“The increase in knowledge is exponential: every ten years the amount of information we have doubles, and it’s being debated whether in fact it doubles every five years. When healthcare professionals finish their degrees, they still lack over half the knowledge they will need to do their job during their lifetime. The knowledge they have gained in medical school will be outdated in twenty or thirty years, unless they opt for a lifelong learning programme.” Jim Roldan, CEO of Linkcare, is convincing in his evaluation of the flow of knowledge, the speed with which it circulates and is renewed. In this rapid change he has known how to see an opportunity, and perhaps also a solution.
“Population ageing is considerable. A total of 80% of public health spending is on care for people over fifty years old. Consequently, as the population ages, healthcare demand increases. The current model does not function very well. One of the reasons for this is that the model is mainly based on doctors and specialists, and was designed for a population with acute illnesses. Now, many patients are elderly people who need a different kind of care, involving monitoring disease development, encouragement and socialization. Doctors and specialists do not have the right professional background for this task. Another kind of healthcare professional is required, who is called a ‘case manager’ in some countries.”
Taking these factors together, Jim Roldan has devised a healthcare system based on information exchange. It is a structure in which knowledge is shared horizontally and vertically. In horizontal collaboration, doctors form groups according to their speciality and share protocols and clinical data, always with the patient’s permission and anonymously. This would be like a kind of social network with areas for discussion between people who have common interests. However, Roldan considers that the real challenge is to achieve vertical collaboration. This consists of giving the responsibility for many decisions that are currently made by specialists to the healthcare levels that are closer to the patient.
«We need to double the number of professionals in less than a decade»
This is where the ‘case managers’ come into play. This new kind of professional would have to use protocols to manage the health of patients who do not have serious conditions, and to refer patients to a higher level of healthcare if they need the support of a specialist. “The equivalent in Spain would be the general practitioner. However, it takes ten years to train a general practitioner, and we need to double the number of professionals in less than a decade. Either we double the number of faculties of medicine, or we devise a new qualification that is similar to a medical degree but takes as long as a nursing qualification. Some countries have allocated case management to the general practitioners, in others it is the task of the nurse practitioner”.
This system would cover the vertical dimension of the health system, up to the last person responsible for health: the individual. Linkcare is testing strategies for patient empowerment, including gamification, which makes management of your own health into a game, and health monitors, which are mobile devices that monitor the amount of exercise that you do. The data are associated with medical protocols, so that at the end of the day a report is sent to the user on his/her activity. “Pilot studies are already running in these projects. Unfortunately, they have not yet been rolled out on a large scale in any health district.
Nevertheless, Catalonia is on the right path, as healthcare is being reorganized into districts and a space is being created for dialogue between the people that form part of this community. I am talking about health consortiums, which have another advantage: they must do more with less. The budget cuts are what they are, so we have to leave the comfort zone and find strategies that are more effective at a lower cost”. Therefore, the conditions are ideal for proposing and testing alternatives to conventional healthcare.