1. 1
Digital
transformation
of
the
health
sector
–
opportunities
and
challenges1
Dr
David
Noble,
Founding
Director,
BDI
Health
“When
you
grow
up
you
tend
to
get
told
that
the
world
is
the
way
it
is
and
you're
life
is
just
to
live
your
life
inside
the
world.
Try
not
to
bash
into
the
walls
too
much.
Try
to
have
a
nice
family
life,
have
fun,
save
a
little
money.
That's
a
very
limited
life.
Life
can
be
much
broader
once
you
discover
one
simple
fact:
Everything
around
you
that
you
call
life
was
made
up
by
people
that
were
no
smarter
than
you.
And
you
can
change
it,
you
can
influence
it,
you
can
make
things
that
other
people
can
use…
Once
you
learn
that,
you'll
never
be
the
same
again.”
Steve
Jobs
Transformation,
be
it
digital
or
otherwise,
is
fundamentally
a
cultural
event.
A
revolution
if
you
will.
Technology
provides
the
tools
for
the
revolution.
The
outcome
of
transformation
is
dependent
on
the
usefulness
of
the
tools
and
the
validity
of
the
reason
for
the
change.
Our
health
care
system
is
economically
unsustainable
and
must
undergo
transformation
and
medicine
is
moving
from
a
physician-­‐centric
model
towards
a
patient
or
user-­‐-­‐centric
model.
So,
will
doctors
be
replaced
by
technology
or
robots?
I
do
not
think
this
will
happen,
although
the
role
of
the
doctor
will
inevitably
change
as
a
result
of
this
technological
and
social
progress.
Technology
is
just
a
tool
to
achieve
this
better
outcome;
the
question
is
how
to
transform
the
health
sector
by
applying
technology
to
achieve
better
economic
and
social
outcomes
–
for
medical
practitioners
as
well
as
for
patients
and
their
families,
and
ultimately
for
the
country
as
a
whole.
What
the
health
community
needs
to
understand
is
that
people
want
to
have
the
tools
to
help
them
lead
a
full
life;
they
do
not
want
just
more
tools
designed
for
a
limited
life.
The
four
Cs
In
order
to
take
advantage
of
the
technological
tools
of
this
digital
health
revolution,
we
need
to
have
transformation
as
part
our
corporate
DNA.
This
requires
four
key
assets
in
our
collective
human
capital
-­‐
capability,
capacity,
culture
and
courage.
• Capability
is
the
intrinsic
strengths
and
weaknesses
of
the
people
in
the
organisation
• Capacity
is
the
collective
skills
and
knowledge
acquired
from
learning
and
lived
experience
• Culture
(or
fit)
relates
to
understanding
our
position
and
relevance
in
the
marketplace.
It’s
about
understanding
user
expectations
and
our
role
in
their
world.
• Courage
is
the
willingness
to
defy
convention
and
accepted
practice.
To
persist
because
you
believe
what
you
are
dong
is
right.
Drivers
of
the
digital
transformation
of
health
Until
the
Global
Financial
Crisis
(GFC),
the
health
system
worked
in
autonomously
governed
silos.
No-­‐one
particularly
worried
about
how
much
it
cost.
The
system
was
based
on
supply
and
demand,
with
the
medical
profession
in
the
driving
seat.
Post
GFC,
everyone
started
to
look
carefully
at
the
cost
of
health
care.
The
ageing
population,
combined
with
awareness
that
with
age
comes
increasing
healthcare
cost,
has
driven
all
governments
to
reconsider
the
health
care
model
and
to
ask
how
technology
can
assist
in
improving
care
while
also
reducing
cost.
The
traditional
“sickness”
model
1
This
is
an
edited
version
of
a
presentation
given
by
Dr
David
Noble
at
Telstra’s
Chief
Technology
Office
on
16
April
2015.
[1]
This
is
an
edited
version
of
a
presentation
given
by
Dr
David
Noble
at
Telstra’s
Chief
Technology
Office
on
16
April
2015.
The
views
expressed
here
are
personal
in
nature
and
do
not
necessarily
reflect
those
of
Telstra,
IBM,
Federation
University
Australia
or
any
other
third
party.

2. 2
The
traditional
health
care
model
is
what
could
be
called
the
‘’sickness
model”.
