beyond the medical curve presentation
DESCRIPTION
The future of health care and digital technology: presentation to the MLC Risk Conference August 2014TRANSCRIPT
Presented by Professor Steven BoyagesTHE UNIVERSITY OF SYDNEYAugust 2014
BEYONDTHE MEDICAL CURVE
© 2014 BUSINESS HEALTH PTY LTD
OUR HEALTH IN A DIGITAL WORLD
COMMUNICATION: CONTENT IS KING | AUGUST 2014
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
3
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
DevelopmentEducation
Training
Care
Prevention
GenerateKnowledge
ImpactKnowledge
ApplyKnowledge
HEALTH WORK IS A BALANCED MATRIX
TechnologyPlatform
Team andWorkflow 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 typeJuly-December 2009
Clinical incident notifications in IIMSJanuary 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 asbionical creativity engineering)is the application of
biological methods and
systems found in natureto 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 impairment Renal 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 contributeto 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.
45
Absorbable stents
GENOMICS
The era of personalised medicine
Clinical Applications of Whole Genome and Exome SequencingDiverse applications of WGS in clinical medicine
47Adapted 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
PharmacogenomicsPopulation
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
POLICY
