By Sarah Dods, Research Theme Leader, Health Services
It seems that almost every politician, health economist, policy expert and health-care worker has a different take on the state of the nation’s health system and ways to make it more sustainable. But notably absent from the debate so far is the role of technology.
So, how can digital innovation improve the health system’s bottom line?
Rising health costs
We know that Australia’s health system, in its current form, is not sustainable. Treasury projections show that we currently spend more than 20% of all government tax revenue on health, and that if current trends continue, this will rise to 40% by 2043.
State government expenditure is even more dire, currently at 40%, and rising to 100% in the same period. Over the past ten years, health-care spending has risen faster than the growth of our gross domestic product (5.4% vs 3.1%) and in 2012 health overtook retail as Australia’s largest employment sector.
The drivers of this growth are an ageing population that is living longer but not in good health, increasing rates of chronic disease (such as diabetes, heart disease, cancer and asthma) that require long-term health management, and increasing expectations around medical advances and what our health system can treat.
For my grandparents’ generation, the expectation for failing hip joints was a pair of walking sticks and self-management. Today, we expect hip replacement surgery, and new hips. The social outcome today is much greater, but there is an economic cost that we need to acknowledge.
The exact maximum proportion of our national budget that can sensibly be spent on health is still up for debate, however it is clear that this limit is in sight. So, economically speaking, what are the alternatives?
Keeping a lid on spending
One approach is to look for new sources of funding into the system. Individuals already fund nearly 20% of health-care expenses through out-of-pocket payments. The current proposal of GP co-payments is one way to increase this.
But when people can choose how they interact with the health system, they will generally opt the lowest-cost option (to them) that meets their needs. So, if they have to pay to visit their GP, then they are more likely to go to the emergency department at their nearest public hospital as an alternative – at much higher cost to the health system.
A second approach is to look at how the system spends the current funding, and whether it is possible to improve what is achieved with the current budget. The best places to seek these improvements are the parts of the health system with the biggest expenditure, which are hospitals (40%), and medical services (18%).
Savings could be found through efficiency gains (doing the same things, but in smarter ways), better utilising lower cost parts of the health-care system that meet patients needs, and by changing operating models (doing smarter things to get desired outcomes).
There is a growing collection of technological solutions that started as research to demonstrate their clinical safety and economic value, and are at, or rapidly moving towards, early roll out.
Big data analytics can predict who, when and why patients arrive at hospitals. These tools can predict emergency department arrivals and how many will need admission, and days when there will likely be insufficient beds available to meet these needs.
This kind of forecasting enables hospitals to move from reactive planning (need a bed now), to proactive planning for emergency department and elective surgery needs, and look to reduce waiting times, improve bed usage, and reduce staff stress levels along the way.
Decision-making around how patients are discharged from hospital is equally important, including understanding and overcoming the barriers that keep people in hospital after they are clinically ready to go.
Patients with chronic diseases, for instance, are high users of our health-care system. For some of these patients, there is growing evidence that their needs may be better met – clinically and economically – through guided self-care at home using broadband communications.
In rural areas, broadband can also improve access to essential health services, enabling better early diagnosis and treatment of conditions before they become major and require hospitalisation. CSIRO is helping to deliver specialist ophthalmology (eye care) services, for example, to remote communities in Southwest Western Australia and the Torres Strait Islands.
At CSIRO, we are also exploring the options to take patient prediction tools to the next level: whether forecasting can also predict health deterioration. This would enable simpler, earlier medical intervention, saving the social and economic cost of a visit to hospital.
The health system is going through a profound generational change in the transition from paper to fully electronic records. The computational standard SNOMED CT is emerging internationally as the tool that will enable these records to exchange detailed, precise concepts and information.
Figuring out how to implement and manage the complexities of the standard across the many non-standard (and often text-based) health record systems is a research challenge in itself. But once implemented, the potential for big data analytics, machine learning and decision support will result in higher quality and safer patient care, as well as enormous efficiency gains in reporting, health business systems, and population health.
