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  • People are using A&E departments as convenient drop-in clinics for minor ailments because they cannot get GP appointments
  • In January 2017 the British Red Cross said A&E was struggling with a "humanitarian crisis" to keep up with a rush of patients over  the winter
  • UK’s Prime Minister suggests that all GP surgeries should open from 8am to 8pm, 7 days a week 
  • Primary care in England is in crisis, fuelled by a large and increasing demand and a shrinking supply of GPs
  • 75% of GPs across 540 general practices over the age of 55 are nearing retirement, and newly trained GPs are seeking employment abroad
  • By 2020 there could be a shortfall of 10,000 GPs in England
  • Curing the primary care crisis would relieve pressure on A&E departments
  • A simple, cheap and easy-to-use online dashboard could help relieve the primary healthcare crisis
 
A smarter approach to the UK’s GP crisis
 
Could the vast and escalating primary care crisis in England be helped with a new and innovative online dashboard, which automatically sends short videos contributed by clinicians to patients’ mobiles to address their FAQs?
 
Dr Seth Rankin an experienced GP thinks it can. Click on the photo below to access a short video, which demonstrates how the dashboard works.

 
 
 

UK’s Secretary of State predicted the healthcare crisis
 
The UK’s Secretary of Health has frequently stressed the urgent need for more innovation in healthcare. In 2015 he said: “If we do not find better, smarter ways to help our growing elderly population remain healthy and independent, our hospitals will be overwhelmed – which is why we need effective, strong and expanding general practice more than ever before in the history of the NHS.
 
An easy and effective way to improve GP services

Most patients don’t remember half of what is said in short GP consultations. This is why videos are so important. Unlike doctors and pamphlets videos never get tired, never wear out, and are available 24/7, 365 days a year. Unlike the Internet, the dashboard provides premium reliable healthcare information, which easily can be consumed by patients and shared among family, friends and carers. The video content can be viewed many times, from anywhere, and at anytime. The dashboard is fully automated [see figure below], relieves GPs of a lot of unnecessary work, and importantly, reports on how patients’ use the different videos,” says Rankin; CEO of the London Doctors Clinic; and formally the managing partner of the Wandsworth Medical Centre, and co-chair of Wandsworth CCG’s Diabetes Group.
 
A fully automated dashboard to improve efficiency and increase the quality of care
 
 
Reducing unnecessary A&E visits

‘The dashboard uses videos of local healthcare professionals because both patients and doctors want to improve their connectivity. The dashboard is embedded with about 120 short, 60 to 80 second, talking-head videos, which address patients’ frequently asked questions. Research suggests that the average attention span for people watching videos on mobiles is between 60 to 80 seconds. The dashboard has been specifically designed to help increase patients’ knowledge of their condition, propel them towards self-management, slow the onset of complications, lower the number of unnecessary visits to A&E, reduce face-time with GPs, and enhance the quality of care,” says Rankin.
 
Essential behavioral techniques

The efficacy of healthcare education is enhanced by embedded behavioral techniques, which nudge people to change their diets and lifestyles, improve self-monitoring of their condition, and increase adherence to medications.  The HealthPad dashboard benefits from such behavioral techniques.
 
Part of comprehensive communications system

The dashboard has been developed by health professionals with significant patient input, and aims to get effective educational content to the largest number of people at the lowest price possible; and without requiring effort from health professionals to mediate or facilitate the flow of the knowledge. To achieve this the dashboard is not a “lock-in” system, but designed to be easily and cheaply re-engineered to integrate with various other communications systems, see diagram below. The only thing that the dashboard requires is a connection to the Internet. 
 

 
GP surgeries at saturation point

A 2016 study published in The Lancet suggests that between 2007 and 2014 the workload in NHS general practice in England had increased by 16%, and that it is now reaching saturation point. According to Professor Richard Hobbs of Oxford University and lead author of the study, "For many years, doctors and nurses have reported increasing workloads, but for the first time, we are able to provide objective data that this is indeed the case . . . . . As currently delivered, the system [general practice in England] seems to be approaching saturation point . . . . . Current trends in population growth, low levels of recruitment and the demands of an ageing population with more complex needs will mean consultation rates will continue to rise.”
 
