Three Steps to Drive Integrated Care, Faster

Preparing for integrated care is a top priority for healthcare organisations across the UK. SAS, a global leader in business analytics, propose that through better utilisation of the data already available to clinicians, managers and Boards, the journey to integrated care can begin today.

In 3 steps, SAS suggest a pathway to unlock the power of data and transform your approach. Here are a few of the top tips suggested in the ‘3 steps to drive integrated care, faster’ Whitepaper.

Step 1: Fully exploit your existing knowledge

  • This isn’t about collecting new data.
  • The right insights are locked in the extraordinarily rich pools of administrative, operational, patient-centred, research and financial data.
  • By transforming data into insights, you can instigate new actions and processes that will deliver greater value.
  • Empower everyone from clinicians to managers to explore and analyse past results and scenarios in order to answer today’s healthcare questions.

Step 2: Change the way you think about decision-making

  • Eliminate the ‘politics’ from decisions around integrated care by putting data front and centre.
  • Base decisions on deep insights with less subjectivity and far greater objectivity.
  • Change the way that you think about decision-making – from treatment-centred to patient-centred.
  • Scaled up these insights could be used to inform new care pathways – potentially at a population level.

Step 3: Get started with easy wins

  • At the beginning of your journey to making data-driven value decisions about how to integrate care, start small.
  • Consider a single solution with the built-in ability to scale in terms of both the volume of data being included and the complexity of the analyses being undertaken.
  • Start out with easy-to-use tools to get all integrated care decision-makers on a common ground of understanding.

Integrated care puts the patient at the heart of decision-making. By turning data into insights decisions can be focused on delivering optimal financial value and patient outcomes. This combined with better collaboration across organisations, real transformation can be achieved.

It will require the right technological capability and expertise to source data and deploy a data-driven decision-making process. But by starting the journey with an outcomes mindset, organisations can get on the right track – making integrated care less vision, and more reality.

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‘Three steps to drive integrated care, faster’

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Key Findings From Social Care Leaders Roundtable

Digital tools have an important contribution to make in reducing risk in social care, but they should never be used to replace professional judgement. That was the key conclusion of a roundtable hosted by Together for Health and Salesforce Industries on the role of technology in reducing risk for vulnerable people.

Technology such as AI-driven decision-making support tools can only be as good as the data they are built upon. Like every area of public service, the pandemic has driven online collaboration in social care and supported greater information sharing between teams.

“We had a workforce which was reluctant to utilise technology, but now they are much more comfortable about using it,” one of the expert panel said.

“Now we are thinking about what the technological approach will look like when we’ve got office-based staff again, and understanding whether they will continue to use technology in the way that they have – so how we engage with our staff, and how they engage with users.”

Collaboration to provide support for people who were shielding during the pandemic provided one opportunity to improve data sharing: “We started to talk much more about sharing data. It really has opened the doors and got people thinking about sharing information, particularly with our health colleagues.

Over the years difficult lessons have been learned about the use of decision support tools, whether technological or paper-based. For example, they must avoid the pitfalls of becoming tick box exercises, and they must never be used as an excuse for a particular course of action which negates professional judgement.

One child protection expert said: “There have been recommendations from serious case reviews and elsewhere that we need to be really careful about ‘checklist social work’ around scoring and rating risk. In terms of child sexual exploitation, in the beginning there was a lot of reliance on waiting for three or four things that meant [action should be taken], but of course, they never, ever account for the whole circumstances of the child’s experience. This should never replace professional judgement

“AI should be assistive, it should be used to inform, but it shouldn’t be relied upon to make decisions, or be an excuse for a decision that is being made. The technology is there to support professional judgement, not replace it.” 

Social care departments need a rigorous assessment of all the potential data sources which can help them assess and manage risk: “Have you actually got all of the data? Can you access it? Can you service it? Because it sits in multiple places, some of it will be in people’s heads, it could be paper-based. Can you aggregate it and then use technology to surface that information based on [the situation]. 

“So we are going to into somebody’s house, there is a potentially vulnerable child. Do we know all about all of the adults or the other children within that household? Their interrelationships and so forth? Are we able to surface that kind of information so that when a social worker is walking into that situation they are better informed? That is where things like data surfacing can help inform that professional judgment.

