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Informatics and the new normal of healthcare

Published 27 March 2014

Dr Cathy Kelly, medical director of Aridhia, discusses how Scotland's clinically-led use of informatics acts as an exemplar for the adoption of similar ambitious projects across the UK


Chronic disease is the leading cause of mortality and morbidity in the world, claiming 36 million lives each year. Despite the widespread impact of chronic disease, clinical information relating to patients' care is often held in organisational silos, and not shared effectively between providers who need to deliver care within their local health economy, and there is often limited information sharing with patients themselves. This can make it difficult to assess clinical outcomes across the entire pathway of care and to ensure that patients are empowered to take more of an active role in managing their own care.

Diseases such as cancer and diabetes are increasing in prevalence globally and the projected costs of delivering care are not sustainable. As the world's healthcare systems come under increasing pressure, there is an urgent clinical and economic need to manage those conditions more effectively.

If we are to deliver lifelong health and improved patient outcomes at a time when budgets are being squeezed, a comprehensive transformation is required. It is universally accepted that medicine is becoming an information science and I strongly believe that biomedical informatics, personalised medicine, data and collaboration are at the heart of the 'new normal' of healthcare.

We know that current methods of managing chronic illness often involves a degree of "trial and error" treatment, where medications are prescribed and response assessed over a period before changing to a second line option if there is limited clinical improvement. Cancer care is one of the few exceptions to this rule where treatments are recommended based on individual likelihood of response, determined by genetic profile.

Proper use of healthcare analytics and informatics can support better understanding of disease prevalence, risk factors and impact of variables such as ethnicity, deprivation and comorbidity. It can also ensure that the NHS uses data to translate research, innovation and best practice into effective and cost-efficient treatments and services for patients. However, it is also now clear that the NHS is expected to contribute to the government's 'Plan for Growth' which entails focusing on delivery of innovations to improve patient outcomes and contribute to economic growth.

In May 2013 the government announced that fifteen new Academic Health Science Networks (AHSNs) had been confirmed by NHS England and that these networks will focus on delivering innovations to boost patient outcomes and contribute to economic growth. Faced with these realities, it becomes clear that to create wealth, an AHSN should consider focusing on building a business model that addresses the new realities of the healthcare system.

Informatics alone cannot solve this problem, or generate wealth when used in isolation. I firmly believe that innovation will only be achieved by academia, healthcare and industry working together; collaboration is a vital piece of the puzzle. To better understand this area, we recently launched a co-authored report with Chris Roche at big data company EMC that outlines the need for AHSNs to adopt long-term thinking in order to improve patient outcomes, whilst maintaining a sustainable health system. The ability to rapidly collect and analyse clinical, patient, imaging and genomic data and deliver real-time disease management services is the key to enhancing service delivery, stratifying patient risk and improving clinical outcomes.

In my time at Aridhia we have benefited greatly from forging strong working relationships with organisations from across the entire health, research, lifescience and IT spectrums including NHS Scotland, the University of Dundee and Pivotal, a spin-off analytics company from EMC, with whom we are in partnership to deliver our advanced healthcare analytics platform which offers the potential to deliver capability through cloud-based execution on a price per patient basis, and which is due for release this year.

We have used this open business model approach to accelerate innovation, and strongly believe, as do Pivotal, that the more collaboration is undertaken, the greater the degree of innovation generated. As a result, Aridhia and Pivotal are now working together with a host of NHS Scotland boards, Scottish universities and lifescience organisations to provide the biomedical informatics platform underpinning the Stratified Medicine Scotland Innovation Centre. This centre will focus not only on delivering improvements to inform the delivery of quality healthcare, but will also act as an incubator for innovation in stratified medicine.

Scotland's significant past investment in collaboration and clinically-led use of informatics has produced impressive outcomes. For the last 20 years, GPs, patients and secondary health professionals have worked together using informatics to enable a more integrated care approach for diabetes. Advances in informatics technology has enabled patient-centric data to be collected and shared with authorised care providers, and with patients themselves, and analysed to manage and coordinate care and to assess the impact of an integrated care model on patient outcomes. As a result of this coordinated approach, there is published evidence of a 40% reduction in both blindness and amputation for diabetics in Scotland.

The Scottish example is very encouraging and acts as an exemplar for implementation of similar ambitious projects across the UK. This is vital if we are to accelerate the transformation of care delivery, reduce variation and waste, improve patient safety and generate wealth. With the decoding of human genome, the promise of molecular medicine is enormous but these benefits can only be realised by bringing together patients, clinicians, academic, life scientists, IT experts and informaticians to form the multidisciplinary teams of the future.

Patient-centred partnerships are vital if we are to deliver on the promise of personalised therapy and lifelong health. Those partnerships that build and invest in both new business models and platforms that allows collaboration to take place both at the biomedical informatics level and relationship level will have the best chance of succeeding in the years to come.

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