More than 1m patients visit GPs every day

A 2014 Deloitte’s report commissioned by the Royal College of General Practitioners (RCGP) suggests that the GP crisis in England is the result of chronic under-funding and under-investment when the demand for GP services is increasing as the population is ageing, and there is a higher prevalence of long-term conditions and multi-morbidities.
 
Each day in England, more than 1m patients visit their GPs. Some GPs routinely see between 40 to 60 patients daily. Over the past 5 years, the number of GP consultations has increased by 60m each year, and now stands at about 370m a year. Over the same period, the number of GPs has grown by only 4.1%.
 
Stress levels among GPs are high and increasing

Deloitte’s findings are confirmed by of a 2016 comparative study undertaken by the prestigious Washington DC-based Commonwealth Fund, which concluded that increasing workloads, bureaucracy and the shortest time with patients has led to 59% of NHS GPs finding their work either “extremely” or “very” stressful: significantly higher stress levels than in any other western nation. GP stress levels are likely to increase.
 
In a speech made in June 2015, the UK’s Secretary of Health said, “Within 5 years we will be looking after a million more over-70s. The number of people with three or more long term conditions is set to increase by 50% to nearly three million by 2018. By 2020, nearly 100,000 more people will need to be cared for at home.” Dr. Maureen Baker, the former chair of the Royal College of General Practitioners (RCGP) has warned that, “Rising patient demand, excessive bureaucracy, fewer resources, and a chronic shortage of GPs are resulting in worn-out doctors, some of whom are so fatigued that they can no longer guarantee to provide safe care to patients.” And Dr  Helen Stokes-Lampard, the new head of the RCGP, warns that patients are being put at risk because they often have to wait for a month before they can see a GP.

 
Newly trained GPs are seeking employment abroad

Trainee GPs are dwindling and young GPs are moving abroad. According to data from the General Medical Council (GMC), between 2008 and 2014 an average of 2,852 certificates were issued annually to enable British doctors to work abroad. We now have a dangerous situation where there are hundreds of vacancies for GP trainees. Meanwhile, findings from a 2015 British Medical Association (BMA) poll of 15,560 GPs, found that 34% of respondents plan to retire in the next five years because of high stress levels, unmanageable workloads, and too little time with patients.
 
5,000 more GPs by 2020

In 2016 the government announced a rescue package that will see an extra £2.4bn a year ploughed into primary care services by 2020. This is expected to pay for 5,000 more GPs and extra staff to boost practices. When the Secretary of Health trailed this in 2015, doctors’ leaders did not view it as a viable solution. Dr Chaand Nagpaul, chair of the BMA’s GP committee, warned that, “delivering 5,000 extra GPs in five years, when training a GP takes 10 years, was a practical impossibility and would never be achieved.” In 2016, Pulse, a publication for GPs, suggested that the Health Secretary understands that he cannot deliver on his election promise of 5,000 new doctors by 2020, and is negotiating with Apollo Hospitals, an Indian hospital chain, to bring 400 Indian GPs to England.
 
Pharmacists in GP surgeries
 
In July 2015 the NHS launched a £15m pilot scheme, supported by the RCGP and the Royal Pharmaceutical Society (RPS), to fund, recruit and employ clinical pharmacists in GP surgeries to provide patients with additional support for managing medications and better access to health checks.
 
Dr Maureen Baker said, “GPs are struggling to cope with unprecedented workloads and patients in some parts of the country are having to wait weeks for a GP appointment yet we have a ‘hidden army’ of highly trained pharmacists who could provide a solution”. Ash Soni, former president of the RPS suggested that it makes sense for pharmacists to help relieve the pressure on GPs, and said, “Around 18m GP consultations every year are for minor ailments. Research has shown that minor aliment services provided by pharmacists can provide the same treatment results for patients, but at lower cost than at a GP surgery.”
 
