The world is increasingly digital. In all its manifestations digital is becoming crucial to doing business with global impact, developing solutions and adopting new technologies that will create growth, and provide better and affordable healthcare through wider choice, greater quality of service and greater efficiencies.

The healthcare sector in particular is under enormous pressure to contain costs but at the same time increase patient choice, improve quality and safety of provision, and handle increasingly complex and expensive technologies. The Institute of Digital Healthcare, a partnership between the NHS, WMG and Warwick Medical School, has been established to provide solutions to these challenges. It will benefit from WMG’s extensive multi-disciplinary experience of successfully introducing new technologies and management practices into other sectors, combining the rigour of academic research with innovative applications. Situated in the International Digital Laboratory, the Institute is ideally placed to make the necessary scale and speed of impact within the NHS and wider healthcare sector.

Foreword

Professor Lord Kumar Bhattacharyya, KB, CBE Chairman of WMG, University of Warwick

2

Professor Lord Kumar Bhattacharyya

4. Introduction

5. Innovation Process for Health and Wellness Management

6. eHealth Innovation

Evidence Summaries

Information Design

Policy in Digital Healthcare

Summative Evaluation

8. Healthcare Technologies

Clinical Health Monitoring

Rehabilitation and Assistive Technology

Unobtrusive Monitoring of Functional Health

Wearable (Ambulatory) Monitoring

10. Healthcare Systems Engineering/

Informatics and Virtual Reality/

Neuroimaging Statistics

11. Education

Back cover. Contacts

Contents

3

Professor Christopher James

Professor Jeremy Wyatt

The Institute of Digital Healthcare’s (IDH) objective is to improve the quality, safety, accessibility and productivity of healthcare by supporting the implementation of digital solutions for the public, patients and professionals, underpinned by rigorous, multi-disciplinary research, development and evaluation. Our model of research-led innovation in healthcare entails identifying real problems, understanding them by identifying relevant theories, selecting appropriate technologies and developing new solutions where necessary. Each solution then needs rigorous evaluation for safety, effectiveness and cost implications before promotion to healthcare systems.

All this requires close working with industry, the NHS and across many disciplinary boundaries. The IDH employs experts in biomedical and information engineering, health psychologists, a statistician and three clinicians with public health, hospital medicine and community health backgrounds. Some have spent several years working in the NHS while others have significant industry as well as academic experience. Our focus ranges from whole organisations and care pathways to individual clinicians and patients down to capture and interpretation of biomedical signals. This means that we can understand and analyse most health related problems, then develop, evaluate and deploy innovative digital solutions. To find out more on how you can participate in one of our events or sign up for our training or educational activities please visit our website.

We look forward to hearing from you.

Professor Christopher JamesCo-Director

Professor Jeremy Wyatt Co-Director

Institute Directors

NHS Midlands and East is a cluster of three Strategic Health Authorities (SHAs), NHS West Midlands, NHS East Midlands and NHS East of England. NHS Midlands and East has 88 NHS organisations and covers a population of 15 million. A key link between the Department of Health, as the headquarters of the local NHS, SHAs are responsible for ensuring that healthcare spending across the region delivers better services for patients and value for money for tax payers.

WMG, an academic department of the University of Warwick, was established by Professor Lord Kumar Bhattacharyya in 1980. Today this global Group works across many sectors and has experience in healthcare research including: rapid prototyping for healthcare, clinical systems improvement, virtual surgery, self-care, experiential engineering for healthcare environments, and bone tissue engineering.

The IDH is a five year partnership with NHS West Midlands, WMG and Warwick Medical School (WMS), which aims to improve people’s health and wellbeing through the development, evaluation and use of innovative digital technologies, and services.

Our approach to digital healthcare builds on our expertise in the design, development and evaluation of healthcare technology, e-health services, informatics and virtual reality. Our research directly exploits technological advances for the healthcare sector. Working with all providers in the healthcare sector, we incubate and carry out research and development that will enable healthcare practitioners to make a real difference to peoples’ lives.

Driven by research teams that draw on a wide range of backgrounds including biomedical engineering, health informatics, healthcare virtual reality and neural engineering, means we are well placed to assist in the development of and spread of advanced digital innovations.

We offer the opportunity to collaborate and benefit from knowledge, expertise and skills in developing and testing new technologies and looking at smarter use of current technologies, to make a real difference to the lives of those suffering from a variety of health related problems. The IDH also offers you unrivalled education and training opportunities.

