eHälsa är mer än sjukvård

Dagens sjukvårdssystem är episodiskt och reaktivt och patienten har en passiv roll.
Vi behöver istället ett system som verkar preventivt och proaktivt tillsammans med aktiva medborgare och patienter!
eHälsotjänster som är smidiga och resurssparande för både patienter och vårdgivare är nyckel-verktyg för att möjliggöra detta systemskifte.

Bakgrund

De långtidssjuka och kroniskt sjuka står för över 80% av den totala vårdbudgeten i de flesta länder.
Deras ohälsa består till största delen av:
  1. Medicinska faktorer (fysiska besvär och mätbara symtom)
  2. Psykologiska faktorer (depressioner, stress, utanförskap etc)
  3. Personliga faktorer (socioekonomi, levnadsvanor etc)
Dagens sjukvård bör alltså breddas, idag fokuserar sjukvården mestadels på att isolerat behandla de medicinska faktorerna, trots att dessa påverkas i hög grad av de övriga faktorerna. Men detta är ändå bara en nivå inom hälsa, det finns minst fyra nivåer som alla kan möjliggöras eller förstärkas av eHälsotjänster:

1. Prevention

Uppmuntra och stöd friska medborgare som vill undvika sjukdom på kort och lång sikt att aktivt kunna följa sina hälsovärden med hjälp av friskvårdsappar, aktivitetsmätare och hälsokontroller samt verktyg för sundare levnadsvanor och egenmonitorering av ärftliga riskfaktorer.

2. Online-tester för snabbare diagnoser

Pedagogiska självtester på nätet där man svarar på frågor om sina besvär och får ett beslutsunderlag med anpassade egenvårdsråd eller uppmaning att söka läkare.

3. Diagnos & behandling

Här verkar dagens sjukvård: man går till doktorn när man märker ett medicinskt besvär, får en diagnos och behandling.

4. Kontinuerlig monitorering

Kroniskt sjuka patienter använder appar och enkla mätinstrument för att optimera sin behandling och veta att de gör allt som de kan för att lindra sjukdomens symtom och progression. Inom en snar framtid kommer vården att samla in dessa data för automatisk analys med hjälp av AI-system som skapar trygghet utan att belasta vårdpersonalen och och larmar om risk uppstår för kommande skov.

Patient empowerment 

Paul Corrigan, en välkänd vårdstrateg som hjälper brittiska sjukvården NHS med förändringsarbete hade ett tydligt budskap kring patientens roll i sitt tal i Almedalen 2016:
Efterfrågan på sjukvård har exploderat på grund av de stora framstegen inom att bota och bromsa allvarliga sjukdomar. 
Så sjukvården ropar efter flera läkare och sköterskor, men det är omöjligt.
Så om vi inte börjar se patienter som medverkande tillgångar så kommer dagens sjukvårdsmodell att kollapsa.
Idag arbetar läkare för och patienterna, inte med patienterna.

Vi behöver en dramatisk “Patient empowerment”!

Hans grundrecept för att gör patienterna motiverade att ta en aktiv roll är till synes enkelt:
Doctors should ask: “What matters to you?” instead of “What’s the matter with you?
Det vill säga; läkaren bör ha en mera coachande roll och se till helheten i patientens upplevda hälsa samt stödja patientens aktiva roll i vårdprocessen.
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Läkartidningen skrev redan 1999 om Patient Empowerment
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European Patients Forum har en definition:
“Patient empowerment is a process that helps people gain control over their own lives and increases their capacity to act on issues that they themselves define as important.”

Patientens egen tid kontra vårdens tid för patienten

När patienterna får anpassade digitala verktyg som hjälper dem att vara aktiva medverkande i sina vårdprocesser så utnyttjas även en obalans i tillgång på tid som idag är outnyttjad.
Patienterna är mycket motiverade och har tid att arbeta med att förbättra sin hälsa kontinuerligt, medan vårdgivaren har mycket lite tid för varje enskild patient och denna tid används idag till stor del för sådant som patienterna skulle kunna göra själva på ett bättre sätt på internet, exempelvis inför ett vårdmöte.
Denna obalans skapar frustration, då patienten känner sig maktlös istället för i kontroll, vilket i sig kan förvärra den upplevda hälsan.

Nya globala aktörer inom eHälsa

Google har startat bolaget Verily som har stora resurser och en mission att utveckla nya avancerade hårdvaror och mjukvaror som ger ett helhetsgrepp inom personlig hälsa.
De har en djärv och för många provocerande vision:

På vilket sätt kommer nya globala aktörer som Google att påverka vår svenska sjukvård när de börjar sälja sina tjänster online direkt till medborgarna?
Vad känner du inför allt detta?
Återkoppling, tips och kommentarer välkomnas!
– Henrik Ahlén, eHälsa – Strateg & Produktionsledare
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PS Läs gärna denna grundliga analys av dagens vård och nya digitala möjligheter för kronikervård i tidskriften Nature Biotechnology:
Digital medicine’s march on chronic disease:
“The US healthcare system is ill-equipped to handle our epidemic of chronic disease. This is because most chronic disorders develop outside healthcare settings, and patients with these conditions require continuous intervention to make the behavioral and lifestyle changes needed to effectively manage disease.
A 15-minute visit with a physician every few months, general recommendations to lose weight and exercise, and a lifetime of post-diagnosis pharmacologic treatment are not enough to solve our epidemic of chronic disease.”

Do you want online support before-during-after your doctor’s visit?