Progressive and helpful move
 
The efficacy for an enhanced role for pharmacists in primary care has already been established in the US, where retail giants such as CVS, Walgreens and Rite Aid provide convenient walk-in clinics staffed by pharmacists and nurse practitioners. Over time, Americans have grown to trust and value their relations with pharmacists, which has significantly increased adherence to medications, and provided GPs more time to devote to more complex cases. Non-adherence is costly, and can lead to increased visits to A&E, unnecessary complications, and sometimes death. According to a New England Healthcare Institute report, Thinking Beyond the Pillbox, failure to take medication correctly, costs the US healthcare system $300bn annually, and results in 125,000 deaths every year. 
 
Takeaway

People with complex conditions deserve to be seen by a GP who is not stressed and who can devote the time and attention they need. “Videos could play a similar role to practice-based pharmacists. Both deal with simple day-to-day patient questions, and relieve pressure on GPs, which allows them to focus their skills where they are most needed,” says Rankin.
 
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  • Diabetes UK’s (DUK) 2016 State of the Nation Report calls for diabetes education to be improved
  • Effective education can reduce the vast and escalating burden of diabetes and is significantly cheaper than treatment
  • Traditional diabetes education is failing miserably
  • DUK’s education only reaches a small percentage of people with diabetes
  • Self-management is the only realistic way forward to better diabetes management, but will require a transformation of the current patient-educator relationship
  • Could DUK play a leading role in this transformation?
 
Improving diabetes education to enhance patient outcomes
 
For the past decade at least, the charity Diabetes UK (DUK) has been “calling for governments to do more” to improve diabetes care in order to stem the vast and escalating burden of the condition. Currently, 4m people or 6% of the population are living with diabetes in the UK, and this is projected to rise to 5m by 2025. It is estimated that around 10% of the NHS yearly budget is contributed to the treatment of diabetes; which equates to £10.3bn a year.

The prevalence of type-2 diabetes (T2DM) in particular has been increasing rapidly, and is now one of the world’s most common long-term health conditions. Life expectancy on average is reduced by up to 10 years for people with T2DM. Experts say effective education can prevent the onset of T2DM, help with its management once diagnosed, and slow the onset of complications, such as heart failure, blindness, kidney disease and lower limp amputations. The 2016 DUK State of the Nation report called for diabetes education to be improved.

 
Traditional diabetes education is failing

In the video below Richard Lane, Ambassador and Immediate Past President of DUK, describes the significant improvements in diabetes education since he was first diagnosed in the 1970s, and briefly describes DAFNE (Dose Adjustment For Normal Eating), one of the official UK adult courses for managing type-1 diabetes. Also, a patient with type-1 describes how helpful she found some voluntary diabetes educational courses.
 
 

Notwithstanding individual successes, traditional diabetes education programs are failing to reach a sufficient number of people to be effective in reducing the overall burden of the condition. Only 2% of people diagnosed with type-1 diabetes and 6% with T2DM attend official diabetes educational courses. Each year there are 24,000 early deaths from diabetes-related complications, and also 7,000 avoidable amputations. DUK wants 50% of people living with diabetes to receive education over the next five years.
 
DUK's education and support

DUK spends about 50% of the money it raises annually on diabetes education. Of the £37m it raised in 2015 it spent £8.0m on its “Better Care Everywhere” program that works with healthcare institutions, “to make sure people had access to the 15 healthcare essentials”; £7.0m on its “Not Alone with Diabetes” program, which is its helpline; £1.5m “Reducing the Risk of Diabetes”, which is DUK’s participation in the National Diabetes Prevention Program; and £8.2m, “Growing the Impact of DUK’s Work”, which develops “networks of healthcare professionals,” to “work with local community groups and volunteers all over the country”: a total of £24.7m. 

Here we describe these expenditures as education and support services. 
Despite over £20m worth of diabetes educational and support services delivered by DUK each year, and the £10.3bn spent by the NHS on diabetes care and education, diabetes in the UK remains the largest and fastest growing health challenge of our time. “Diabetes is a very serious and complex health condition that requires constant self-management,” says Chris Askew, DUK’s CEO. 
 