Australia is rightfully proud of our record of medical research achievements. But there is a strong case to refocus a significant part of our investment in clinical research towards building an equally strong capability in health-care services research.
Finding ways to deliver high-quality care with good patient outcomes at an affordable cost to the nation is just as important as finding cures for diseases.
Chances are you have a bottle of seed oil somewhere in your kitchen pantry. Most of us use it to cook on a daily basis. But did you know that oil can also be used to produce recyclable bags and the ink in newspapers?
Since oil is needed for such a wide variety of products, it’s important that we find ways to extract as much of it as possible from seeds.
This is where Frankie Rickard comes in.
Frankie is a Food Science student from Melbourne University who worked with our Food, Health and Life Science Industries group over the summer as part of our vacation student scholarship program. She was involved in a project looking at how much oil different oil seeds could hold.
“The aim of this project was to determine whether there would be an increase in value for farmers if you increase the oil content in seeds,” said Frankie.
Frankie spent her summer in the plant laboratory comparing the physical and chemical elements of different lupin seeds with soybean, peanut, sesame and macadamia seeds to determine how much oil, carbohydrates and protein were in each.
She found that sesame seeds had the highest oil content at about 60 per cent, and peanuts followed closely behind at 48 per cent. Lupin seeds, however, had only about 7 per cent oil content, which prompted Frankie to explore how to increase the oil content to that of the peanut.
By inserting different genes controlling various ‘oil synthesis enzymes’, Frankie learnt how to rapidly manipulate oil accumulation in the leaves of a model tobacco plant, a system that has proven to be a reliable indicator of what changes can be achieved in seed tissues.
Watch Frankie’s summer experience:
Frankie believes this project has been extremely worthwhile, and has provided a great insight into a career of researching.
“Although not all of my results worked, and at times things were frustrating, the best part was getting a feel for how things worked in the lab and seeing science as a career rather than just a subject at uni,” says Frankie.
Click through for more information about CSIRO’s summer vacation scholarship program.
By Angela Beggs
It’s official: after ten years in the making, the Gemini Planet Imager (GPI) – or planet hunter if you will – is now up and running in Chile.
The new Gemini takes the title of the world’s most advanced piece of equipment for capturing images and analysing planets around stars. It will help to provide astronomers with new data about a planets atmospheric makeup and characteristics.
This paparazzo of space can snap those hard to see planets that live next to big, bright stars, and probe their atmospheres, even if they have been known to be a little camera shy in the past. It will also help to hunt down and study the dusty disks around young stars.
It is the most advanced instrument to be deployed on one of the world’s biggest telescopes – the 8-meter Gemini South telescope in Chile – and the first images are almost ten times better than the previous generation of instruments. In one minute, users are seeing planets that previously took up to an hour to detect.
Our scientists contributed to the Gemini’s calibration interferometer (one of the four major systems that make up the GPI) by creating state-of-the-art beam splitters.
What’s a beam splitter you ask? It’s an optical device used to split a beam of light into two. Splitting the beam allows for light from the same source to be used for dual purposes simultaneously, in this case, being a reference point and detecting data.
The beam splitters are used in pairs, and there are a total of eight on board – each one is about the size of a two dollar coin.
Our Precision Optics team was able to draw on their many years of experience in optical fabrication, coating and metrology to help develop these devices.
When they’re not busy helping to create elements that can spy on space, the team specialise in the design and production of ultra-high precision optical systems and components for use in areas like defence, security and medicine. You might even be familiar with their quest to redefine the standard kilogram.
So while the new Gemini might not be great news for the young ‘camera shy’ planets of galaxies far, far away, it’s an astronomical step towards finding out how planets form and evolve and understanding what their atmospheres are like.
