Innovation can facilitate better health outcomes

Be aware of the danger but seize the opportunity

by Professor Sheena Reilly

As the Palaszczuk Government enters its second year in office, the Premier has highlighted her commitment to restoring frontline health services in Queensland. New nursing positions and a commitment to improved nurse-patient ratios is at the forefront.

The Federal Health Minister has a number of reviews planned or underway including reviews of the Pharmaceutical Benefits Scheme (PBS), the Private Health Insurance rebate and the Medicare Benefits Schedule.

Unfortunately these won’t prevent costs from escalating. Nor will they fix the growing crisis we face in managing the burden of chronic disease affecting Australians from the cradle to the grave.

This crisis has placed increased pressures on the health system and created huge policy challenges. To quote John F. Kennedy:

“The Chinese use two brush strokes to write the word ‘crisis.’ One brush stroke stands for danger; the other for opportunity. In a crisis, be aware of the danger — but recognize the opportunity.”

The Danger

Queensland’s Chief Health Officer clearly and starkly laid out the danger in the 2014 Health of Queenslander’s report.

• Chronic disease causes about 80–90% of all deaths, hospitalisations and associated costs.
• Obesity rates have doubled in Queensland (the worst in Australia) in the past 20 years, with 2 in 3 adults and 1 in 4 children being overweight or obese.
• Obesity is a major contributor to the onset of other chronic diseases such as; type 2 diabetes, hypertension, heart attacks and some cancers.
• A 5.5 fold increase in the prevalence of dementia is anticipated over the next 40 years.
• The disease burden is 2.1 times higher in Indigenous Australians.

The Australian Bureau of Statistics data validates the current danger; 7 million Australians have chronic health conditions. Treasury modelling predicts the future danger, that by 2046 healthcare costs have the potential to absorb all state revenue.

If this prediction is correct, there will be no income to do anything else — imagine, no budget for schools or infrastructure . There has never been a stronger argument for changing the way we deliver and manage healthcare in Australia.

The burden of chronic disease

Most of our healthcare costs are driven by longevity and unhealthy lifestyles, which in turn drive the burden of chronic disease. Governments have responded with projects to target modifiable risk factors for chronic disease, however much more needs to be done to reverse the trend. According to Queensland’s Chief Health Officer, about one third of the total disease burden and 43% of premature deaths could be avoided if they could be addressed in a timely way.

The same goes for two thirds of adults at risk from cardiovascular disease. High cholesterol is untreated in 50% of adults and 13% have untreated high blood pressure. 20% of diabetes cases are undiagnosed and more than half are inadequately managed.

Our healthcare services are straining and sometimes buckling under the demand — the number of hospitalisations each year continues to increase at nearly twice the rate of population growth.

Not only does chronic disease burden place additional demand on health services, it also contributes to a significant loss of productivity within the workforce.

The Opportunity

The opportunity is staring us in the face. The era of big data and disruptive technologies has begun to revolutionise the way our financial systems work, how we purchase and market services, how we find accommodation, and controversially, how we book our taxis.

Yet, the boundless paper that remains within our healthcare system and the fragmentation and disconnect between these systems (e.g. GPs, specialist services, hospitals and other providers), is akin to standing in line to withdraw cash using a passbook from a bank in the 1960s.

Healthcare delivery is of course more complex than banking, booking accommodation or ordering a taxi. In Australia, a number of new initiatives are being pioneered to facilitate better access and governance to an extensive range of health data that is routinely collected. Frustratingly, most of this data is underutilised, remains dormant and is not shared.

Technological advances and sophisticated data analysis techniques present an opportunity to incorporate predictive analytics to illustrate a clearer picture from the available information, which in turn will help practitioners identify and address risk factors for chronic conditions before they become critical.

One example of this is the Gold Coast Integrated Care Delivery Model. This project brings together healthcare teams (Gold Coast Hospital and Health Service, General Practice and community-based teams including non-government organisations) to produce a single integrated system to minimise duplication and maximise care coordination. The intent of the Integrated Care Delivery Model is to produce the best patient outcomes at the lowest cost.