A fundamental transformation is required

Increasing self-management is relevant, especially as resources for diabetes are shrinking as the prevalence of the condition is rapidly increasing, particularly among children. However, achieving effective self-management requires a fundamental transformation of the way diabetes education is delivered. 

It is projected that 66% of people in the UK will have smartphones by 2017. It seems reasonable to assume therefore that the majority of people  living with diabetes will have smartphones by 2017. People regularly use their smartphones for 24-hour banking, education, entertainment, shopping, and dating. Diabetes education has failed to effectively leverage this vast and rapidly growing free infrastructure and peoples’ changed lifestyles to introduce effective educational support systems to enhance the quality of diabetes care, increase efficiency, and improve patient outcomes. Today, mobile technology is part of everyday life and people expect to be connected with their relevant service providers 24-7, 365 days of the year from anywhere. 

Here is just one example of a simple evidence-based  dashboard designed to help re-engineer primary care management of diabetes by (i) increasing the connectivity between health professionals and patients, (ii) enhancing patient knowledge of diabetes, (iii) encouraging people to self-manage their condition, (iv) increasing the efficiency of GP clinics, and in the medium to longer term, (I) keep people out of A&E, and (ii) slow the onset of complications. 
 


Click on the image to see a demonstration of the dashboard
 

At very little cost, such a system could be rolled-out nationally through Clinical Commissioning Groups (CCG), integrated into GP clinics, and provide the basis of a national platform for diabetes education. Once patients and health professionals become engaged and familiar with the initial service offering, CCGs can bolt on additional services to further help people ward-off or manage their diabetes. This follows the model of digital champions, which succeed by using a core service to engage, and build a user base, and then add more services, so continuously increasing their users’ familiarity with their services. Engaging patients and health professionals any other way tends to fail.

The  diabetes education dashboard ensures that people either at risk of diabetes or living with diabetes will always be part of an educator-patient network, which should increase the variety; velocity, volume and value of educational healthcare information patients receive.

 
The escalating incidence of diabetes is not new

Data reported by DUK in 2015 revealed that over the past decade the number of people living with diabetes increased by 60%, and the charity’s leaders claimed that the public health situation in the UK with regard to diabetes is being allowed “to spiral out of control”. “Diabetes already costs the NHS nearly £10bn a year, and 80% of this is spent on managing avoidable complications,” said Barbara Young, then the CEO of DUK. Such findings, while shocking, are not new. 
 

The vast and escalating burden of diabetes

Tackling diabetes is important for the future of the NHS as there are over 4m people living with diabetes in the UK at present. This represents 6% of the UK population, or 1 in every 16 people. About 90% of the cases have T2DM. 90% of people with T2DM are overweight. Lifestyle changes and weight loss can help to prevent T2DM from ever occurring. Obesity is 40% more common among people living in deprived areas. 11.9m people in the UK are currently at risk of developing T2DM, but more than half could delay or even prevent a diagnosis by improved diets and lifestyles. This requires effective education that engages people and encourage them towards healthier lifestyles. About 10% of the cases are Type-1, which usually develops in childhood, and is often inherited. The NHS spends £10.3bn every year on treating diabetes, which equates to 10% of its entire budget. 80% of this is spent on diabetes medication. The annual indirect costs, such as productivity loss and informal care, are estimated to be £13bn. Effective education is cheaper than treatment.

 
The government will not spend more on diabetes

DUK’s repeated calls for the government to do more for diabetes care have been unsuccessful. This is largely because the NHS is struggling to cope with a surge in demand for care while suffering a major budget squeeze. In 2016, the government took back control of overspending semi-autonomous hospitals as part of its crackdown to tackle a NHS deficit of £2.45bn; the biggest overspend in its history.
 
DUK is a significant provider of diabetes education

To look at some aspects of DUK’s educational achievements we have taken a selection of extracts from its 2015 Annual Report. Against each extract is a short comment.