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How 3 Local Councils are Tackling Digital Inclusion

The connection between digital inclusion, wealth and health was brought to the forefront in a recent discussion between leaders from Wigan Council, Stockport Council and Lambeth Council at PublicTechnology Live

The pandemic has exacerbated the need for internet access to conduct every aspect of citizen life – whether that is for work, relationships, shopping, education as some examples. More than ever it has demonstrated how a lack of digital skills and access to tools can have a negative impact on socio-economic mobility.

Digital inclusion is now ranked as a top priority for local authorities, providing an opportunity to build on the important work that was already underway in this area. “Digital inclusion needs to be fundamental in all our conversations” says Alison McKenzie-Folan, Chief Executive, Wigan Council as she explains her approach as empowering communities to lead happier and healthier lives.  

But in what ways has the digital inclusion agenda progressed this past year and what can we expect in the future? The discussion brought out 3 key themes. 

  1. Partnerships  

Across Lambeth a primary focus for the past 12 months has been connecting its rich community and voluntary sector by setting up a new Digital Inclusion Network, enabling it to share information and devices more effectively. The council has played a key role as convenor, coordinator and collaborator, says Chloe Bernard-Grahame, Strategy & Partnerships Manager at Lambeth Council.  

These partnerships have helped to establish a connection with hard-to-reach digitally excluded communities and shaped more meaningful support though the additional benefit of shared knowledge and expertise.  

  1. Mentoring  

In Wigan, the closure of libraries and community hubs became the driving force behind a new mentoring programme to provide residents with digital support. Aptly named ‘Techmates’ this support service has been helping people like Dorothy, who was deaf and living alone. Through the mentoring service, she was able to get a device and connect with her friends and participate in video calls.  

Another volunteer has helped a couple who had never embraced tech before. Mentoring support opened up a world of possibilities for them both and will have changed their relationship with technology for the long term, beyond the pandemic. 

  1. Access to Devices  

In Stockport, 87% of the population is online in some way. But as Kirsteen Roe, Service Director, Citizen Focus at Stockport Council explains this also means that there remains 40,000 people who aren’t. And whilst people may be classified as being ‘online’ many are still struggling with devices and data packages.  

Through a device lending service, the council has lent 307 devices and data packages over this past year and has a waiting list. The service has encouraged people and businesses from across the area to donate unused or unwanted devices through the council. 99% of participants with the scheme say that it has positively impacted their lives. 

The Future 

As we look to the future continuing to address the digital skills challenge will be imperative. Whilst there is a Government skills roadmap, this is a complex challenge with a no one size fits all approach.  

For some digitally excluded groups, reach is the major challenge. Evidence suggests that the most digitally excluded are also the most likely to not access adult education. Tapping into the existing community and voluntary networks already connecting with these groups can be a way to attach digital skills to other interactions and overcoming this challenge. 

Furthermore, with 80% of jobs now requiring some kind of digital skill – and only 48% of the workforce equipped with these skills, working with colleges and businesses to equip young people now going into the workplace remains an utmost priority. 

Digital inclusion leaders at Wigan, Stockport and Lambeth clearly highlight the deep connections between digital inclusion and health. The pandemic has been a facilitator for positive action in this area but there is still a long way to go to ensure that every citizen has access to the internet and can benefit from the opportunities that come with that.  

To view the full discussion, please click here

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Building Trust Key to Delivering Health Equity for BAME Communities

The need for public services to rebuild trust emerged as the key theme in our recent webinar, hosted in partnership with the Office of the Public Guardian, focused on Bridging the Gap: Delivering Health Equity for BAME Communities.

Nick Goodwin, the Public Guardian, has been concerned at the low take-up among BAME communities of the Lasting Power of Attorney, the legal agreement that lets you appoint one or more people to help you make decisions or to make decisions on your behalf if you no longer have the capacity.

Office of the Public Guardian data reveals that the areas where someone is most likely to have a diagnosis of dementia are where you are least likely to find people who have a Lasting Power of Attorney, such as Bradford, Leicester, Birmingham and London. Many of these areas encompass BAME communities. This leads to people being kept in hospital when they could be back in the community.

Goodwin said: “The Alzheimer’s Society estimates that over a million days of hospital beds [each year] are taken by people who lack capacity, who could actually be out in society. Lasting Power of Attorney often facilitates people going home early when their attorneys can speak for them.”

