beyond the medical curve presentation

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.

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Anthropometric data after 8 weeks

32

Biochemical data after 8 weeks

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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

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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 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

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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

PROFESSOR STEVEN BOYAGES

STEVE.BOYAGES@GMAIL.COM