5 October 2017

Australian digital health at the crossroads

KnowCents Technology

Digital transformation has been slow to arrive in the healthcare sector, for good reason.

The sector is inordinately complex, fraught with risk and regulation, and the economics of supply and demand, especially around the services of doctors, has retarded the normal rapid equalisation of informational power that digital technology brings to the consumer, in this case, the patient.

But things are starting to change, and quite quickly.

One sign is the interest in the sector of a little known, but huge and powerful, company called Equinix. In the terminology of the seminal economics bestseller Freakonomics, Equinix is a “connector” organisation. Connectors are the facilitators of mass markets. They arrive and work at the beginnings of big changes to markets.

Equinix connects companies and institutions to the internet on one side, at scale and with high efficiency, and on the other side to vast amounts of cloud-based services. These includes data storage services, such as those provided by Amazon and Microsoft.

Some of the more interesting clients of Equinix include Amazon, Microsoft, Oracle, SAP, Alibaba, the Chi-X stock exchange, many major banks, and some of Australia’s largest retailers. Essentially, anyone who is big and moving fast into digital transformation of their organisations.

It’s important to notice that Equinix houses direct competitors. That’s because “connection”, where digital is concerned, is about efficiency, and all the big players are optimising for that efficiency by using this group.

The growth of Equinix has followed the rise of the digital revolution. The company started with the major service suppliers to the internet, such as Google, and then moved through finance, marketing and media, travel and retail. Now it sees an opportunity in health.

Local managing director Jeremy Deutsch believes the Australian health ecosystem is showing all the signs of needing the sort of services Equinix provides.

The other major factor pushing the sector are patients. Specifically, digitally connected and empowered patients, who, as consumers, are starting to vote with their smartphones and laptops.

The power isn’t significantly evident yet, because healthcare is stubbornly regulated and controlled by governments, and the culture of medicine and doctors is that they control things, but the signs are there.

Early next year, for instance, Medibank Private, which currently has more than one million users of its app, will upgrade the app to include live mobile payments of all sorts of medical services, including bulk billing, gap payments and the like for both doctors and allied health practitioners. No more messing about with credit cards, Medicare cards and all sorts of gaps to chase up. Medibank Private will also add a booking system for all doctors and allied professionals.

As we know from the controversy over specialist gap directories, the private health insurers are very keen on “compare the market” applications. They want transparency of medical services to increase efficiency so they can lower their premiums. The power is starting to shift to the consumer. Doctors will need to adapt. So will hospitals and other health organisations. Patients are going to get more leverage, and soon.

But as ready as things seem for Australia, and as good as our healthcare system is today – we remain the envy of many OECD countries despite the many complaints – the arrival of the digital revolution in healthcare in this country is asking some very demanding questions of us as a community. Questions which, if we fail to respond to properly, we may find ourselves falling behind nations which are embracing digital technology in healthcare.

Central among those questions is the idea of healthcare interoperability, a centralised medical record for everyone in the country, and perhaps, the rise of artificial intelligence and how we are going to treat the opportunities and threats that it presents.

Interoperability is how all our health systems talk to each other. A simple example in finance is how one bank’s ATM talks to another, seamlessly. In travel it’s how one airline system will easily talk to another to get you somewhere.

In health, virtually no systems talk to each other and it’s a big issue for the progress of digital efficiency.

Critics would say that we’ve done an awful job so far on interoperability in health. They would point to things such as the fact most GPs and specialists still rely heavily on the fax machine to talk to other providers and ask: “What if the banks were still using faxes to move money around?”

It is true the various software and secure-messaging vendors, along with the major healthcare data players, such as the large pathology providers, have largely failed to organise well enough to make communication of vital healthcare data efficient and secure.

Much of the problem has been a lack of co-operation between competing parties. Pathology providers, for instance, want to hold in place their downstream channels to resell their services through GPs. So making the system highly efficient and open hasn’t been a particularly high priority for them.

There have been a lot of efforts and a lot of failure so far.

But the march of digital technology, patient connectivity, consumer demand and cloud-based services means the time is now for these groups to come together and work for the greater good.

