I have just come back from a pretty amazing two day meeting.  The Centre for Social Impact ( led by Peter Shergold) and Cisco got together with 60 senior Australian beauracrats and brought innovation experts from around the world to talk about how to innovate in the delivery of public sector policy.

Sounds like it could have been boring...but it was anything but.  When you have innovation leaders like John Kao ( re Innovation Nation), Jonty Olliff-Cooper (DAMOS) and Beth Noveck (White Deputy Chief Technology Officer for Open Government) all talking about how to transform goverment through open engagement with citzens it was a "mind shifting" two days.

How does this relate to Digital Healthcare design. The link came first in John Kao's discusion around the use of design thinking.  Quoting Wikipedia:

"Design thinking is a process for practical, creative resolution of problems or issues that looks for an improved future result. It is the essential ability to combine empathy, creativity and rationality to meet user needs and drive business success. Unlike analytical thinking, design thinking is a creative process based around the "building up" of ideas."

What became clear in the discusisons (and presentations) that followed was that this concept of design thinking has been central in the delivery of successful public sector innovations (and public sector innovation is what designing new hospitals is all about).  The innovations we heard about were driven by the public sector deeply engaging with the citizens, empowering them with the ability to gather together and exchange/build ideas.  Finally it engaged the public sector management in a way that created empathy and understanding.   Yes there were lots of web 2.0 tools and innovative ways to drive engagement and feedback, but the issue was not the technology, the issue was creating the opportunities to listen in a way that creates understanding.

This struck me as the challenge that we have in front of of us.  We are all comming to the task of how to better deliver healthcare with great personal passion, but the issue we face is can we put aside our individual passions and listen to those in the system, providers and users, so we can really uderstand their needs.

A difficult challenge, but one with great practical rewards.

For those interested in exploring this field I thought I would do a bit of a summary of the key sites active in this area.  There are few activities dedicated to the application of health IT in healthcare design, however, the X3 Summit is a major conference in the US on the subject.  On the event website at www.x3summit.com  you can see  the program for this year's conference (Duke University May 5-7) and past programs.  It gives you a good idea of what is happening in this field.

While there is not a single site dedicated to issues around Digital Healthcare Design (if I am wrong please leave a comment on the blog...I would love to know the details)  there is a large amount of acitivity around healthcare design issues in general.  One of  the leading Australian centres active in this area is CHAA (Centre for Health Assets Australia). Associate Professor Jane Carthey is Director of the Centre and it is part of the Built Enviroment Faculty at the UNSW. They are responsible for producing the Health Facility Guidelines.  This is the publication that we want to supplement with a set of Health IT guidelines.  You can find CHAA at www.fbe.unsw.edu.au/chaa/.

Internationally, the major site is probably from the Health Design Technology Institute, which was supported by the Robert Wood Johnson Foundation in the US.  This group has a focus on evidense based design and has some fantastic papers on the subject that can be downloaded from their site (see www.healthdesign.org ).  All this is an important foundation to the work for developing the focus on Digital Healthcare Design in Australia.

Some other intesting sites are

• Centre for Health Systems Design
• Informed Design
• www.facilitiesnet.com/healthcarefacilities
• Picker Institute
• Healthcare Design Magazine
• Healthcare Building Ideas Magazine
• Academy of Architecture for Health
• Health Environments Research and Design Journal
• Healthcare Design Conference

I will get back to you soon with some details about an event we are organising in Australia on digital healthcare design, looking at how to design a digital hospital for 2020

Best regards

Brendan

It has been a while since I have been blogging.  The transition to Cisco (from the CEO position at HISA) temporarily diverted my attention away from blogging,  but I am now back.

Taking up the position at Cisco has opened my eyes to what is a bit of a missing link in the delivery of healthcare in Australia. 

Australia has over $20 Billion in hospitals currently in the planning, design and construction phases.  However, even with this enormous financial investment, there are no guidelines or even guiding principles for how information technology can be best included in these designs.

There is a big need for a multidisciplinary group that brings together architects, designers, engineers, IT professionals, healthcare providers and consumers to look at the interface between design and information technology. The objective is to bring these groups together and to drive innovation in healthcare delivery.  

If you are interested in this field, then join up to he Digital Hospital Design Group on The Health Hub ( see http://www.thehealthhub.org.au/pg/groups/3304/digital-healthcare-design/ ) and help us build this group and bring some guidance to the health facilities and systems that are going to deliver care to Australian communities over the 20 years.

This is an important task.  I hope it is going to take us all out of our comfort zone, with conversations involving a broad range of professionals and health consumers who have previously not had an opportunity to interact.