DUK:11,000 people learnt how to better understand and manage their condition through our Type 2 online education course.” 
 
COMMENT: This represents about 0.3% of the people in England diagnosed with T2DM.
 
DUK:Our care line supported 22,361 people who needed encouragement, information or someone to talk to”. 
 
COMMENT: This represents about 0.6% of people in England living with diabetes.
 
DUK:5.9m visits to the Diabetes UK website in 2015 – almost 10 per cent more than the year before – giving people the opportunity to learn more about the condition, what we do and how to get involved.”               
 
COMMENT: The key question here is the quality of the visit to the DUK website. Questions include inter alia: What is the average ‘dwell time’ for each visitor to DUK’s website? How many repeat visits does the website receive? What is the average number of pages viewed by visitors to DUK’S website? What are the most popular website pages viewed? What are the least popular website pages? How many visitors to the website come from the UK? What percentage of the people who visit the website “get involved”? How long do they stay involved? What percentage of the website’s visitors register with the site?
                                            
DUK:15,196 people found out their risk of developing Type 2 diabetes at one of our Roadshows – and can now take steps to avoid it.” 
 
COMMENT: This represents about 0.1% of the people in the UK at risk of T2DM.
 
DUK: “Educated more than 17,000 healthcare professionals to better work with and support those living with diabetes.”
 
COMMENT: Is this cost-effective? Would not online engagement be more appropriate?
 
DUK:11,000 people registered to educate themselves about managing their Type 2 diabetes via our online course Type 2 Diabetes and Me.”
 
COMMENT: This represents about 0.3% of people in England diagnosed with T2DM.
 
DUK:11.9 million people in the UK are currently at risk of developing Type 2 diabetes, but more than half of those people could delay or even prevent a diagnosis . . . In 2015 we worked with NHS England and Public Health England to develop the NHS Diabetes Prevention Programme. This partnership has the potential to help people in England who are at high risk delay – in some cases even prevent – Type 2 diabetes, and is being watched by the rest of the UK with interest.
 
COMMENT: In 2015 the UK government's Public Accounts Committee (PAC) observed that the national prevention initiative, which costs over £35m each year, lacked urgency, and recommended that it should, “develop a better and more flexible range of education support for diabetes patients.
 
A HealthPad Commentary reviewed the national prevention program, described an innovative and successful US diabetes prevention initiative, and concluded that because the UK program employed 19th century technologies to address a 21st century epidemic it would likely fail. The Commentary further argued that preventing T2DM entails winning the battle against obesity, reducing poverty, and changing peoples’ diets and lifestyles. To do this, education programs need to employ modern behavior techniques to engage people and coax them to change their behaviour.
 

A further HealthPad Commentary, described the growing frustration of the government’s PAC and the National Audit Office (NAO) with the country’s diabetes establishment.
 
DUK: Our ‘Know Your Risk’ volunteers helped over 15,000 people find out their risk of Type 2 diabetes at one of our events, while our online tool was used over 240,000 times.”
 
COMMENT: This represents 0.47% and between 6 to 7.5% respectively of people living with T2DM in England.
 
DUK should report costs and outcomes not costs and the distribution of services

Two points about DUK’s statements of its educational achievements:
  1. The majority of the charity’s education and support services only appear to reach a small percentage of the total number of people either at risk of T2DM or those living with diabetes. We have drawn attention to the fact that a large percentage of people with T2DM are over weight and 40% of obese people reside in deprived areas of the UK. To be effective diabetes education must have the Heineken effect.
  2. For the past decade at least, the DUK has tended to report the costs and distribution of its education and support services. More relevant would be for the charity to report costs and the effects its services have had on reducing the burden of diabetes, slowing complications, improving efficiencies, and enhancing patient outcomes.
Diabetes education providers should adopt school performance measures

For years the UK’s state education service has been using pupil outcome measures to rate the performance of its schools. Why is this not the case for diabetes education? Can you imagine if year-after-year millions of children in England were failing their public examinations, and year-after-year education officers only reported the costs and distribution of their services?  Can you imagine if the public education services only taught a very small percentage of the children eligible for education and there was no information about children’s performance in examinations?
 
