Technology changes the chronic disease reality

08 June 2018

Chronic diseases place a disproportionate burden on the healthcare system. In the private sector, for instance, less than 6% of all people with medical insurance are responsible for more than 20% of the total claims paid out. This 6% is made up of high-risk patients who suffer from chronic diseases, and the situation worsens every year.

Considering further that between 2006 and 2015, strokes and heart disease cost South Africa R25 billion, and that 55% of deaths in our country during 2015 were due to chronic lifestyle diseases, it is clear that we have to find a better way to deal with the situation.

The two companies that form Bytes Healthcare Solutions, a part of the Altron Group, have taken up this challenge by investigating how technology can help manage – and even prevent – chronic diseases.

At the recent Africa Health conference and exhibition, Med-e-Mass and MediSwitch shared some of their thinking and illustrated the extent to which technology can change the healthcare management game.

Dilip Naran, head of solutions at Med-e-Mass, focused his presentation on how systems can make a difference at primary healthcare level – the point where effective intervention can reverse chronic disease trends.

“To implement systems that can effectively manage chronic disease, we need to change the mindset of practitioners and develop a well-designed IT platform,” Dilip said.

He listed the requirements such a platform had to adhere to. Chief among these were interoperability and ease of use. “The doctor should not have to fumble through the application,” Dilip emphasised.

Patient engagement was another success factor. Given that patient health happens mainly away from the doctor’s rooms, it is critical to have a way to capture relevant information – hence the importance of electronic health records that incorporate the data gathered by personal health and fitness devices.

“Data and information must be aggregated around the patient,” Dilip said, “not around the medical disciplines or facilities involved in delivering care.”

This requirement underlines the utmost importance of interoperability. In order for different practitioners to collaborate on the care of a chronic patient, systems have to talk to each other, as well as address concerns about security, accuracy and privacy.

A resource that enables the above, is HL7 FHIR. Fast Healthcare Interoperability Resources (FHIR) is an interoperability standard for the electronic exchange of healthcare information. FHIR was developed by Health Level Seven International (HL7), a not-for-profit organisation accredited by the American National Standards Institute that develops and provides frameworks and standards for the sharing, integration and retrieval of clinical health data and other electronic health information.

According to Dilip, Med-e-Mass is one of the first companies to have implemented HL7 FHIR in South Africa. This enables the company to provide a platform that links patient, provider and payer (or medical scheme) with one another in a healthcare ecosystem that improves quality of care and drives down cost of care.

An extensive pilot project that Med-e-Mass ran with Medscheme over the past two years has proven the benefits in real life. There was, for example, a marked decrease in hospitalisation in patients that were on the electronic health record care plan compared to those who did not participate. Furthermore, the pilot showed that the average consultation took 15 to 20 minutes – putting paid to the unfounded assumption that technology will slow doctors down.

Paul Saunders’ presentation painted a picture of technology playing a preventive and even more personalised role. MediSwitch’s product manager and data scientist shared with audience members the intriguing fact of his company having built an artificial intelligence algorithm that could predict with 77% accuracy the likelihood of a person contracting diabetes.

The algorithm used only one year’s anonymised claims data, which included clinical information and lab results, from one medical scheme. With more data covering longer periods, the accuracy will improve considerably.

Why does it matter to be able to predict diabetes?

Diabetes is the third most common disease in South Africa. Yet, says Paul, 38% of diabetics go undiagnosed, meaning that their condition is not managed and that they end up costing the healthcare system dearly in terms of hospitalisation, amputations and loss of eyesight.

A solution that flagged warning signs and prompted a person to seek medical attention, could make a massive contribution to long-term quality of life and healthcare cost management.

The personalised healthcare solution Paul foresees would make use of a patient’s medical history, lab results, genetic markers, and wearable and other IoT devices. It would be mobile-enabled to empower the patient to take immediate action.

The catch with such a solution, is the level of personal information that a patient would have to be willing to share. “When does it become too personal?” Paul asked. “That is a question every person would have to answer for him- or herself, and at every turn the patient must have the power to decide what information may be shared with whom, and to opt out.”

It is true that patients increasingly want to participate actively in their own healthcare, and that this trend is expected to continue. Paul therefore believes that a critical mass of people will find enough value in cognitive, predictive healthcare to be willing to part with enough personal information for such a solution to be effective.

As much as healthcare is about people caring for people, Med-e-Mass and MediSwitch are showing that the future of high quality and affordable healthcare is a high tech game.