The opportunity we have is to use data that is routinely collected about our health and well-being across the course of our lives. Much of this information is securely stored at separate points in the health system, such as in databases at hospitals, health departments and other organisations that provide healthcare services. Having access to routinely collected healthcare data has the potential to inform research by creating a chronological sequence of health events that can be joined to provide insight into population-based outcomes. This will inform change in the way we deliver healthcare and lead to the establishment of critical minimum healthcare datasets.

How to take advantage?

Two things are needed.

Firstly, government and policy makers must continue work to support greater research and clinical use of routinely collected data.

A recent Productivity Commission report stated, “There is a case for maximizing the benefits that the community achieves from the data it has paid for.”

This work has already begun. The Council of Australian Governments released a National Government Information Sharing Strategy in 2009. In 2010, the Australian Government endorsed a set of High Level Principles for Data Integration, first of which states, “Agencies must treat data as a strategic resource and support their wider use.” Health is recognised as a key beneficiary for the increased use of routinely collected data for research.”

In 2015 the National Innovation and Science Agenda (NISA) was launched by the Turnbull Government as a strategy to strengthen Australia’s innovation system and future economic prosperity. One component of this strategy is the delivery of nationally significant datasets to support the digital marketplace. This momentum needs to continue with policy makers, governments and practitioners aligning to facilitate access to the increasing amount of data gathered inside the health system.

Secondly, researchers must adapt their research methods and learn to embrace healthcare data.

Unofficial estimates suggest that for the National Health and Medical Research Council to hold current grant funding success rates over the next 5 years, the amount of funding required from the Government would effectively need to double. A change in academic outlook away from silos of discrete research projects towards larger, interdisciplinary research teams that take advantage of existing data in our healthcare system will be essential.

In the long term, researchers and policymakers should broaden the initiative to focus on child health. It matters because children’s illnesses are at risk of being overwhelmed by the needs of our ageing population. It matters because good health underlies child development, delivering adults capable of driving our nation’s social and economic wealth. It matters because lifelong diseases such as diabetes, obesity, deafness and kidney failure start very early in life. Addressing the roots of ill health in childhood may be the only way to lower the burden and costs of ageing for generations to come. Pathways to future health begin to diverge from foetal life.

Logan Together is a project which provides a template for the way forward.

This initiative will provide opportunities to longitudinally evaluate child development, health, education, social and community wellbeing across the Logan community.

It will initially focus on families with children in the pre-birth to age eight cohorts living in Logan City to drive change that will benefit all Logan families and the initiative will have the Logan City local government area as its geographic scope.

Logan Together is built upon a leadership model of State, Federal and Local Government representatives along with community, education and provider partnerships. It will apply publicly sourced data (NAPLAN, pre-natal clinics, census data, public-data sets) to evaluate the core questions of the program.

And as technology advances, the opportunities are endless:

• Wearable technology provides opportunities to continuously monitor changes in physical, psychological or social wellbeing.
• Smartphone applications that interact directly with patients on a routine basis have the ability to record, interpret and feedback information.
• Geographic Information Systems (GIS) can be combined with healthcare informatics to better address patient needs and identify potential trends for the improvement in quality of care.
• Healthcare monitoring could link multiple data sources for longitudinal data visualisation.
• Predictive technologies have the capacity to alert us to a health event (e.g. falls in the elderly) before the event takes place.

If researchers and practitioners can work together to develop innovative models of care and adopt enabling technologies, we can harness the potential benefits from this growing mass of healthcare data.

This has the potential to dampen the growth of chronic health problems across the country, improve management of the health budget and deliver a more efficient and sustainable health service.

The benefit to utilising existing data is that there is minimal waste, it is cost effective, accessible and can withstand periods of funding constraint.

This is an opportunity too good to miss.

ABOUT THE AUTHOR

SHEENA REILLY

Professor Sheena Reilly is Director of the Menzies Health Institute Queensland (MenziesHIQ).

Professor Reilly’s previous appointment was with the Murdoch Children’s Research Institute (Associate Director of Clinical and Public Health), and the Department of Paediatrics, University of Melbourne.

Sheena is an inaugural Fellow of the Australian Academy of Health and Medical Sciences, and Fellow of the Australian Academy of Social Sciences, the UK Royal College of Speech and Language Therapists and Speech Pathology Australia.