Tag Archives: “good idea”

Abolish National Insurance and replace it with a health co-payment, pensions and retirement insurance

So things are heating up in the English NHS. Reforms are rushed, reckless, at a time of crisis, many are warning. Is that strictly true? Reform to those who have to implement it can always seem rushed, especially when driven by a reforming coalition government and a mounting debt burden. The past, oh, say 20 years, have not been easy for the NHS, but what is becoming evident is that a reforming mindset has not set in.

What do I mean by a reforming mindset? I mean a willingness for clinicians, managers and all the other staff to engage with the challenge of improving the quality of the healthcare patients receive — indeed, of justifying the public expenditure by providing a service that patients and the taxpayers more generally will value and use with confidence. With an obviously too broad a brush, this means that opportunities to innovate are missed, opportunities to try something new are avoided. It means that the ‘top’ has failed to manage, preferring perhaps to be stewards of their NHS organisations, adopting an inclusive approach that avoids confrontation, never upsets a particular stakeholder group too much, and in general avoids making waves. Apart from the day-to-day challenges of clinicians, we see, despite the McKinsey report on managerial excellence, weak strategic execution. Now the chips are down, decisions need to be made that will upset people — see my earlier post on shroud-waving. Each profession seems to be taking turns highlighting how their specific interests will be threatened.

Rather than coming forward with innovative and creative solutions, minds are retreating into denial and avoidance of the challenges ahead.

As any regular reader of this blog will know, I quite like disruptive innovations. Healthcare hasn’t had much of it really, just a sustained litany of top down reform pressure, but the real reforms, which need to come from those who are in daily contact with patients cannot be best served by organisations parachuted in to ‘encourage innovation’. This has to be embedded in people’s daily approach to work. Having run an internal consultancy in a very big academic health science centre, I appreciate the fundamental importance of using internal capabilities and building internal capacity.

But what might act as an incentive? We now know that being publicly owned and funded does not guarantee that organisations will be kind and caring toward patients. There are just too many instances where NHS or social care organisations have been able to abuse the public’s trust behind a veil of public ownership. The challenge facing Monitor and the Care Quality Commission isn’t just to regulate, but to disinfect.

My thoughts, though, turn to patients as a force for change. I have always felt that patient involvement is the most disruptive force in healthcare, and we have had years of this or that programme to engage patients in their healthcare to uneven effect. The one thing, though, that might actually make a difference would be to introduce a substantial co-payment which patients would pay, as part of the funding of the system. Now, the health economists will jump up here and call such a proposal a ‘policy zombie’, a term for an idea that should stay dead. However, co-payments are used in such advanced health systems as France and Spain.  Indeed, I think the best thing the NHS could learn from these other systems is the use of co-payments to align patients’ and clinicians’ interests. The old adage ‘fog in Channel, Europe cut off’, can also mean that good ideas ‘out there’ never get ‘in here’. If you don’t look, you don’t see, and won’t find.

Paying for this is offers an interesting option. A huge amount of money is raised every year through National Insurance ‘tax’, which is a broadly hypothecated (but regressive) tax for health, social care, unemployment, that sort of thing; its original purpose as a form of ‘insurance’ has now been lost. In 2007-8 it raised some £98 billion.  My proposal is this. Abolish NI and return the money to individual taxpayers and employers. In turn, individuals will use this money for a variety of purposes such as the healthcare co-payment, investing in pensions, funding ‘retirement’ social care insurance, and probably a lot of other things I can’t think of, and which are currently paid for out of public coffers — isn’t one issue facing the coalition government how to shrink the public side of the balance sheet and shift funds into spending from individuals based on choice?

The NHS funding side looks like this. Over the next few years, the NHS has to find around £20 bn of its current £110 bn or so annual cost as savings.  The NHS continues to make these savings. In time, annual NHS spend (ceteris paribus) of around £90 bn would now be composed of £70 bn in central state funding and £20 bn in income from patient co-payments. The effect of this is liberating more generally, but achieves an important social benefit as it broadly aligns the interests of all parties, and engages patients in the actual cost of their healthcare — a tax-funded system with no co-payment insulates patients from the financial consequences of their healthcare decisions. Of course, I know that some design features are needed to take account of people with no income, fraud, and so on, but nothing that is a deal-breaker as other countries have managed this so presumably it can be done.

