Can AI and technologies help improve health, social care and social security services delivery?
Imagine a theoretical, but possible case of Elizabeth, a 48 year old woman, whose occupation is one that includes a high percentage of driving each day. She suffers from chronic type 2 diabetes and has been told that an amputation is now necessary. She is a single mother with a five year old son, and lacks both family and community support. In addition to her respective healthcare provision, post amputation she will also qualify for sickness benefit and afterwards disability benefit with functional and vocational rehabilitation support.
So, in terms of her ongoing care, she will require support from not just her healthcare provider for both her physical and mental wellbeing but also from social services and social security too to ensure she is able to support herself and her son in the future. A complex, but sadly not a rare situation.
What if it were possible to identify in advance those aspects of Elizabeth’s current and future needs that would help give her, her son and those involved in her care and welfare a coordinated delivery of care. But, how would priorities be defined? How would care responsibilities be assigned and to whom? How would Elizabeth’s health, social care and social security be coordinated across disparate organisations whilst ensuring clear communication channels are available for all those involved? And, how to make sure that Elizabeth feels she is getting the attention and support she so badly needs?.
Chronic diseases, such as type 2 diabetes, are a significant cause of disabilities and fatalities. Worldwide 7 out of 10 people die from some form of chronic disease. In Europe two out of three people at retirement age will have at least two chronic conditions. Cardiovascular diseases, cancer, diabetes and COPD account for the majority of these cases. An individual patient, irrespective of age, can suffer from a variety of chronic conditions simultaneously and all too frequently these are accompanied by anxiety, depression or other possible mental health situation.
The change in how care needs to be managed and delivered is now all too obvious. We are witnessing the increasing shift from chronic to complex disease, acute to chronic care needs and the absolute requirement for coordinated primary, secondary and community care.
But the challenges don’t stop there. In my experience, demographic changes, behavioral transformations, socio-economic pressures amongst others, are contributing factors in both physical and mental disability, loneliness, low income, unemployment, displacements, poor housing conditions to name just a few.
As a result, I see that care and social security interventions are more commonplace and imply multiple disciplines with involvement from different types of organisations. For them social inclusion, reactivation and integration are paramount.
Additionally, individual self-management of care needs is becoming a preferred option. But to do this effectively requires crossing organisational boundaries, improving care stakeholder coordination and the overall promotion and fostering of self-care management.
Thus, due to the pressure on both health and social resources, the ability to deliver personal high quality care to all when individuals are increasingly suffering from highly complex conditions, is at breaking point.
Regrettably the instances where there is a very high-level of health and social complexity converging, is growing. Frequently in all these types of cases, like Elizabeth’s above, the individual is viewed as a patient from a healthcare perspective, whereas for social services and social security they are seen as a citizen or resident with the right to receive benefits or identified as someone with social care needs.
Each organisation takes ownership for the area in which they serve but the challenge is to avoid redundancies and gaps in care by better coordinating efforts, while giving more voice to the person and their families. Being person centric is paramount.
Integrated care: The third care path
There are many different ways to define integrated care. Armitage et Al found more than 175 definitions and concepts. In this article Integrated Care is understood as a person centric service delivery model where health, social care and/or social security are provided in an integrated and coordinated way to support the individual.
Relying solely on the healthcare providers or the social care bodies to provide for an individual’s wellbeing is no longer a sustainable or viable option. Healthcare for instance cannot address child protection or disability benefits in the same way that social care cannot be responsible for the treatment of a chronic disease.
The coming together of both health and social care providers ostensibly acting as one, is an absolute.
Only then can complex situations where health and social complexity are combined be properly managed.
Integrated Care can be achieved via a number of different paths: Evolving from the Health Care Sector, from the Social Care Sector, from the social security or starting right from the beginning with an Integrated Care Path.
Looking for solutions: Why artificial intelligence can help make the difference
It is not just about our understanding of complex health and social situations. It is also about giving time back to the person, be they citizen, patient, care giver, or physician, just to mention a few.
An ideal scenario is to give all people involved, including the individual at the core, the ability to identify needs across the care spectrum, define a tailored and coordinated care plan properly executed before a situation becomes critical. Care becomes proactive rather than reactive. There is more time to allow for the ‘unforseen’ and deal with it. There is less pressure on resources; not just individuals, but systems and finances too, through the efficiencies gained in pre-emptive planning.
But how do we get to that ideal scenario. The use of data is implicit and a key common denominator. Transforming data into knowledge and using it to think ahead is paramount. Artificial intelligence as a technology is capable of accessing and reading structured and unstructured data, including free text written in “daily” language. With the adequate training this technology can understand images, videos and voice. It is also able to learn and augment knowledge by executing comprehensive algorithms at different levels. A system such as IBM Watson can read and extract insights at a pace of 200 million pages per three seconds and gives the opportunity to provide insights into thereto unrevealed data.
Think about how much time it would take care professionals to read, absorb and analyse that volume of data – time that could be spent with those individuals that require their time and attention.
Let us now revisit Elizabeth’s case and review some of the areas where the application of AI could have helped Elizabeth and her son.
It could have:
- Read laws, catalogues of benefits to which the person and or her son could be entitled to and assist the person with understanding the information and documentation to be presented to the respective organizations.
- Read electronical medical records, social care notes, scientific journals, and present highlights of medical and social needs and summaries of reports.
- Cross key findings with evidence-based medicine, evidence-based social care, to help the workers responsible for service provision to save time by reading on behalf of them and presenting them for their consideration with the relevant information.
- Providing holistic view to multi-disciplinary teams to work in a coordinated way.
- Smooth processes by supporting adequate knowledge exchange and care planning.
This technology is already available and is already widely used in the consumer world. What is stopping Artificial intelligence from helping to bring integrated care to another service dimension?
 World Health Organization. Non communicable diseases. [online] Available at: https://www.who.int/en/news-room/fact-sheets/detail/noncommunicable-diseases [Accessed 9 Apr. 2019].
 European Chronic Disease Alliance. Ncdalliance.org. (2019). European Chronic Disease Alliance leading network to address employment of people with chronic diseases | NCD Alliance. [online] Available at: https://ncdalliance.org/news-events/news/european-chronic-disease-alliance-leading-network-to-address-employment-of-people-with-chronic-diseases [Accessed 9 Apr. 2019]
 Armitage et Al,International Journal of Integrated Care – Vol. 9, 17 June 2009 – ISSN 1568-4156 – http://www.ijic.org/
 IBM Corporation, IBM Watson: Next-generation cognitive system,2013 – https://www.ibm.com/developerworks/community/blogs/efc1d8f5-72e5-4c4f-99df-e74fccea10ca/resource/White%20Papers/IBMWatsonNextGenerationofCognitiveSystemswhitepaper.pdf?lang=en