Profile: Converging care and research: Professor Andrew Morris

Reality caught up fast with economists and politicians last year when the World Economic Forum announced its finding that chronic diseases will cost the world $47 trillion by 2030.

Professor Andrew Morris says this is just as well, since it used to be seen as strictly a healthcare issue for leaders in medicine to deal with on their own.

As Scotland’s Chief Health Scientist, Prof. Morris is in the middle of promoting collaboration across clinicians, scientists, government and patients to deal more effectively with a problem not likely to go away any time this century.

Speaking with eHealthspace.org, Prof. Morris said his medical expertise in treating patients with Diabetes Types 1 and 2 led him to “try to improve the lot” for people with long term complex conditions by way of system-wide leadership.

A keen observer of how different countries deliver healthcare, he remarked how often their systems are fragmented and not really focused on the patient. “They are also characterised by waste, a lot of duplication, sometimes harm. So what motivates me is how we can improve systems to actually develop better quality services.”

He said for people with chronic diseases - many of whom have more than one - their journey of care can require the support of up to 15 different healthcare professionals distributed across general practice, specialties, allied health, community and hospital care. “So linking that journey of care together in an event based way - a way that can support individual patients is very important.”

A particular area of focus for Prof. Morris is the translation of research into improved clinical practice, which he said requires a change of tack from typical medical research. “If you look at the criteria for success of research institutes or many university departments, it’s often about grant acquisition and markers of esteem like how you are known internationally, and papers published. But actually there’s another step in the journey: impact.”

He said in Scotland they have been working to ensure medical research is maximised in terms of actual benefit to the public. “[This approach] is beyond grant acquisition and applications. And actually I think it’s what the public expect. If you think about most medical research, it’s either funded by the charitable sector or the government - so it’s the public pound. So we’ve got to look at the return on investment.”

Speaking at the recent NSW Agency for Clinical Innovation’s Network to Network Conference, Prof. Morris elaborated on Scotland’s “health science network” model. He said it has involved bringing together the “heavy hitters” in research together with healthcare providers within a single collaborative framework known as Health Science Scotland. He said its main task is to see collaboration across education, research and clinical delivery - three functions he said are typically siloed from each other.

“So we’ve got every person with diabetes in Scotland - all 251,000 of them - being monitored on a daily basis with a single clinical information platform, it goes into all 38 hospitals, and 1,043 clinics, sharing data.” He said this level of patient monitoring and information sharing has achieved significant patient outcomes: “Our [diabetic] amputation rates have gone down 40 percent, and our blindness rates by 40 percent as well.”

The other important aspect of Health Science Scotland has been its ability to attract research dollars into the country by positioning Scotland itself as a single research site. “Industry can go anywhere on the planet and they do … people are seeing this environment as a good place to do business. [Our approach] has brought in millions and millions of innovation funds.”

He said some key principles for achieving this has been an emphasis on the use of informatics, cutting through regulatory burden and working with industry such as pharmaceuticals via a “mature open innovation” approach. Prof. Morris added that infrastructure has been created to make this possible, including health informatics centres, a biorepository for genomic studies, and hubs where imaging results from across the country are calibrated and analysed.

He also said a streamlined “single sign off” for research and development and ethics approvals has allowed the time delay in getting clinical trials underway to be reduced to an average of 18 days. “In some parts of Europe it’s 18 months,” he remarked.

Prof. Morris said the incentive for Australia to up its efforts to harness information technology to converge care and research is particularly significant in light of advances in genomic medicine. “To accommodate this we’re going to face a tidal wave of data”, he said, noting big data has hit the financial services and retail industries in recent times, and because of genomics “it’s about to hit medicine.”

Prof. Morris said the challenges facing society in tackling chronic disease remain immense, but noted “in the middle of difficulty lies opportunity” - a quote by Albert Einstein. “And there is a huge opportunity - and actually patients need this because they get fed up with being shifted from pillar to post with no one knowing what their journey of care has been.”