10 July 2019

Is this man just a little bit crazy?

Policy Social Media Technology

Matiu Bush must be a little bit crazy.

Sitting centre panel at the Wild Health Summit last month, among an elite group of doctors, senior tertiary clinical information officers, state ehealth management, and software vendor and MBS representatives, discussing how we might hope to streamline the wickedly complex problem of transitioning our system from acute care to chronic care efficiently, he challenged the entire group with a simple and confronting idea.

Spend no money, engage the community where it intersects with our most troubled and expensive cohort of patients, namely the over 70s, and radically reduce the size of the impending chronic care crisis via community-assisted prevention.

Even better, use social media for social good. Connect communities and enable the innate goodness that exists in most people and communities to help others.

People do like to do good occasionally, especially when it’s made simple for them, Bush pointed out.

Bush’s “One Good Street” initiative is a classic case of: “It’s not the technology stupid.” Although, given it is underpinned by Facebook, you might say: “It’s not the expensive, new and possibly over-engineered technology, stupid.”

At its heart, One Good Street aims to reduce loneliness and social isolation among seniors by outlining a platform of opportunities for people to offer their assistance to older residents in their neighborhood. The key is outlining an ecology of practical activities for assisting elderly in their street.

With multiple community members, networked to each older persons’ needs, the work is shared. The process ends up being far more effective than many single initiatives working in isolation, which is largely what happens now with the over-70s sector.

The temptation for the digital health community might be there to dismiss One Good Street as a noble, and possibly neat, addition to a spectrum of community health initiatives. But an initiative which isn’t really closely related to the heavy-lifting needed to get better-connected health information into the “main system” in order to advance the overall health and safety of the community. After all, where’s the data, the analytics, the health record, and such?

But what Bush outlines is a digital health ecosystem which is much broader than people suspect. It is a spectrum that stretches from the most complex and expensive electronic health record at the epicentre of a modern hospital’s connectivity and efficiency, outwards through the various patient-management technologies in primary care, specialist and allied care, and eventually into the community itself.

And, Bush pointed out, we are potentially seriously underestimating the potential of the data and connectedness of the community, at the very outer edges of our system, to contribute to the efficiency of the overall system.

Bush said the most useful medical data on of our most vulnerable and costly demographic of patients, was often to be found on the social media of the individuals, their families, or local community workers engaging with them.

And that with something like One Good Street, and the contribution from more and more community members to this data, it would become one of the most valuable sources of health information data on such individuals.

But this whole concept feels very counterintuitive to how our health system is set up. It’s a system that increasingly is underpinned by the government funding of new and effective digital technology solutions. Money makes this system work doesn’t it? It incentivises GPs and influences their behaviour via fee-for-service. Money is needed to build more and better hospitals for acute care, and which are vote winners. And that funds a burgeoning medical technology sector.

What happens if you take the money out and say you can solve a sizeable part of our problem if we somehow mobilise innate community goodwill? That via a scaled, community-led solution that focuses on the outer edges of the ecosystem, over-70s isolation and loneliness, you can, over time, significantly reduce the burden on both the primary and tertiary care systems.

It doesn’t feel like there is any mechanism in our current system that would naturally enable the One Good Street solution.

One senior government panel member at Wild Health, who, like many of the audience seemed enamoured with Bush’s pitch, said if such a program were to be taken under the wing of a government department and seriously funded, it would soon disappear amid politics and bureaucracy.

Although One Good Street is nearly 18 months old, Bush’s logic and pitch on this simple idea and pilot had a room of digital health professionals stuck somewhere between flabbergasted with its simplicity, minimal expense, and vast potential, and at once suspicious and wary as to where such community inspired disruption might end up.

The idea that something so simple might actually be more effective overall than your run-of-the-mill shiny new hospital technology, or even the GP population of a region, is anathema to how many of us view solving ongoing issues in out complex ecosystem.

It’s not that we still won’t be needing a selection of these new and expensive systems, or, less general practitioners, if something like One Good Street could actually thrive.

Acute medicine is what hospitals do best, and that isn’t going to go away. Hospitals need these systems. And general practice needs to grow and be significantly better funded and connected as we move to a world where chronic care is our bigger issue.

It’s just that the sort of lateral and simple solution that a concept like One Good Street offers might significantly alter the settings in healthcare for the better, and release funds where they could have even more impact.

It might just save a tonne of money by reducing the entry of older, more-complex to the more expensive and difficult end of the system. And what a neat side effect: Seniors who are less lonely, isolated and having more fulfilling latter years.

The biggest issue for One Good Street is that there is very little in the way of mechanisms for mainstream medical community, and it funding bodies, to integrate such a concept into our current ecosystem. It doesn’t fit.

It’s not ultimately driven by a need for investment and therefore has no currency (pun intended) for the movers and shakers who run the show.

This is not to say that government, technology vendors, and everyone inbetween are in some way bad because the system turns on money. Most people you run into in the digital healthcare sector are much more passionate about better outcomes than they are about money. It’s just that there isn’t anything that makes this sort of idea available to be easily integrated into the spectrum of healthcare services.

But such initiatives should be part of the system. We should start seriously considering how we can seamlessly join community power into this complex equation.

One Good Street started as a project of the Victorian Department of Premiere and Cabinet project, submitted by Matiu Bush, and voted on by the community, with funding of just $30,750.You can join the One Good Street group at https://www.facebook.com/groups/onegoodstreet.

 Matiu Bush is the Deputy Director of the Health Transformation Laboratory at RMIT in Victoria