Geraldine McMurdie, Head of Intermediate Care at HC-One, the UK’s largest independent care home provider, is a member of the BAME Communities Advisory Group for the Department of Health and Social Care, established during the pandemic. She said the group had highlighted the importance of building relationships through “trusted people and trusted places, making sure that there were different modes of communication to reach people from different ethnicities and races so that they felt they could go to information from sources that were relevant and relatable to them, or the information was tailored in a way that was meaningful to them”.

London GP Dr Edwina Akerele added: “People already know who they trust. If it’s going to take years to build trust in us, we need to bring on board the people they already trust, and work with them. That was a gap that we realised we hadn’t been utilising.”

Akerele said that as the vaccination programme has been rolled out, “we have the faith communities opening up vaccination centres, we have videos from imams and from temples saying ‘look at my arm, I’ve had this done’. And you can see straightaway how much that’s influenced people. If people see us working together, and you see the leaders that they trust working with us, the more likely people are to join in and want to engage”.

Akerele believed that an important step in building confidence among BAME communities in public services “is that people have to acknowledge the racism within the NHS. In the last year people are starting to talk about it more, but what we need to see is action and evidence that people are working towards reducing or eliminating racism within the NHS”.

Goodwin stressed that 49 per cent of the workforce at the Office of the Public Guardian was from BAME communities, and highlighted the work to build relationships with underrepresented groups around the Lasting Power of Attorney.

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How to Influence the Wider Determinants of Health

The wider determinants of health are well understood as large contributing factors to a person’s health. However for professionals working across health and care settings – as well as wider public services – putting the theory into practice has not always been so easy to achieve.

Whilst the ambition for cross-system interventions does exist, operating structures and silo working often act as a barrier to change. The very nature of the wider determinants of health means that it is very difficult for one part of the system to address alone; it requires collaboration and joined-up working.

The release of ‘Integration and Innovation: working together to improve health and social care for all’ White Paper is an important milestone in the journey towards tackling the wider determinants of health. The paper sets out a framework for improved integrated care, which will take a systems-wide approach to health – shifting the conversation from the provision of ‘good healthcare’ to creating the right environments for ‘good health’.

This is not to take away from the achievements of both grassroots and national initiatives that already demonstrate system-wide collaboration as a way to influence better health outcomes for local populations. Examples include Greater Manchester Health & Social Care Partnership, the NHS Healthy New Towns programme and The Wigan Deal.

However to put the wider determinants of health more into everyday practice for all communities, it will be the further roll-out of Integrated Care Systems (ICSs) and a clear definition of responsibilities that will be the real gamechanger.

Bringing together health, social care, public health (and potentially representatives from the wider public space where appropriate, such as social care providers or housing providers) the ICS Health and Care Partnership will be responsible for developing plans that address the wider health, public health, and social care needs of the system.

The opportunities of collaboration are clear. But how systems now seize this opportunity to influence the wider determinants of health will be interesting to see. What role will you play in turning the theory into practice? What changes would have the biggest impact on health for your local population?

To find out more about the Wider Determinants of Health in practice, don’t miss our upcoming event on 28 April 2021. This 5-hour introductory event will bring together leaders and practitioners from across health and care, local and central government, education and housing to explore the core social, cultural, political, economic, commercial and environmental factors that influence health. Book your place to broaden your thinking and discover new ways to better influence Population Health in your community.

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Reducing Risk in Children’s Social Care

Adult and children’s social care have great potential to improve services and reduce risk by linking data silos and automating processes, says Matthew Cooper, Public Sector Leader for Salesforce Industries.

“Technology across central and local government has evolved in a series of data silos, and adult and children’s social care is no different. These data silos introduce risk, gaps in process, and rely on the human element to traverse those gaps,” he says.

This creates barriers to interagency working and leads to inconsistencies in the way social care is provided: “Our social care workers face an ever-increasing workload, and we need to provide tools to help them make the most appropriate decisions when determining eligibility for care services provisioning. There are lots of areas where data silos introduce room for error and where processes should be linked to help our care workers make informed decisions.”

One of the biggest areas where automation can make a difference is risk management. Matthew says: “At the moment it is fairly subjective, so if you have quite a new social worker versus a highly experienced one, do they look at risk in the same way? Is there consistency in the approach?”

