There are well recognised macro trends that show that the current healthcare delivery model will be difficult to sustain at current investment levels. These trends are covered in depth elsewhere but are briefly summarised below:
An ageing population
Like many developed countries, the population in Scotland is living longer with the old age dependency (OADR) ratio being predicted to move from 30% to 48% in the next twenty years. More people living with long term conditions will produce extra demand on both primary and secondary healthcare. As a result, the current delivery model (and associated quality standards) for health and social care services will not be sustainable on current investment levels.
Prevention, prevention, prevention
The top four killers of people under the age of 65 in Scotland are lifestyle driven diseases and more people are living longer with long-term health conditions. For example, Type 2 diabetes, a preventable condition, is predicted to double in next ten years and the treatment of diabetes already absorbs 10% of NHS Scotland budget (£1bn pa).
The Christie Commission report clearly states the need to invest in preventative measures across the public sector to reduce demand:
"..achieving a radical shift towards preventative public spending is likely to be controversial, but we consider it to be essential. High levels of public resources are devoted annually to alleviating social problems and tackling ‘failure demand’ – demand which could have been avoided by earlier preventative measures. But it is a reactive spending – targeting the consequences, not the causes. Until now we have funded that ‘failure demand’ with annually increasing budgets. That is no longer an option. So tackling these fundamental inequalities has to be a key objective of public service reform."
Digital and dermatology
As well as the macro trends associated with people living longer and with more long term conditions there are several factors that have resulted in increasing pressure on dermatology services in particular. With summer and the promise of sunnier climes, many Scots jetting off to the sun or heading on staycations and catching the few rays of sun our own sky has to offer. Add to this the fact that people are now more aware of what legions are and waiting-time targets for suspected cancerous cases, dermatology now has 283,000 outpatient appointments each year with 41% of these bring first-time appointments.
As the demand for services continues to grow, limits to the available supply put pressure on health services, and costs inevitably rise. To relieve this pressure, the NHS is looking beyond traditional service models and the role digital technology can play. Digital dermatology services could play a crucial role in delivering efficiencies within the NHS.
Digital health is a growing convergence of digital technologies with healthcare to enhance the patient experience, involve patients more actively in taking ownership of their well-being and providing multi faceted solutions for health practitioners to rely on as demands rise beyond manageable expectations. Covering mobile health, health information technology, wearable devices, telemedicine and personalised medicine, digital health looks to reduce inefficiencies, improve access to healthcare, reduce costs and make healthcare more personalised for patients. The NHS is now actively exploring the possibilities and benefits digital health can provide UK service users.
The monitoring of health and well-being through connected hardware and mobile devices is now widely accepted as an effective method for improving health outcomes across many health conditions. It also offers potential to improve the patient experience and reduce demand for face to face consultations in primary and secondary care.
For dermatology, then, there are many potential digital solutions that could be explored to help meet the demand on clinicians for consultation time and help to reduce the pressure on the services at hand. To find out, NHS Scotland teamed up with Scottish Enterprise, Innovate UK and the Scottish Government to fund a competition that would allow leading organisations in the UK to explore the innovations in digital health.
This gave Storm ID a great opportunity to develop a service that leverages our own digital health platform, Lenus Health, which enables patients to securely share data with health professionals that they have collected via wearables, connected hardware and mobile devices.
The platform has been designed to support the development of a broad ecosystem of digital health services that target different types of condition from hypertension and COPD self-management to prescribed physical activity.
Digital dermatology service
To support the outcomes of this dermatology competition, we are developing a dermatology digital service that offers an asynchronous virtual consultation service on top of the Lenus platform. Combining a mobile app that is used by patients to share high-resolution images of their skin condition and a separate web application for Dermatologist consultants to review, triage and assign a workflow to each patient case submitted.
The ambition of the service extends to integrating machine driven diagnosis to support improved triaging of cases.
How digital technologies can improve healthcare is a question we are deeply invested in exploring here at Storm ID, and our Director, Paul, is really excited about this project:
"We are pleased to be involved in the Dermatology SBRI programme. The project has great buy-in from senior NHS clinicians and it fits well with our focus on developing new, digitally enabled services for healthcare. It also represents a great opportunity to leverage our growing machine learning capability into the design of a new service."