Removing probably the bulk of NI income from the public revenues has enormous consequences, and it does require comparable reinvestment in those services currently funded by the NI system, but by individual taxpayers instead. Most of the discussion on the abolition of NI has focused on the government continuing to be responsible for the items NI pays for (e.g. the apparent position of the Institute of Directors in the UK). My proposal shifts this burden entirely to an insurance model and has the effect of shrinking the state by building up individuals — goodness, a big society.

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An Auditor of One

A surgical team from Wilford Hall Medical Cent...

An Auditor of One checking on surgical performance

The UK’s coalition government’s reform agenda continues to unfold with the planned scrapping of the Audit Commission. While the Commission has good analytical capacity and did focus on issues of importance, the need to shift the audit function further into systems and out into the community was not one of its core objectives.

In healthcare, I have written and spoken of the patient as the “auditor of one”, as the patient is the only person who has a real experience of the continuum of care, and it is only through the patient that the integration or not of services is achieved. While bureaucratic processes may try to knit systems together at their edges, only users have that ‘joined up experience’, and it is by engaging with them more effectively that radical service improvement will come about (the use is really the most disruptive force for quality improvement we have).

The next test for audit in the UK will be ensuring that all these auditors of one can be effective; rather unfortunately, the government is referring to them as “armchair auditors” a term which tends to describe distant interest, rather than engaged in the critical appraisal of performance. But organised interest groups can emerge, or existing one expand their scope of interest to increase the salience of issues in the delivery of publicly funded services.

I think one auditor is really enough anyway, but the National Audit Office will need to expand its remit in at least two areas if it is to be really worthy of public expectations, to include:

  1. value-for-money retrospective audits (and not just of assessing implementation against legislative intent);
  2. prospective audits of planned legislation (similar to the US non-partisan Congressional Budget Office).

I might add a third, namely being advised by, and engaging with, the public, perhaps through regional citizen audit advisory groups who can act to bring local concerns together where national concerns, at least, are an issue. There are models for this sort of relationship which would enhance accountability, transparency and visibility with the public.

De-layering the National Health Service in England

Bureaucracy - Magritte

Bureaucracy by Magritte

The well-known organisational practice of delaying has emerged as one way to achieve public sector austerity. This is to be aplauded, not regretted as it is applied to the English NHS. In fact, those looking to the total costs of running health systems should be taking serious note of what this is all about.

Public sector work has tended to favour layers of bureaucracy, to respond to the tendency of civil servants to do what is called rent-seeking, which in the end means building empires, or expand a sphere of influence. In the regulatory context, it is called regulatory creep, as mandates are progressively, but subtly expanded by rent-seeking regulators.

The end result is large spans of control for civil servants, but little actual progress in achieving public sector objectives and goals. This stifles creativity and further rigidifies individual behaviour into highly structured ways of working — further compounding the potential waste of public money.

In addition, the tendency of bureaucracies to create bureaucracies means that individual jobs are often highly compartmentalised from other jobs, as individuals carry specific dossiers or briefs. The compartmentalisation of government into ministerial portfolios adds additional barriers to sharing work, ideas, or insights across government, further compounding the opportunities to deliver better value for money.

The White Paper on the NHS plus the overall behaviour of the UK’s coalition government reflect a consistent and simple message about the way the public sector should be organised to undertake its tasks. De-layering means removing non-value-adding levels of organisational bureaucracy, layers with the sole purpose of either move information up (or down), or checking or verifying the work of others.

The NHS itself has been too long likened to a supertanker, but a school of fish is what we want — nimble organisations that can respond quickly to change. Instead, some commentators have questioned the proposed reforms, asking what will happen when you need to pull some strings centrally to get things done? What these commentators don’t realise is that healthcare is a complex adaptive system, which means that there aren’t really strings to pull.  Decades of belief in this assumption has produced ill-thought out control mechanisms, and inappropriate and pointless layers of supervisory control (such as Strategic Health Authorities), which really can be only weakly effective at best and destructive of initiative at worst. It is not unusual for SHA staff insert themselves into processes to assert  a measure of control reflecting their priorities, ignoring the real needs of people dealing with a front-line challenge.  Indeed, the rent-seeking behaviour of these quasi-civil servants challenges the validity, the very authority, of those who own the front-line problems in healthcare to actually solve these problems. Before all this, we had the failed Modernisation Agency, the failed NHS Training this, or NHS University that.

