Digital Health Institute (DHI Scotland)
Art of the possible for health and social care …
Profile: Digital Health Institute (DHI Scotland)
ADMIN HUB: University of Edinburgh
FUNDING: £11 million (initial investment)
Art of the possible for health and social care
The ideas could come from citizens, social workers, carers, nurses, doctors, paramedics, community groups or hospital porters – or emerge from an academic research lab or industrial workshop – but the innovative products for digital health and social care that eventually go on the market, based on those original ideas, could generate millions of dollars in sales and save countless lives in the process.
Not every idea for digital health will translate into medical, welfare or business success. Some ideas will fail because they are not practical or economic and some will fail because they are not innovative enough, but innovators must be encouraged to give it a try and receive the support they deserve, no matter where they come from in the medical or social care spectrum. Sometimes the idea may lead to nothing, but the person who conceived it may be “talent-spotted” by another organisation and go on to develop a digital product which does prove successful. What matters is to make sure clever people and ideas are not lost and sweep away the obstacles laid in their path.
Digital health will be one of the keys to the future of medical and social care, and the challenge facing government, as well as academics and commercial developers, is how to make the most of the commercial opportunities created by digital health, deliver better health and social care via digital technologies and harvest the innovative ideas for products which come not just from scientists and engineers but also from the people who use them. The other challenge is to bring all these people together to create teams which are greater than the sum of their parts, to develop new solutions. Scotland has come up with the answer by setting up the Digital Health Institute (DHI), bridging the gap between the different stakeholders in digital health and empowering them to “collaborate and co-produce products and services that will be transformational.”
“Many of them haven't even spoken to each other before,” says Brendan Faulds, Chief Operating Officer of the DHI, “so one of our first jobs is to build a network to enable information to flow, and create a community where there is a clear focus on doing something with the talent we have in Scotland and the innovative ideas that talent produces.”
Some ideas can be “breathtakingly simple,” says Faulds. For example, care professionals in East Lothian came up with new ideas to enable people suffering from dementia to remain at home for longer by monitoring everyday actions, such as safe use of the cooker. Good ideas like that can easily get stuck in endless layers of bureaucracy, but the DHI is going out of its way to encourage people to come forward, so they can by-pass conventional routes. Engagement teams are taking a proactive approach to reach all sectors of the health and care community, whilst government leaders in health and social care also drive the search for new ideas – ensuring both a ‘bottom-up’ and ‘top-down’ approach.
This strategy is also beginning to pay off in terms of new projects: “In the last two months alone,” says Faulds, “the number of ideas received has quadrupled compared to the previous two months.” Conferences and other public events will also play a key role in discovering ideas.
According to Faulds, the technology is moving so fast, it is hard to keep track of advances, and this can lead to lots of duplication of effort which the DHI can help researchers to avoid, at the same time as supporting the development of collaborations and matchmaking people and organisations.
The DHI is a collaborative partnership between public and private organisations, bringing together the country's leading health and care operators, academic researchers and technology businesses at home and abroad (the companies present at the DHI launch included IBM, Philips, Deutsch Telekom, Celesio, Continua Health Alliance and Lockheed Martin), “to speed up research and development in order to produce innovative new technologies that will transform the quality of people's lives and help Scotland become an exporter of world-leading products and services.”
The DHI has three interwoven objectives: academic, business and civic success. Apart from improving the performance and cost-effectiveness of health and social care in Scotland as well as the patient experience, the chief aim is to make an economic impact by nurturing new companies and helping them develop new products, taking advantage of Scotland's academic resources and boosting the research base in the process, including the funding for a doctoral programme and a new MSc in digital health.
Another aim is to “build the global reputation of Scotland as a centre of innovation for digital health,” engaging international companies whenever they have something to contribute. For example, if a company from China or Poland approached the DHI with an idea for a digital product, it might be introduced to a research team who could help them progress it, as long as there were benefits for Scotland in terms of job creation, inward investment, funding and research, or delivery of a new product.
“The ideal project will press all the buttons for academic, business and civic objectives,” says Faulds, “and our membership so far – over 200 individuals, businesses and health and care organisations from Scotland and beyond – reflects the full spectrum of the industry.”
Whilst Scottish Enterprise continues to focus on funding new businesses, the DHI will aid in assessing potential projects (including viability testing), steer them towards the appropriate funding, particularly for any research that is needed, and offer business advice.
