Uusi teknologia terveydenhuollossa. Niilo Saranummi

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1 Uusi teknologia terveydenhuollossa Niilo Saranummi

2 Click VTT to Group edit Master title style Turnover 320 M. Personnel 2,900 Click to edit Master text styles ICT for Health Second level Third level Fourth level Fifth level Connected health and health information infrastructure Human data mining, diagnostics and decision support More information: 24/09/2014 2

3 Click Jäsentelyä to edit Master title style Aluksi Teknologian ja hoitoprosessien vuoropuhelu Click to edit Master text styles Isot trendit Second level 4 P ajattelu Third level Terveysjatkumo ajattelu Fourth level Teknologian Fifth rooli level 3 P ajattelu Uusia teknologioita Ikääntyvän väestöryhmän teknologiat Elintavat krooniset sairaudet Lopuksi mhealth, biohakkerointi Genomitieto Digitaalinen jalanjälki 24/09/2014 3

4 TEKNOLOGIAN JA HOITOPROSESSIEN VUOROPUHELU

5 Click Tiede-to tai edit teknologialähtöiset Master title style innovaatiot esim. CT-, MRI- ja UÄ-teknologiat Click to edit Master text styles Lähtölaukaus vuorovaikutteiselle Second level kehitykselle oli digitaalitekniikassa Third level tapahtuneet innovaatiot, jotka mahdollistivat vaativan Fourth level laskennan. Fifth level Kuvantamiseen perustuvat tutkimus- ja hoitomenetelmät ovat sen jälkeen kehittyneet käsi kädessä digitaalisten kuvantamisteknologioiden kanssa Vrt. kuvantaminen tänään ja ennen CT:n, MRI:n ja digitaalisen UÄ:n keksimistä Clinical application generations 1 G 2 G 3 G 4 G Services create needs for new technology products Technologies enable new services Device technology generations 1 G 2 G 3 G 4 G n G 24/09/2014 5

6 Click to edit Master title style Näyttö Parhaat hoitokäytännöt (Duodecim) Hoitoprosessien ja teknologian vuoropuhelu Click to edit Master text styles Second level Services Third create levelneeds for new technology Fourth level products Services Fifth level Technologies enable new services Näyttö terveysteknologioiden arviointi (FinOHTA) Technologies Context: Medical knowledge, organizational structures, laws, regulations, guidelines, stakeholders, media, Best practices Services are based on best practices Service processes Technology supports and enables service provision Technology products 24/09/2014 6

7 Click Kaksi to kehityspolkua edit Master title style 1. Professiot käyttävät teknologiaa (ml. ICT) toimintojen tukena Click to edit Master text styles ja mahdollistajana Second level Digitaalinen kuvantaminen Third level Lyhytkirurgia Fourth level Edellytyksenä Fifth tälle levelon ollut profession tuki 2. Organisaatiot käyttävät teknologiaa (ml. ICT) toimintojen tukena ja mahdollistajana Potilastietojärjestelmät Sähköinen potilaskertomus Telelääketiede mhealth 24/09/2014 7

8 ISOT TRENDIT * 4 P AJATTELU * TERVEYSJATKUMO AJATTELU * TEKNOLOGIAN ROOLI 3 P AJATTELU

9 The Future Paradigm: Transform Medicine from Curative to Preemptive Click to edit Master title style Click to edit Master text styles Second level Third level Fourth level Fifth level Predictive Personalized Preemptive Participatory 9 9

10 Terveysjatkumo Click to edit Master (Health title style Continuum) CARE by PROFESSIONALS SELF CARE Click to edit Master text styles Second level Third level Fourth level Fifth level Active Health Worried Well Fitness Ageing Independently Ambient Assisted Living Home care & Independent living Wellness management Elevated risk factors Disease Management Chronic disease Rehabilitation Emergency Care Acute illness (episode) Elective procedures Elective Care PROACTIVE REACTIVE 24/09/

11 Click to edit Master title style Continua Health Alliance Quality of Life Click to edit Master text styles Second level Third level Fourth level Independent, Healthy Living Fifth level Chronic Disease Management PROACTIVE Community Clinic Doctor s Office Residential Care Assisted Living Skilled Nursing Facility REACTIVE Acute Care Specialty Clinic Community Hospital ICU $1 $10 $100 Cost of Care / Day $1,000 $10,000 24/09/