It is an experiment, but then the exciting parts of life, personal or professional usually are.

I hope to see you at the HUB.

If you want to send me a message to talk about involvement just click on the message function in the drop down menu and we can talk. 

See you in the Digital Healthcare Design Group.

Best regards

Brendan

Last week the Department of Health and Aging released its report to support Australia's first National Primary Healthcare Strategy.  This is an important report to read for those interested in Consumer e-Health.  You can download a copy of the report from  http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/nphc-draftreportsupp-toc .

There are two important things to take home from this report.  The first is there is a clear recognition throughout the report that e-health technologies, including web based information sources, mobile computing systems and online health records are vital elements that need to be further developed to better engage consumers in better maintaining their health.  This is not only discussed in the chapter dedicated to e-health (Element 6 of the report), but also inferred throughout the report when delivering on the reports objectives are discussed.

The second important consumer e-health aspect to the report is that while there is a recognition of the need for these systems there is no real detail on what they would look like or how they would be delivered.  There is some discussion regarding access to a personal health record, but again little detail on the what or the how around it. 

To me, this further emphasises the need to rapidly develop the discussion around what are the required consumer e-health systems and how we could develop and deploy them.  Unlike the professional systems that are in the spotlight now, where the roll out is gated by large capital investments from the Federal and State governments, the implementation of consumer systems are going to be driven much more by open market developed applications and the implementation will only be gated by the cost and the value that they deliver to consumers.  This is a notoriously difficult genie to control once it is out of the bottle.

If we want to make sure that Australia's health consumers have access to the applications which will really improve their ability to manage their health then we need to work out  how to create the market conditions that foster these types of applications. 

Hopefully through the Health Beyond group on the Health Hub we can develop that sort of conversation.

Sorry I have been "off the air" for a  few weeks, but there has been lots happening which has kept me away from the Health Hub.

The first distraction was the HIC'09 conference in Canberra which HISA ran.  This was a great success, with a very wide range of topics covering leading edge science to the latest e-health systems implementations in Australia. There were some consumer e-health relevant presentations (I did one at the Nursing Informatics event), but there were not enough, next year we need to mobilise and get a workshop going for the event.

However the most important news from my perspective (which was also announced at the HIC conference) was that I am resigning from HISA.  After three and half fantastic years as CEO I have decided to leave HISA and take up a new role at Cisco.

BUT...I will still be in the e-health space and will continue to blog on the Health Hub.  Consumer e-Health is an exciting and rapidly growing segment in which I will maintain a strong interest.

Next week is HISA's national conference (HIC09) in Canberra and it's time for reflection on some of the big issues in e-health.  In consumer e-health this has got to include how consumers are going to take advantage of the significant planned invest in the "professional" e-health systems.

First, what do I mean by professional e-health system.  Well, these are the technologies that link our hospitals/clinics,  pharmacy, diagnostic and care planing operations.  They will enable the health consumer to get safer and more cost effective care.  This is all about how we treat patients when they are in care.

Ok, these are pretty significant benefits, BUT....they don't reflect what could be some even larger benefits generated through our e-health investment.  These are the benefits driven from actually keeping patients out of care and they are realised through engaging consumers more effectively in their own health mangement. 

While there is a strong recognition of the need for a personal health record for consumers, that system, by itself, is not going to entice consumers to take better care of themselves.  Health consumers require high value experiences to better engage themselves in managing their own care. 

Some of these experiences are now being partialy delivered (albeit in a relatively disjointed fashion) with highly engaging online systems that support all types of health and fitness needs, with well qualified information resources, online therapy, training and social networking processes.  These are supported with an exciting range of sensors and devices which often use game technology to make information input and tracking an enjoyable and a higher value experience.  What they often lack (except in the case of some excellent mental health examples) is the linkage with care providers and the provision of high quality coaching and feedback to guide the consumer.

The ability to link these consumer e-health systems, perhaps through the Personal Health Record, to the professional health systems will allow a crucial link between the consumer and the care provider to be forged.  This will enable the consumer to experience highly relevant and context specific professional feedback that will drive more effective everyday decisions about their health.  It could also deliver an accurate and rich source of valuable patient information to improve the care process when the consumer does find themselves in the health system.

So what REALLY excites me about consumer e-health is its this ability to cost effectively link the care professional and the consumer with information and tools which enable long term better personal health decisions.

I have written a presentation on this issue for the Nursing Informatics Conference next week.  It has a more extensive discussion of this issue with lots of links to sites of interest.  You can download a copy by clicking here

This may sound a pretty dry topic...but it is not.