By Barrie Finnin, Theme Leader, Manufacturing Technologies for Transport and Mining
The recent decisions by Ford, Holden and Toyota to cease manufacturing in Australia have raised serious concerns for the thousands of Australian businesses who work in the automotive supply chain. Manufacturers are asking themselves, how will I respond? How will I transform?
Some suppliers service other markets, so their businesses may continue, albeit with a smaller customer base. However many suppliers are vulnerable and highly dependent on the volume from the auto industry for their survival.
These business owners must choose whether to wind up, or to diversify their business so that they can fill the hole.
At CSIRO we are investigating the concept of diversification for the small and medium businesses in Australia’s automotive supply chain. CSIRO has the largest manufacturing innovation program in Australia, partnering with manufacturers to help solve technical challenges, improve products and processes and develop new technologies.
Our close relationship with industry has allowed us to build a broad picture of the challenges Australian manufacturers are facing. It also gives us the opportunity to play a pivotal role in helping manufacturers innovate, diversify and transition to new markets.
The biggest misconception about diversification is that there is only one way to do it. In fact, diversification can take many forms – diversifying into different supply chains and global markets, or even diversifying products, processes and business models.
Manufacturers that branch out into other industries mitigate the risks that come with limiting themselves to one supply chain.
One company that has continually done this well is Marand Precision Engineering. A key supplier to Australia’s auto sector, Marand is now branching out into aerospace, defence, rail and mining, with automotive business now representing less than 10% of its turnover.
The key question this firm asked itself was: do the components we manufacture always have to go into a car? The simple answer was no. Marand’s specialisation isn’t in automotive supply; rather it is precision engineering – skills that can be applied elsewhere to different markets.
Diversification doesn’t have to be mean moving into new industries. Melbourne-based firm MtM was founded as Melbourne Tooling Co half way through last century, growing to manufacture and design components for Ford, Holden, Toyota, Nissan and Mitsubishi. It even exported parts to Cadillac in North America.
Since 2013, MtM has been selling entire cars – online. The company recently launched the Tomcar, a tough off-roader that is all about customisation – focusing on niche market segments like agriculture, tourism and mining – which can be paid for via the cyber-currency Bitcoin.
Some of the challenges facing our automotive industry – including a high Australian dollar – are unique to Australia. That’s why it’s important for companies to remember that manufacturing is a global business.
Based in Port Melbourne, Futuris Automotive now has established manufacturing plants in Australia, China, North America, South Africa and Thailand. The company has taken advantage of the global marketplace, supplying seats, trims and upholstery to car manufacturers around the world.
Just as companies shouldn’t limit themselves to one supply chain or region, sometimes it’s the product offering that needs to be varied.
Air International Thermal Systems has traditionally provided air conditioning and climate control systems to auto manufacturers. However, the company’s underlying expertise in thermodynamics has allowed it to move into battery pack designs for electric vehicles.
Businesses that understand what they are truly capable of will be more resilient and adaptable to changing market needs.
AW Bell is a family owned and operated business that has been servicing Australian manufacturers with metal parts for over 50 years. Collaborating with CSIRO through the Researchers in Business program, AW Bell developed a new process that allowed it to fabricate complex, lightweight aluminium parts faster and cheaper than conventional techniques.
This step change in capability has allowed the company to become a supplier to the global defence and aerospace industries. It has even supplied components to the Joint Strike Fighter program.
Where to next?
While it is widely agreed that diversification may offer solutions for our auto suppliers, there remains the small matter of timing.
The typical timeframe for a business to successfully translate an opportunity into reality is five to ten years. With only three years until the closure of the Ford, Holden and Toyota manufacturing plants, this process of translation must be accelerated dramatically. This is where a collaborative networks and harnessing expertise are most needed.
In these times of uncertainty, it is important for our manufacturers to remember there are still exciting opportunities to innovate in our manufacturing sector. The companies that tackle this challenge head on will be the ones that successfully make the transition.
