Imagine if you could 3-D print a pink diamond.

Or a £50,000 note.

The world would truly be your oyster.

3-D printing has inevitably received its share of hype. But in this case, the excitement could conceivably be justified. 3-D printing is one of 12 technologies that the McKinsey Global Institute recently identified as having high potential for economically disruptive impact between now and 2025.

Technology can be sexy.

You have to be quite astute, sometimes, to dodge what may seem like manifestations of the latest fat.

Can robots be companions for the elderly?

However, some of the aspects of the NHS are much more mundane; even depressing.

Professor Michael Porter, the world expert in competition, often used to cite in lectures at Harvard how technology itself often doesn’t necessarily mean ‘a competitive advantage’.

This year, it was announced that the costs of the multibillion-pound national health IT programme abandoned by the government are set to continue rising significantly.

The Commons public accounts committee issued the warning as it branded the scheme one of the “worst and most expensive contracting fiascos” in the history of the public sector.

And yet – curiously at the same time – the UK now needs to become world class at developing, testing and rapidly
diffusing the best new technologies and practices.

In June this year, NHS England called on the public, NHS staff and politicians to have an open and honest debate about the future shape of the NHS in order to meet rising demand, introduce new technology and meet the expectations of its patients. This is set against a backdrop of “the funding gap”.

New technology is considered either an opportunity or a threat, depending on how expensive it is.

But a new technology doesn’t necessarily need to be expensive.

A “disruptive innovation” is an innovation that helps create a new market and value network, and eventually goes on to disrupt an existing market and value network (over a few years or decades), displacing an earlier technology.

The term is used in business and technology literature to describe innovations that improve a product or service in ways that the market does not expect, typically first by designing for a different set of consumers in a new market and later by lowering prices in the existing market.

The concern, however, is that the NHS faces tighter financial constraints, a plethora of new private providers will seek new ways of capitalising on the new NHS market. In economic terms, the Health and Social Care Act (2012) has produced the correct ‘rent extraction’ environment for companies seeking to maximise shareholder dividend.

The added concern for some healthcare analysts is that this is diverting resources away from front-line care.

For example, here is a pitch from a provider of “The Friends and Family Test”:

Please click here for a magnified version of this image. You can read from the first paragraph why commissioning this would be so attractive to NHS Trusts, as they all gear up to be Foundation Trusts by the end of 2014.

Publishing has seen innovations which have been ‘revolutionary’. Similar to Gutenberg’s printing technology that replaced handwritten manuscripts, digital technology is replacing printed books. Paper replacing parchment; desktop publishing replaced typesetting, and so on.

Cheaper doesn’t though necessarily mean worse. An ipad to screen for dementia isn’t necessarily better than pen-and-paper.

Some years ago, a group published a paper in the BMJ.

They had sought to evaluate evaluate a brief screening test, the TYM (“test your memory”), in the detection of Alzheimer’s disease. They examined its efficacy in outpatient departments in three hospitals, including a memory clinic.

They involved a large number of people. They included 540 control participants aged 18-95 and 139 patients attending a memory clinic with dementia/amnestic mild cognitive impairment.

They found that the TYM can be completed quickly and accurately by normal controls. They concluded, by comparing the test’s performance to other instruments, that it was a powerful and valid screening test for the detection of Alzheimer’s disease.

Another system of the body provides an equally interesting example.

PCP is an infection of the lungs caused by Pneumocystis jiroveci, which is a common micro-organism in people. It causes disease only in people with weakened immune systems, such as those who have had transplants, chemotherapy, or advanced HIV infection. As the infection progresses, the air spaces in the lungs fill with fluid, making it harder to breathe.

You can apply a ‘pulse oximeter’ to the index finger of an individual to measure non-invasively an oxygen saturation. A ‘tight’ chest and shortness of breath can occur when climbing stairs. This can be evidenced by the pulse oximeter’s change in readings from high to low. This is not a particularly expensive test, say compared to a high-resolution CT scan.

These aren’t of course definitive tests, but simply demonstrations of cheapish equipment can be helpful in medicine without exploding the technology budget.

As a final example, one can think of home pregnancy tests which detect the hormone human chorionic gonadotropin, or hCG. In general, the human body produces detectable levels of this so-called pregnancy hormone only when a blastocyst has implanted into the wall of the uterus. While false positives are rare, there are are several interesting causes of a positive pregnancy test. Very rarely, a positive pregnancy test may be the first indication of a tumour in the ovaries, uterus or endometrium. The amount of hCG secreted by these tumours will vary dramatically depending on the type of tumour. Levels can be sky-high on occasion. Even sophisticated algorithms on computers can get it wrong.

Part of the well-founded anxiety in non-clinicians operating the NHS 111 algorithm is that a call handler might miss a life-threatening meningitis if the correct constellation of symptoms around a headache is missed. The end-point of such calls apparently from the algorithm is ‘go to A&E’ or an ambulance, so hopefully such cases are picked up.

Stephen on the ‘Lex Futurus’ blog (@lexfuturus is PwC’s lead in innovatively transforming legal services) hit the nail-on-the-head for the legal industry, and lessons should be learnt by the medics too.

It’s all about using technology intelligently, stupid.

We now live in a world of email, smart phones, automated document production and Nespresso machines. We have better technology than Roger Moore’s 007 (although there are meetings I would have dearly loved access to his exploding pen) yet, we are working harder and not necessarily smarter.
For in-house lawyers, there should be a “thinking premium” (unless they can negotiate better hours with their CEO) which the technology proffers them, to allow observation, analysis, reflection and strategising – to lift in-housers up from the tyranny of case-by-case reactivity but to think on a proactive basis at an enterprise level.

Instead of the “silver bullet” technology promises, in many cases IT would appear to add to the burden of legal teams, requiring them to extract reports, manipulate into excel, collate additional data manually or, in some cases, do and enter everything twice.
..
In truth, we are sold IT as a panacea – the answer to all our many woes. Well choreographed presentations are whizzed through but smart tech-types, demonstrating how their solution is the key to unlocking our efficiency.

.. IT can be game changing – just make sure you know the game your playing and that you’ve got the tactics mapped out.

These are lessons which could be beneficially considered by those in NHS procurement too.

And it’s likely that assistive technology and telecare will impact, for the public good, in the dementia care of the future.

So like all friends, choose your type of technology carefully?

[Disclaimer: Do not rely on any information in this blogpost.]