“If we use technology to score risk based on a set of criteria, then some of that subjectivity is removed by giving indicators to the social worker, while not taking away from their own judgment.”

If the social worker then reaches a different conclusion, it can trigger “an automated escalation process, so that checks and balances can take place”.

“If you don’t have that and you are relying entirely on the social worker’s judgment – they might have a heavy caseload, they might be under pressure and they might miss something. Automation improves the service and both lowers and mitigates the risk of harm.”

Matthew believes there is still major potential for more use of mobile technology in social care, ensuring social workers have information from a variety of agencies before visiting a client’s home or another setting.

“It’s back to your data silos. If you can take those silos and present information on their mobile on a single screen they can see if a person is in receipt of particular benefits, have visited a hospital recently, or if there have been notifications to the police. If they have a more rounded picture, they can be more effective in their care.”

Automation can be introduced alongside legacy systems, rather than having to do a “big bang application replacement”, Matthew says.

“Nowadays we can introduce replacements process by process while interfacing with the legacy technology and data. So, We can introduce new technology and new practices in a very low-risk way.”

Roundtable: The Role of Technology in Reducing Risk for Vulnerable People

If you’re a senior leader of Social Care or Children’s Services, don’t miss our upcoming roundtable discussing ‘The Role of Technology in Reducing Risk for Vulnerable People’.

To find out more and to Register Your Interest, please click here.

There are only a last few remaining places, so don’t delay in reserving your place.

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Legislating Against Misinformation

The links between misinformation and health have never been more pronounced as social media channels spread harmful inaccurate information about COVID-19 and the efficacy of vaccines.

With the expectation that online targeting systems used to promote content in social media feeds becoming ever-more sophisticated, is now the time to capture some urgency and action around how online platforms are legislated and managed, both within the UK but also internationally?

How misinformation is tackled by the government is of concern to all those working across health, care and wider public services who want to ensure that every person in every community has accurate information to make informed decisions about their health care and wellbeing.

At the recent PublicTechnology Cyber Security Summit, Julian Knight MP explained how marrying competition and legislation aspects together with online safety responsibility – whilst a complex mix – is the best way to approach this challenge. Drawing a comparison to the frameworks and systems already established around financial and legal services, he suggests that if we get it right, good regulation can also benefit business.

Over this past year several important reports and initiatives have paved the way towards a future code of conduct for social media platforms, including:

  • The publication of the Online Harms White Paper published December 2020 sets out plans for a new duty of care to make companies take responsibility for the safety of their users.        
  • Ofcom has been appointed as the regulator for online harms in the UK. They have taken on new responsibilities to protect children and vulnerable people when they are online, with an objective to give everybody greater confidence to enjoy the huge benefits of being online safely.
  • A new Digital Markets Unit has been set up within the Competition and Markets Authority (CMA)with a responsibility to enforce a new code to govern the behaviour of platforms that currently dominate the market, such as Google and Facebook, to ensure consumers and small businesses aren’t disadvantaged.

Regulation is at the heart of these changes – and whilst these new regulatory appointments are still in their infancy – we can be certain of a new era of more responsible actions to benefit citizens and consumers.

As health and care professionals seek to build trust with their patients about their health and care decisions, how these regulations play out will be of utmost interest over the coming months and years.

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Working Together & Population Health at the Heart of NHS Reforms

The release of the ‘Integration and Innovation: working together to improve health and social care for all’ white paper sets out the biggest NHS reforms in a decade.

At the heart of these changes is a shift in focus to delivering outcomes and needs-based services for local populations, taking a Population Health approach. There will be a renewed prioritisation of improving access and quality of care, tackling health inequalities, driving primary prevention initiatives and influencing the wider determinants of health.

Integration will come in two forms. Firstly within the NHS, removing some of the cumbersome boundaries to collaboration and to make working together an organising principle. Secondly, integration between the NHS and others, principally local authorities, as well as different professions, organisations, services and sectors will work with common purpose and in partnership to deliver improved outcomes to health and wellbeing for local people.

There are a number of legislative changes proposed in the paper to remove the needless bureaucracy that has grown up around the commissioning framework for the NHS, amongst other enablers. But more importantly is the intention to establish a statutory ICS in each ICS area. These will be made up of an ICS NHS Body and a separate ICS Health and Care Partnership, bringing together the NHS, local government and partners. ICSs will be accountable for outcomes of the health of the population.

