Predictive Monitoring: Heart Attack and Stroke?

Machine learning via neural networks produces impressive results.  The Blood Glucose prediction hackathon used three data streams: historical blood glucose, insulin dosage and carbohydrate consumption.  This explains approximately 50% of the prediction.

Blood Glucose Predictive Power

Adding three more streams would increase this to 85%; other nutrition, activity and other lifestyle factors.  All these could be simply collected from mobile devices and used in other health prediction applications. It shows the value of monitoring data streams for multiple purposes.  This data could also be analysed alongside logs of blood pressure and heart rhythms.

Just think of the value to people who are at risk of heart attack or stroke.   Real-time predictions of heart rate and blood pressure could set alarms that would moderate a person’s behaviour.  An impertinent machine telling you to Stop driving!, sit down! or have a rest! may upset your plans – but it is better than risking your own or another life.

Machine learning is not rule based – it calculates the rules.

Integrating Social Care and Health

The Government has mandated the integration of health and social care services by 2018, potentially imposing a financial penalties for siloed services.  Good.  There is a budget of about £1bn to ensure there are integrated projects in every part of the country by 2015.

Who is going to lead it in locations where services are delivered?  How is the funding going to be allocated?  These questions do not seem to be answered.  Quarkside suggests looking again at the Framework for Multi-agency Enviroments.  It does not give the answers – but it has a method for bringing all the issues together.  Perhaps the Local CIO Council may give some leadership.

The elderly and their families are most likely to benefit.  Two separate industries, for telehealth and telecare, are growing rapidly.  The new political direction now opens an opportunity for telehealthcare, extending the period older people can remain safely in their own homes.  An integrated service should support all levels of the Kaiser Pyramid.

Observe the need for technology that has to transition from Self Care to Professional Care.  Be aware of the interoperability requirements as more complex monitoring has to be added with increasing risk.  Families will need telehealthcare products that are simple to use.

IDs for a UK Citizen Account

Quarkside has just heard of a way to solve the following problems:

• Benefits costs
• Under employed people
• Education maintenance allowance
• University living costs
• Basic pensions
• Enhanced pensions
• Recovering money for fines
• Health costs

It requires setting up a citizen account (UK citizens only) for EVERY citizen, including children. For sake of an abbreviation, we will call it the UK Citizen Account (UCA). The following rights are given, they are paid from taxation, without exception, into a freely spendable account (FSA).

• 0-16 child allowance, spendable by nominated parent or guardian
• 16-18 youth allowance, spendable by the young person
• 19-24 tertiary education allowance, spendable by the citizen
• 24-67 working age allowance
• 67-80 first pension
• 80+ second pension

Alongside the government input is personal input which is a proportion of taxable income.  This is a protected endowment account (PEA).  The main aim is to build up a personal fund that can be drawn down as housing, pension, health and mid-life education.  The nearest analogy is Singapore’s Central Provident Fund (CPF).  It is a colonial legacy: ” When the Japanese Occupation ended in 1945, Singapore became a British colony again. Life was hard. People struggled to make ends meet. To ensure that workers could take care of themselves in their old age, the Central Provident Fund was set up as a compulsory savings scheme. ”

The benefits to the government are:

• Simplicity of administration – entitlements are universal, every citizen independent of other income
• Means tested benefits cease, such as housing benefit.
• Personal National Insurance (NI) contributions are paid into the PEA, like a compulsory personal insurance.
• Employers NI contributions are paid into the PEA as a percentage of taxable income.
• Debts to the government can be taken from the fund, eg fines, unpaid taxes.
• Choice by the citizen for medical treatment.  The tariffs are well documented.  A percentage is taken from the PEA for every access to NHS services – lower percentage for basic services (10%) – higher percentage for more expensive, private care provision (90%).
• Funding for infrastructure from accrued savings
• Funding for low cost housing by giving loans from accrued personal PEA savings
• Choice to use the PEA for adult education and retraining for new skills.   The Working Age Allowance is always paid to provide some basic income.

The benefits to the citizen are:

• Guaranteed untaxed income throughout life, whether working or not.
• Working will always be better than not working.
• Protected Fund, built up by work, for spending on housing, further education, pensions and health.
• Additional contributions from employers (including self-employed), interest on account and profits from fund investments.
• Opportunity to obtain a mortgage from funds accrued – commercial interest rates will be charged.
• Opportunity to pay for adult education or re-training.
• No risk of bankrupt or stolen pension funds.
• Choice to pay for care at home or residential homes.
• The residue on death forms part of the estate – not taken by the government.

The details can be sorted out, but it avoids the costly mistake of Universal Credits.  Such a total restructure of the welfare state means sacrificing sacred cows. Singapore now has a handle on social welfare costs, unlike the UK.  They have a successful economy.  Rationing of health costs is left to citizens and their families.

And the governance issue is: – citizens will need to have a trusted Identity,  without too many duplicates.  Perhaps this will be good enough to allow them to vote, too.