Visioita tulevaisuusorientoituneesta terveysteknologiasta Tutkimusprofessori Niilo Saranummi niilo.saranummi@vtt.fi
11/11/2011 2 ICT for Health at VTT VTT is an internationally recognised innovator and research institute partnering with industry and health service providers In ICT for Health our areas of expertise include: Health Data Mining mhealth and Beahaviour change support Ambient Assisted Living More information: www.vtt.fi/health Turnover 232 M Personnel 2,740 76% with higher academic degree 5,730 customers Established 1942 VTT has been granted ISO 9001:2000 certificate.
11/11/2011 3 Sisältö ICT trendeistä SOTE-sektorin haasteista SOTE + ICT ja joitakin esimerkkejä Lopuksi
ICT: MIHIN OLLAAN MENOSSA 11/11/2011 4
11/11/2011 5 Main ICT trends in 2010 ROADMAP for Communication Technologies, Services and Business Models 2010, 2015 and Beyond Tekes, VTT, 2010
Ubiquitous computing sensors everywhere! 11/11/2011 6 (c) Modified, original from Pertti Huuskonen, Nokia ResearchCenter
Digital platforms 11/11/2011 7
Tietoturva 11/11/2011 8 Yksinkertaistaen Liittymä Kännykkä, PC, Verkko Resurssit Pilvi Äly Tietovarastot
SOTE-SEKTORIN HAASTEET 11/11/2011 9
11/11/2011 10 Grand Challenges (in all OECD countries) Health expenditure vs. value What is produced with s Quality & Access concerns Expectations & Awareness Main drivers Ageing & Care ratio (huoltosuhde) Life styles Science, Technology and Innovation
11/11/2011 11 70 % of disease burden in Europe is caused directly and indirectly by chronic diseases and conditions
11/11/2011 12 Determinants of health 1. Quality/Efficacy of Healthcare services 2. Behavioural patterns- Lifestyle, environmental factors, Societal circumstances 3. Genetic predispositions, Acquired genetic changes Healthcare delivery system Nurture Exogenous determinants Nature Endogenous determinants Impact on premature death 10% 60% 30% SA Schroeder: We Can Do Better - Improving the Health of the American People. N Engl J Med 2007; 357:1221-8 McGinnis et al., Health Affairs 21(2), 2002
Vaikuttaminen terveyteen 11/11/2011 13
Connected Health choices 11.11.2011 14 Yksilön uusi rooli Responsibility Response Ability Traditional Model Illness Outsourced Reactive Episodic GP s and Hospitals Fee for Service Co-Producer Model Management of health and care Insourced Proactive Continuous Value based business models (shops, retail clinics, value-added processes, user networks) Value based reimbursement Proactive Reactive Patients as passive objects Health & Care Professionals Dependency Individuals as co-producers of Health & Care Citizen- Patient
11/11/2011 15 Intuitive (I) Experimental (E) Precision (P) I E P Characterizing medical knowledge Diseases and health problems can be positioned to this continuum Diagnostics / Therapies Christensen s ideas are based on the idea that different business models are needed when dealing with health problems for which medical knowledge is intuitive, experimental or precise. Christensen, CM., Grossman, JH. & Hwang, J. (2009) The Innovators prescription: a disruptive solution for healthcare. McGraw-Hill.
11/11/2011 16 Business models in healthcare need to be separated (Clayton Christensen) Coherent solution shops To sort out disorders that are still in realm of intuitive medicine Value generation by people (experts) Retail clinics Caring for our everyday rules-based disorders Value generation by processes & application of rules Value adding process businesses For procedures that are performed after definitive diagnosis has been made Value generation by processes and equipment Facilitated user networks Helping patients in caring for their behavior dependent chronic ailments Value generation by organizing, facilitating, maintaining networks Terveyskeskus & sairaala??? Terveyskioski (Ylöjärvi, Lahti) COXA Terveyshyötymalli???
