Event Driven Healthcare and Digital Twins

I am often asked what I mean by 'event driven healthcare'. An event is something that happens to an individual at a point in time which generates a transaction. This could be something as simple as booking an appointment, to capturing a diagnosis, or carrying out treatments or procedures.

Events do not have to be human generated though. In situations such as screening, automated events are generated to ensure we are checked for appropriate cancers and diseases once we enter risk stratified stages of our lives. These automated events are there to protect us - and eventually enable us to self-screen once the technology is availble.

The important thing to note about event driven healthcare is that data is an integral part of our ability to manage any downstream impact of an event taking place. An example of this would be a series of diagnostic results being captured on an individual that leads to downstream automated appointments for cancer under a two week wait rule. This level of automated event management is vital to the effective treatment of specific patient groups. Equally when prescriptions are placed on an individual these would be checked against existing medications to ensure no adverse interactions exist.

Taking the event analogy further and the principles of automation you can establish a theory of a digital healthcare twin. Digital healthcare twins are a fundamental future requirement to manage the wellness of our population. Digital Twins provide the opportunity for individuals to be monitored, risk stratified, and events generated as risk or health indicators become prevalent within a healthcare record. As time progresses and new indicators are developed these can be automated within the platform to enhance our ability to protect our citizens.

For this to be 'real' in England we must progress towards a trusted, event-driven data platform that manages health records in real-time. Following the election (and with some appropriate nudging) Labour has prompted the creation of a Digital Health Record which will almost certainly make it into the ten year plan. What we must all be mindful of is ensuring this strategy is not degraded to a national Shared Care Record.

The worry around the DHR programme is how we may approach this nationally. A lot of investment has been made into Shared Care Records and it will be a conundrum as to how much of this infrastructure should be leveraged to support an event driven platform moving forward.

My worry is that the scope of shared care records is simply not fit to enable event driven healthcare for a number of reasons:

1. Shared Cared Records leverage unstructured, delayed sources of data to present information to clinicians at the point of care - for the purposes of human judgement.
2. Shared Care Records were never designed for consumption to a patient, and are often not designed to curate the data for standardized consumption - meaning an uneducated human may misinterpret the information within the record.
3. Shared Care Record platforms are not build on modern technology or standards which means any form of stratified automation is nearly impossible.

Moving forward a decision will need to be made on what digital assets exist within NHS-England to support the above. It is not viable for us to continue with point to point approaches and distributed data silos and limited standardisation of data. The future will very much be dependent on ensuring we have appropriate information about our citizens to ensure our populations are living well.

As we look beyond current approaches and towards personalised medicine and genomics, event driven stratification will become even more viable - and integral to scaling our health service. Phenotypic and genotypic information will be bought together continuously to prevent disease and support personalised treatments. Eventually personalised treatments will be prescribed automatically based on trusted inputs. This will reduce the overheads on the NHS and provide a next generation health system.

Wellness aside, accidents and major health changes will inevitably happen, and an event model will enable our healthcare workforce to see a clear picture, 'at the right place, at the right time, in the right format'. I have lost count the amount of times I have read or heard that saying in relation to health system architectures over the last 20 years. But the important thing about the statement is that it has to be true to deliver the most effective and safe healthcare.

The challenge we always have is people, and our opinions about the best next steps. I have always veered towards bold decisions with the best strategic intent. That approach doesn't always sit well and will be especially challenging for a long-term programme such as a DHR. It is probably more appropriate to 'divide and conquer' to start with, sort out the primary care data and legalities quickly, get it standardised through supplier support and create the appropriate platform to begin the digital twin journey. What is most important though is that we must remove all of the local and national technical debt - and sunset services which simply are not fit for future models of care and inhibit any ambition to change our care methodologies.

To be clear and in closing. I do not think a single platform exists that can deliver the above. Creating the above will require a coming together of many technologies and partners to enable hyper scale messaging, storage, analytics and presentation at a scale we've not achieved before in the NHS.

Some may read the above and say it is just a dream - and it won't happen in our lifetime, and that the politics, governance, funding, etc. will inhibit any chance of this becoming a reality. I really hope these people are wrong because the car is driving towards the cliff and I hope we can stop it before it gets to the edge.