Introduction

4

Partners

Warwick Medical School (WMS) was established in 2000 and forms the Faculty of Medicine at The University of Warwick. It has grown rapidly and is making significant national and international contributions to education and research in health. Academics at the cutting edge of their fields continue to produce research which is both internationally recognised and relevant to the needs of the national and local health economy.

www.idh.warwick.ac.uk

1) Define the problem, which means understanding the users, the care pathway and the context of use

2) Produce relevant research that underpins the innovation

3) Design and develop to generate a prototype solution

4) Evaluate the prototype to ensure it is safe, effective and affordable

5) Exchange synthesised evidence with stakeholders from the NHS, industry and elsewhere to promote adoption and spread of the innovation

This stakeholder contact will often prompt further improvements to the solution, prompting further iterations of the innovation cycle.

Innovation Process for Health and Wellness Management

Our primary objective is to facilitate the innovation process for health and wellness management related problems. We address this innovation process through five main areas of activity, starting from problem definition all the way through to innovative working practices, these include:

5www.idh.warwick.ac.uk

6

Evidence Summaries We understand that working in the healthcare sector you need access to summaries of high quality evidence about digital healthcare technologies to support your clinical, commissioning and other decisions. To meet this need we are publishing brief, highly readable summaries. Each summary will cover evidence about a specific digital healthcare topic, such as telehealth in heart failure. We consult an expert advisory group to help prioritise topics. The summaries are based on a recent systematic review to provide a brief, high yield overview of the technology and its impact on clinical and cost effectiveness, safety and ease of access to healthcare.

Information Design Through our knowledge and experience we know that how information is presented impacts on how easily you can find and interpret it to make decisions and solve clinical or quality improvement problems. Our expertise in information design means we can apply evidence based principles to improve the layout of clinical documents such as lab reports, discharge summaries or medical records, providing you with faster, safer clinical decisions.

Policy in Digital Healthcare Our experience shows that policy decisions about the use of digital healthcare technologies can be fraught with complexity. To assist you we carry out policy analysis in collaboration with expert advisors in legal, ethical, economic and other disciplines, reviewing evidence and building reasoned arguments to inform your policies and strategies.

Summative Evaluation As well as formative studies, evaluating technology before it is implemented, we design and carry out summative evaluations or impact studies, to measure if a digital healthcare technology has solved the problem it was designed for. This enables you to learn lessons and decide rationally whether and for whom to use the technology; it also provides an evidence base to support marketing. Our evaluation studies take account of a number of specific biases that arise with digital healthcare. This approach to evaluation will provide you with reliable conclusions on which you can base important decisions. We use a range of evaluation methods from qualitative to quantitative as well as secondary research and systematic reviewing.

eHealth Innovation

www.idh.warwick.ac.uk

A randomised trial to determine if clinical use of the profile made a difference to QoL

In collaboration with Bavarian cancer researchers, we designed a simple graphical profile to map ten Quality of Life (QoL) dimensions over time, to help GPs looking after women with breast cancer better understand their needs for ancillary therapies. We then designed a range of studies to pilot and improve this profile and pave the way for a randomised trial to determine if clinical use of the profile made a difference to QoL. After significant development and improvement to the profile, we designed a trial in which we randomised 200 women with breast cancer to use the profile or not. While QoL 6 months after surgery remained disappointingly low across all patients, QoL was significantly higher in those patients whose GPs received the profile and a report based on it, thanks to more appropriate ordering of ancillary therapies such as pain clinics and counselling. Our studies to date have demonstrated improved QoL in women with breast cancer, but the principle of making information more visible and easier to use by clinicians is generic. We therefore believe that clinicians can use similar profile tools to sequentially track and improve other clinical variables in other care groups and clinical settings, to improve QoL and other outcomes.