It appears some organisations are now moving this way, but many people think Australia suffers culturally in that we don’t work well together for the long-term betterment of the community and that we are short-sighted and selfish when it comes to the profitability of our organisations. If feels like New Zealand, like their rugby team, punches well above their weight in digital health, partly because they seem culturally just more collaborative where community is concerned. They do have key structural advantages in government too.

Some question whether market forces alone are going to get us there in time to bring much-needed efficiencies. The potential is huge. The government may have to play a deft hand in helping this to happen.

A related question to interoperability is how we treat patient data, and central to that is the federal government-led My Health Record project.

The MyHR currently aims to provide every Australian who doesn’t “opt out”, a personal, centralised patient record, that can be shared across the health system, with the aim of significantly increasing patient safety, and system efficiency. The target is to get this working properly within the next 15 months.

But like interoperability, the MyHR program, today run by The Australian Digital Health Agency, has been mired in controversy. To date, the program has cost around $1.5 billion, and no-one, so far, is really using it. The ADHA is reasonable new though and full of energetic, smart and committed people. They are trying. They are optimistic.

Doctors have been incentivised to use it, but don’t like spending time loading information, and patients, largely, still don’t know much about it. The project also has a lot of technologists and experts questioning how it will achieve its goals, given the technology and formats chosen for the system.

The money spent for little progress in this field isn’t all that unusual. Getting such a program up in other countries has seen far more waste and much less progress. For all NEHTA has been panned a lot over the years, the learnings Australia has achieved are large. And although there is continuing angst over this major and important project, one thing is certain. Everyone agrees on the goals, and we have a lot of smart and committed people working hard on the issue.The issues with MyHR aren’t so much how much we are spending, but whether the approach is right.

The issues with MyHR aren’t so much how much we are spending,  or have spent, but whether the approach is right.  Whether we are doubling down on our original idea stubbornly,  rather than stepping back a bit, being more forthright about the issues, and preparing to be more flexible in seeking a solution. It’s a wicked issue in most repects of that term and those at the front of trying to solve it now in the ADHA, whether we think they are doing the right thing or not, need our help.

Will a centralised electronic medical record actually produce the benefits promised? Are there serious security issues with “honeypotting” all this data in one place and trusting the government to look after it? And is technology providing better ground-up mobile solutions to the same problem for a lot less money?

There is technology now that will live update your mobile phone with a highly secure personal health record from your local GP’s electronic patient management system. Your phone will soon be able to talk to your health insurer and Medicare for payments, live at your doctor, your pharmacist, and other connected allied health professionals. Is this sort of technology going to see the MyHR never really used?

The key issues of interoperability, the MyHR, the real impact of artificial intelligence in medicine in the mid term, security of health data, and the rapid rise of the connected patient, are all sessions at a unique event being held next week in Sydney called The Wild Health Summit.

The aim, says Wild Health organisers, is to start getting everyone on the same page in these most critical digital health transformation issues.

The summit has managed to attract an “A list” of movers and shakers in all of the above issues, and is putting them on stage in a series of Q&A sessions with the audience, with each session dealing with each issue, and each session featuring thought leaders on that topic.

As an example, for the “MyHR or bust” Q&A session, panellists answering audience and moderator questions include: Tim Kelsey, the CEO of Australian Digital Health Agency; Dr John Lambert, the CCIO of eHealth NSW; Dr Louise Schaper, the CEO of the Health Informatics Society of Australia; and Dr Tony Sara from South Eastern Sydney Local Health District.

The Interoperability session includes Dr Zoran Bolevich, the CEO of eHealth NSW; and Tom Bowden, the CEO of secure messaging company, Healthlink. Professor Enrico Coiera will headline the artificial intelligence Q&A session, along with Callum Bir, immediate past head of Microsoft Health Asia Pacific.

The connected-patient panellists will include Dr Marcus Tan, CEO of our most successful health startup, Health Engine.

Wild Health is being held on October 16 at the Belvoir St Theatre in Sydney. Tickets are limited but available at www.wildhealth.net.au/tickets. If you use our promotion code WILDTMR you will receive a 15% discounts.

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