Your SlideShare is downloading. ×
0
Presented by Professor Steven Boyages
THE UNIVERSITY OF SYDNEY
August 2014
BEYOND
THE MEDICAL CURVE
© 2014 BUSINESS HEALTH...
Workflow
Education
Clinical care
Who am I?1
The nature of the health system?2
The drivers for change in health3
The Value ...
THE NATURE OF THE HEALTH
SYSTEM
The nature of patient care is a constant
HEALTH IS A KNOWLEDGE
BASED PROFESSION
Research
Development
Education
Training
Ca...
HEALTH WORK IS A BALANCED MATRIX
Technology
Platform
Team and
Workflow Platform
High Touch High Tech
THE NATURE OF THE HEALTH SYSTEM
The challenges to the system
Challenges to the health system
RISING DEMAND
• Growing & ageing population
• Chronic illness rising
• High levels smoking...
Projections of Australian government spending by category (per cent of GDP)
INTERGENERATIONAL REPORT 2010
Future industry job growth – Australia 5 years from 2009-10 to 2014-15 (‘000) - DEEWR projections
FUTURE WORKFORCE GROWTH ...
Principal Incident Type Number
Fall 13,137
Medication/IV Fluid 10,793
Clinical Management 10,082
Agression-agressor 6,704
...
INVESTING IN HEALTH TECHNOLOGY
The challenges to the system
Investing in health IT perceived as a solution
to some of the challenges
BENEFITS
• Improved automation
• Improved product...
DIGITAL TECHNOLOGY ADVANCES
Bionics
Bionics
Bionics
(also known as
bionical creativity engineering)
is the application of
biological methods and
systems found...
Bionic eye
Bionic ear
Google Glass
Google contact lens
Pumps and CGM
Variation in the mean glucose level among adults and
adolescents
Russell SJ et al. N Engl J Med 2014. DOI: 10.1056/NEJMoa1...
TYPE 2 DIABETES
REVERSING The Disorder
Reference: 1. International Diabetes Federation. Diabetes Atlas 5th ed, 2012 update. Available
from http://www.idf.org/sit...
900,000 people with T2DM registered on the
National Diabetes Services Scheme²
T2DM in Australia,
June 2013
70,000 addition...
Visual impairmentRenal disease
Neuropathy Cardiovascular disease
Reference:
3. Baker IDI Heart and Diabetes Institute. Dia...
T2DM is characterized ‘classically’ by insulin resistance and beta-cell dysfunction
Type 2 Diabetes – a progressive diseas...
29
Multiple pathophysiological failures contribute
to hyperglycaemia in T2DM
1. Gerich, J. E. Role of the kidney in normal...
31
Anthropometric data after 8 weeks
32
Biochemical data after 8 weeks
33
Low calorie diets reverse type 2 diabetes
800calories per day
CASE STUDY
MRS MW aged 65
Case study: MW
35
MW aged 65
First seen 04/2013
Diabetes type 2 30 yrs; on insulin 15 yrs;
hypertension, on insulin 200 un...
CASE STUDY
OUTCOMES
37
VASCULAR DISEASE
IMAGING
39
Imaging revealing hidden risks
40
Anatomical detail: rapid acquisition
41
Detecting and treating disease early
42
Options to prevent heart attack
43
Heart disease
Absorb: Background
The goal of this trial was to evaluate the use of
bioabsorbable drug-eluting stent (DE...
44
Types of stents
45
Absorbable stents
GENOMICS
The era of personalised medicine
Clinical Applications of Whole Genome and Exome Sequencing
Diverse applications of WGS in clinical medicine
47
Adapted for...
48
Cost of sequencing one genome
Innovations in chemistry,
optics, fluidics,
computational, hardware and
bioinformatics so...
49
The $1,000 genome is here
50
The $1,000 genome is here
On Jan. 14, 2014,
Illumina reduced the cost of
sequencing by a factor of 10
when it unveiled ...
51
World’s largest sequencing operation
Human Longevity Inc.
J. Craig Venter; Robert Hariri and
Peter H. Diamandis
Begin s...
FDA steps in
52
Obstacles
Obstacles to be addressed to bring WGS into routine clinical use
53
Reduce error rate
Improved
bioinformatic too...
Major conclusions of paper
If positive the test was deemed to be clinically useful,
in only one disease (Alzheimer)
54
Dis...
Personal activity monitors The Quantified Self
55
Summary
Unprecedented developments in bionic technology for diagnosis and treatment of disease
Changing nature of chronic ...
Use insurance as a driver to
improve adherence to therapy
Conclusion
57
Implications for the
insurance industry
Types of p...
PROFESSOR STEVEN BOYAGES
STEVE.BOYAGES@GMAIL.COM
Beyond the medical curve presentation
Beyond the medical curve presentation
Beyond the medical curve presentation
Beyond the medical curve presentation
Upcoming SlideShare
Loading in...5
×

