As winter turns Melbourne a darker shade of grey, 11-month-old Toby has a worrying gurgle in his chest. It’s bad enough that his mother, Julianne, wants him seen by a doctor. But instead of taking her son out into the cold on an hour-long trip for a five-minute consultation, she plugs a small digital stethoscope into her iPhone’s headphone jack and gets to work.
The device looks more like a silver yo-yo than a medical instrument but paired with the accompanying wireless, non-contact thermometer it has, in less than a minute, measured Toby’s temperature, heart rate and made a 15-second recording of his breathing.
As he shuffles impatiently in his mother’s arms, a smartphone app analyses the data and gives a prognosis before sending it to a GP for confirmation. It’s nothing more than a passing cold and Toby is soon back on the sofa with a spoonful of cough syrup – the whole process having taken seven minutes and 32 seconds in the warmth of his own home.
Far from science fiction, this product is already on sale. CliniCloud was invented by two Melburnian doctors and while local rules mean this scenario can’t play out fully in Australia because there is no video doctor service yet, it will start shipping across the United States from July 2015 with a family-friendly price tag of $US149.
CliniCloud is one among a wave of new products that, after years of talk, are turning the promise of telemedicine into reality. As patients push to control their care and governments face rising costs and shrinking tax revenues, companies large and small are innovating quickly to sell them answers.
But the market is responding. In recent months Google, Apple and Telstra have all invested serious money in telemedicine. At the other end of the spectrum, start-ups are transforming medical devices that have barely changed for centuries.
Aside from CliniCloud’s smart stethoscope, a Californian company has started selling otoscopes that clip onto smartphone cameras to allow remote viewing of children’s eardrums; Melbourne’s Quanticare Technologies has reimagined the zimmer frame; and a Queensland doctor has created a system that means chemotherapy can be given to patients remotely.
In Boston a hospital is set to start offering a service where newborns can have a droplet of blood from their heel fed into a genome sequencer; it will act as a crystal ball that foretells the risk of everything from short-sightedness to cancer long before they’ve taken their first steps.
Knowing your child has a predisposition to, say, type 1 diabetes or obesity might not be fun, but it could save their life – and keep them out of a public hospital where the cost of care before drugs comes to between $1500 and $2000 a night.
STRAIN ON THE PUBLIC PURSE
If the great enabler for all this activity is the spread of broadband internet and the ubiquity of smartphones, the real economic driver is that healthcare costs are rising faster than the rate of inflation at a time when government coffers are being squeezed on multiple fronts.
The answer, according to most in the medical industry, is introducing technology that works to empower patients so they can, and will want to, take on more of the costs.
Thus far the federal government’s biggest contribution to changing the future of healthcare has been the creation of the National e-Health Transition Authority (NEHTA) and its myHealth Record system, formerly known by the less catchy title of Personally Controlled Electronic Health Record System (PCEHR).
It hasn’t been a roaring success. The PCEHR has already cost $1 billion to develop with very few records to show for it.
In Tuesday night’s budget, however, the government committed $485 million over the next four years in a do-or-die push to resurrect myHealth. The system, which is designed to give every Australian an electronic medical file that can be shared across the nation, is something most agree should vastly improve transparency and, as a result, diagnosis.
However, it is one doctors feel disinclined to use. For many medical practitioners, the problem with myHealth is that in its current incarnation patients have far too much control of their own records.
The Australian Medical Association has argued that doctors could not be confident in a record that could have huge gaps deleted by patients embarrassed about their conditions, which might change a diagnosis and leave doctors liable. Could a hospital trust a record that didn’t mention an emergency patient’s hepatitis C? And would a gynaecologist feel confident if a woman refused to disclose her prior pregnancy terminations?
With Health Minister Sussan Ley announcing last week that the public will now have to opt out of myHealth if they don’t want their records on the national database, the system should get a big boost. What the doctors do, and whether it can lead to savings of billions of dollars a year as some have forecast, remains to be seen.
‘WE’VE GOT TO DO BETTER’
The scale of the costs issue can be seen by looking at the growth in funding since the advent of Medicare in 1975. In 1971 Australia spent 5.6 per cent of its gross domestic product on healthcare; by 2014 this had risen to 9.5 per cent. During that time the national population almost doubled, from 12.94 million to 23.8 million people.
“Healthcare costs are rising faster than GDP is rising so unless we decide as a country that we’re willing to spend up to 20 per cent of GDP on health we better do something,” says Steve Hambleton, the chairman of NEHTA and the most recent past president of the AMA.
“We’d have to go to the people of Australia and say, ‘Health is important so we’ll take money out of roads, schools and pensions to pay for it.’ But the population think the balance is about right. So if we’re going to stick to health spending being 10 per cent of GDP we’ve got to do health better.”
For CliniCloud co-founder Andrew Lin, getting to the point of actually selling his devices has been a long road with many fights – mostly with his Chinese-Australian parents, who’d prefer him to take a road more travelled rather than spending hungry nights working on software code.
“It’s been a bit of a struggle … and I’ve had my fair share of scoldings from my parents,” he laughs. “They see you’ve done so well at school, done six years of medicine, and wonder ‘Why throw it all away?’ Because being a doctor is a big deal, especially in a Chinese family. But it’s about being passionate about what you do. Inherently it’s risky … but I really think I can make a difference and I really want to.”
CliniCloud uses clever algorithms to diagnose basic conditions, while also feeding the data to doctors online in case it’s something more serious, such as pneumonia. For Lin, who also spent two years working at global consultancy firm Bain & Company, tools such as CliniCloud are vital for slashing the burden of healthcare on government finances by acting as the first stop for many inquiries.