12 Click 3P - ICT to edit everywhere Master title style Click to edit Master text styles Second Personal level Kansalaisella / potilaalla on rooli oman terveytensä Third ja level sairauksiensa hallinnassa Fourth level Fifth level Empowerment & motivaatio & vastuu Responsibility with Response Ability Personalized Palvelut on sovitettu käyttäjän tarpeisiin, kykyihin ja mieltymyksiin Profilointi (mieli ja keho) Geno- ja fenotyyppi Käyttäytymistieteet Pervasive Sovellukset ja palvelut ovat käytettävissä missä tahansa ja missä vaan ( anytime & anywhere ) Apps + pilvi (mhealth) ehealth, EHR, PHR Terveystietoväylä Ontologiat, sanastot ja koodistot 24/09/

13 Click to #1: edit Master title style Ilves report My data, my decisions ehealth Task Force Redesigning health in Click to edit #2: Master text styles Europe for 2020 Second Liberate level the data Third level Fourth level #3: Fifth level Connect up everything #4: Revolutionise health #5: Include everyone Recommendations for action I: A new legal basis for health data in Europe II: Create a beacon group of Member States and regions committed to open data and ehealth III: Support health literacy IV: Use the power of data V: Re-orient EU funding and policies 24/09/

14 Click to edit Master title style Sairauksien hoidosta terveyden hoitoon Click to edit Master text styles SAIRAUKSIEN HOITO Second level Third level Fourth level Fifth level POTILAASTA AKTIIVISEKSI TOIMIJAKSI TERVEYDEN HOITO Sairaus Sairaanhoito Reagoiva Tapauskohtainen Laitoskeskeinen Palvelumaksu Terveyden hoito Omatoiminen Ennakoiva Jatkuva Yhteistoiminta Tulosperusteinen maksu 24/09/

15 Tähän tarvitaan Taltioni ja earkisto KULUTTAJAT POTILAAT AMMATTILAISET Terveys ja hyvinvointi Kroonisten sairauksien hoito ja kuntoutus Sairauksien hoito Terveystaltio Yhteentoimivuus (standardit) Tietosuoja HETU Potilaskertomus

16 Click to edit Master title style From an acute Illness enterprise WE ARE ON A JOURNEY To a health improvement system Click to edit Master text styles Complexity & Investment Second level Third level Fourth level Fifth level Random acts of clinical improvement Managing episodes of care Disease management Populationbased care Overall Quality of Care Time 16

17 Click Monta to P:tä edit Master title style Click to edit Master text styles Second level Third level Personal? Fourth level Personalized? Fifth level Sinun Sinulle Participatory? Yhteistyössä Predictive? Ennakoiva Pre-emptive? Kerralla kuntoon Pervasive? Aina saatavilla 24/09/

18 UUSIA TEKNOLOGIOITA * IKÄÄNTYVÄ VÄESTÖRYHMÄ (AAL) * ELINTAVAT KROONISET SAIRAUDET (MHEALTH, BIOHAKKEROINTI, GENOMITIETO, DIGITAALINEN JALANJÄLKI)

19 Liz Boehm, Forrester Research defines it through Four pillars of aging-in-place 19 Health Medication Disease management Wellness Stuff people wish they didn t have to think Safety about. Physical security Personal protection Control of environment You CAN get out of bed in the morning. Contribution Legacy Meaning/purpose Value Stuff people want. Connectivity Family Friends Community WHY you get out of bed in the morning.

20 KROONISET SAIRAUDET ELINTAVAT MHEALTH, BIOHAKKEROINTI, GENOMITIETO, DIGITAALINEN JALANJÄLKI In 1750, Benjamin Franklin in his Poor Richard's Almanac observed the great difficulty of knowing one's self, with: "There are three things extremely hard, Steel, a Diamond, and to know one's self.

21 Terveyteen vaikuttavat tekijät 10% Terveydenhoito 60% Eläminen (Nurture) 30% Perimä (Nature) SA Schroeder: We Can Do Better - Improving the Health of the American People. N Engl J Med 2007; 357: McGinnis et al., Health Affairs 21(2), 2002

22 Age-Adjusted Prevalence of Obesity and Diagnosed Diabetes Among U.S. Adults Aged 18 Years or older Obesity (BMI 30 kg/m 2 ) No Data <14.0% % % % >26.0% Diabetes No Data <4.5% % % % >9.0% CDC s Division of Diabetes Translation. National Diabetes Surveillance System available at

23 Evidence Based Associations between Risk Factors and Conditions Risk Factors Tobacco smoking Citizen Modifiable Risk Factors Alcohol consumption Conditions Type 2-diabetes Modifiable by Citizens Non-Modifiable by Citizens Diet Physical inactivity Obesity Accidents Working environment Environmental factors Family history and gender Preventable cancer Cardiovascular disease Osteoporosis Musculoskeletal disorders Hypersensitivity disorders Mental disorders Chronic obstructive pulmonary disease