Would people accept an education report that said, “This year Worthy schools spent £20m on physics teaching, which only reached 0.3% of pupils who would benefit from the subject, and we have no idea what percentage of those that were taught either took or passed the recommended physics exams”?
 
Technologies facilitate and transform diabetes education

With failing education programs people with diabetes are being driven to self-manage their condition with inadequate support. Inexpensive and ubiquitous technologies facilitate this, and increasingly people are demanding tools that track weight, blood pressure, daily exercise and diet. From apps to wearables, healthcare technology lets people feel in control of their health, while also providing health professionals with more patient data than ever before. 
 
With more than 100,000 health apps, rapid growth in wearables, and 75% of the UK population now owning a smartphone, digital technology is well positioned to significantly improve diabetes education and management. Such technologies while ubiquitous, are ineffective if only used as an adjunct to traditional education. Traditional diabetes education programs have failed to introduce widespread digital support strategies, which significantly enhance the quality of care, increase efficiencies, and improve patient outcomes for the majority of people living with diabetes.
 
In the first video below Richard Lane describes how digital technology is helping people self-manage their diabetes. In the second, Lane and a patient diagnosed with T2DM suggest that the biggest challenge for diabetes care is actually engaging people who are either at risk of the condition or living with diabetes. Only once people are engaged do you stand a chance to raise their awareness of the disease, and encourage them to change their diets and lifestyles in order to slow the progression of the condition and even prevent it.
 
How can mHealth help in the management of diabetes?
 
What are the biggest challenges of diabetes care?
 
Changing the patient-educator relationship
 
Self-management of diabetes should not be viewed simply as developing a website and providing a portfolio of techniques and tools to help people living with diabetes choose healthy behaviours. A necessary pre-requisite for effective education to reduce the burden of diabetes is the actual engagement of people who are either at risk of T2DM or living with diabetes. (Where are the national diabetes registers?). Once engaged education should inform and empower people, and provide them with access to continuous self-management support. This is substantially different to the way traditional diabetes education is delivered as it transforms the patient–educator relationship into a continuous, rich, collaborative partnership. A future HealthPad Commentary will describe an innovative and cost effective Mexican mHealth program, which has radically changed the patient-educator relationship by encouraging people, who are either at risk of T2DM or living with the condition, to take ownership of their own health, and become an integral member of their care team.
 
Takeaways

Diabetes is an out of control killer disease, which experts belief could be stemmed, reduced and prevented with effective education that is significantly cheaper than paying for treatment. Current diabetes education programs are failing miserably, and the prevalence of the disease is increasing rapidly, especially in young children.

Diabetes education and support require a radical overhaul to prevent the disease from spiralling out of control and bankrupting the NHS. This needs leadership to shape and drive a new and effective diabetes engagement/education model. Could DUK provide this?
 
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  • Healthcare systems throughout the world are in constant crisis
  • Attempts to introduce digital infrastructure to improve the quality of care, efficiency, and patient outcomes have failed
  • Modern healthcare systems were built on the idea that doctors provide healthcare with meaning and power, but this is changing
  • Advances in genetics and molecular science are rapidly eating away at doctors’ discretion and power
  • People are loosing their free will and increasingly being driven by big data strategies
  • An important new book suggests that a biotech-savvy elite will edit people's genomes and control health and healthcare with powerful algorithms, and that people will merge with computers
  • Homo sapiens will evolve into Homo Deus
 
Future healthcare shock
 
This book should be compulsory reading for everyone interested in health and healthcare, especially those grappling with strategic challenges. Homo Deus: A brief history of tomorrow, by Yuval Harari, a world bestselling author, published in 2016 is not for tacticians responding to their in-trays, but for healthcare strategists planning for the future.