“If we’re going to reduce healthcare costs, hospital costs and clinical costs there just have to be more innovative ways to offload the work and get the same level of service,” he says. “The costs of doing healthcare [in the home] are many magnitudes lower.
“But at the moment there are no tools available to track what’s going on … So we want to make the home more clinically directed. Without them we won’t be able to achieve the savings needed.”
Despite having been born of a soldering iron in co-founder Hon Weng Chong’s garage and developed by engineers at the pair’s Bourke Street headquarters in Melbourne, as the law stands CliniCloud cannot be used in Australia. Any doctor hoping to get Medicare benefits for their work must conduct their consultation face to face, which in turn has stalled most efforts to launch virtual visits.
CliniCloud connects with a separate Doctor on Demand service that provides patients with virtual consultations over video. It has no broad equivalent in Australia outside of small bush towns with no other choice. But it might be available by the end of the year.
CONSUMER-DRIVEN CHANGE
Telstra Corp’s flagship healthcare system will be ReadyCare, which works with Swiss provider Medgate to give customers access to doctors over the phone or by video link.
Telstra is uniquely positioned as a trusted brand with the cash needed to consolidate the market and make an impact. Telstra Health managing director Shane Solomon has spent more than $140 million acquiring disparate health technology firms in the past 12 months and wants it to generate more than $1 billion in annual revenues by 2020.
“We’re seeing a little pre-Uber-fication here,” Solomon says. “If you look at the US [health consortium] Kaiser Permanente, they now do 50 per cent of their consultations online.
“So there is a fundamental change in the way people get repeat prescriptions and if you look at what will drive this it’s not going to be the doctors – it’s going to be the consumers.”
Solomon is open about the fact that the generations-old tradition of waiting in the local GP’s office could soon come to an end, resulting in financial uncertainty for healthcare providers across Australia. “We don’t hear GPs saying it can’t be done but instead we hear them worrying about their position, and rightly so,” he says.
“We have a dual-strategy on telemedicine: one is to do the disruptive model to prove it can be done safely and conveniently, and the other is to create the platform that would enable GPs to do exactly the same thing for their own patients. So I just think the technology will help them adapt.”
While CliniCloud will soon be used in the US, it is fighting for a share in a very competitive landscape. Several other point-of-care diagnostic tools are coming onto the US market, and teams of doctors and developers are competing to be the first to build a multi-use tool that can diagnose 15 diseases and conditions, including diabetes, stroke, anaemia and pneumonia, in 30 patients within three days.
One of the finalists, Scanadu, can already measure temperature, oxygen levels, heart rate, blood pressure and the patient’s electrocardiogram reading when placed against the temple for a few seconds.
But the risks for players involved is also measured in the billions of dollars and thousands of lives. Shareholders of companies such as Telstra are generally cautious and carefully monitor the company’s spending.
CHEMOTHERAPY BY VIDEO
While the costs of losing are currently immaterial, the e-health stakes will inevitably rise to the point where backing the wrong technology or being usurped by a foreign service provider could cost local companies huge sums of money that could be spent elsewhere.
In Townsville, in far north Queensland, oncologist Sabe Sabesan is developing another foundation of Australia’s medical future among the ochre-red sands of remote townships. His mission is to take cancer treatment to the patient, rather than bringing the patient halfway across the country to get the treatment.
Sabesan came to Townsville 12 years ago via an internship in the red centre of Alice Springs and training in Brisbane, where his patients would travel more than 1000 kilometres for a five-minute appointment. It got him thinking about a better solution.
He began a pioneering tele-chemotherapy program that allowed nurses who were a 10-hour drive away in the regional centre of Mount Isa to deliver cancer therapy under video supervision by doctors in Townsville. The program has recently been extended so that doctors in Cairns can supervise care in remote Queensland communities such as Weipa, Cooktown and Thursday Island, 39 kilometres north of the Cape York Peninsula.
Previously, patients on TI, as it’s known, would have to travel to Cairns for care. That trip involved a drive to the harbour, a boat to nearby Horn Island, another bus to the airport and a flight to the Queensland tourist city, and cost the state government about $2000 – not including the accommodation fees for patient and family. “There are many other fields of medicine that should be able to look after their patients on video-link,” Sabesan says.
As well as improving quality of life for patients, the service cuts down waiting lists at larger hospitals and also boosts local capability, he adds. “The rural sector becomes more confident to look after these people closer to home.”
POTENTIAL OF WEARABLE DEVICES
Meanwhile, doctors are also finding ways to use wearable health products and the human genome to treat problems long before they ever arise. In Boston’s Brigham and Women’s Hospital, a program called the BabySeq Project will soon use the blood of newborns for genome sequencing.
Dystopian as it sounds, an interview of 387 parents found that almost 90 per cent would be interested in getting genome screening. Such tests could lead to drugs tailored from birth to treat illnesses decades before the smallest symptoms arise.
NEHTA’s Hambleton sees the potential. “We can tap into a patient’s fitness app from their smartphone and tell them they’re not walking enough and the phone can say, ‘You haven’t done your 10,000 steps today,'” he says.
“If you’ve had your genome sequencing done and you have a heart attack, in some cases [certain medications] won’t work and if we knew your genetic susceptibility we could give you a better drug. And if you’re genetically susceptible to diabetes your phone may remind you to do more exercise.”
Another fundamental question must be answered by society at large – are we ready to be treated by robots rather than humans? And will we be prepared to accept the results when someone’s child is killed by a poor diagnosis from a computer algorithm or video consultation that failed to spot symptoms?
“I think it’s a hugely important question … and I don’t think we are,” Hambleton says. “We think computers are perfect and will inherently make us better. It’ll be a philosophical question that society must ask itself. Five years from now we’ll be in a very different space but in 10 years it’ll be somewhere impossible to predict.”
Source:AFR