Alongside structural and legislative change will be the development of a data strategy for health and social care, which will capture and build on the lessons of the COVID-19 response and set the direction for data in a post-pandemic system, ensuring that the power of data, used properly, is able to support the transformation of care.

Should the proposals be successfully introduced, the NHS, care organisations and individuals will all benefit from integrated care as the default, reduced legal bureaucracy, and better support for social care, public health and the health services.

If you’re interested to find out more about Population Health & PHM – don’t miss our upcoming event on 24 February 2021. This 5-hour introductory event will bring together leaders and practitioners from across health and care, local and central government, education and housing to collaboratively identify and demystify the what, why and how Population Health and Population Health Management (PHM) systems can change the way we approach the delivery of UK health and care.

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Webinar Round-up: Connected IT to Deliver Care – Any Place, Any Time

Digital transformation during the pandemic has broken down the barriers between health IT systems and the communities they serve.

“Suddenly the edge of the network isn’t controlled anymore – it’s everywhere, it’s your home, it’s your phone, it’s everything. And you can’t do that without the cloud,” Jonathan Murden, lead healthcare technologist for Citrix, told the webinar Connected IT to Deliver Care – Any Place, Any Time.

The webinar was led by Together for Health – a series of events across the public sector led by Dods Group – and IT solutions specialists Citrix.

Keynote speaker Dr Adrian Hayter, a GP at the Runnymede Medical Practice who is also NHS national clinical director for older people, highlighted how a combination of digital technology and the advent of integrated care systems across England finally gives the NHS the chance to meet the public’s expectations that the care they receive is joined up.

Connecting up the sources of information allows a single view of an individual’s health and care, provides insights and intelligence to support population health management and enables consumer apps and wearables to support people in managing their own health and wellbeing.

In many NHS organisations the pandemic has changed the technology team from being seen as a support service to being acknowledged as strategic partners in delivering care, with the IT director working alongside the medical and nursing directors in solving critical problems.

Adrian highlighted the importance of digital teams building on the heightened clinical enthusiasm for technology to learn how to deliver transformation together.

“In this pandemic it’s been amazing how people have worked together to solve problems in quick ways – in almost a hackathon type approach – really involving clinicians in that conversation in a way where transformation can really take hold”.

Panellist Justin Beardsmore, chief technology officer at Lewisham and Greenwich NHS Trust, emphasised the importance of technologists building close relationships with clinical teams to enable a deep understanding of how technology can meet the needs: “You need to get as close to the coalface as possible. It [involves] a lot of observations. You need good relationships.”

The need for remote working during the pandemic has improved the support that GPs and others are able to give frontline community workers such as care home staff. Adrian said: “What we have seen is that the technology has enabled systems of care to support those frontline workers to use simple devices such as oximeters to spot the deteriorating signs of a resident before [it becomes critical].”

In many parts of the country this has enabled GPs to use a ‘virtual ward’ approach to supporting care home residents and people in their own home. Simple observations for vital signs have been transmitted to the GP surgery for assessment, greatly improving the chances of identifying someone at risk from illnesses such as COVID-19 and sepsis.”

“The technology is accelerating at pace,” Adrian said.

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How AI has Revolutionised Health and Social Care

Is AI in the health and care industry hype or reality?

With global spending on AI in healthcare expected to reach $6.6 billion by 2021, expanding to $150 billion by 2026 there is little doubt that AI is here to stay.

The NHS alone has announced its intention to spend £250 million on AI to support a broad range of clinical decisions. These examples include how to speed up test results for cancer screening, brain scans and heart monitoring as well as other predictive models to drive efficiency in the system such as forecasting bed availability or identifying those patients that could be treated in community settings.

As we look to optimise resources across the UK health and care system and deliver best care outcomes, how can we further advance the application of AI to enable the emulation of human tasks through learning and automation?

The pandemic has been an opportunity to accelerate the application of AI. Whereas previously AI was viewed more as an advisory tool, the types of decisions required to manage COVID-19 have benefited from the predictive qualities of AI. Rather than advising, AI has been informing key decisions including those around national lockdowns, as well as serving as a backbone to Track & Trace systems. How will AI remain at the heart of our managerial decision-making for the future?

