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

2. 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

3. 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

5. THE NATURE OF THE HEALTH
SYSTEM

6. 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

7. HEALTH WORK IS A BALANCED MATRIX
Technology
Platform
Team and
Workflow Platform
High Touch High Tech

8. THE NATURE OF THE HEALTH SYSTEM
The challenges to the system

9. 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

10. Projections of Australian government spending by category (per cent of GDP)
INTERGENERATIONAL REPORT 2010

11. Future industry job growth – Australia 5 years from 2009-10 to 2014-15 (‘000) - DEEWR projections
FUTURE WORKFORCE GROWTH AT FEB 2010

12. 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

13. INVESTING IN HEALTH TECHNOLOGY
The challenges to the system

14. 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

15. DIGITAL TECHNOLOGY ADVANCES
Bionics

16. 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

17. Bionic eye

18. Bionic ear

19. Google Glass

20. Google contact lens

21. Pumps and CGM

23. Variation in the mean glucose level among adults and
adolescents
Russell SJ et al. N Engl J Med 2014. DOI: 10.1056/NEJMoa1314474

24. TYPE 2 DIABETES
REVERSING The Disorder

25. 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

26. 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

27. 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

28. 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. 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. 31
Anthropometric data after 8 weeks

32. 32
Biochemical data after 8 weeks

33. 33
Low calorie diets reverse type 2 diabetes
800calories per day

34. CASE STUDY
MRS MW aged 65

35. 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?

36. CASE STUDY
OUTCOMES

37. 37

38. VASCULAR DISEASE
IMAGING

39. 39
Imaging revealing hidden risks

40. 40
Anatomical detail: rapid acquisition

41. 41
Detecting and treating disease early

42. 42
Options to prevent heart attack

43. 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. 44
Types of stents

45. 45
Absorbable stents

46. GENOMICS
The era of personalised medicine

47. 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. 48
Cost of sequencing one genome
Innovations in chemistry,
optics, fluidics,
computational, hardware and
bioinformatics solutions

49. 49
The $1,000 genome is here

50. 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. 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

52. FDA steps in
52

53. 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

54. 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

55. Personal activity monitors The Quantified Self
55

56. 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

57. Use insurance as a driver to
improve adherence to therapy
Conclusion
57
Implications for the
insurance industry
Types of policy Coverage

58. PROFESSOR STEVEN BOYAGES
STEVE.BOYAGES@GMAIL.COM