On March 5 CSIRO hosted a workshop that brought together automotive suppliers from across Australia to explore opportunities for diversification in the manufacturing sector.
CSIRO has conducted research for the companies mentioned in this article.
By David Cox, Group Leader, Sensory and Behavioural Sciences
So little Harry won’t eat his vegetables? Well, he’s not alone. Poor Harry is just protecting himself from the danger of alkaloid toxins – although he doesn’t actually know this.
At the tender age of four, Harry is neophobic (fearful of new things) and facing “the omnivore’s dilemma”. The dilemma is that humans need to eat a variety of foods to grow healthy and strong but there are lots of foods out there that our sense of taste tells us might be poisonous.
There are good reasons for this because some bitter plants, for instance, contain alkaloid toxins. But some bitter components of foods, particularly in vegetables, are good for us.
So avoidance of bitterness is innate because it’s associated with toxins – and it results in children rejecting vegetables.
Widening Harry’s palate
Children only have an innate preference for sweet foods because of their association with dietary energy, and only learn to like salt early in life (at about four months of age).
But they need to learn to like bitter and sour foods too. In Brassica vegetables such as broccoli, cauliflower and kale, for instance, compounds such as glucosinolates and phenolics that contribute to the tastes bitterness and sourness are the same as those that contribute to their “healthy characteristics – the inhibition of carcinogenesis.
Luckily, for Harry, he has his family around him. Mum is a trusted source of information about what’s right and what’s wrong, and the gatekeeper of the food supply.
The trouble, of course, is that mum can’t face another temper tantrum over a Brussels sprout. So what to do?
The study I was involved in included a group of four- to six-year-old neophobic children. We found exposing kids to vegetables about eight or nine times over two weeks and offering them a non-food reward for tasting them resulted in a significant increase in liking vegetables, compared to just exposing them to the food.
For example, every time a child tasted a vegetable, she got a sticker to put on a chart. This kind of reward provides positive reinforcement, and the display and self-monitoring of achievement. All this is stuff is known to reinforce behaviours.
The UK research echoed and supported these findings.
Models of behaviour
Parental role modelling is important too and more work is needed to provide parents with the skills to deal with refusals. This includes improving parents’ belief in their ability to prevail in certain situations. This belief plays a major role in how people approach goals and tasks.
But does it even matter? Won’t Harry just grow out of it?
It’s true that, at four years of age, Harry has hit his neophobic peak and things might get better through gradual exposure and learning what’s safe.
Things will also change as eating vegetables becomes associated with pleasant outcomes, such as having a nice meal with friends and family. The conviviality associated with the consumption of a formal meal is thought to unconsciously increase the liking for the foods eaten.
But it’s tough because there aren’t too many immediate benefits from eating vegetables and it’s a waste of time telling him they’re healthy.
We know that taste perception rather than health information has the biggest influence on liking brassica vegetables among adults. So learning to like his vegetables early on is important because it’s going to influence what Harry eats for the rest of his life.
The importance of persistence
Loving eating vegetables at an early age could set Harry up for a life of low energy dense, high micronutrient rich diets that are going to help his weight and may protect him against chronic diseases.
So don’t give up. Exposure to a wide range of tastes in a pleasant eating environment, and watching his mum and dad eat vegetables will all help.
And when Harry’s younger sibling is still in the womb, it will probably help a lot if mum eats her vegetables because research shows flavours travel through the amniotic fluid to the growing foetus and influence food acceptance soon after birth.
So investing in their own healthy eating helps mothers save dinner table battles months or years later. Fathers, who are likely to be worse at protecting their health, should also take heed and become the right kind of role model for their children by eating vegetables too.
By Ali Green
Almost one in four older Australians are affected by chronic health conditions, and close to 1.2 million currently suffer from more than one. Given our ageing population, this number is set to increase significantly by 2030, adding more pressure to our health system.
Life for a chronic disease sufferer with complex conditions like diabetes, heart or lung disease typically means two to three hospital stays per year, on top of multiple visits to the GP for regular health checks.
