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TRANSCRIPT
Dr Stephen ChildChief Medical Officer
Southern Cross Health Society
Auckland
11:50 - 12:10 Things That Matter - The Human Side of Medicine
Human side of technology
Healthy Partnerships
Human side of technology
Stephen Child
Chief Medical Off icer
M.D. FRACP(C) , FRACP
Human side of technology
Healthy Partnerships
General practice – top 10 (Australia)
1. Hypertension 2. Immunisation 3. Upper respiratory
tract infection4. Depression
5. Diabetes 6. Lipids
7. General check 8. Osteoarthritis 10. Prescription9. Back pain
Human side of technology
Healthy Partnerships
Contract with society?
1938-41
Erosion of doctor-patient relationship
$Third-party
funder
Human side of technology
Healthy Partnerships
What’s changed?
• Growing patient expectations
• Funder wants value
• State suspicious of self-regulation
= reduced autonomy and wellbeing
Human side of technology
Healthy Partnerships
Expectations
Patient (customer )
• “Diagnosis”
• Personalised
• Empowerment
• Quality
Funder (customer representation)
• Quality outcome at low cost (value)
• ROI: Productivity, brand, etc
Human side of technology
Healthy Partnerships
New Zealand find ‘game changer’ for bowel cancer (NZ Herald article)
Human side of technology
Healthy Partnerships
Elizabeth Anne Holmes
Wanted to be a billionaire but faces decades in jail
Human side of technology
Healthy Partnerships
Cancer therapy
Aromatherapy Ayurvedic RykeHerbalism Homeopathy
Shamanistic Naturopathy Urotherapy Diets +++ Macrobiotics
Probiotics Bioresonance Magnet Therapy Light Therapy Orgone
Polarity Therapeutic Touch Zoetron Aloe Cannabis Capsicum Castor Oil Ginseng Grapes Kombucha Milk Thistle
Mushrooms Acupuncture Chiropractic Craniosacral Colonics Cupping Ear Candling Reiki
Shiatsu Hypnosis Faith-based Meditation NLP Qigong
Bee Venom Caesium Salt Chelation Colloidal Silver Emu Oil
Hyperbaric OrthomolecularOxygen Shark Cartilage
Vitamins
Human side of technology
The medicalised smartphone
Source: ‘The Patient Will See You Now’, Eric Topol
Human side of technology
Healthy Partnerships
Google is tackling specific diseases
Source: CB Insights
Human side of technology
Healthy Partnerships
1. Not informed
2. Ill informed
3. Imbalanced information
4. “At risk” – fear - pain
Vulnerable
Human side of technology
Healthy Partnerships
Condition X
30% placebo
always effective
20 people take
treatment A
20 people take
treatment B or
placebo
Evidence based or biased?
Human side of technology
Healthy Partnerships
Background
Wang MT, Gamble G, Grey A. JAMA Internal Medicine. 2015;175(5):845-848.
Oestrogen and progestin replacement Prevention of cardiovascular disease in post menopausal women
Tympanostomy tube insertion Treatment of persistent otitis media
Vitamin D and calcium Prevention of fractures
Vitamin E Prevention of cardiovascular disease and cancer
Mammography screening Detection of breast cancer from 40 years
Percutaneous coronary intervention Treatment of stable coronary artery disease
Rosiglitazone Treatment of type 2 diabetes
Arthroscopic surgery Treatment of osteoarthritis of the knee
PSA screening Detection of prostate cancer
Vertebroplasty Treatment of osteoporotic vertebral fractures
Rosuvastatin Treatment of haemodialysis patients
Intensive glucose control Treatment of type 2 diabetes
Prednisolone Treatment of wheezing in preschool children
Darbepoetin alfa Treatment of type 2 diabetes and chronic kidney disease
Renal artery revascularisation Treatment of renal-artery stenosis
Calcium Prevention and treatment of osteoporosis
Intensive BP control Treatment of critically ill patients
Aspirin and heparin Women with recurrent miscarriage
Fish oils Prevention of cardiovascular disease
Type 2 diabetes screening Detection of type 2 diabetes
Established Practices and Indications
Human side of technology
Healthy Partnerships
Paternalistic approach Patient-centric approach “The Patient Will See
You Now”
Human side of technology
Healthy Partnerships
Likely future?
