1. 16th Annual conference and Scientific Symposium
Issues and challenges of Connected Health:
a clinical perspective
Albert Alonso
Innovation Directorate

2. Why Connected Health?
• Enables more informed decision-making and enhanced quality of care
• Saves lives through remote consultations, whether urgent or
diagnostic
• Creates more efficient, convenient and potentially more cost-effective
delivery of care
• Facilitates earlier – and more accurate – diagnoses
• Provides greater and faster access to a patient’s medical
history, reducing the risk of negative drug interactions or poor
response to a course of treatment
• Improves administrative efficiency and coordination.
• Allows rural residents to receive expert diagnosis and treatment from
distant medical centers.
• Increases timeliness of treatment and decreases transfer rates, while
reducing medical costs through video technology
• Supports real - time treatment by first responders through the use of
smartphones.
• Enhances senior wellness and preventative care through telemedicine
and remote in-home monitoring.
HISI Annual Conference, Dublin, November 16th 2011

3. Sounds great!
Does it fit in our clinical perspective?
HISI Annual Conference, Dublin, November 16th 2011

4. Meet a 21st century Older Person
Who’s Mary?
• Aged 79 years
• Lives alone (family home)
• Arthritis (legs and hands)
• Long-standing digestive problem
• Mitral valve leakage
• Small mental lapses - ? TIAs
• Technophobe (ATM, care alarm)
• Independent but sociable
Adapted from M. Rigby. Social Care Informatics in Support of Integrated Care. INIC, Odense, 2011
HISI Annual Conference, Dublin, November 16th 2011

5. Meet a 21st century Older Person
What does Mary need?
• Nutrition support
• Mobility support
• Shopping
• Bathing support
• Socialisation opportunity
Adapted from M. Rigby. Social Care Informatics in Support of Integrated Care. INIC, Odense, 2011
HISI Annual Conference, Dublin, November 16th 2011

6. Meet a 21st century Older Person
Who does help her (informal care)?
• No children
• Stepson, niece; each 90 minutes
away; working
• 2 sisters – equally dependent, do
not drive
• Neighbours – elderly couples 70+,
each husband with history of
cancer
Adapted from M. Rigby. Social Care Informatics in Support of Integrated Care. INIC, Odense, 2011
HISI Annual Conference, Dublin, November 16th 2011

7. Meet a 21st century Older Person
Who does help her (formal care)?
• General Practitioner – uninterested,
repeat meds., nothing curable
• Cardiologist – medication
• Orthopod – undecided
• Neurologist – unsure
• Geriatrician – peace maker
• Home nurse – monthly
• Respite care – annually
Adapted from M. Rigby. Social Care Informatics in Support of Integrated Care. INIC, Odense, 2011
HISI Annual Conference, Dublin, November 16th 2011

8. Meet a 21st century Older Person
Social care essentials
• Difficult negotiations between
family, health care, and social care
providers
• Daily hot meal delivered 5 days
• 1 hour home support
• Eventually family also arrange 7 day
home visit support including
midday meal
Adapted from M. Rigby. Social Care Informatics in Support of Integrated Care. INIC, Odense, 2011
HISI Annual Conference, Dublin, November 16th 2011

9. Meet a 21st century Older Person
Who manages her health?
• Health seriously compromised if
not helped holistically
• Health care and Social care need
harmonising
• Family and carers’ own needs are
factors
Adapted from M. Rigby. Social Care Informatics in Support of Integrated Care. INIC, Odense, 2011
HISI Annual Conference, Dublin, November 16th 2011

10. Is Connected Health good for Mary?
HISI Annual Conference, Dublin, November 16th 2011

11. Maybe, but we could do it better
HISI Annual Conference, Dublin, November 16th 2011

12. To begin, we need to change our clinical
perspective
HISI Annual Conference, Dublin, November 16th 2011

13. HISI Annual Conference, Dublin, November 16th 2011

14. A clinical perspective for NCDs
Socio economic
determinants Health
promotion
Lifestyle – environment
Risk and protective factors
Systems
Gender Genes biology
Biological expression of
Chronic diseases Personalised
Medicine
•Primary prevention
Age •Secondary prevention
Clinical expression of •Tertiary prevention
•Treatment
Chronic diseases
Adapted from Bousquet et al. Genome Medicine, 2011, 3:43
HISI Annual Conference, Dublin, November 16th 2011

15. Classical phenotypes
Patient with chronic disease Based on “a priori”
ontologies
CVD COPD Diabetes
Assessment of co-morbidities and severity
Classical phenotypes in patients with severe defined diseases
and co-morbidities and severity
Responsiveness to treatment follow-up
Adapted from Bousquet et al. Genome Medicine, 2011, 3:43
HISI Annual Conference, Dublin, November 16th 2011

16. New phenotypes
Patient with chronic disease
Based on statistical
models: complex
Co-morbidites
components of onset,
(standardised assessment
persistence,
prognosis
Severity of co-morbidities
(standardised assessment)
Novel phenotypes in individual patients with
severe co-morbidities of chronic disease
Responsiveness to treatment follow-up
Adapted from Bousquet et al. Genome Medicine, 2011, 3:43
HISI Annual Conference, Dublin, November 16th 2011

17. Moving to 4P medicine
Predictive, preventive, personalised, participatory
Classical
• New studies needed on precise patients’
Phenotypes phenotypes and follow up
• Systems medicine: Massive amount of patients’
data should be available (new societal
responsibility)
• ICT are the only way to collect and exploit these
data: new information management systems are
required, smarter monitoring solutions.
New We need this connected health to make integrated
Phenotypes care possible
HISI Annual Conference, Dublin, November 16th 2011

18. Back to Mary
Citizen first
Care secondary
ICT discrete enabler
Adapted from M. Rigby. Social Care Informatics in Support of Integrated Care. INIC, Odense, 2011
HISI Annual Conference, Dublin, November 16th 2011

19. Thanks for your attention
HISI Annual Conference, Dublin, November 16th 2011