Over the past decade (medical) science and technology have developed a healthy incestuous marriage. The way science (propositional knowledge) and technology (prescriptive knowledge) support each other has led to the most outstanding advances in human productivity. Just as scientific breakthroughs can facilitate technological innovation, so too technological advances enable scientific discovery, which drives more technological change. It comes as little surprise that our Manly community also included “affiliated research and education” as a sought after capabilities for inclusion at their Hospital site.
Today towards 5 billion people are generating digital information. The volume of data uncovered through genomics and stored in hospitals, pharmaceutical organisations and compiled by medical research is massive. Health care data is growing at the rate of 48% per year and likely to exceed 2,300 exabytes by 2020. Data pours in from new research, electronic medical records (like eHealth), imaging, wearables and epidemiological monitoring. One of the most promising business opportunities in the future is the Internet of Medical Things (IoMT). All this data and technology can be quite overwhelming for GPs. Today Dr. Google has no filter on the medical data currently being accessed by lay people. The giant data bases of medical and health information needs ownership, storage accessibility, with robust security and integrity checks on false data and news. For in all that authenticated data lies clues to the next medical breakthrough, curers and efficiencies. The prediction is that the current model of patients seeking medical help to rescue them from illness will be replaced by “doctorless patients”, who are digitally literate, tapping in on this authenticated data in a meaningful way to keep healthy on a daily basis. Instead of going to hospital, the hospital may come to them, with sophisticated technology monitoring their vital signs. At their home hospital, they will be surveyed constantly by specialist medical staff able to zoom in on their health problems in both predictive and current timeframes.
We are trending from healthcare being delivered from centralised facilities (such as hospitals and clinics) to a much more decentralised model where healthcare can be delivered at any place (including our home). The industry is moving from episodic care to more holistic care. The big brake throughs are likely to come from the integration of wearable technologies and artificial intelligence (AI), in the areas of chronic disease management, diabetes, cardiovascular disease, obesity and sleep disorder. Just 15 years ago it cost $100 million to map one human genome, now it costs $1,000. In 10 years time this is likely to be reduced to $100, thanks to the advances in modern technology. Weightwatchers share price went down 95% in 3 years simply because the company completely missed the Fitbit and wearable craze. Break throughs are occurring everywhere, like Thriver – an app where a home finger-prick test put onto a swab can be sent off to get the results immediately. CrowdMed, another app, where you enter your symptoms on-line and a crowd of on-line clinicians provide its diagnosis. 3D printing can print human parts (ear, bones, cartilage, etc. to produce completely transplantable replacement tissue.
Unlike other industry sectors (eg. Banking), the Health sector itself in Australia is lagging seriously behind when it comes to innovation and technology, especially as technology shifts more and more into the hands of people (be they customers, patients or consumers). Our Health sector is extremely siloed and lacks effective integration, is drowning in regulations, hamstrung by legislation limiting the flow of important medical information and data pertaining to the wellbeing of patients, thereby impacting clinical outcomes. Rather than managing the information and data revolution, in Australia healthcare is in catch-up mode. Health care is 10% of Australian GDP – $154 billion is spent annually. We are number 2 behind China in medical technology. The biggest risk to our industry is losing confidence of practicians (like GPs) and users (like patients) through poor security and privacy plus inaccurate readings and targeting the wrong problem or patient audience.
The vertical integration of related research, big data analytics and the transparency afforded by information sharing, can facilitate more consistent health payments & billing, improved patient care, diagnosis & clinical decision making and through predictive analytics reduced health insurance premiums, etc. All very real possibilities. With the Manly Community’s preference for using the Hospital site to fill the gaps in our health care capabilities (aged care, palliative care, addiction rehab, etc.), it is not just about community health care benefits that will take the pressure off our hospital system but also the shift self-help and home hospitals that will generate the greatest savings. While medical research delivers innovative productivity breakthroughs, improvements in health education and better synergetic communication between all involved parties involved at the site (be they residents, carers, workers or members of the broader community) can generate immediate benefits. The more empowered these people become through innovation and technology, the more they are able to maximise the extent of self-help applied to their own health care and the care of others.
Below are some existing technology innovations worthy of consideration for early adoption across the site to support health care productivity, governance and administration.
- Adopt existing Federal Government eHealth System (My Health)
- Reengineer the health system by making use of the existing eHealth patient recording system. Signing people up is the first important step towards enabling more integrated and coordinated health care services (involving patients, doctors, hospital nurses, pharmacists, podiatrists, nutritionists, and allied health professionals, physios). This system is already in use in regions such as North Queensland and Western Sydney, with 4.2 million people now enrolled.