It
is
based
on
remunerating
doctors
for
treating
illness.
The
medical
practitioner,
using
an
evidenced
based
approach,
investigates
the
illness
using
a
variety
of
testing
methods,
and
based
on
this
data
then
intervenes
and
tries
to
alleviate
the
symptoms
and
ultimately,
if
possible,
cure
the
condition.
In
this
traditional
model,
the
patient
has
to
trust
the
practitioner’s
skills,
knowledge
and
contacts,
to
get
the
best
outcome.
This
model,
which
is
highly
regulated
and
relies
on
precedent
and
peer
reviewed
practice,
leads
to
increasing
demands
on
the
health
care
budget,
as
testing
and
intervention
regimes
become
more
and
more
sophisticated
and
therefore
more
and
more
expensive.
In
a
universal
health
care
system,
such
as
in
Australia,
the
Government
comes
under
increasing
pressure
to
continually
improve
the
standard
of
care
for
the
community,
which
leads
to
increasing
scrutiny
of
the
cost.
However,
as
it
is
highly
regulated
and
based
on
precedent
and
accepted
practice,
it
is
resistant
to
significant
change.
The
“wellness”
model
The
new
model
of
health
care
is
the
“wellness
model”.
This
is
different
to
the
traditional
model,
in
that
it
relies
on
prevention
of
illness,
and
is
aimed
at
keeping
the
user
healthy
for
as
long
as
possible.
The
doctor
can
be
one
of
a
number
of
health
practitioners
working
together
to
keep
the
patient
well;
only
where
this
approach
fails,
as
it
were,
does
the
traditional
model
of
treatment
kick
in.
It
is
much
cheaper
–
both
for
the
individual
and
for
the
society
and
economy
as
a
whole
-­‐
to
keep
people
well
and
out
of
hospital
and
out
of
the
traditional
health
care
system
for
as
long
as
possible.
IT
companies
are
attracted
to
this
new
model
of
healthcare,
as
it
is
not
highly
regulated;
it
is
based
on
a
preventative
approach
using
diet,
exercise
and
wearable
technology
which
monitors
the
person’s
lifestyle
and
vital
signs.
It
is
a
massively
growing
market.
For
example,
IBM,
Apple
and
other
partners
have
just
announced
a
partnership
to
capture
and
analyse
personal
health
data,
to
provide
better
predictive
analytical
tools,
with
the
stated
aim
of
improving
healthcare
and
outcomes.
To
dramatically
advance
the
quality
and
effectiveness
of
personal
healthcare,
IBM
is
establishing
a
Watson
Health
Cloud
that
will
provide
a
secure
and
open
platform
for
physicians,
researchers,
insurers
and
companies
focused
on
health
and
wellness
solutions.
The
HIPAA-­‐enabled
Watson
Health
Cloud
will
enable
secure
access
to
individualized
insights
and
a
more
complete
picture
of
the
many
factors
that
can
affect
people’s
health
2
.
Who
owns
your
health
data?
This
and
other
personal
health
applications
raise
the
question:
Who
will
own
the
data
generated
from
these
new
devices
and
stored
and
analysed
in
the
cloud?
Whereas
in
the
past
the
doctor
or
medical
practitioner
held
all
of
your
data
in
one
place
and
controlled
it,
and
virtually
owned
it,
in
the
future
the
‘patient’
or
user,
will
generate
his
or
her
own
data.
This
raises
the
vexed
question
of
who
owns
the
user-­‐generated
data?
The
traditional
medical
system
does
not
yet
understand
the
importance
of
this
issue;
they
are
used
to
always
owning
their
patients’
data
and
having
access
to
it.
What
happens
if
a
third
party,
such
as
IBM
or
Google,
captures
the
user
generated
data
from
the
patient,
and
the
medical
practitioner
has
to
pay
to
get
access
to
it?
The
medical
community
will
be
left
behind
in
the
race
to
control
user
data
if
they
do
not
wake
up
to
the
importance
of
the
data
gatekeepers.
As
far
as
the
patient
is
concerned,
many
younger
people,
the
digital
natives,
seem
a
lot
more
relaxed
about
sharing
their
personal
data
with
others.