7

Case stu

dy

eHealth Innovation

8

Healthcare Technologies

Clinical Health Monitoring Based on desired health status outcomes, we can design systems that measure various physiological parameters such as BP, HR, ECG, pulse-oximetry and spirometry. Whether within a hospital, GP clinic or the home, it may involve communication of the data to remote locations. We develop algorithms to provide either a decision support system or a simple health status monitor. The design parameters allow the monitors to be used in either stand-alone, telemetry or m-health situations. As with remote decision support systems for telemetered patients; or a handheld device to predict the onset of labour in pregnancy; or a mobile based device to track chronic conditions such as diabetes. Rehabilitation and Assistive Technology

Our research extends to the development of systems for use in rehabilitation, wherever that may take place. Rehabilitative and assistive technologies usually incorporate a clinical health monitoring device and may or may not be ambulatory. The result of developing rehabilitation technology that can be used in the home is faster and better recovery from injury, for example recovery of upper limb mobility after stroke through personalised assistive robotics. It can also result in more informative health monitoring of a rehabilitation regime through everyday actions such as an instrumented orthosis using shoe inserts or an instrumented crutch; and can enable significant quality of life enhancements in brain computer interfacing technology for ALS or locked-in syndrome.

Unobtrusive Monitoring of Functional Health In unobtrusive monitoring, health or wellness is inferred through monitoring of non-physiological observations (e.g. belt-worn accelerometry, GPS, bluetooth encounters) and/or environmental sensors (e.g. PIR sensors, cameras, etc). These measurements are made over prolonged periods of time and can be used to infer health trajectories. Our algorithms can extract information from data taken from a variety of disparate sensors. Activity signatures can be deduced and changes in these patterns inferred, this would be useful in caring for the elderly with dementia, remote monitoring for falls, remote monitoring for psychiatric well-being, etc.

Wearable (Ambulatory) Monitoring

We can develop ambulatory systems for you to be able to measure either physiological parameters and/or behavioural parameters such as accelerometry through a body worn system. Either through single units or through distributed systems, high capacity, high data throughput systems could be devised that incorporate low power in a small form factor. These monitors can be used with chronic conditions such as diabetes or to predict or alert on debilitating episodes e.g. falls in the elderly. They can also objectify current state of health/wellness for long term conditions such as bipolar disorder, or for use in specific clinical assessments for example cardiac/neurophysiologic monitoring and CFS.

www.idh.warwick.ac.uk

9

Auditory Neuroimaging: assessment of cochlear implant performance outcomes

For the profoundly deaf or severely hard-of-hearing, a neurosensory prosthetic known as a cochlear implant (CI) can be used to provide a sense of sound. A CI is composed of an array of electrodes implanted into the inner ear (cochlear) and an externally worn speech processing unit. Despite their great success, the performance outcomes for CI users are characterised by a very large spread, particularly in challenging listening conditions, i.e. multiple talkers in a reverberant room. No matter how much CI technology and speech processing strategies are optimised, one of the largest sources of variability in overall performance lies with the implantee using the device.

Through multi-disciplinary teams we will investigate the wide variation in performance of hearing impaired subjects with a CI, using non-invasive objective electrophysiological measures. With the age of patients receiving CIs getting younger, and an increasing number of children with multiple additional needs, there is a great need for new objective methods such as those that do not require verbal or behavioural feedback. We will non-invasively record the electrical signals generated by the brain in response to sound stimuli. The project has been split into three parallel themes needed for good speech perception in challenging conditions: spatial localisation of sound; primitive neural coding of perceptually relevant stimuli; and cognitive abilities and attention.

The outcomes will have the potential to improve basic understanding into how an implanted auditory prosthesis interacts with the human central nervous system and leads to the perception of sound. The brain signal measures used will be developed into new clinical test procedures for the determining of candidacy, clinical management and prediction of behavioural outcomes for CI implantation, particularly useful in situations where the participant is unable to respond i.e. pre-lingual implantees.

Case stu

dy

Healthcare Technologies

10

Healthcare Systems Engineering/ Informatics and Virtual Reality/ Neuroimaging Statistics

Healthcare Systems Engineering To consistently provide optimal care, meet efficiency targets, improve clinical productivity while keeping costs down, health care organisations must be continuously reconfigured within their unique existing constraints. Through our expertise in the development of the closed-loop lifecycle framework we deliver a strong emphasis on modelling and analysis of highly unstructured complex service systems. By integrating data mining with process mining we can improve healthcare system quality and productivity. Our Pathway Variation Analysis methodologies and technologies analyse, monitor and conduct root cause analysis for whole system improvements that directly benefit patient care whilst simultaneously improving quality and efficiency. The interdisciplinary approach to our research integrates complex service system modelling, decision making, industrial engineering (operations research/ simulations) and health economics.