One of the DHI's initial priorities is recruitment of members, offering services such as:
> Onsite facilities to develop digital health & care products and services;
> Collaboration opportunities to build partnerships or access the supply chain;
> Testing services with DHI and health and care providers, including the NHS and Local Authorities, to accelerate the approval process;
> Evidence-based evaluation and approval processes provided by Scotland's academic community;
> Support to bring new products to market and to export them globally.
In some cases, what may be needed to get a new product to market is not so much the science as an understanding of market potential – for example, health economists may have a key role to play in evaluating and developing a product.
How does it work?
The DHI has adopted a three-pronged approach to bring ideas to market, assessing them according to their stage of development – conceptual, ready for testing and ready to commercialise.
The Digital Health Exploratory identifies potential projects based on current intelligence – scanning the research horizon for innovative ideas. This has already led to an exciting new project called ‘The Future Ambulance,’ engaging paramedics and patients to help improve the ergonomics of the ambulance itself and develop new devices – for example, a device to measure the levels of proteins (troponin) released in the blood when the heart has been damaged, so patients can be tested in the ambulance instead of waiting 30 minutes after getting to hospital. Another basic idea is to move the monitor screens in the ambulance so that paramedics can focus on their patients at the same time as watching multiple screens.
The Experience Laboratories provide an environment where users (service users, carers, clinicians, practitioners and third sector organisations), businesses and researchers can collaborate and prototype healthcare solutions. Managed by a team of researchers and designers, including several from the Institute of Design Innovation at the Glasgow School of Art, the DHI labs in Forres replicate real life conditions to test new technology, as well as study services, roles and behaviour, “often the biggest barrier to successful innovation.” The labs are interested in gathering qualitative data as well as quantitative data. For example, they can analyse the interaction between the physician and patient, focusing on behaviour. The labs are also where “creative meets technical world”, with design a key part of the science involved, enabling products to function as well as possible before moving on to the prototype stage.
Ideas which prove successful in the Experience Laboratories may become candidates for further research, development and exploitation. One of the prototypes recently tested in a lab is a new device to help people in remote areas self-monitor for melanoma, using a special camera to photograph their skin, then sending the image to consultants, via the Internet.
The Experience Labs have also been involved with the Future Ambulance project, organising three labs in a dialogue described as “the art of the possible.” The project has three elements: first, the paramedics act out real-life scenarios which are then re-run accommodating novel ideas, to analyse what difference new solutions may make; second, group discussions; and third, individual sessions, finding out in detail what the paramedics think. This is all part of an inter-disciplinary team approach which aims to co-create and co-design new solutions from the ground up, rather than develop a solution then impose it on users.
The Digital Health Factory helps members progress solutions much closer to market, providing technical resources, including access to expertise and test environments, business mentoring and help with funding. Its aim is to develop commercialisable solutions to real-life health challenges, and one of its projects is a collaboration with Health Alert 24, working with parents and NHS Fife to develop a device called ‘My Little One’ – a tablet-based system which allows parents to view their new-born babies via Wi-Fi and a camera in the cot.
The future of the DHI could go in virtually any direction, just as digital technology could also develop in any direction. At the moment, more and more ideas are being submitted, especially apps. As mobile phone technology advances, it could become the major platform for digital health, while wearable devices will also increase in importance. But no matter what trends emerge and how successful the DHI is, the technology is only part of the story, and the vision remains very clear: to establish Scotland at the forefront of digital health and care technology.
“The DHI will not be judged on any individual project output,” says Faulds. “Not every innovation we help to develop will become a commercial success or lead to a breakthrough in healthcare, but our success will come from how well we facilitate projects and promote the importance of digital health, bringing interested parties together. We may be involved from the earliest stage all the way through to commercialisation, or we may only get involved briefly. It is hard to do an ‘elevator pitch’ to explain what the DHI is, because it covers so many fields and has such a wide stakeholder base. Getting everyone speaking the same language can be difficult, but we're making a difference already in terms of new projects, and concrete examples that everyone can relate to will help more people understand what we are doing – and hopefully also contribute ideas in the future.”
What is digital health?
Digital Health is the use of information and communications technologies as health-care solutions, taking advantage of the latest advances in mobile technology and sensor technology to reduce inefficiencies, improve access to services (especially in remote areas), reduce costs, increase quality and make medicine more personalised. Digital health technology could also be designed “to empower people to be equal partners in the design and delivery of their own health-care services,” not only monitoring and managing their own health but also providing feedback which could help with the development of future solutions.
The hardware used includes a range of wireless devices, wearable devices, sensors and software sensing technologies, microprocessors and integrated circuits, delivered via the Internet, including social networks as well as mobile/cellular networks.