The insights in the White Paper have put paid to the assumption that overarching control mechanisms can work, putting the onsus on problem owners to solve these problems. There are proposals in the While Paper which accept the need for flexible and dynamic responsiveness to the local and real-world interface between the patient and their care provider. Many in the NHS will fail to understand this, and as in any organisational change process  there are some people who ‘don’t get it’.  By and large, failure to alter personal behaviours is a recognised barrier to implementing reforms, and many such people will need to be shown the door and encouraged to pursue other careers. The NHS often forgets to bury its dead and it frequently eats its young, meaning that failed bureaucrats get recycled and good ideas destroyed by a controlling culture.

I have immense confidence in the ability of the right people to solve the problems, (indeed of the ability of GPs to ‘get it’). There are also real challenges for the chief executives of the foundation trusts and other NHS providers to demonstrate the necessary leadership and management skills to drive out the costs and inefficiencies that are shot through the system; CEOs will be particularly challenged as they must now actually manage, and not simply administer a publicly funded entity and avoid rocking the boat.

There are too many quangos and other organisations around staffed with individuals from failed agencies so one must be vigilant to ensure that the delayering process does not just turn into a recycling exercise.

Want to know  more?

Charles Perrow’s important work, Complex Organisations, highlighted the hierarchical structure of professional organisations and asks important questions about how and why we construct overly complex organisations, and why they can become dysfunctional.

Bonfire of the health system vanities: poly-mess

Firefighters trying to save an abandoned conve...

Lawmakers burning discredited health policies

‘Significantly, the core principles (and expected savings) of polysystems have proven difficult to achieve with more focus on the buildings rather than the changes to care and behaviours.’

So says a recently hitherto secret report that NHS London (UK) has been sitting on. What a surprise though. Healthcare change is difficult and the focus on so-called polysystems missed the point. In origin, they are really polyclinics, and well-designed would cut admission rates to secondary care; they would also bulk up on specialist services, including day-care work and short-stay facilities.

A bureaucratic orientation driven by doctrinaire thinking and misaligned incentives are clearly to blame, plus, of course, a fear, within the NHS of actual service reconfiguration and change that alters the structure and nature of clinical work.

Whether the new UK government coalition should actually stop the polysystems (a euphemism too far, I fear) is another question, as the underlying logic, used successfully in other countries is sound.  What really failed was management, and the vaunted commissioning system, which failed to demand, perhaps even conceptualise, service changes. No doubt, resistance from the clinical professions may have no small part in failure, but clinicians are been substantially disenfranchised from NHS reform, with the top-down, initiative driven thinking.

Less is more. Few but more substantial changes, may ultimately lead to the service and quality improvements.

Polyclinics are a missed opportunity, and having been badly conceived are now a tainted option. The political pull back to the status quo becomes a real a risk, when in fact greater effort than ever is needed to improve service delivery and productivity.

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Dx + Tx = Ix

Magnetoencephalography

Integrated treatment is an important step in service innovation, and it is no less important to see how the convergence of diagnostic technologies and methods with treatment methods will lead to integrated, one-stop encounters.  This is more than an integrated provider, but the development of theranostics (therapy/diagnostics), which combine what in the past have been discreet clinical steps into a single diagnostic and treatment encounter.

We are still developing methods here, but in the image guided surgery is an example. The ability to bring together disparate knowledge, currently spread across different brains (i.e. experts) into a single brain will create new clinical professions, shift knowledge from higher levels of expertise to others who delivery services augmented with machine intelligence embedded in the devices. These sorts of development disintermediate clinical workflow, to use disruptive terminology, but reintegrate the clinical workflow in new ways, this time around the patient, rather than the clinician.

Importantly, the diagnostic bottleneck which health systems find causes waiting and delay is likely to be largely eliminated for a wide range of procedures, as at the point of diagnosis, treatment would also be provided. With improved detection methods, too, this treatment will start sooner — we are still learning of the clinical benefits of bio-conjugated quantum dots, and biosilicon, and other new materials, but they are likely to underpin a new health service delivery paradigm.

The equation in the title simplistically represents the shift toward integrated therapeutics, which in the end may be the biggest next step in medicine since discovering germs as will germs came specialisation and the burgeoning of clinicians and expertise, coupled with the universities in creating specialist bodies of knowledge. Ix, integrated care, builds on integrated knowledge (IKnow?) which is something we are slowly appreciating as the problems we face effectively challenge the narrow disciplinary models we see at university and in clinical practice.

The question though is whether policy and decision makers will be bold enough to face up to these opportunities or will vested legacy interests prevail?