The book is published a year after an OECD report concluded that NHS England is one of the worst healthcare systems in the developed world; hospitals are so short-staffed and under-equipped that people are dying needlessly. The quality of care across key health areas is “poor to mediocre”, obesity levels are “dire”, and the NHS struggles to get even the “basics” right. The UK came 21st out of 23 countries on cervical cancer survival, 20th on breast and bowel cancer survival and 19th on stroke.


Harari pulls together history, philosophy, theology, computer science and biology to produce an important and thought provoking thesis, which has significant implications for the future of health and healthcare. Homo Deus, more than the 2015 OECD Report will make you think.
 
Healthcare’s legacy systems an obstacle for change

While a large and growing universe of consumers regularly use smartphones, cloud computing, and global connectivity to provide them with efficient, high quality, 24-hour banking, education, entertainment, shopping, and dating, healthcare systems have failed to introduce digital support strategies to enhance the quality of care, increase efficiency, and improve patient outcomes.

Why?

The answer is partly due to entrenched legacy systems, and partly because digital support infrastructure is typically beyond the core mission of most healthcare systems. Devi Shetty, cardiac surgeon, founder and CEO of Narayana Health, and philanthropist, laments how digital technologies have, “penetrated every industry in the world except healthcare”, and suggests doctors and the medical community are the biggest obstaclesto change.
 
 
Doctors’ traditional raison d'être is being replaced by algorithms

Notwithstanding, modern medicine has conquered killer infectious diseases, and has successfully transformed them, “from an incomprehensible force of nature into a manageable challenge . . . For the first time in history, more people die today from old age than from infectious diseases,” says Harari.
 
Further, modern healthcare systems were built on the assumption that individual doctors provided healthcare systems with meaning and power. Doctors are free to use their superior knowledge and experience to diagnose and treat patients; their decisions can mean life or death. This endowed doctors and healthcare systems with their monopoly of power and their raison d'être. But such power and influence is receding, and rapidly being replaced by biotechnology and algorithms.

 
Healthcare systems in crisis

This radical change adds to the crisis of healthcare systems, which lack cash, and have a shrinking pool of doctors treating a large and growing number of patients, an increasing proportion of whom are presenting with complicated co-morbidities. Aging equipment in healthcare systems is neither being replaced nor updated, and additionally, there is a dearth of digital infrastructure to support patient care.
  
A symptom of this crisis is the large and increasing rates of misdiagnosis: 15% of all medical cases in developed countries are misdiagnosed, and according to The Journal of Clinical Oncology, a staggering 44% of some types of cancers are misdiagnosed, resulting in millions of people suffering unnecessarily, thousands dying needlessly, and billions of dollars being wasted. Doing more of the same will not dent this crisis.
 
Computers replacing doctors
 
As the demand for healthcare increases, healthcare costs escalate, and the supply of doctor’s decrease, so big data strategies and complex algorithms, which in seconds are capable of analysing and transforming terabytes of electronic healthcare data into clinically relevant medical opinions, are being introduced.
 
Such digital infrastructure erodes the status of doctors who no longer are expected solely to rely on their individual knowledge and experience to diagnose and treat patients. Today, doctors have access to powerful cognitive computing systems that understand, reason, learn, and do more than we ever thought possible. Such computers provide doctors almost instantaneous clinical recommendations deduced from the collective knowledge gathered from thousands of healthcare systems, billions of patient records, and millions of treatments other doctors have prescribed to people presenting similar symptoms and disease states. Unlike doctors, these computers never wear out, and can work 24-7, 365 days a year.
 
The train has left the station

One example is IBM’s Watson, which is able to read 40 million medical documents in 15 seconds, understand complex medical questions, and identify and present evidence based solutions and treatment options. Despite the resistance of doctors and the medical establishment the substitution of biotechnology and algorithms for doctors is occurring in healthcare systems throughout the world, and cannot be stopped. “The train is again pulling out of the station . . . . Those who miss it will never get a second chance”. For healthcare systems to survive and prosper in the 21st century is to understand and embrace “the powers of biotechnology and algorithms”. People and organizations that fail to do this will not survive, says Harari.
 