In Australia’s largest clinical telehealth trial, we’ve equipped a group of elderly patients with broadband-enabled home monitoring systems to help them manage and monitor their conditions from home.
Patients can use the machines to measure their blood pressure, blood sugar, ECG (to detect heart abnormalities through electrical signals), lung capacity, body weight and temperature in a process that generally takes around 10-20 minutes.
The monitoring system’s large screen helps guide patients through the different procedures, and the data is sent off to a secure website where it becomes immediately available to a care team including the patient’s nurse and doctor. Daily stats are checked regularly by a specialist nurse who can assist the patient via telephone if there are any changes in their regular patterns.
150 patients across Australia are testing out the machines as part of the CSIRO-led trial. Here are a few of their stories.
Janice and Bill
Victorian retiree Janice suffers from an irregular heartbeat, diabetes and low blood pressure – conditions that require twice weekly visits to her doctor and multiple hospital stays to be controlled. She also has diabetes related retinopathy which has caused her to lose most of her vision, making medical visits difficult for both herself and husband Bill.
Since using the telehealth monitoring system, Janice’s GP and hospital visits have reduced significantly, and she can better manage her symptoms to prevent hypoglycaemic episodes. Bill also has a clearer idea of how Janice is doing from day to day.
“If Janice’s blood pressure reading is particularly low, I can prevent any dizzy spells by getting her to sit down and giving her a glass of water. If her measurements are stable, I can pop out to do some shopping or walk the dog knowing that she should be fine on her own for a little while,” says Bill.
Jack has ischaemic heart disease and chronic obstructive pulmonary disease (COPD). This affects his airways causing breathlessness, a chronic cough and mucus build-up.
During a routine check of Jack’s telehealth monitoring data, his nurse Lay noticed that his ECG results were slightly unusual. This prompted the nurse to call Jack, who complained of shortness of breath. An appointment was made with Jack’s doctor for a full ECG, which turned out to be fine.
As a result of this episode, Jack’s nurse arranged to visit him at home to discuss a medication regime and teach him to use his medicated spray. This meant Jack could self-manage his shortness of breath and prevent unnecessary doctor visits.
75-year-old Frances (pictured top) has a respiratory condition called bronchiectasis. This can easily develop into a chest infection without early warning and lead to a stay in hospital.
Every day, Frances conducts a ten minute check up with the telehealth monitoring system in between washing up the breakfast dishes and getting ready to go out. A nurse at the other end of the internet connection checks Frances’ measurements, looking for any signs of early deterioration.
“I was surprised by the idea of self-monitoring at first, but now that I’m used to it, I think it’s a terrific idea. It has really helped me to better understand my health,” says Frances.
As Australia’s population ages and more demand is placed on our health system, telehealth can help reduce patient hospitalisation, and the related costs, by allowing patients to better manage their chronic diseases from home.
The Home Monitoring of Chronic Disease for Aged Care project is an initiative funded by the Australian Government.
CSIRO is participating in One in Four Lives: The Future of Telehealth in Australia event, at Parliament House this morning from 7:45am AEDT.
Media: Sarah Klistorner M: +61 477 716 031
Every two years CSIRO and the Bureau of Meteorology get together, crunch the numbers and release a definitive report on long term trends in Australia’s climate – The State of the Climate.
The SoC 2014 released today is focused on the changes that have been observed in Australia’s long-term climate trends and it shows that temperatures across Australia were, on average, almost 1°C warmer than they were a century ago, with most of the warming having occurred since 1950.
“Australia’s mean temperature has warmed by 0.9°C since 1910,” BoM chief Dr Vertessy said. “Seven of the ten warmest years on record in Australia have occurred since 1998. When we compare the past 15 years to the period 1951 to 1980, we find that the frequency of very warm months has increased five-fold and the frequency of very cool months has decreased by around a third.
