Telling doctors they lack the ‘culture of innovation’ is not the way to coax them into the interoperability vortex.
There is nothing an Australian doctor hates more than being told by non-doctors what they should or should not do to improve things for their patients.
So it came as no surprise that hackles were raised when Charles Cornish, the Australian head of US insulin dosing technology provider Monarch Medical, told delegates at this week’s Wild Health Summit that it was the attitude of Australian clinicians which was holding back innovation in digital health.
“I always think about whether Australia is ready for innovation culturally as opposed to whether we need to be throwing more money at it,” Mr Cornish said. “It comes down to the culture of wanting to be innovative.”
As one prominent GP and mental health specialist said to me the next day, the comments were “not really very helpful”.
“I am tired of the ‘reluctant clinician’ narrative,” she said. “Particularly when it is driven by people who benefit from technological innovation. I am ‘reluctant’ to use thalidomide, but it’s not because I’m uneducated, it’s because I make a clinical choice. And it is legitimate.”
Quite so.
Of course clinicians are crucial to the successful implementation of digital technology in healthcare. But berating them for their attitude is not the way to bring them along on this ride we all know must be taken.
There are legitimate and sensible reasons why doctors look at the latest you-beaut app or data-sharing platform with some scepticism.
Here are a few for starters.
Privacy
Privacy issues are concerning and have yet to be resolved. There’s a reason why healthcare is one of the top targets for hackers worldwide.
Recent research has revealed that 78% of global healthcare providers offering frontline services have experienced at least one data breach since 2021.
“One of the biggest concerns to 91% of Australian healthcare IT professionals around patient records is information being revealed, lost, stolen or not adequately backed up. Accidental data leaks from employees also grew year-on-year, with 43% of Australian organisations experiencing an accidental data leak compared to 35% in 2022,” wrote Tom Raynel from ITBrief Australia.
“This led to a rise in overall data leaks from employees, with 66% of Australian healthcare organisations experiencing a planned or accidental data leak and 63% experiencing a data breach from an outside source or DDoS attack.”
Solve that instead of criticising practices for their password policies and you’ll go a long way.
Weaponised data
Ask any GP who has been audited for MBS item numbers that don’t necessarily reflect the true nature of their practice – mental health consultations, anyone? – and you will find a very good reason why doctors look askance at data-sharing innovations.
“Data has been weaponised against us and our practices, so we are reluctant to share more of it,” said one GP to me this week.
Increased inequity
Technology, digital health, apps, smartphones, wearables – all these things require levels of IT literacy, education, access and above all, money.
Convince GPs that digital innovation makes for better outcomes in ALL patients, regardless of socioeconomic status, and you will win some converts.
Reciprocity
Where are the benefits for clinicians? Does the technology save a doctor time? Does it feed back information that will help the clinician treat their patient? Does it require hours of attention from the doctor just to make it work? Does that time spent pay off in the end?
Answer those questions honestly and thoughtfully, and doctors will start to come on the journey.
Clinical benefits
There has been a lot of debate of late on the clinical benefits of digital and AI interventions, particularly in the mental health space.
Doctors, particularly GPs with no skin in the money-making game are sceptical about how digital interventions can actually benefit the patients they are supposedly aimed at.
“Increasingly, the ‘evidence’ is ‘lite’,” wrote Associate Professor Louise Stone recently.
“There are trials where less than 20% of the cohort complete the intervention. Most trials exclude disadvantaged populations. There are trials which base their evidence on a tiny cohort of people who bear little resemblance to the population they claim to represent.
“Nevertheless, this ‘evidence’ becomes enshrined in policy, perhaps because the funders and the researchers become entangled.
“We would not be considered ‘reluctant’ to use a drug or device if we thought either was clinically unhelpful.
“But with technology-based mental health strategies, the low take-up by patients and clinicians is usually cast as a problem with motivation and capability, rather than a rational clinical decision around efficacy and patient preference.”
Banging on about interoperability, FHIR standards, HL7, and transactional data hubs is all very well in a room full of fellow travellers, but converting overworked, underpaid, browbeaten GPs is going to take a different language.
There’s a reason why practices cling to their fax machines. They work. They’re time-tested and proven. They make things easier for the doctors, which leads to more time for the patients.
There could be some lessons learned from the way sales reps sold the first fax machines to medical practices back in the 80s.
If we want today’s (and tomorrow’s) technologies to be as ubiquitous in 40 years’ time as that magic dusty box in the corner of the receptionist’s space remains, then we need to learn how to sell it to the users.
Language matters, people.
Cate Swannell is the editor of Health Services Daily, where this was first published.