Best technology first

Proton Therapy

An announcement in the past year that the UK’s NHS would be expanding the availability of proton therapy — a 40 year old technology — does make one wonder. Of course, proton therapy is pricey for the underlying technology, but its precision and better beam control adds benefits when one moves beyond a simple cost model (proton therapy suites run around $125 million or so) to whole system thinking.

Isolating the costs of particular pieces of equipment leads to a tiering of diagnostic procedures, use of protocols around narrow areas of diagnostic accuracy, and ensure that patients will experience simpler technologies first before progressively better diagnostic accuracy is needed; in effect the patient is forced to endure uncertainly as the clinical decision system moves to the more certain, but less available technologies.  MRI technologies provide more certain diagnosis, and a quicker diagnosis can lead to starting treatment sooner, or importantly, ruling out further treatment.

My view is that by using the best technology first, the whole systems costs of diagnosis, treatment, patient time, clinical on-costs, and waiting, anxiety, etc. can be bundled more tightly together. This eliminates wasting clinical time through duplication of procedures, but using different technologies each time. The advantage of more advanced technologies like the MRI is also reduced exposure to radiation (which is more likely with combinations of x-ray and CT as steps along the clinical diagnostic pathway.

Universities: are they as smart as we all hope they are?

Edsel

News item in the UK: The sector’s funding body, the Higher Education Funding Council for England (HEFCE), announced (on 1 February 2010) that budgets are to be cut by £449 million for 2010/11.  This includes:

* A 1.6 per cent reduction (£215 million) in teaching funding;

* Research budgets will remain the same as last year;

* A 16.9 per cent cut in capital funding;

* A 7 per cent reduction for funding of special programmes and initiatives.

In a letter to vice-chancellors setting out the budgets, HEFCE said it recognised that the reductions will be “challenging” to institutions.

Now what is to be done? Predictably, the higher education sector in the UK is arguing that this will affect perhaps 200,000 students who won’t be able to get a university education. A few weeks ago, the sector argued that the UK’s place as a top tier home of higher learning was at risk — but that came from the elite Russell Group, which represents perhaps the top of the top universities in the UK.

There are a number of possible ways of thinking about this. A few:

  1. Universities already get a lot of money, and they perhaps could reduce their running costs — think of the disorganised structure of the academic year, think of teaching loads or confused performance management (is it teaching quality, research or publications??), and pretty good employment contracts. (I had one once.)
  2. There are too many universities trying to do too much, and perhaps it would not be a bad thing if some either closed or merged with another institution. The loss of the old polytechnics deprived the higher education system of a sensible alternative. Since comparisons to the US are frequently made, it is worth noting that some of the US’s top institutions are not called “university”, anyway, but ‘institute’ and indeed ‘polytechnic’. One could also look for new innovative institutions to emerge to challenge much that universities do. For instance, research institutions without university links, or which are focused on compelling issues — check out the Santa Fe Institute, for instance. Universities are not the only fruit!
  3. Cutting capital funding is not such a bad thing, given the horrendous financing of a state-sponsored capital funding body. Better universities learn how to build collaborative relationships with sources of capital, than expect their funding automatically to come from the state.
  4. Perhaps too much inadequate research is done, poor deployment of intellectual effort at reaching wider learning communities, responding to new ways of structuring learning beyond the rather tired full or part time dichotomy, and so on.

But of course, the key dilemma remains, what is to be done?

I take an optimistic view, but I would put the challenge at the door-step of the universities.

Rather than complain, prove that 800 years of public and private investment hasn’t been wasted, and come up with sensible solutions that would establish a sustainable approach going forward.  I doubt 200,000 or 200 students would be disenfranchised as a result, new ideas would emerge.

A recent book review in the Financial Times of Louis Menand’s The Marketplace of Ideas, would be a good place to begin some fresh thinking. The reviewer, Christopher Caldwell, notes:

Starting in the 1970s, professors, newly alert to injustices in society at large, took aim at credentialism and departmentalisation in every nook and cranny of American life – except, Mr Menand notes pointedly, their own. The professorial hierarchy continued to rest on a system of arduous PhDs (raising high barriers to entry), “disciplinarity” (denying the authority of the non-credentialed to teach or even discuss academic subject matter), and tenure (jobs for life). It was a system well-suited to monopolising bureaucratic power, but less well-suited to the free flow of ideas. Menand cites a 2007 study to show that, in the 2004 presidential elections, 95 per cent of the social science and humanities professors at elite US universities voted for John Kerry and 0 per cent (statistically speaking) for George W. Bush. Monopolies produce smugness and sameness in universities, just as they do anywhere else.

