You’re not allowed to bag out the government when you’re a primary care consultant, but Tim Blake has a few choice words regardless.
Many primary health networks use Tim Blake, and his company Semantic Consulting, to improve healthcare through better adoption of digital tools.
New models of care, enabled by digital health, will be a hot topic at our inaugural Burning GP Summit in June. However, with all the opportunities that digital tools open up, implementing them can be fraught with challenge.
Tim has seen the full spectrum of reactions to digital health. Some general practices doggedly resist new technology, yet others have an eager appetite for digitally enabled models of care. Sometimes, he sees both in the same day.
How do most primary care health clinics respond to new digital tools?
I can tell you a story about when we were working on implementation of remote patient monitoring at a Victorian PHN. One morning we went to a general practice and presented the solution to them and they basically said, “How dare you! This is terrible. This will never fit into our workflows. We don’t want to use this. Go away.”
Then, that same afternoon, we talked with a general practice who said, “This is fantastic. Where has this been for the last 10 years? This is going to change the way that we practise medicine! Thank you so much.”
Experiences like that lead you to go, “Hang on a minute! We just did exactly the same thing in two different places and got two extreme reactions. This is not about us.”
What is it about then?
Technology is not the problem. How change is managed is the problem.
What we have found is that general practices and health services are all at different stages in their journey towards digital health maturity. What’s needed is messaging and training relevant to where a clinic is on the spectrum of digital health maturity.
Clinics in early stages of digital health maturity, tend to be more focused on, “What is digital health? Why should I care? I don’t understand this. I’m not paid to do this work. Why should I bother with this?”
At the other end of the spectrum, under the same set of conditions, you have health services who say, “This is great. We totally get this. Can you show us how to do it?
They’re two different problems. At the less mature end of the spectrum you have a motivation problem. At the top end of the spectrum you have an information problem.
Yet, traditionally, when technological change is required in healthcare, the spectrum of maturity is disregarded and everyone gets exactly the same training materials and messages and it’s assumed that will work.
Do some clinicians just need to wise up and get with game?
I have a lot of compassion for medical practitioners because we’ve not necessarily supported them over the last few years.
What frustrates me most is government and federal agencies and the larger state groups who continue to treat everyone as the same when it comes to approaching change.
There is no nuance in the way that we try to sell the value of change, depending on where people might be at in their understanding.
Not only is there a lack of nuance, there’s no interest in thinking through the nature of the problem or trying to understand that it might be more complex than that. There is just this myopic push forwards that says “Let’s get it done”. Then everyone is surprised that the communication hasn’t been effective.
That happens over and over and over.
Do you have an example?
My Health Record.
The history of My Health Record has been one of, “Let’s implement. Then, okay, that hasn’t been very successful. Let’s do the next thing. Oh, that hasn’t been very successful either.”
There’s very little reflection about why adoption hasn’t been successful, and there’s very little interest in learning why it was unsuccessful.
When people like our organisation come along and show them what we’ve learned (about how to improve digital uptake), they’re neither interested, nor do they understand it.
Hang on. So, when you have tried to share insights on how the Department could be more effective in the rollout, the people you spoke to were not interested?
Yes, that’s right. There’s a prevailing narrative that digital literacy is often the problem when it comes to change.
Yes, digital literacy is a problem, however, there’s a more fundamental problem – data literacy. We don’t train health professionals very well about the role of data in what they do.
What’s the difference between digital and data literacy?
Digital literacy is just about how technically we make use of digital tools, how confident we are to do that.
Data literacy is a core understanding that data has a role in my in my career, whatever it is, because I can use data to improve. It is fundamentally about understanding both “the numbers”, and also the stories because data can be qualitative as well as quantitative. Data provides evidence about the impact that we have, or have not, had so that we can create a continuous quality improvement loop.
It’s the idea that you do something, you see how effective it was, you reflect on what you could do differently and you improve. Then you do it again.
What we found in all our research with PHNs and with all the data we now have, is that when data literacy is in place, people are much more motivated to become digitally literate.
Why?
Because they see the reason why they need to use these digital tools. It’s like when people’s IQ goes up when they’re motivated.
If you try to create digital literacy when people have no motivation then it’s amazing – you can throw millions of dollars at digital literacy and get only a marginal gain.
Ah, we’re doing things the wrong way around! The bureaucrats need to know this, Tim. Maybe they are data illiterate too?
I’m not saying that the bureaucrats can’t read data, they probably can, they’re bright people. However, they don’t necessarily get how big an issue this is for the rest of health care. It’s one of the systemic flaws in the health system.
Imagine that overnight, doctors and nurses everywhere learn how to analyse the data in their clinics, how much difference would that make realistically?
Huge amounts.
Admittedly, we are missing some pieces of data but a lot of the data we gather is never used because we’re told to gather it, not because we want to gather it.
You hear: “Oh, the Commonwealth told us we have to capture this.”
It comes back to that lack of data literacy, lack of knowing how you can use data to improve. That’s what’s behind the lack of motivation for adoption.
Instead, imagine if we knew how to use the data to change health outcomes. Imagine if we gathered data because we saw the value of it, because we wanted to use it to improve healthcare. That’s what it means to be a learning health system.
“Learning health system” is phrase used in the new digital health blueprint. Thanks for explaining what that means …
You’re welcome, but this puts the onus on organisations to recognise how to use and learn from data and train people.
Wild Card question: Would you rather live in a boathouse, a treehouse or a teepee?
I think I’m a tree house kind of guy.
My kids would say that’s probably because I look like an Ewok.
There’s something appealing and calming about being high up in a tree. Perhaps I’d have to deal with fewer government bureaucrats.
Want to explore how the Commonwealth and PHNs could be really helping GPs? Burning GP will take place 14-15 June at the Mantra on Salt Beach at Kingscliff, northern NSW. Find the program and tickets here.