SOTE + ICT 11/11/2011 17
11/11/2011 18 Tulevaisuuden palapeli Ikääntyvät itsenäinen suoriutuminen Kuluttaja potilas Terveydenhuollon ammattilaiset Muut palvelun tuottajat
11/11/2011 19 Taltioni Sitra, SADe Kuluttajan potilaan palvelut KanTa-palvelut
11/11/2011 20 Changing context Changing ground rules Petra Wilson, Cisco / Continua Virtualised resources Diagnose and cure Prevention and Health maintenance Physical resources
Etähoito 11/11/2011 21
11/11/2011 22 Ohjelmistojen regulaatio tulossa Pohjana Medical Device Directives (samat vaatimukset kuin FDA:lla) Tavalliset lääkintälaitteet (MD) Implantoidut laitteet (in-vivo MD) Laboratoriolaitteet (in-vitro MD) Lisäksi + Medical software tullut voimaan + mhealth tulossa
11/11/2011 23 VTT Supporting diagnostics Having atrophy? Data quantification Health problems Tools for extracting objective measures from data: images, signals (e.g. EEG), molecules from blood. Decision support Diagnostics Having Alzheimer s disease? Analyze databases: compute distributions for healthy and diseased Visualise my patient against all other cases in the database. Database Diseased cases Healthy cases Volume 2000 ml Volume 2000 ml
11/11/2011 24 Disease State Fingerprint (PredictAD) for early diagnostics of Alzheimer s Disease Lack of tools for efficient quantification of patient data is a major bottleneck in the spread of automated and objective analysis tools into clinical practice VTT has developed a clinical decision support tool for detecting complex diseases at an early stage and for monitoring their treatment efficacy The tool provides a disease state index reflecting the state of the patient and allows easy visualization of the patient status The approach is generic and able to combine heterogeneous and incomplete data The technology is implemented and clinically validated in the for the diagnosis of Alzheimer s Disease, but can be applied to other complex diseases
11.11.2011 25 NOKIA: Wellness Diary Personal wellness management tool in the mobile phone based on cognitivebehavioral self-management models Diary for health and wellness related self-observations + calendar Simple and fast self-observations + automatic feedback Available in situations where lifestyle choices are made Integration into daily life and time management
11.11.2011 26 Our approach in behavior change support: Combining personal health technologies and psychological intervention methods Personal health technologies can integrate behavior change support into people s daily lives Computer-aided interventions have been shown to be effective in treatment of depression, anxiety, and various health problems Mobile and wearable technologies are especially suitable for daily self-observation and maintenance of well-being Cognitive-behavioural interventions provide skills to evaluate personal values and lifestyle, set personal goals, and plan lifestyle changes Personal health technologies + = Psychological intervention methods and physiological knowledge Tools for behavior change
11.11.2011 27 Measurements - blood pressure - blood glucose - weight - daily steps Personalised feedback: Remote patient monitoring combined with decision support Upload monitoring data Personalized feedback and alerts Personal Health Record (PHR) & Evidence-based decision support rule-engine for selecting feedback messages among ~250 candidates View data & react Messages, alerts PHR/EHR view Alerts appear in the professional's worklist
11.11.2011 28 Sipoo Health centre pilot architecture Patient centered data storage Principal clinical data storage Monica application Continua xhrn-interface - Upload data - Get feedback Medinet Personal health record Mediatri Electronic health record Decision support system
11.11.2011 29 AmIE Ambient Intelligence for the Elderly Aikavälillä 05/2007-02/2010 toteutettu tutkimus-projekti, jossa tutkittiin ja testattiin ikääntyneiden kotona asumista tukevia älykkään ympäristön ratkaisuja ITEA2-projekti, jossa mukana VTT:n lisäksi yli 20 partneria 6 eri maasta: Suomi, Belgia, Ranska, Alankomaat, Espanja ja Turkki VTT:n tutkimuksen sisältöä Ikääntyneen kokonaisvaltainen hyvinvoinnin arviointi (perustuen Oulun kaupungin Hyvinvointiprofiiliin) Tiedonkeruu, -käsittely ja visualisointi eri loppukäyttäjäryhmille Laitteiden välinen yhteensopivuus ja tiedon yhdistäminen eri antureista Hyvinvoinnin arviointiohjelma (monitorointi ja päiväkirja) Muistutukset Interaktiivinen henkinen ja fyysinen harjoittelu kosketusnäyttösovellusten avulla Teknologian evaluointi kenttäkokeilla
11.11.2011 30 Ikääntyvän hyvinvoinnin arviointiohjelma OMINAISUUDET Jatkuva hyvinvoinnin tarkkailu Apu ikääntyvän huolehtimisessa Mahdollistaa nopeamman reagoinnin hyvinvoinnin muutoksissa Etähallinta internetin kautta Tukee ikääntyvän päivittäisiä rutiineja Mahdollistaa muiden sovelluksien helpon käyttämisen Yksinkertainen käyttää kosketusnäytöllä KÄYTTÖKOKEMUKSET Laitetta on testattu 9 ikääntyvällä kotiympäristössä Saatu myönteistä palautetta, mm. Helppo käyttää Hyödyllinen TULEVAISUUS KEHITYSTYÖSSÄ Sosiaalinen verkostoituminen yksinäisyyden estämiseksi Hyvinvointiprofiilin kehittäminen Hyvinvointitiedon kerääminen ympäristöstä Sensoritiedon lisääminen Ennaltaehkäisevät toimet hyvinvoinnin parantamiseksi Hoitoprosessiin liittäminen
LOPUKSI 31
11/11/2011 32 Rahoitusinstrumentteja Tekes SOTE-ohjelma EU 7. Puiteohjelma ICT for Health einclusion CIP / PSP ITEA (Eureka) Artemis AAL JP Suomen Akatemia + JPI:t Active and Healthy Ageing European Innovation Partnership
11/11/2011 33 Systeemimuutos Asiakkaat Organisaatio Työvoima Prosessit Markkina Palvelut Uuden tyyppiset verkostot ja arvoketjut Teknologia- ja tuoteinnovaatiot Organisatoriset innovaatiot Asiakasrajapinta- ja jakeluinnovaatiot Laitteet Infrastruktuuri
11/11/2011 34 VTT creates business from technology