- Health care data integration and transparency is another opportunity. People need to be better informed on how to embrace eHealth so that they only have to provide their details once. GPs and specialist doctors also need to promote and encourage their patients to sign-up. Community & GP education in the long term benefits of eHealth to the patient is also lacking. The problem at the moment is that the data is not being sufficiently used primarily because multiple duplicates of the same information is being maintained in different data silos.
- Research into Prevention Treatments at the optimum time for patients and the community generally. Getting preventive knowledge out to people, ties in with item 3 – empowering people to be able to help themselves more through the power of available information on preventative strategies. This is about SM Experts creating well researching up-to-date information being available that people need in a form that delivers them maximum benefit. Getting this same information onto the screens of clinicians and then seeing where it goes next. Given 50% of the cost of health care is consumed by a small percentage of chronically ill patients, identifying who these are make pro-actively planning possible so that the right health care services are made available in anticipation of patient needs.
- Self-Help education and communication. With the right information being made available to the right people, who can improve their own health performance in the most productive manner.
- Predictive Patient Analysis By studying an individual’s genetic profile, it is possible to predict illnesses to which people are most prone. Algorithms have been developed with 90% confidence levels to predict if someone is going to be hospitalised in the next 2 years. Having such information available to not only the individual patient but also to all those with authorised access, empowers all parties to collaborate more effectively and be alert to the early signs of illness detection. Through predictive analysis, early diagnosis is more likely towards finding treatments of the illness and its eventual cure. Some illnesses are hereditary, whereas others can be predicted with a high degree of certainty from the life experiences of others with similar afflictions.
- Vertical Integration of Care Services
Chronic disease management systems, such as that available from Health Care Homes, are able now to identify at-risk patients. By identifying the best local providers to meet each of a patient’s needs and co-ordinating their respective care, effective strategies can be devised for patient participation in better managing their own health care.
- Technology Tools
- Mobile phone apps aiding self-analysis and sharing of real-time medical information with (away) health professionals, as outlined in the two examples that follow:-
6.1.1 A renowned Australian innovator Dr. David Sinclair (discoverer of the anti-aging molecule – resveratrol) has designs apps that support solutions to serious problems associated with the aging process – like obesity, type 2 diabetes, genome disorders and Alzheimer’s disease.
6.1.2 An American Dr Topol has developed powerful innovative tools for sequencing a person’s genome to predict the effects of any drugs, through the provision of adaptors (connected to conventional Smart Phone) and new apps to effect the imaging, diagnostic testing and printing of results. These apps enable a patient to display and print images of their own organs on demand, in order to monitor the progress of drugs that have been prescribed by doctors. This approach empowers people, as patients, to participate in their own self-diagnostic monitoring of the effects of the drugs being taken; drugs that have been prescribed for their health (for good or not so good).
- Wearable technology such as BitFit, virtual-reality headsets, health monitors, hearing alerts, etc. will be able to track every aspect of health and fitness and when combined with AI the business opportunities are limitless in facilitating better health care.
- Gaming is becoming an increasingly important tool in health care because it is very engaging and the results used to provide an indication of brain power and mental health. A good example is the use of virtual reality gaming (like “Virtual Forest”). This game has been found to be highly successful for the elderly with Dementia & Alzheimer’s. This highly interactive game picks up the hand movements of the elderly which impacts upon the images they watch being displayed on screen. Such gaming has been shown to deliver long lasting health improvements, sometimes reducing the need for as much medication. Other gaming is effective in monitoring the degree of infliction, deterioration or improvements.
- Social Networking (like YSH, Facebook, Twitter and Skype) is particularly effective for community participation in health care self-help, volunteering and the sharing of personal life experiences across a broad communication platform.
- Governance and Administration processes are being seriously disrupted by platforms like Blockchain & Ethereum. Such “crypto-helpers” exist within a decentralised transaction network of computers, creating trust between groups of users through the distribution of an on-line ledger technology. For example “Smart contracts” are an app on the Blockchain, which uses its computer protocols to control accounts, money transactions and executes operations like the terms of an agreement. This removes the need for human involvement in monitoring contract compliance and enforcement. By digitising business rules, legal agreements are able to be codified and enforced across a group of on-line users that have the technology platform. This codification articulates, verifies and executes an agreement between two parties (like patients, carers, administrators, residents) in place of traditional contractual arrangements. “Smart contracts” and distributed ledger technology is destined to be a major digital disruptor for legal and accounting professions, reducing the need for these traditional roles by emphasising the need for specialists. Services like banking, finance, government and health care are all early adopters of this technology platform seeking step change in their process productivity.
“The health care industry in Australia is challenged by fiscal pressures, a growing population that is living longer and with increased complex health needs. The industry acknowledges the pain points and is focused on innovation to meet consumer expectations and drive efficiencies for better outcomes.’ Julie Hunter, MD Health Education & Government CBA.
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