The Groupe Speciale Mobile Association (GSMA) predicts that the mobile-health market will generate global revenues in the neighbourhood of US$23 billion by 2017, with Europe becoming the largest mobile-health region by 2017, with revenues of US$6.9 billion.
Why digital health?
Many countries around the world are facing a major crisis due to the pressures of an ageing population and the health problems associated with rapid economic growth – for example, increased levels of cardiovascular illness and diabetes in developing countries.
Current models of health and social care cannot easily scale up to meet these demographic challenges, despite recent technological advances. A meeting of the Scottish Parliament Finance Committee in February 2013 highlighted the fact that the public sector ‘funding gap’ will increase to almost £3 billion by 2016–17. It was noted that “the cost of a primary care consultation would need to be reduced by more than 38 per cent for spending on primary care for those above the age of sixty-five to remain constant in real terms by 2033.” And digital health interventions are recognised as key to the solution, because they are more cost-efficient and empower both patients and healthcare professionals.
With 19 universities to draw on for support, some of which are recognised as leaders in informatics, life sciences and medicine, plus a healthy SME sector with an excellent record for developing digital products, the DHI has solid foundations to build on. Scotland also has a good reputation for progressive healthcare services, and a willingness to embrace innovation. NHS24, acting on behalf of NHS Scotland and the Scottish Government, is a “three star” Reference Site. Reference Sites provide the European Innovation Partnership on Active and Healthy Ageing with examples of a comprehensive, innovation-based approach to active and healthy ageing – coalitions of regions, cities, integrated hospitals or care organisations that help to demonstrate how innovative practices could be transferred to other European contexts.
Scotland’s geography is also a relevant factor. On the one hand, it is easy for people and organisations to network because they are clustered together in a relatively small area, and on the other hand Scotland has a scattered population in remote areas where demand for digital health (particularly telehealth) is strongest, making it ideal as a test-bed for future research.
More experienced Experience Labs
“We have the opportunity to build on current practices and develop them,” says Elizabeth Brooks, Design Director of the DHI's Experience Labs. “We work together as an inter-disciplinary team to facilitate the creation of new solutions, targeting research to unpick the subtleties that lie behind design in a shift away from purely quantitative studies to more qualitative work, developing ideas as a team with the participants in the Labs – ideas that we would never be able to create on our own.”
The Labs are developing existing methodologies, building on experience gained and, in the process, creating a design-led environment for innovation in digital health – and a new toolkit for product design.
“We don't want to jump to solutions,” says Brooks. “If someone comes to us with a solution, we may pull back and ask what problem it's trying to solve, then focus on the process involved, so we help build the right product.” Brooks says this approach is more holistic and complex, involving more people than traditional methods, with designers a critical part of the team from the start, along with users and potential patients, engineers, psychologists and technologists. According to Brooks, the role played by the designers is based on classic craft design, visualising the solution and working closely with clients and the rest of the team to produce the solution, as part of a completely integrated development process.
“The Scottish Ambulance Service has a vision of delivering more care locally in patients’ own homes or communities through the enhanced utilisation of telehealth technology. Our partnership with the DHI has helped us gain access to people that we would never have been able to access within our service. This has filled a huge gap in our skillsets to enable the expertise to be provided in a way that is not commercially driven. This helps us maintain the independence that we require to develop the right technical and operational solution for patients and staff alike, and will place the Scottish Ambulance Service at the forefront of world-class ambulance provision for patients in the community,”
Pamela McLauchlan, Director of Finance at the Scottish Ambulance Service
“The advances in technology and connectivity will help make care safer and more efficient, and improve decision support for paramedics,” Gerry Egan, Clinical Paramedic
“The experience lab gave us immediate access to the patient experience, good and bad, of our proposed digital intervention. This was immensely useful. We’ve done six months of research in one day.” Dr Peter Murchie, Clinical Consultant at the University of Aberdeen, who came up with the idea for the melanoma project
“We created a basic prototype of the skin examination application and simulated the experience of using it in the home. This allowed us to quickly test the concept with potential users and with the staff who would deliver the new service, generating a wealth of insights and practical ideas to shape the design from the perspective of the users.” Gemma Teal, Design Researcher at the Glasgow School of Art
“The Experience Labs ensure that the patient’s point of view is listened to.” Sheila Bruce, Volunteer
“In Scotland, approximately 10–12 per cent of all babies are admitted to a special care baby unit because they are either premature or just too poorly to remain with their mothers. We hope that My Little One will help to overcome the sense of isolation by allowing mothers to see their baby at a time when they are unable to be close” Dr Sean Ainsworth, Consultant Paediatrician & Neonatologist