An interview with Nick Chinn of WeCommunities
What does the Patient Centricity concept mean to those on the front line – the nurses and doctors at the sharp end of public health services?
Theirs is a world of relentlessly growing workloads, shrinking budgets, long hours and stretched resources. Would empowering patients with access to – and control over – their own health data just make their lives more difficult and complicated? Or could it help them to work more efficiently, to provide better care and make better use of their time and resources?
Internet of Me spoke to Nick Chinn of WeCommunities, who believes that what data-driven innovation can do for patients and for healthcare professionals are sides of the same coin. Up for grabs is transformation of services that makes life on the front line better while also saving money, driving efficiency and improving outcomes. Empowering patients and engaging them in their own health through access to data is key to moving away from a system that exists to fix us rather than prevent us getting sick in the first place.
Making health IT better
Nick brought his experience from a career in IT to bear on the health sector after his wife Teresa, a community nurse, became frustrated by a sense of professional isolation that almost drove her to quit. Together they set up WeCommunities which manages a number of Twitter chats that offer places for healthcare professionals to talk and share experiences, ideas and best practice. Nick has also worked for a number of healthcare IT firms, including Premier IT which specialises in workforce planning and performance software.
A key problem holding back health services, he says, is their failure to adopt the consumer-focused technology we take for granted in almost every other walk of life.
“I find it very strange that I can get an Uber and can find out about the driver, what car they drive and what they look like,” he says. “I can see, to the minute, exactly when they are going to turn up. And yet, as a patient I don’t know when my district nurse is going to arrive. I’m trying to transform district nursing so that nurses aren’t overloaded with work and to ensure that work is matched to their skills.
“I realised, after trying to do this for four years, that there’s a clinical system that looks after the patient, then multiple systems that look after the staff. That works in a hospital environment, but when you’ve got nurses in the field with so much fluctuation and zero visibility of your workforce, it just doesn’t work.”
A credit score for health
From the patient’s perspective, data-driven technology delivers not only convenience and efficiency when it comes to interacting with health services but also opportunities to be more engaged with one’s own health and to live more healthily. Nick points to the use of credit scores as an example of how the sharing of data has enabled the financial sector to provide valuable services that are convenient, fast and efficient for both businesses and consumers.
Nick says: “You hear anecdotally that patients are exhausted from multiple tests and telling everyone what they’re allergic to, every single time they walk through a new door.”
In essence, such patients are sharing and re-sharing the same data over and over again, albeit verbally. Meanwhile, in just about every other aspect of our lives, data about us and our behaviour is shared between organisations in ways that deliver fast, efficient services with direct benefits.
“I find it quite bizarre that we’ve had credit ratings in their current format for about 20 years and yet, we don’t have a similar rating for health. With a credit score you get told what’s wrong with your rating and what you can do to have a positive impact on it.”
Something similar, he says, could allow providers to tailor services that are personalised to an individual’s lifestyle and particular healthcare needs. Such an approach would help patients manage long-term conditions themselves and, just as importantly, encourage the public at large to take more responsibility for their own health and adopt beneficial lifestyle changes.
“What we should be doing is helping people disengage with the health service, rather than monitoring and tracking them through lots of different long-term engagements.
“If you’ve got a long-term condition you might have a quarterly review but, actually, you could be doing something regularly for yourself – diabetes is the obvious condition for this sort of approach.”
This is not just an opportunity for innovation, he says, but a necessary shift for health services facing the soaring costs of a population getting older and larger – in both senses of the word. Personal experience made it clear to Nick how little the current system does to help people be more pro-active.
More on Patient Centricity: Interview with Jen Horonjeff of Savvy Cooperative
“Ten years ago, after losing my father at 65, I realised I was slightly overweight and should go for a cholesterol test. I was 35 and the doctor said he wouldn’t test me because I wasn’t in my mid-40s and I’d get a pre-50 MoT anyway and if there are any problems I would find out then.
“I had come in proactively to check my state of health and all that happened was that I was told to lose some weight, and then I never heard from again them – not a single follow-up letter. If we used data more effectively, someone could say to me ‘These are the top five things you need to fix in the next five years, Nick, this is the thing you need to fix in the next year, and here’s a program that will help you do that’.
“And then if we’re all a bit fitter we’re going to reduce the demand on the NHS by empowering ourselves. You’ve got Public Health England talking about prevention and promotion but they’re ridiculously underfunded. And all they can really do is campaigns when what we need is outcome-based commissioning.”
Nick practices what he preaches – he set about changing his lifestyle and is now taking part in the NHS Thousand Miles Challenge to run a thousand miles in a year.
What are we waiting for?
So, if the benefits are so clear and seemingly straightforward to achieve, what’s getting in the way? The biggest barriers to transformation of health services, says Nick, are to do with NHS bureaucracy, whether that’s entrenched practices, data silos, procurement processes or incumbent legacy systems that are contractually immovable.
“One of the reasons why a large percentage of the workforce is disengaged in IT is the fact that over the last five, ten, 15 years, they’ve been asked to put lots of information into systems but they don’t get anything out of it. They haven’t seen it actually empowering them as clinicians and I don’t think they’ve seen that the patients are empowered either.
“The most advanced we seem to have got is to send a text reminder the day before to say you’ve got an appointment, but it doesn’t even tell you where the appointment is or what you need to do prepare for it.
“Then there is the fact that a lot of people in healthcare don’t want to empower patients because they have a model that works on performing a specific activity and getting paid for that.
“And this whole kind of fallacy about the complexity of IT around encryption, security and interoperability – it’s not even a health thing, it’s a public sector issue.
“But it might also be that some of them are just scared witless of being responsible for some huge data breach.
“So that’s where the individual holding more of their data could win. There are lots of organisations out there that are trying to help us get healthier. And it’s not rocket science. When you look at the whole obesity crisis, there are people out there that want to help and we all have smartphones so we could set them on a pathway that they do themselves rather than waiting 15 years for them to get diabetes.”
Details and schedules for all the WeCommunities Twitter chats can be found at http://wecommunities.org