24 Non-Communicable Diseases are diseases that will break the bank Margaret Chan, Director General, WHO 2011 Globally deaths due to chronic diseases exceed 35 million annually. Nearly 2/3 of deaths are due to chronic diseases. In USA 75% of health expenditure is caused by chronic diseases. CDC USA

25 TERVEYSHYÖTYMALLI (CHRONIC CARE MODEL) Cooperative Key elements Community based Transformation of health care Restructuring of physician practice Challenges: Reimbursement / incentives? academic/research focus

26 Let s look at lifestyle He needs to comply with medical advices while shopping, cooking, eating, exercising He needs to get educated & timely updated on topics of his/her own interest He needs to remember what to do, and when for drug intake, physiological parameters monitoring, at work, at home, at school, on the move Carry out daily activities at home and on travel (personal hygiene, housekeeping, cleaning ) and cultivate interests Having a social life with friends and a social role (team up with peers to solve own or other s problems, contribute to social improvement )

27 Others also influence your lifestyle Food Industry Supermarket Media Industry Physical Activity Home Hospital Medical Doctor Workplace School Pharmacy Pharma Industry

28 VALUE PROPOSITION All persons healthy or at risk of developing an illness JENNI, 31 YEARS AT RISK SONJA, 20 YEARS AT RISK In theory ROBERTO, 48 YEARS AT RISK Value CARLO, 10 YEARS AT RISK COMMON GOAL: STAY HEALTHY

29 VALUE PROPOSITION revisited JENNI, 31 YEARS AT RISK SONJA, 20 YEARS AT RISK Value Value ROBERTO, 48 YEARS AT RISK Value But in practice. 1) UNIQUE PERCEPTION OF WHAT VALUE IS PER INDIVIDUAL 2) VALUE PERCEPTION NOT HEALTH RELATED Value CARLO, 10 YEARS AT RISK And it is not health that we value!. 1) LONG TERM HEALTH RELATED VALUE HIDDEN BEHIND OTHER PERSONAL VALUE PERCEPTIONS COMMON GOAL: STAY HEALTHY In practice We are all different & motivated by different things in our life situations

30 What Click to is My edit Data Master title style Click to edit Master text styles Second level Third level Fourth level Fifth level Weber, Mandl, Kohane. Finding the Missing Link for Big Biomedical Data. JAMA, May 22, 2014, doi: /jama /09/

31 Click Our digital to edit traces Master are title (all) style health related Click to edit Master text styles Second level Third level Fourth level Fifth level 24/09/

32 Our Click digital to edit traces Master are title (all) style health related but today they are in siloes Click to edit Master text styles INDIVIDUAL DATA PUBLIC DATA PRIVATE DATA Second level Third level Fourth level Fifth level 24/09/

33 MYDATA PILOTS AND SERVICE TRIALS Click to edit Master title style MOTIVATE & TRACK BY QUANTIFIED SELF DATA Click to edit LIFE-STYLE Master GUIDANCE text BASED styles ON Second level GENOME SEQUENCE & PERSONAL HEALTH DATA Third level Fourth level PERSONAL HEALTH DATA ACCOUNT Fifth level 2 yr pilot funded by 4 M MOTIVATE & TRACK BY USER S PERSONAL DATA FOOTPRINT AND BEHAVIOR CHANGE MONITOR BY BODY PHYSIOLOGY SOCIAL NETWORKS & SERVICES FEEDBACK FOR IMPACT & CHANGE MONITOR BY BIOCHEMICAL AND MICROBIOTA CHANGES 24/09/

34 LOPUKSI

35 Tietotekniikka pitkäaikaissairauksien hallinnassa Ennakoiva terveydenhoito Sairauden hallinta (esim. tyypin 2 diabetes) Liitännäissairaudet 100 /hlö 30 M /hlö 60 M /hlö 870 M 3 KUSTANNUKSET 1 Interventio joka 5. vuosi alle 2,5 h viikossa liikkuville suomalaisille ( vuotiaat) 2 Vuosittaiset kulut omahoidon tuesta Tyypin 2 diabetes (T2D) potilaille ( vuotiaat) 3 T2D:n vuosittaiset hoitokustannukset, kun liitännäissairaudet huomioidaan

36 Sairauksien hoidosta terveyden hoitoon SAIRAUKSIEN HOITO TERVEYDEN HOITO POTILAASTA AKTIIVISEKSI TOIMIJAKSI Sairaus Sairaanhoito Reagoiva Tapauskohtainen Laitoskeskeinen Palvelumaksu Terveyden hoito Omatoiminen Ennakoiva Jatkuva Yhteistoiminta Tulosperusteinen maksu

37 Health A proposal for a definition of health: The ability to adapt and self manage in the face of social, physical, and emotional challenges. BMJ 2011;343:d4817

38 TECHNOLOGY FOR BUSINESS