Informatics and Virtual Reality

We can assist you in designing enhanced user experiences using the design and integration of digital representations that supports social and cognitive activities in ways that extend your current capabilities. This is completed through appropriating and assembling a diverse range of technologies such as haptic interfaces, handheld and pervasive computing. Through our specialist expertise in informatics we can develop powerful computational resources to enable sophisticated modelling, visualisation plus the storage of large volumes of data. By developing and using techniques to extract information, knowledge and wisdom from raw data we can enable you to make informed decisions when developing efficient processes, or to understand how disease might affect populations.

The use of 3D visualisation enables us to develop methods for you to visualise and interact with complex data sets such as visual only to multimodal and multisensory.

Neuroimaging Statistics

We have extensive experience in the analysis of neuroimaging data, including Functional Magnetic Resonance Imaging (fMRI), structural MRI, Positron Emission Tomography (PET) and Electroencephalography (EEG). These types of high dimensional data require custom software that we have developed and validated.

We can help you design your study, adapted to the needs of your research, whether you are trying to discover which brain regions are engaged in complex tasks, or whether you're trying to measure the impact of a stimuli on established brain networks. Cognitive neuroscientific questions often require complicated behavioural stimuli and create meaningful outcomes, visualised with detailed renderings that help localise the brain regions involved. Clinical trials require carefully defined outcomes that are sensitive to the impact of a drug. We can help define and characterise outcomes that are robust and interpretable, and that will scale up to larger clinical trials.

www.idh.warwick.ac.uk

11

Education

The digital revolution has presented significant challenges in the delivery of healthcare for everyone in today’s society. The approach to healthcare has shifted its focus from the treatment of long-term conditions to the prevention of illnesses and maintenance of healthy lifestyles. We live in a world with tighter fiscal constraints, leading to an increasing patient to healthcare professional ratio, with an obvious need to maintain and improve the standards and quality of healthcare.

The proliferation of digital technologies and techniques has provided a new avenue for healthcare providers worldwide to meet these challenges. This paradigm shift has created a pressing need for a bright, well-educated and flexible workforce capable of designing, using and evaluating these technologies, with a thorough understanding of the clinical, engineering, ethical and social constraints surrounding them.

To meet this need, we have developed an innovative Master's programme which is the first of its kind globally that authoritatively reviews all these disciplines and enables students to synthesise them into a comprehensive, coherent and career-advancing experience. This course will give you the knowledge and skills to drive, manage and evaluate the advances in technology and techniques that underpin digital healthcare.

A unique feature of the new Master's programme is that you benefit from working in multi-disciplinary teams that will bring together multiple skillsets to solve complex real-world problems. The course will be taught using a flexible framework, allowing modules to be chosen from one of two specialisms engineering or clinical to suit your background and best meet your professional development needs. By working in multi-disciplinary teams across the clinical and engineering specialisms you will gain an in-depth understanding of the design constraints seen from both the clinical and engineering perspectives. This strategy provides unique learning and generic skills development opportunities, not offered anywhere else.

The course is offered on a full-time or part-time basis and the structure of the modules provides flexibility for those already working and looking to upgrade their skills, or for continuous professional education.

www.idh.warwick.ac.uk

The information contained in this brochure was correct at the time of going to print. For updates and latest information, please check our website.

Designed by watermarkdesign.co.ukPhotography by George Archer Photograhpy

www.georgearcher.com

Institute of Digital Healthcare

International Digital LabUniversity of WarwickCV4 7AL

Web: www.idh.warwick.ac.ukTel: +44 (0)24 7615 1261 or (0)24 7615 1262Email: idh@warwick.ac.uk Twitter: www.twitter.com/IDHwarwick

Contacts

eHealth InnovationProfessor Jeremy Wyattj.c.wyatt@warwick.ac.ukDr Kevin YapK.Yap@warwick.ac.uk

Healthcare Technology/ Biomedical Engineering

Professor Christopher Jamesc.james@warwick.ac.ukDr James HarteJ.Harte@warwick.ac.uk

Healthcare Systems Engineering

Professor Darek Ceglarekd.j.ceglarek@warwick.ac.uk

Informatics and Virtual Reality

Professor Vinesh Rajavinesh.raja@warwick.ac.uk

Neuroimaging Statistics

Dr Thomas Nicholst.e.nichols@warwick.ac.uk

EdinburghGlasgow

Newcastle

Liverpool

Manchester

Nottingham

London

Cardiff

Coventry

Birmingham

Dublin

Belfast