission impossible? (2018, with Morton and Soorapanth, Future Hospital Journal)
Professor Stephen K Smith is a clinician/executive having held senior positions in Academic Medicine and the NHS at the University of Cambridge, Imperial College, London, NTU Singapore and most recently the University of Melbourne. He currently serves on various health and health technology Boards including Chair of East Kent Hospitals University NHS Foundation Trust, and Netscientific Plc. and previously the Boards of Imperial College, London, Imperial College Healthcare NHS Trust, the National Healthcare Group, Singapore, the Royal Melbourne Hospital, Melbourne, and the Victorian Comprehensive Cancer Centre, Australia.
Professor Smith led the formation of the UK's first Academic Health Science Centre at Imperial College Healthcare NHS Trust and was its first CEO. A gynaecologist by training, he has published over 230 papers on reproductive medicine and cancer. He was awarded his Doctor of Science in 2001 for his work in Cambridge on the complex gene pathways that regulate the growth of blood vessels in reproductive tissue. He was founder/director of the Sino-Japanese pharmaceutical company, GNI Group Plc, that is quoted on Tokyo SE and currently chairs a group of start-up digital health companies. He is a Trustee of Pancreatic Cancer UK and the Epilepsy Society.
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