The title of this blog entry takes from a line in the film Independence Day, where the President says to the Geoff Goldblum character, ” And we’ll see if you’re as smart as we all hope you are” It is now time for the universities with their massive subsidised top-tier braintrust put on their thinking caps, stop playing victim and take responsibility for the solution.  The university-based economists let us down quite badly with failing models of our economies, and we are all paying for it in one way or other. Let’s not see two in a row.

Obama and Health Reform in the USA

A statue of Asclepius. The Glypotek, Copenhagen.
In whose name do we reform healthcare?

President Obama’s comments today to the American Medical Association in Chicago represent the slow, but certain, turning off the health reform supertanker that is the US healthcare system.  Despite evidence of the need for improved clinical working practices, use of guidelines, better use of evidence, powerful groups have resisted over the years opportunities for root and branch change.  Speaking to the AMA, Obama identified a few key barriers he sees as crucial to change:

  • eliminate the notion of pre-existing conditions
  • find alternatives to fee-for-service reimbursement
  • share best practice better.

Of course, there are many other moving parts within each of these, and others he mentioned (e.g. generic medicines, clinical IT, etc.).  But these three offer opportunities for substantial realignment with the US.  In turn, and briefly, by eliminating the insurance barrier of pre-existing conditions means adopting population-based health risk.  That moves the US to social insurance models familiar to Europeans.  The problem will be overcoming the problem of free-riders, which be-devil some US policy commentary, but free-riders in automobile insurance claims are not quite the same thing as someone who is poor and in ill-health getting access to healthcare.  Alternatives to fee-for-service opens the door to outcomes-based payment systems, enables better bundling of care across clinical pathways and more closely aligning payment to what actually happens to patients.  By integrating care, financial incentives move closer to actual clinical and hospital work patterns; similarly, with innovative thinking about how to structure reimbursement based on outcomes, payers can more effectively encourage reform with hospitals, to move them away from fragmented care.  Sharing better practice should seem the natural thing to do, given that everyone in the end does benefit when good practices are shared.  But sharing better practice can undermine competitive advantage in market-driven health economies; by shifting to alternative payment systems, sharing practice will make more sense, especially if payers act together.  However, ever mindful of potential for collusion, payment systems and information sharing must enable consumer and payer choice, rather than close down options, in an anti-competitive spirit.

This president is compelling in his expression of the anxiety so many Americans feel about what is wrong with their healthcare system, and he is to be commended for taking this challenge into the heart of the medical community.  In that respect, I am optimistic that some sort of change will come in the US.  More importantly for other countries’ healthcare systems, we see a lesson in a way to conduct health reform.  His big-tent approach is a lesson for other countries that feel health policy and reform comes from aligning the interests of narrow interests, of specialist commentators, academics and civil servants.

One lesson to take away is that health reform is something that must be conducted within the society, with all the key participants engaged.  It is not just the culmination of a rational research study, using contracted experts, who more often than not breathe each others’ air.  No longer, I think, can international observers be critical of US reform intentions.  Indeed, for some countries who think they have a pretty good and publicly funded system, US reform may show them to be small, mean-spirited systems, narrow in focus and costly overall.

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E-health and Ontario

The wordmark of the Government of Ontario, fea...
Waiting for the e-health revolution

From across the Atlantic comes news of apparent financial maladministration at E-Health Ontario, the body charged with implementing the province’s e-health strategy.  It seems to be the usual nonsense of untendered contracts, friends in high places, and chums helping chums.  It is also an example where no one seems to have asked the simple question, “why would you do that?”  — the strategy is a nonsense, and I am surprised that no-one challenged this before the policy had gone this far in implementation.

I would, naturally be more inclined to be concerned if the province’s e-health strategy were actually about e-health, or likely to deliver results worth having, but the $700 million or so per year will be spent on things like a diabetes registry, wait times, electronic prescribing/electronic health records.  Only the last have anything really to do with e-health.  The last can also be procured, so there really isn’t a need to make a supplier meal out of putting something in place.  I will concede though that an EHR is a critical component of e-health, but it isn’t quite the same as e-health — it is a bit like confusing the foundation of a house with the home it will become.  But having worked on eRx,  the province’s failure to prioritise some sort of a patient-held smart card is a mistake as without this it is difficult to deal effectively with identity.