Continua is an organisation which develops specifications for uniform communications interfaces in consumer health devices and certifies products compliant with these specifications. 

Ok, I can now see the yawns and eyes drifting shut, but this is important. 

For consumers to really embrace e-health requires that the input of information be as simple as possible.  In fact, ideally it should be totally transparent to the user.  This is the sort of future that Continua looks to enable.  The availability of standard interfaces opens up the apllication of these devices to all the small and innovative software development companies that can integrate the devices into home based health products. 

So a potential scenario is that a person on a weight management program can hop on the scales in the bathroom and their weight can be recorded on their electronic health record...a scary thought for some, but very helpful for many.

So the latest products announced by Continua are an A&D blue tooth weight scale, and a blood pressure monitor, plus a Roche blood glucose meter (see http://www.continuaalliance.org/products/certified-products.html ).

Continua are only just starting to announce the products that are passing through their certification process, so look out for more announcements in the future.  These are the products which will be defining in the next generation of consumer e-health systems.

Just a quick note to let everyone know that The Journal Of Virtual Worlds Research has just released a dedicated edition on "Virtual Worlds for Health and Healthcare"  see http://daneelariantho.wordpress.com/2009/08/03/3d-virtual-worlds-for-health-and-healthcare-a-special-issue-of-jvwr/ .  It has some interesting articles for those seriously involved in health applications using virtual world technology.

I thought the release last week by Bayer Health of their new blood glucose measuring device (Diget) was an interesting one.  Not so much because the device neatly integrates with the Nintendo DS gaming system and provides game rewards (new powers, access to new levels, etc) but because the eHealth Europe ( http://www.ehealtheurope.net/news/5051/nintendo_ds_to_offer_diabetes_care ) has reported that the device will also will also upload data to the DIGET website and integrate with their diabetes management system designed for children between the ages 5 and 14.

The big issue with personal health records is not so much the technology (both Global Health and Healthe have been providing consumer focused personal health records for years), the real issue is making it worthwhile for consumers to enter the data.

It is always a balance of weighing up the time spent in the boring task of inputting data against the benefit derived from better managing your health.  The problem is the downside of data input always has to come first, it is an immediate issue, while the benefit of a healthier lifestyle can take months before a positive feedback is realised.  This is of course separate from the difficulties healthcare practitioners have in inputting information...but that is an issue for a separate discussion.

So anything that makes health data input easier has got to be an important step in the broader use of personal health records and the better management of our lifestyle.  As a consequence the DIGET product announcement is important.  But this is only one of many such announcement you may be seeing in the near future.  Lifescan have announced a blood glucose device for the the Apple iphone (http://www.diabetesmine.com/2009/03/lifescans-new-diabetes-iphone-app.html )  and there will be announcements for other smart phones coming out soon.

The application of gaming technology is one of the most promising areas for making the input of of health data a higher value experience.  This, combined with the spread of the high power mobile computing platforms (read smart phones) integrated with all sorts of sensors, means that the objective of convenient health information data entry that is linked with our healthcare providers care plan that allows us to make more effective lifestyle decisions, is getting closer.

ABI Research has just come up with a prediction that wearable senors to measure important body parameters and communicate the data to remote systems will grow to 400  million devices by 2014.  They predict that:

"Demand will come from the professional healthcare, home healthcare and sports and fitness markets, but these markets will develop at different speeds and will support different applications. The sports and fitness market represents more than 90 percent of the market today."

You can see the whole article at http://www.businesswire.com/portal/site/google/?ndmViewId=news_view&newsId=20090723005635&newsLang=en

When you look at the players in this segment you see a healthy mix of big technology companies and small innovators. This provides a stong foundation for segment growth.  The list the major players as: 

Atmel, Bluetooth SIG, Broadcom, Continua Health Alliance, CSR, Cypress Semiconductor, Dynastream Innovations, EM Microelectronic, FitLinxx, GE Healthcare, Healthsense, Inc., Intel, Microchip Technology, Nike, Nokia, Nordic Semiconductor, Philips, Polar Electro, Roche Diagnostics, Sensium, Sony Ericsson, ST Ericsson, Suunto, Texas Instruments, Uniband Electric Corporation
Wireless-Life Sciences Alliance, ZMD.

The question we need to ask ourselves is how do we, as a community of interested professionals (care providers, technologists and vendors) best engage and guide this activity.  Given Australia apears to be embarking on a fresh health IT future it appears a good time to work with these groups to ensure we are early adopters of these technologies, but also to make sure that the sorts of innovations they are driving are incorporated in our design of health IT for Australia.