The news that the RACGP had struck a deal to “support” a previously unknown, foreign software vendor, Hello Health, to build a completely new patient management system (PMS) for Australian GPs, sounded initially like fake news.
Certainly, Australian GPs are constantly wanting more out of their PMS software vendors, and it would be rare for you to find a GP that didn’t have some issue with their PMS. But the market is already served by about seven local vendors. It is highly competitive, evolving fast with new mobile and cloud players and dominated by two very longstanding and well-respected brands, Best Practice and MedicalDirector.
Between MedicalDirector and Best Practice, the amount of money spent on sponsoring and supporting the RACGP through events, publications and advertising over their collective 25 years in the market would be into the several hundreds of thousands of dollars. So, in a sense, the industry has supported the RACGP and its members in more ways than just supplying their key technology over the years.
And all the local vendors, including these two major players, give much of their time to assist the RACGP and the Australian Digital Health Agency (ADHA) in developing clinical standards and better interoperability, that is aimed at helping the whole healthcare industry, and GPs in particular, move faster towards more efficient data sharing and connectivity.
Only three weeks ago all the major software vendors were with the RACGP in a day-long forum helping thrash out all important clinical software standards needed to make GPs more seamlessly connect with each other and allied services. The RACGP were paid by the ADHA to run this forum. And as recently as last week, many of the same vendors attended the RACGP e-health committee’s e-health forum.
But despite years of the RACGP ehealth committee trying to foster a better relationship between the vendors and the college, and trying to develop a better ehealth GP community overall, none of the vendors were consulted or warned about the Hello Health initiative.
Unbeknown to these other key stakeholders, the RACGP had done a deal with a foreign software vendor to help them enter the Australian market by agreeing to use the college’s networks, contacts and membership to assist Hello Health in an eight-month consultation process.
Given the circumstances of the local market, its vendors and their relationship over the years with both the RACGP and the ADHA, which pays the RACGP to bring the software vendors together, you might wonder what the RACGP is thinking.
While it is entirely acceptable that the RACGP support competition in the sector and through that, potential improvement to our all-important GP software industry, it is hard to see why the RACGP did not consult anyone in the local software market who they are regularly dealing with.
All the major vendors we contacted and the Medical Software Industry of Australia (MSIA), which has been an influencing factor in getting most of the vendors involved in these RACGP e-health consultations run on behalf of the ADHA, confirmed the Hello Health deal was a surprise.
One clue as to what might have happened involves the RACGP’s own e-health committee. This is the group the RACGP relies on to push the innovation limits of local software vendors, engage with government and regulators on technology, and generally set the RACGP strategy around digital health. It appear this group was not actually consulted on the Hello Health deal.
According to sources within the RACGP the deal was developed outside the framework of the college’s e-health committee entirely by another group that is charged with developing the commercial interests of the college. That group is likely to be Oxygen.
Oxygen is a separately incorporated subsidiary of the RACGP which lists its vision as breathing “new life into general practice, delivering the right products, in the right place, at the right time to improve health outcomes and people’s experience of health. In its mission statement it says that Oxygen aims, among other things, to:
• Partner with industry to bring the best technology to general practice
• Use software applications to make it easier for GPs and practice teams to analyse their de-identified data and other practice information
• Provide tools that allow (with appropriate consent) the aggregation of de-identified data for analysis within and between practices, allowing the benchmarking of clinical and business de-identified data
A few years back Oxygen found itself involved in a major controversary after it did a deal with local software vendor to start a venture in data extraction from GP’s practice software. That venture, which the RACGP had reportedly invested in heavily, went south but not before more than a year of various RACGP executives flying around the world to do deals to develop the business.
Oxygen’s past interest in investing in data extraction software and this deal, which is to assist a new, and apparently cloud-based entry into the PMS market, might be overlapping. Although the college currently is saying they have no financial interest in Hello Health, if the college did end up with an interest in a PMS vendor such as this, then they would have access to the same data that Oxygen talks about in its mission statement.
From its very early years, MedicalDirector has run a similar data business by extracting de-identified data out of its GP-users’ desktop systems. The data is extracted with permission and de-identified. PENCAT is the major local software vendor in this market.
The decision to go ahead with the Hello Health deal, according to college insiders, was made at Council level.
If true, it appears the college is approving commercial ventures with one committee, the Council that has obvious potential to conflict with the work of another committee, its own expert e-health committee.
If, as has been suggested, the RACGP e-health committee opposed the venture, when they became aware of the plan, and advised the Council to pull out of the deal, then the college will be hard pressed to explain why the Council still gave the deal the nod.
There are probably only three reasons that the RACGP could have for doing a deal like this. Seeking to genuinely improve the competition and quality within the Australian clinical software market, potentially gaining a stake in GP and patient data generating software system down the track and, or money.
The RACGP has been working with the local industry for years and while there are of course the odd spats, at no time has the college identified that the quality and competitiveness of the local software industry is an important issue which they needed to address. Which sort of rules out the them seeking to improve the competitiveness and quality of the local industry.
The potential access to data option seems feasible given the past activities of its commercial arm, Oxygen with respect to owning data extraction and analysis assets.
And money? The key question seems to be, would the RACGP have chosen to help a foreign software company in the manner being outlined without some financial incentive?