Without system redesign in the province, the e-health strategy is really just throwing good money away and given the current economic (and political) climate, this is no longer an option, if it ever really was.

Two things are of critical importance.  First the province needs to have a thorough-going governance review of e-health Ontario, mainly to determine how to make sure it is fit for purpose in actually providing the leadership for development of an e-health infrastructure service delivery platform.  Secondly, and this is the challenge, it is necessary to make sure that the e-health services are ones that the public will use and value.  The province has failed on both counts.  The next challenge though will be to find people to review e-health Ontario who haven’t been tainted by this scandal and benefited from the feeding frenzy e-health Ontario created. It may require looking further afield, to interested, but uncontaminated parties.  They may even not live in Ontario — golly gosh, so much for made-in-Ontario mediocrity.

So, having vented on that last point,what would an outline e-health strategy look like for Ontario, assuming that some governance arrangements are put in place,.  These are really just illustrations as certainly I would want to get a good understanding of priorities from interested patient groups:

  • There are about 90 rural and small hospitals in the province.  A good plank in an e-health strategy would be to enable them to become a single, integrated, but distributed healthcare provider, perhaps with some sort of local and shared corporate governance.  A distributed healthcare provider, using e-health infrastructure technology would deliver specific outcomes to rural people, such as access to networked diagnostic imaging technologies, electronic prescribing and remote access to health records.  I would certainly save people in Thunder Bay a lot of trouble getting down to Toronto for a scan.  With a little bit of imagination and thought, this could work.
  • About 60% of diagnostic facilities are located in Toronto, but which has only about 25% of the population; these are licensed clinics which often only offer a single procedure.  Using networked imaging technologies, remote diagnostic telecare booths (you can buy one from Cisco) many of these suboptimal centres could be relocated either to the rural network, in the previous plank, or provide a more accessible urban service across the provinces main urban centres.
  • Smart card technologies (whether a smart card or an electronic secure passport) would give a better reason for constructing electronic health records than ones focused on improving data access for health professionals alone.  Patients, when given access to their health information, will have a vested interest in ensuring that the information is correct (my Ontario health record when I lived there had an error showing I had a condition affecting women, but I am a man — I still don’t know if the error was corrected; in an electronic system, that error would have been a problem, but I would have made certain that it was corrected, too).  As an ‘auditor of one’ patients can make sure information is correct, and drive substantial service quality improvements.  This is not to say that health professionals can’t do that, just that the evidence shows it comes slowly and is complicated by cartel-like professional practice barriers.  Start by putting the e-health card in the hands of the heavier users of the health system, to better manage their healthcare, access to information, and gradually as people see their family doctor, or get born, migrate the whole population over.  Of course, this will mean that family doctors, clinics, pharmacies will have to adopt some sort of information system.
  • Don’t do what the English NHS is doing with Connecting for Health, by creating a large-scale government-led initiative.  E-health Ontario’s predecessor took a look at Denmark, but failed to learn the lessons despite what they wrote in their sham of a consultation document — they missed the point partly because they appeared to have another agenda heading toward a particular solution.  Denmark has shown how disparate stakeholder groups can work together to create an information system that works, and does things people value.   Better that than spend vast amounts of money on a grand plan to nowhere.

The general plan is to build an infrastructure that starts with the patient/family as user.  My experience in developing an interactive health television channel showed me the importance of starting there, and defining the benefits from that perspective.  Change will drive from that end too.  Finally, engage all the stakeholders (like the Danes did), find commercial partners with interesting technologies that do things that people value (rather than whizzy technologies), look for alternative systems to pay for healthcare services, as failure to develop a suitable and workable reimbursement system for e-health services is a barrier ( just ask Norway).  Oh yes, don’t forget political will.

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Gaming and predictive modelling: potential healthcare disruptor technologies

There is no consensus on how closely the brain...
Prediction, intelligence and cognition: convergence a real possibility

Gaming and simulations plus modelling are health markets that look very interesting and offer considerable opportunity for disruption of existing knowledge processes in healthcare:

Predictive modelling

  • to help people understand and manage their health better by using modelling to visualise health states using avatars and body-image
  • moving beyond the use of predictive modelling and data mining to find high- or at-risk individuals for case management purposes
  • link modelling to powerful mapping visualisation technologies to enable better decision-making and planning

Simulations and games

  • engaging health professionals and consumers in simulated environments using gaming methods
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