It
is
often
a
matter
of
the
patient
or
user
making
a
trade-­‐off
between
privacy
and
personal
benefit.
The
problem
arises
if
the
data
is
later
used
for
purposes
other
than
for
which
the
individual
has
approved
its
use.
Many
companies
rely
on
the
letter
of
the
law
to
determine
their
approach
to
social
issues,
whereas
in
many
cases
it
is
more
a
2
https://www-­‐03.ibm.com/press/us/en/pressrelease/46580.wss

3. 3
matter
of
ethics
and
moral
standards.
Companies
who
want
to
succeed
in
this
area
need
to
ensure
that
they
put
in
place,
and
adhere
to,
a
strict
moral
and
ethical
code
when
dealing
with
personal
data.
Data
philanthropy
An
extension
of
data
ownership
is
the
concept
of
data
philanthropy.
Currently
there
are
two
basic
camps
with
regards
to
data.
Those
who
see
it
as
an
open
resource
that
can
be
used
to
make
a
profit
and
those
who
fear
reuse
as
a
threat
to
privacy
and
civil
liberty.
But
there
is
a
third
option
in
the
discussion:
Big
Data
as
a
raw
resource
for
public
good.
At
the
center
of
any
universal
health
care
system
are
the
commitments
to
providing
social
benefit
to
everybody,
not
just
to
those
who
can
afford
to
pay:
the
elite,
the
privileged
and
the
wealthy.
Data
philanthropy
provides
an
opportunity
for
the
for-­‐profit
sector
to
align
with
one
of
the
core
tenants
of
universal
health
care;
either
peripherally
as
a
component
of
corporate
social
responsibility
or
as
one
of
the
central
pillars
of
their
business
operational
platform.
Mental
health:
the
new
care
frontier
for
digital
technology
One
of
the
key
health
challenges
is
mental
health.
The
Australian
Government3
,
for
example,
has
just
released
a
700-­‐page
report
by
the
National
Mental
Health
Commission’s
into
the
current
system
which,
according
to
Federal
Health
Minister
Susan
Ley,
“details
a
$10
billion
system
—
most
of
that
money
is
spent
on
welfare
payments
for
the
mentally
ill
—
which
fails
people
at
every
turn,
whether
they
are
visiting
their
GP,
attempting
to
access
community
support
or
living
in
regional
and
remote
areas”.
Suicide
is
one
of
the
biggest
killers
of
our
youth;
our
nations
future
workforce.
Mental
health
is
therefore
not
just
a
significant
health
issue,
it
is
also
a
major
economic
challenge
as
well.
Perhaps
one
of
the
options
is
to
“flip
the
model”
and
look
for
the
positives
in
mental
health,
such
as
the
link
between
creativity
and
mood
disorders.
For
example,
BDI
Health
decides
to
use
data
analytics
and
a
“flipped
model”
to
develop
a
“working
well”
approach
to
the
problem,
with
the
aim
of
achieving
a
40%
reduction
in
employee
absenteeism,
presenteeism
and
compensation
claims,
which
would
mean
a
significant
productivity
boost
for
the
Australian
economy.
This
is
an
area
where
the
wellness-­‐based
approach
could
achieve
significant
economic
and
social
benefits,
and
it
is
an
area
open
to
new
entrants
who
can
take
a
fresh
approach
based
on
mood
monitoring
and
self-­‐help
tools,
linked
to
treatment
plans
and
practitioners.
When
BDI
Health
looked
at
this
space
we
saw
that
a
diagnosis
of
mental
illness
creates
stigma
and
that
as
a
company
it
was
not
our
position
to
influence
the
medical
profession
and
the
rate
of
diagnosis
of
mental
illness.
What
we
could
do
was
influence
how
the
community
and
business
sector
perceived
such
a
diagnosis.
We
wanted
the
public
perception
to
shift
from
one
of
disease
and
disability
to
one
of
capability,
capacity,
culture
and
courage.
In
short
we
wanted
to
use
hard
science
to
dispel
popular
mythology
that
people
with
mental
illness
are
in
some
way
inferior.
This
is
the
core
of
our
business
“cultural
revolution”
and
data
analytics
is
just
one
of
the
digital
tools
we
use.
