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

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

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Beyond the medical curve presentation Beyond the medical curve presentation Presentation Transcript

  • 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
  • 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
  • THE NATURE OF THE HEALTH SYSTEM
  • 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
  • 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, 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
  • 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 AT FEB 2010
  • 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
  • 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 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
  • DIGITAL TECHNOLOGY ADVANCES Bionics
  • 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
  • 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/NEJMoa1314474
  • TYPE 2 DIABETES REVERSING The Disorder
  • 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
  • 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
  • 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
  • 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.
  • 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.
  • 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 units per day Height 155 cm; weight 140 kg Poor circulation Unable to exercise What is her risk? Would you insure her?
  • 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 (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.
  • 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 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
  • 48 Cost of sequencing one genome Innovations in chemistry, optics, fluidics, computational, hardware and bioinformatics solutions
  • 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 the HiSeq X. The machine, about the size of a large photocopier, can knock out 20,000 human genomes per year.
  • 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
  • FDA steps in 52
  • 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
  • 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
  • Personal activity monitors The Quantified Self 55
  • 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
  • Use insurance as a driver to improve adherence to therapy Conclusion 57 Implications for the insurance industry Types of policy Coverage
  • PROFESSOR STEVEN BOYAGES STEVE.BOYAGES@GMAIL.COM