Issues And Challenges Of Connected Health A Clinical Perspective - Albert Alonso

Issues and challenges of Connected Health: a clinical perspective

Albert AlonsoInnovation Directorate

16th Annual conference and Scientific Symposium

HISI Annual Conference, Dublin, November 16th 2011

Why Connected Health?• Enables more informed decision-making and enhanced quality of care• Saves lives through remote consultations, whether urgent or

diagnostic• Creates more efficient, convenient and potentially more cost-effective

delivery of care• Facilitates earlier – and more accurate – diagnoses• Provides greater and faster access to a patient’s medical history,

reducing the risk of negative drug interactions or poor response to a course of treatment

• Improves administrative efficiency and coordination.• Allows rural residents to receive expert diagnosis and treatment from

distant medical centers.• Increases timeliness of treatment and decreases transfer rates, while

reducing medical costs through video technology • Supports real - time treatment by first responders through the use of

smartphones.• Enhances senior wellness and preventative care through telemedicine

and remote in-home monitoring.


Sounds great! Does it fit in our clinical perspective?


Meet a 21st century Older Person

Who’s Mary?

• Aged 79 years• Lives alone (family home)• Arthritis (legs and hands)• Long-standing digestive problem• Mitral valve leakage• Small mental lapses - ? TIAs• Technophobe (ATM, care alarm)

• Independent but sociable

Adapted from M. Rigby. Social Care Informatics in Support of Integrated Care. INIC, Odense, 2011



What does Mary need?

• Nutrition support• Mobility support• Shopping• Bathing support• Socialisation opportunity




Who does help her (informal care)?

• No children• Stepson, niece; each 90 minutes

away; working• 2 sisters – equally dependent, do

not drive• Neighbours – elderly couples 70+,

each husband with history of cancer




Who does help her (formal care)?

• General Practitioner – uninterested, repeat meds., nothing curable

• Cardiologist – medication• Orthopod – undecided• Neurologist – unsure• Geriatrician – peace maker• Home nurse – monthly• Respite care – annually




Social care essentials

• Difficult negotiations between family, health care, and social care providers

• Daily hot meal delivered 5 days• 1 hour home support• Eventually family also arrange 7 day

home visit support including midday meal




Who manages her health?

• Health seriously compromised if not helped holistically

• Health care and Social care need harmonising

• Family and carers’ own needs are factors



Is Connected Health good for Mary?


Maybe, but we could do it better


To begin, we need to change our clinical perspective



A clinical perspective for NCDs

Socio economicdeterminants

Gender

Lifestyle – environmentRisk and protective factors

Biological expression ofChronic diseases

Genes

Clinical expression ofChronic diseases

Age

Health promotion

Systemsbiology

PersonalisedMedicine

• Primary prevention•Secondary prevention• Tertiary prevention

• Treatment

Adapted from Bousquet et al. Genome Medicine, 2011, 3:43


Classical phenotypes

Patient with chronic disease

CVD COPD Diabetes

Assessment of co-morbidities and severity

Classical phenotypes in patients with severe defined diseases and co-morbidities and severity

Responsiveness to treatment follow-up

Based on “a priori” ontologies



New phenotypes Patient with chronic disease

Co-morbidites(standardised assessment

Severity of co-morbidities(standardised assessment)

Novel phenotypes in individual patients with severe co-morbidities of chronic disease

Responsiveness to treatment follow-up

Based on statistical models: complex

components of onset, persistence,

prognosis



Moving to 4P medicine

Predictive, preventive, personalised, participatory

• New studies needed on precise patients’ phenotypes and follow up

• Systems medicine: Massive amount of patients’ data should be available (new societal responsibility)

• ICT are the only way to collect and exploit these data: new information management systems are required, smarter monitoring solutions.

We need this connected health to make integrated care possible

ClassicalPhenotypes

NewPhenotypes


Back to Mary

Citizen first

Care secondary

ICT discrete enabler



Thanks for your attention

Health & Medicine

Issues And Challenges Of Connected Health A Clinical Perspective - Albert Alonso