A vision about supporting
the entire healthcare visit process
for both patients and doctors

Swedish version

Before your visit

Imagine that you have a health problem that you want to book an appointment for at a medical clinic.
You pull out your smartphone and go online to book an appointment. Then a question pops up: “We recommend you to fill in this questionnaire before your appointment so that the doctor has a better view of you needs.”
So of course you accept this and spend a couple of minutes filling in an interactive health survey that helps you understand the probable cause of your health problem. The survey then gives you useful information and advice on what you can do yourself and advice about seeking the right type of healthcare, based on your condition.
If your survey answers indicate that you are at risk of developing some form of chronic disease, you are also asked to go through an interactive screening survey for that.
Based on your identified health problem, the system also suggests that you should take some blood tests so that the doctor can see the results during your appointment. The system automatically generates a lab remittance, so that you can go anytime to a test center and take your tests. A few hours later you get a text message: “Your lab tests are now ready, log in here to see the results”.
In your lab results, you can see how your values have changed over time, read about what they indicate and what you can do to optimize the values.
A summary of your health surveys and lab tests are automatically available to your doctor during your visit.

During your visit

When you meet your doctor, the two of you sit down with an iPad that is showing your summary.
As you go through the results together, the doctor can directly on the iPad verify your disease history and earlier medications. The doctor can also show short videos explaining possible types of treatments. When needed, the decision support system in the iPad also recommends examinations, medication and remittance to a specialist. All this is easily done during the course of a regular doctor’s visit.

After your visit

At the end of your visit you get a printed summary, in the language of your choice. It is also sent to you as a link in a text message or email, so that you easily can share the summary with your family if you want to.
  • What is the plan that we agreed on? (goals we set, what medications should I take, when and how?)
  • What shall I, as a patient, do? (advice on diet and exercise, time for the return visit)
  • Information about my treatment (links to information pages, videos)
  • Who shall I contact if I have questions, and how?

Why is this not widely used today?

Many of us appreciate mobile apps and digital services that support various processes in other service sectors, such as banking, travel and online shopping.
There are no insurmountable, technical obstacles to implementing a comprehensive digital service like this for most types of pre-booked healthcare visits today. There also should not be any economical barriers, as the investment needed to build and manage these types of digital services is extremely small compared to the enormous cost savings and health benefits they enable for the whole healthcare process.
Some parts of the described services already exist in some places, but they are not spread nationally and most often they are only used in small, local pilot projects.
There is a need to change the roles so that the patients get the tools necessary to become more engaged in the healthcare process already from the start, and the doctors act more like coaches and knowledge brokers. This role transition is necessary for the healthcare system, and it is beneficial to everybody.
See also my post What is eHealth?
– Henrik Ahlen,
eHealth Advisor & Production Manager

Two eHealth Driving Forces

Health care systems around the world are now starting to see several disruptive transformations. One of the most important factors behind this is the rapid development in the emerging eHealth services.

But many citizens, doctors and patients are still asking “But what is eHealth good for, really?”. The reason for this is that is so hard for us to imagine new ways of doing things, new types of services that enable new types of interactions between patients and health care.

The future of health care is already here, but it is very unevenly spread in different countries, regions, hospitals, clinics and various patient groups. But it is obvious that eHealth has many possibilities for both patients and healthcare professionals, mainly driven by two disrupting forces; the smartphone and the possibility of continuous health monitoring.

The Smartphone

Patient empowerment is about enabling patients to engage themselves in their own health care.
The main tool for this is the ubiquitous smartphone, our central and very personal communication device.

It’s about self-care through self-tracking. 
Our smartphones are always with us and contain advanced sensors for fitness and health that can track fitness data such as physical activity and other lifestyle factors as well as medical data like heart rate, gait and much more.

There are also hundreds of thousands of health-related apps to choose from and a quickly growing array of certified medical body sensors that connect wirelessly to the body and upload personal health data for automatic or manual analysis.

Topol

This is a highly recommended book by Dr Eric Topol, notice his spot-on subtitle “The Future of Medicine is in your hands”.

Dr Topol says: “Smartphones will be immeasurably transformative for the future of medicine.”

 

 

A large International survey of adult smartphone users in 14 countries clearly shows that the citizens are already way ahead of our current health care systems:
“80% of consumers want to interact with their doctors on mobile devices. 2/3 would prefer to get medical advice on their mobile devices instead of going to the doctor’s office.”

Continuous Health Monitoring

“When you go see your doctor, they will give you a bunch
of drugs based on how they saw at one single office visit.
Its almost criminal.”
– Eric Dishman, Director Health Innovation, Intel
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A major problem with our current healthcare system is that it is based on spot-checks by doctors only when we experience acute health problems, or during yearly routine check-ups.
At all other times, the doctor is unaware of patient’s health and the patient has no access to personal health data for self-care.
The smartphone and connected medical sensors and devices enable us to track health data continuously.
This has never been possible before and it will have tremendous health benefits:
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Benefits for everybody

  • Daily health and fitness tracking.
  • Personal learning tool for insights about my wellbeing and what lifestyle choices that work best for me.

Benefits for patients with chronic diseases

  • Personal learning tool for insights about my disease activity and medication effects related to my lifestyle.
  • Prevention of exacerbations by alerting me when critical medical data trends point towards upcoming complications.

With continuous health monitoring, the health care professionals can have a much more coaching role and be instantly available online when personal contact is needed. It also thereby saves a lot of staff resources and enables many patients to stay in their own homes.

So let’s embrace these possibilities! There are several issues and risks involved that need to be considered and changing work methods is always met with resistance. But the current system is not sustainable and if we involve all the stakeholders in this transformation, the results will be worth it!
  
– Henrik Ahlen, 
eHealth Advisor & Production Manager
See also my post: What is eHealth?