Beyond the medical curve presentation

144

Published on

The future of health care and digital technology: presentation to the MLC Risk Conference August 2014

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
144
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
5
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Transcript of "Beyond the medical curve presentation"

  1. 1. Presented by Professor Steven Boyages THE UNIVERSITY OF SYDNEY August 2014 BEYOND THE MEDICAL CURVE © 2014 BUSINESS HEALTH PTY LTD OUR HEALTH IN A DIGITAL WORLD
  2. 2. Workflow Education Clinical care Who am I?1 The nature of the health system?2 The drivers for change in health3 The Value of investing in DIGITAL HEALTH4 3COMMUNICATION: CONTENT IS KING | AUGUST 2014 OUTLINE The impact of digital technology on disease5 Research
  3. 3. THE NATURE OF THE HEALTH SYSTEM
  4. 4. The nature of patient care is a constant HEALTH IS A KNOWLEDGE BASED PROFESSION Research Development Education Training Care Prevention Generate Knowledge Impact Knowledge Apply Knowledge
  5. 5. HEALTH WORK IS A BALANCED MATRIX Technology Platform Team and Workflow Platform High Touch High Tech
  6. 6. THE NATURE OF THE HEALTH SYSTEM The challenges to the system
  7. 7. Challenges to the health system RISING DEMAND • Growing & ageing population • Chronic illness rising • High levels smoking, obesity, stress • High consumer expectations • Patient Safety • Workforce shortages and attitudes • Manage demand within finite resources • Cost vs investment • NSW spends about 28% of budget on health care • 1.3 million dollars per hour CONSTRAINED CAPACITY
  8. 8. Projections of Australian government spending by category (per cent of GDP) INTERGENERATIONAL REPORT 2010
  9. 9. Future industry job growth – Australia 5 years from 2009-10 to 2014-15 (‘000) - DEEWR projections FUTURE WORKFORCE GROWTH AT FEB 2010
  10. 10. Principal Incident Type Number Fall 13,137 Medication/IV Fluid 10,793 Clinical Management 10,082 Agression-agressor 6,704 Behavior/Human Performance 5,446 Pressure Ulcer 4,512 Documentation 4,182 Accident/occupational health and safety 2,735 Organisation management/service 1,647 Medical device/equipment/property 1,519 Blood/blood product 910 Agression-victim 768 Health care associated infection/infestation 679 Pathology/laboratory 415 Complaint 401 Nutrition 395 Security 228 Building/fittings/fixtures/surrounds 174 Oxygen/gas/vapour 40 Total 64,767 Patient safety IIMS notifications by principal incident type July-December 2009 Clinical incident notifications in IIMS January 2005 – December 2009
  11. 11. INVESTING IN HEALTH TECHNOLOGY The challenges to the system
  12. 12. Investing in health IT perceived as a solution to some of the challenges BENEFITS • Improved automation • Improved productivity • Reduced duplication • Improved safety • Improved patient and staff experience • Improved reach of information and service • Financial investment not realised • Poor connectivity • Lack of common standards • Increased risk to patients • Increased staff frustration and lower morale • Staff expectations not realised • Poor execution and implementation due to inadequate training RISKS
  13. 13. DIGITAL TECHNOLOGY ADVANCES Bionics
  14. 14. Bionics Bionics (also known as bionical creativity engineering) is the application of biological methods and systems found in nature to the study and design of engineering systems and modern technology
  15. 15. Bionic eye
  16. 16. Bionic ear
  17. 17. Google Glass
  18. 18. Google contact lens
  19. 19. Pumps and CGM
  20. 20. Variation in the mean glucose level among adults and adolescents Russell SJ et al. N Engl J Med 2014. DOI: 10.1056/NEJMoa1314474
  21. 21. TYPE 2 DIABETES REVERSING The Disorder
  22. 22. Reference: 1. International Diabetes Federation. Diabetes Atlas 5th ed, 2012 update. Available from http://www.idf.org/sites/default/files/5E_IDFAtlasPoster_2012_EN.pdf [accessed Nov 2013]. International Diabetes Federation Diabetes Atlas 2012
  23. 23. 900,000 people with T2DM registered on the National Diabetes Services Scheme² T2DM in Australia, June 2013 70,000 additions over the past 12 months² Total annual cost of T2DM is up to $6 billion (T1DM $570 million)³ ≈ 200 new cases per day²
  24. 24. Visual impairmentRenal disease Neuropathy Cardiovascular disease Reference: 3. Baker IDI Heart and Diabetes Institute. Diabetes: The silent pandemic and its impact on Australia. Available from http://www.diabetesaustralia.com.au/Documents/DA/What's%20New/12.03.14%20Diabetes%20management%20booklet%20FINAL.pdf [accessed Nov 2013]. Major complications of diabetes3