International
opportunities
Australia
is
well
placed
to
develop
and
export
health
and
wellness
related
technologies
and
applications,
as
it
is
an
ideal
incubator
–
combining
a
universal
health
system
with
a
booming
private
health
sector.
Many
US
companies
are
looking
at
Australia
as
a
potential
market
to
trial
a
number
of
new
systems,
because
Australia
has
a
number
of
advantages,
including
relative
cost
advantages
over
the
US
health
market,
as
well
as
being
a
stable,
English-­‐speaking
democracy
with
an
open
market
approach.
3
http://www.theaustralian.com.au/national-­‐affairs/health/sussan-­‐leys-­‐mental-­‐health-­‐redesign-­‐from-­‐ground-­‐
up/story-­‐fn59nokw-­‐1227306991992

4. 4
New
Zealand
provides
an
example
of
what
is
possible,
in
terms
of
transformation
of
the
health
care
sector.
Faced
with
the
prospect
of
an
unsustainable
health
system
New
Zealand
embarked
on
an
audacious
plan
to
transform
their
health
care
system
and
create
an
export-­‐driven
medical
technology
economy
that
linked
into
the
transformation
process.
As
a
result
local
and
international
companies
can
together
to
partner
with
the
public
sector
to
create
a
framework
for
sustainable
health
care
and
economic
growth.
The
big
opportunities
are
in
our
region,
in
China
and
India
in
particular,
where
the
scale
of
the
opportunity
for
healthcare
may
far
outstrip
the
EU
and
US
markets.
China,
with
1.5
bn
people,
is
aiming
to
introduce
a
universal
healthcare
system.
The
objectives
in
the
developing
and
the
developed
markets
are
well
aligned-­‐
better
patient
outcomes
and
lower
total
health
care
costs.
These
new
regional
markets
provide
an
ideal
opportunity
for
companies
such
as
Telstra
to
grow
their
health-­‐related
businesses.
Summary
The
narrative
for
companies
entering
the
digital
health
space
is
that
digital
transformation
can
help
address
the
risk
to
national
prosperity
of
the
current
healthcare
system,
and
can
help
achieve
productivity
improvements
while
also
improving
the
quality
of
life
of
Australians.
While
it
is
seen
as
legitimate
to
make
a
profit
from
health,
this
needs
to
be
combined
with
an
approach
that
demonstrates
care
and
advocacy
–
on
the
individual
and
the
societal
level.
The
differentiators
in
business
are
changing,
and
this
is
also
the
case
in
the
health
sector.
Once
companies
just
sold
products,
and
then
as
the
products
became
similar,
the
approach
changed
to
selling
services.
The
service
economy
then
changed
to
the
"experience
economy".
The
next
stage
is
the
"cause
economy",
where
customers
will
not
just
buy
what
you
do,
but
also
why
you
do
it.
Emerging
trends
like
data
philanthropy
makes
universal
health
care
the
ideal
"cause
economy"
opportunity.
Companies
that
are
viewed
as
having
lost
their
"cause"
will
struggle
and
will
be
replaced
by
those
that
can
demonstrate
their
cause
credentials,
in
their
company
culture
and
in
living
that
culture
in
every
interaction
with
their
customer.
This
is
the
low
hanging
fruit.
-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐
David
Noble
MBBS,
FANZCA
is
the
Founding
Director
of
BDI
Health.
David
comes
from
a
medical
background
as
a
consultant
anaesthetist.
In
2001
he
expanded
into
medical
hardware
innovation
and
later
into
health
care
transformation.
In
2012
David
was
invited
to
be
a
strategic
adviser
to
IBM
Australia
in
the
space
of
Smarter
Health
and
in
2015
he
accepted
a
mentor
position
at
Innovyz,
a
private
technology
accelerator
in
Adelaide.
He
is
also
an
external
member
of
Centre
for
Biopsychosocial
and
eHealth
Research
&
Innovation
at
Federation
University
Australia.
David’s
lived
experiences
as
a
clinician,
entrepreneur
and
patient
provides
the
insight
that
allows
him
to
challenge
medical
mythology,
custom
and
convention;
creatively
disrupt
the
century
old
traditional
models
of
health
care
and
construct
models
that
are
relevant
to
the
needs
and
expectations
of
a
progressive
and
modern
society.