In clinical settings there also remains a lot of opportunity to be uncovered. The application of an AI-driven computer vision model to more accurately diagnose wet or dry AMD in the eye in itself is ground-breaking – but as a result of further experimentation, there is potential for AI to do much more. A new discovery has uncovered how AI can recognise patterns within the pupil to accurately identify the gender of the patient. This level of assessment and identification goes far beyond the capabilities of a clinician. If AI can do this, what else can it do? How can we further our understanding of patients through AI diagnosis?

What next for AI?

As the pandemic has shown us, the application of AI and analytics for forecasting is certain to accelerate our thinking about how to optimise this as a tool in other scenarios. But whilst there is much progress being made – and much still to do – AI is not a foolproof solution.

Due to the data inputs and assumptions made when developing the machine learning models, there is an inevitable bias in AI models. The role of clinical experts therefore remains as critical as ever. Their critique of the output of AI models, applying their experience and expertise is essential to decision-making. The future will be one where the partnership between AI and clinical expertise will shape better decision-making and better results for patients.

There are other limitations to the application of AI across health and care settings in respect to data privacy as well as data quality, as well as the continuing debate around ethics and use of AI. As we balance the opportunities with the challenges, we’ll need to shape an AI strategy that is fit for purpose.

To find out more about how AI has revolutionised the health and social care industry, view this SAS webinar and learn about:

  • The ways AI has already revolutionised the health and social care industry
  • How AI is at the forefront of tackling COVID-19
  • How AI is helping to save countless lives
  • What lies in the future for health and social care using AI

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What’s the new normal in health care?

Change is the only certain as we start to look beyond the pandemic.

We now have an opportunity to shape the new normal – but what does that mean? Experts at SAS explore 8 key trends and areas of change in this report, challenging traditional ways of working, provoking new questions and inspiring new ideas. We’ve picked out the following key trends from the report below:

The shape and delivery of health care services will look different to today

Whilst the landscape of patient care was already changing, the pandemic has triggered a more significant review of point of care, as well as delivery of care. Virtual consultations have grown through necessity, but will our collective experiences embed this for the future? The report explores care model innovation, new needs for infrastruc­ture and service and the potential for disruption by new players.

AI has the potential to play a key role in the future of managing HAIs

Patient safety and infection control have been key issues in the fight against the spread of COVID-19. A review of approaches to hospital-acquired infections (HAIs) will be inevitable. What role could AI now play in keeping patients safe? The report examines a case study from a hospital in Denmark which has become the first place in the world to implement a complete system for monitoring HAIs. The expectation is to reduce the number of infections during hospitalisation by one third  – is there an opportunity to expand this kind of approach?  

Prediction, prevention and early intervention will be a priority

Keeping citizens healthy and well – as well as reducing the burden of the sick on health care services have both been prevalent themes through the pandemic. These will continue to be important themes as we shape the future. What role does technology play in helping us forecast and manage future pandemics? Supercharging technologies like computer vision, text analytics and predictive modeling with AI can help doctors diagnose diseases earlier and with greater accuracy. The report is packed with practical ideas for how data and technology will be essential as part of our future for prediction, prevention and early intervention.

Now is the time to unlock the power of data-driven thinking in hospitals

The amount of data collected and analysed by hospitals and health care organisations across the world was already on the rise, but the global pandemic has sharpened the focus on data even more.  With trends changing not daily, but hourly, the need for real-time data and analytics drive decision-making has been essential. Whilst the pandemic has pushed for more rapid adoption of analytics, explore with SAS experts where we go from here.

AI can help us get back to care with efficiency and a focus on outcomes

Constraints on capacity and resources will continue to challenge health services for the foreseeable. How in the future can data and technology help us to identify patient treatment needs and use data from one patient, to help the care of the next patient? Through a case study from Amsterdam UMC, one of Europe’s largest oncology centres, the report explores how computer vision and predictive analytics to better identify cancer patients who are candidates for lifesaving surgery.

Data, digital technologies and AI will be core components of the new normal

As we’re seeing across all public services, the pandemic has accelerated digitsation and innovation – skipping years in many cases in driving change. This change is here for good. We are now at the beginning of the next chapter of health care in the UK – and this SAS report offers much food for thought as create, innovate and shape the future.

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‘What’s the new normal in health care?
Changes post-COVID-19 and beyond’

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