  25. 25. T2DM is characterized ‘classically’ by insulin resistance and beta-cell dysfunction Type 2 Diabetes – a progressive disease AdAdapted from Bailey et al. Krentz AJ, Bailey CJ. Type 2 Diabetes in Practice. 2nd ed. London, UK: Royal Society of Medicine Press; 2005.
  26. 26. 29 Multiple pathophysiological failures contribute to hyperglycaemia in T2DM 1. Gerich, J. E. Role of the kidney in normal glucose homeostasis and in the hyperglycaemia of diabetes mellitus: therapeutic implications. Diabetic Medicine. 2010; 27: 136-142. 2. Valentine, V. The role of the kidney and sodium-glucose cotransporter-2 inhibition in diabetes management. Clinical Diabetes. 2012; 4: 151-155. Adapted from Defronzo RA. Diabetes 2009;58:773–95.
  27. 27. 31 Anthropometric data after 8 weeks
  28. 28. 32 Biochemical data after 8 weeks
  29. 29. 33 Low calorie diets reverse type 2 diabetes 800calories per day
  30. 30. CASE STUDY MRS MW aged 65
  31. 31. Case study: MW 35 MW aged 65 First seen 04/2013 Diabetes type 2 30 yrs; on insulin 15 yrs; hypertension, on insulin 200 units per day Height 155 cm; weight 140 kg Poor circulation Unable to exercise What is her risk? Would you insure her?
  32. 32. CASE STUDY OUTCOMES
  33. 33. 37
  34. 34. VASCULAR DISEASE IMAGING
  35. 35. 39 Imaging revealing hidden risks
  36. 36. 40 Anatomical detail: rapid acquisition
  37. 37. 41 Detecting and treating disease early
  38. 38. 42 Options to prevent heart attack
  39. 39. 43 Heart disease Absorb: Background The goal of this trial was to evaluate the use of bioabsorbable drug-eluting stent (DES) platform among patients undergoing elective percutaneous coronary intervention (PCI) for a de novo coronary lesion. The bioabsorbable structure of the stent is made of polylactic acid, a biodegradable polyester derived from lactic acid.
  40. 40. 44 Types of stents
  41. 41. 45 Absorbable stents
  42. 42. GENOMICS The era of personalised medicine
  43. 43. Clinical Applications of Whole Genome and Exome Sequencing Diverse applications of WGS in clinical medicine 47 Adapted for Clinical Chemistry from Chrystoja CC, Diamandis EP. Whole Genome Sequencing as a Diagnostic Test: Challenges and Opportunities. 2013 Nov 13 Clinical Applications of Whole Genome and Exome Sequencing Individualization of treatment Molecular characterization of disease Pharmacogenomics Population screening for disease risk Prenatal screening
  44. 44. 48 Cost of sequencing one genome Innovations in chemistry, optics, fluidics, computational, hardware and bioinformatics solutions
  45. 45. 49 The $1,000 genome is here
  46. 46. 50 The $1,000 genome is here On Jan. 14, 2014, Illumina reduced the cost of sequencing by a factor of 10 when it unveiled the HiSeq X. The machine, about the size of a large photocopier, can knock out 20,000 human genomes per year.
  47. 47. 51 World’s largest sequencing operation Human Longevity Inc. J. Craig Venter; Robert Hariri and Peter H. Diamandis Begin sequencing up to 40,000 human genomes per year and has plans to scale- up to 100,000 genomes per year Genetic and Engineering News, April 2014
  48. 48. FDA steps in 52
  49. 49. Obstacles Obstacles to be addressed to bring WGS into routine clinical use 53 Reduce error rate Improved bioinformatic tools Reduce hidden sequencing costs Prospective clinical trials Develop quality assurances & standardisation Address ethical & interpretative concerns
  50. 50. Major conclusions of paper If positive the test was deemed to be clinically useful, in only one disease (Alzheimer) 54 Disease risk is likely not assessed efficiently by WGS in the other 23 diseases likely because environmental factors may have been dominant over genetic factors
  51. 51. Personal activity monitors The Quantified Self 55
  52. 52. Summary Unprecedented developments in bionic technology for diagnosis and treatment of disease Changing nature of chronic illness 56 1 2 Need to consider some chronic illnesses more as a disability3 Increasing lifespan for those with chronic illness4 Reversibility of chronic disorders eg heart disease and diabetes5 Impact of genomics on assessing risk6
  53. 53. Use insurance as a driver to improve adherence to therapy Conclusion 57 Implications for the insurance industry Types of policy Coverage
  54. 54. PROFESSOR STEVEN BOYAGES STEVE.BOYAGES@GMAIL.COM
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×