The impact of evolutionary science on healthcare systems

Roger Kornberg, Professor of Medicine at Stanford University who won the 2006 Nobel Prize in chemistry, "for his studies of the molecular basis of eukaryotic transcription", describes how human genome sequencing and genomics have fundamentally changed the way healthcare is organized and delivered. “Genomic sequencing enables us to identify every component of the body responsible for all life processes. In particular, it enables the identification of components, which are either defective or whose activity we may wish to edit in order to improve a medical condition,” says Kornberg.



 
The new world of ‘dataism’

Harari’s “new world” describes some of the implications of Kornberg’s discoveries, and suggests that evolutionary science is rapidly eroding doctors’ discretion and freewill, which are the foundation stones of modern healthcare systems and central to a doctors’ modus vivendi. Because evolutionary science has been programmed by millennia of development, our actions tend to be either predetermined or random. This results in the uncoupling of intelligence from consciousness and the “new world” as data-driven transformation, which Harari suggests is just beginning, and there is little chance of stopping it.
 
Over the past 50 years scientific successes have built complex networks that increasingly treat human beings as units of information, rather than individuals with free will. We have built big-data processing networks, which know our feelings better than we know them ourselves. Evolutionary science teaches us that, in one sense, we do not have the degree of free will we once thought. In fact, we are better understood as data-processing machines: algorithms. By manipulating data, scientists such as Kornberg, have demonstrated that we can exercise mastery over creation and destruction. The challenge is that other algorithms we have built and embedded in big data networks owned by organizations can manipulate data far more efficiently than we can as individuals. This is what Harari means by the “uncoupling” of intelligence and consciousness.
 
We are giving away our most valuable assets for nothing

Harari is not a technological determinist: he describes possibilities rather than make predictions. His thesis suggests that because of the dearth of leadership in the modern world, and the fact that our individual free-will is being replaced by data processors, we become dough for the Silicon Valley “Gods” to shape.
 
Just as African chiefs in the 19th Century gave away vast swathes of valuable land, rich in minerals, to imperialist businessmen such as Cecil Rhodes, for a handful of beads; so today, we are giving away our most valuable possessions  - vast amounts of personal data - to the new “Gods” of Silicon Valley: Amazon, Facebook, and Google for free. Amazon uses these data to tell us what books we like, and Facebook and Google use them to tell us which partner is best suited for us. Increasingly, big-data and powerful computers, rather than the individual opinion of doctors, drive the most important decisions we take about our health and wellbeing. Healthcare systems will cede jobs and decisions to machines and algorithms, says Harari.
 
Takeaways

For the time being, because of the entrenched legacy systems, health providers will continue to pay homage to our individuality and unique needs. However, in order to treat people effectively healthcare systems will need to “break us up into biochemical subsystems”, and permanently monitor each subgroup with powerful algorithms. Healthcare systems that do not understand and embrace this new world will perish. Only a relatively few early adopters will reap the rewards of the new technologies. The new elite will commandeer evolution with ‘intelligent’ design, edit peoples’ genomes, and eventually merge individuals with machines. Thus, according to Harari, a new elite caste of Homo sapiens will evolve into Homo Deus. In this brave new world, only the new “Gods”, with access to the ultimate source of health and wellbeing will survive, while the rest of mankind will be left behind.

Harari does not believe this new health world is inevitable, but implies that, in the absence of effective leadership, it is most likely to happen.

 
 
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Sensor Kinesis Corporation

Biosensor technology

Hi-tech company that is developing proprietary, flexible microbiosensor integrated computer chips suitable for printing on many surfaces.

These chips which detect certain biomolecules can be linked to smart devices and shared via cloud technology.

SKC’s chips are being developed to detect and measure biological signals and data from humans and then use smart devices to transmit the information for analysis and storage.

These microbiosensor chips are also being developed for use as diagnostic devices for early detection of human diseases as well as pathogens in the food chain from the farm to consumer.

Early applications could include the efficient, accurate, and inexpensive detection of air and waterborne pathogens in restaurants, hospitals, and hotels.


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