Self-regulation (and sanction) Super-specialisation
Corporatisation/competition
“Protocolisation” of
medicine
Self-regulation (and
sanction)Super-specialisation
Corporatisation/
competition
Human side of technology
Healthy Partnerships
Medically Unexplained Diagnosis (MUD)
Germany n=620
consecutive
66% MUD
By 12 months:
Somatoform 22.9%
Affective 12.4%
Anxiety 11.4%
Human side of technology
Healthy Partnerships
MUD: GP
UK: 18% MUD
Chest pain, fatigue, dizziness,
headache, swelling, back pain,
SOB, insomnia, abdominal pain,
numbness
26% biological cause
IBS, Fibromyalgia, BDS, chronic
pain etc.
Human side of technology
Healthy Partnerships
Will patients be better ?
• Vulnerable to exploitation
• Solutions without problems
• Increased “worried well “
• Who will they trust?
Human side of technology
Healthy Partnerships
Will people trust Google?
Source: CB insights (morning consult + politico national tracking poll)
“How much do you trust Google to keep your personal
data private?”8%
Don’t know/ no opinion
53%Not at all/ Not very much
39%A great deal/ a fair amount
Human side of technology
Healthy Partnerships
How ethical is the business model?
1. Define “value” offered
2. Transparency:
price, quality
3. Trustworthiness
Human side of technology
SouthernCross
nib Sovereign Unimed PartnersLife
Accuro Others
New Zealand’s private health insurance market
62%
15%
7% 5%
3%2%
6%
Source: HFANZ March 2018
Human side of technology
Healthy Partnerships
Who is Southern Cross Health Society?
Biggest customer
62% of market, pays 73% of NZ’s health insurance claims
Not standard insurance – friendly society
For every $1 received in premiums, 90c paid in claims
Doctor initiated 1961
Human side of technology
Relative change of health insurance claims paid and
New Zealanders with health insurance
Source: HFANZ
Human side of technology
Healthy Partnerships
GP research November 2017
Over 20 in-depth
interviews
140 GP survey
responses
Human side of technology
GPs interested in accessing patient feedback
Interested in feedback
about specialists
Interested in feedback about
other healthcare providers
(eg physiotherapists)
Human side of technology
Need a plumber?
• Quality?
• Qualifications?
• Recommendations?
• Ability to understand the job?
• Invoice is visible
• Cost comparison
Human side of technology
Healthy Partnerships
Outcomes and Experience Questionnaire (OEQ)
49,000 responses*
Patient Reported Outcome Measures Survey (PROMS)
5,300 responses*
*May 2018 figures
Human side of technology
Healthy Partnerships
Patient outcomes and experience programme results
• highly likely to refer their friend or family member to see the provider who treated them
• Average of 94% for Experience and 88% for Outcomes
Human side of technology
Patient outcomes and experience programme results: Detractors
Misogynist. Couldn’t talk
to me, or gave me
contradictory information.
So I took my husband
along, and he talked to my
husband instead of me,
that way I could find out
what was happening.
He is very blunt and
did upset me by the
manner in which he
assessed my low pain
threshold.
I could have
been better
informed.
Technically brilliant
but would be good
to know how to deal
with people at their
most vulnerable.
Human side of technology
Healthy Partnerships
Presentation titlestyle exampleIf there’s a subheading, it can be entered here
Thank you
Thank You
Human side of technology
Public information
and campaigns
Personalised
automated
advice
Online
interaction
Personal
interactionF2F
Website self-help
Social media channels
Media
Assessments
Symptom checkers
Monitoring
Targeted marketing
Apps
Chat
Txt
Social messaging
Phone
Picture
Video
Referral to
F2F provider
Increasing clinical richness and cost
Patient’s
Healthcare
Home
Human side of technology
Healthy Partnerships
Healthline
5% to ambulance (postural dizzy)
23% to GP
22% self-care
0.02% complaints/compliments (1/6 clinical)
for mental health/addiction
40,000 calls per month
10,000 calls per month
Human side of technology
Healthy Partnerships
FIT= 5% positive
95% test within 45 days
60% adenoma
30% dysplasia
5-8% cancer
1-3% normal
1/10,000 death with colonoscopy
Screening
Human side of technology
Healthy Partnerships
Health technology assessment process
01 02 03 04
Rapid
assessment
Full
assessment
Prioritisation Implementation
Human side of technology
Health technology assessment process
Application Safety Efficacy
1. 2. 3. 4. 5.QALY benefit Business decision
Quality
Adjusted
Life
Years