CONFLICT OF INTEREST
Without any evidence of a burning reason to fix or change local technology and GP software, the deal looks like it will come close to being in conflict with several parts of the college’s own Advertising and Sponsorship policies, in particular parts of section 4 and 5.
For instance, Section 4.1a states: “ … when assessing any Advertisement or Sponsorship proposition, due regard must be given to member perspectives, views and concerns.”
How could the RACGP Council possibly say that they’ve met this criteria if their own committee on e-health was not consulted, and when they did become aware, they advised the college not to proceed with the deal.
The deal also feels grey with respect to the RACGPs comprehensive policy on endorsement.
That policy states: “The RACGP from time to time is asked to evaluate Products, to recognise those demonstrating credibility in satisfaction of uniform, non-discriminatory and transparent evaluation criteria.”
RACGP chair Tim Koh told the publication, Pulse+IT, that the college had no financial stake in Hello Health and that the college was not as yet endorsing the product, but it had given its “support” to helping the consultation process for the company to assess what it needs to do to adapt the product to Australia.
The RACGP’s endorsement policy says, in essence, that a product is endorsed when they formally grant a product endorsement.
But formal or not, by agreeing to take the lead on a consultation process about this new software with “its members” directly, the RACGP could easily be perceived as offering some form of endorsement.
Asked to comment on the deal, Dr Frank Pyefinch, founder of both MedicalDirector and then Best Practice, which together now service about 90% of GPs, said “Best Practice supports competition in the medical software industry. We believe that products should stand or fall on their merits in terms of functionality, useability and price.”
But he also pointed out, Hello Health software was used in the US where the workflows for GPs are vastly different, and that on a cursory examination of their demonstration software it had virtually no functionality that made it suited to the local market.
Matthew Galetto, who is the CEO of Australia’s recently developed cloud-only PMS for GPs, MediRecords, also said he welcomed “new cloud entrants to the GP and specialist markets that help promote the value and benefits of cloud technology.”
“This especially applies to vendors that are open to partnering with other health and technology companies in the spirit of collaboration and interoperability to improve the flow of clinical information across systems, thereby improving efficiency and information access to providers and patients alike.”
But Galetto was less happy about the RACGP entering into commercial consulting services, promoting or marketing any specific vendors’ products or services to its members.
“If the RACGP are interested in understanding their members needs in terms of identifying a “product is modern, convenient, and the most relevant and supportive software system for the general practice environment”, then they should fund that research and make it available to the general market and their members”, he told TMR.
While both these individuals obviously have vested interest in this fight, most GPs who know them would also accept that their experience and expertise in developing innovative new patient management systems for doctors, desktop and mobile, spans some 30 years between them and would be hard to match, even on a global scale.
The Hello Health deal seems extraordinary in so many ways including its motivations and its implications. Major questions we have include:
• Why is the RACGP backing this new foreign entry into our local software market when the local market is very well served and highly competitive already?
• How does the RACGP council justify spending members resources and time on a project that their own expert committee rejects as a bad idea?
• Why is the RACGP suddenly representing that GP software is an issue in Australia?
• Who did the due diligence on this deal? The council? How is the council better qualified than their own expert e-committee?
• How much money is the RACGP taking to back this venture?
• Has the college considered the implications for their members if they end up alienating the local clinical software industry?
TMR put these questions and more to the RACGP yesterday. In response we received the following statement from RACGP chairman Dr Tim Koh.
As noted in the article published by PULSE IT, Hello Health is currently in the early stages of the creation of a product that suits the unique and evolving needs of Australian GPs and their healthcare teams in Australia.
RACGP has agreed to facilitate a consultation between Hello Health and our members. The RACGP has not endorsed and does not have a stake in Hello Health or the product it plans to produce.
Status as “Supported by the RACGP” is granted when an individual or organisation is formally collaborating with RACGP to provide benefit to the membership, and the wider community. An individual or organisation’s products and services must meet assessment criteria and be offering reputable, robust and mutually sustainable solutions to general practice and/or the community.
In entering this relationship, Council and the RACGP carefully considered the feedback received over many years from the membership as well as commentary from eHealth and other expert advisory committees. Council considers this a unique opportunity for RACGP members to help tailor the development of the product before it enters the Australian market.
The Hello Health opportunity to provide extensive input on the development of general practice software is a first for RACGP and its Fellows. RACGP member consultation will help ensure Hello Health’s unique product is modern, convenient, and suitable for the general practice environment.
The RACGP has not formally endorsed any potential product that will come available following consultations. Any decision on this would be made under in accordance with the RACGP Endorsement Policy, in the interest of the members. The Hello Health product once released will compete in the marketplace with other products and will be assessed by the GP community on its merits.
Working with the company Hello Health does not replace the relationship the RACGP has with any other organisation or government entity. Hello Health are progressive and proactive in their approach which RACGP hopes will assist practices across Australia.
Hello Health is one of the advertising sponsors supporting the RACGP’s annual conference GP18. Companies can buy advertising space and exhibit at RACGP conferences through a publicly available process and in fact the number of exhibitors at the conference increases every year.
Declaration of interest:
Jeremy Knibbs, the author, and the publisher of TMR, is also a non executive director of the PMS vendor MediRecords. This is not a paid role, however he owns a shareholding that is equivalent to approximately one third of one percent