“The duration, frequency and intensity of heatwaves have increased across large parts of Australia since 1950. Extreme fire weather risk has increased, and the fire season has lengthened across large parts of Australia since the 1970s.
“We have also seen a general trend of declining autumn and winter rainfall, particularly in southwestern and southeastern Australia, while heavy rainfall events are projected to increase. Australian average annual rainfall has increased slightly, largely due to increases in spring and summer rainfall, most markedly in northwestern Australia.”
CSIRO boss Megan Clark said Australia has warmed in every State and Territory and in every season.
“Australia has one of the most variable climates in the world. Against this backdrop, across the decades, we’re continuing to see increasing temperatures, warmer oceans, changes to when and where rain falls and higher sea levels,” Dr Clark said. “The sea-surface temperatures have warmed by 0.9°C since 1900 and greenhouse gas concentrations continue to rise.”
CSIRO and the Bureau of Meteorology play a key role in monitoring, measuring and reporting on weather and climate, contributing to improved understanding of our changing global climate system. State of the Climate 2014 is the third report in a series and follows earlier reports in 2010 and 2012.
Below are some of the main facts from the report.
- Australia’s mean surface air temperature has warmed by 0.9°C since 1910.
- Seven of the ten warmest years on record have occurred since 1998.
- Over the past 15 years, the frequency of very warm months has increased five-fold and the frequency of very cool months has declined by around a third, compared to 1951–1980.
- Sea-surface temperatures in the Australian region have warmed by 0.9°C since 1900.
- Rainfall averaged across Australia has slightly increased since 1900, with a large increase in northwest Australia since 1970.
- A declining trend in winter rainfall persists in southwest Australia.
- Autumn and early winter rainfall has mostly been below average in the southeast since 1990.
Heatwaves and fire weather
- The duration, frequency and intensity of heatwaves have increased across large parts of Australia since 1950.
- There has been an increase in extreme fire weather, and a longer fire season, across large parts of Australia since the 1970s.
Global atmosphere and cryosphere
- A wide range of observations show that the global climate system continues to warm.
- It is extremely likely that the dominant cause of recent warming is human-induced greenhouse gas emissions and not natural climate variability.
- Ice-mass loss from the Antarctic and Greenland ice sheets has accelerated over the past two decades.
- Arctic summer minimum sea ice extent has declined by between 9.4 and 13.6 per cent per decade since 1979, a rate that is likely unprecedented in at least the past 1,450 years.
- Antarctic sea-ice extent has slightly increased by between 1.2 per cent and 1.8 per cent per decade since 1979.
- The Earth is gaining heat, most of which is going into the oceans.
- Global mean sea level increased throughout the 20th century and in 2012 was 225 mm higher than in 1880.
- Rates of sea-level rise vary around the Australian region, with higher sea-level rise observed in the north and rates similar to the global average observed in the south and east.
- Ocean acidity levels have increased since the 1800s due to increased CO2 absorption from the atmosphere.
- Atmospheric greenhouse gas concentrations continue to increase due to emissions from human activities, with global mean CO2 levels reaching 395 ppm in 2013.
- Global CO2 emissions from the use of fossil fuel increased in 2013 by 2.1 per cent compared to 3.1 per cent per year since 2000.
- The increase in atmospheric CO2 concentrations from 2011 to 2013 is the largest two-year increase ever observed.
Future climate scenarios for Australia
- Australian temperatures are projected to continue to increase, with more hot days and fewer cool days.
- A further increase in the number of extreme fire-weather days is expected in southern and eastern Australia, with a longer fire season in these regions.
- Average rainfall in southern Australia is projected to decrease, with a likely increase in drought frequency and severity.
- The frequency and intensity of extreme daily rainfall is projected to increase.
- Tropical cyclones are projected to decrease in number but increase in intensity.
- Projected sea-level rise will increase the frequency of extreme sea-level events.
Media: Huw Morgan M: +61 417 834 547