Secrecy and inconsistency surrounding the RACGP's Hello Health deal is potentially endangering both the credibility of the organisation and the future of health technology delivery
Last week the RACGP announced that it had signed a three-year marketing and consultancy deal with US-based software vendor, Hello Health, via software development company Myca.
At the time the deal was first mooted last year the official line from the RACGP was that there was no formal commercial deal, that it was not endorsing the company, and that Hello Health simply was a major sponsor of its conference. That statement now looks like it was misleading to members.
The announcement belies some very serious potential issues of conflict and governance for the RACGP. Far more than it seems to be currently contemplating. In the statement last week the RACGP says:
“The intent behind the arrangement with Myca is simply to improve the products GPs use at their desks every day. GPs will always have a choice of provider, so Hello Health will provide an additional choice in the market.”
The statement also makes it clear that “the college has been seeking changes to the GP medical software market for some years”, and because the RACGP is a not-for-profit organisation, it has therefore allocated the project to the commercial arm, Oxygen.
“The arrangements contemplate a long-term relationship between Myca and RACGP Oxygen, and were approved by the board, before the execution of the contracts.”
Notably, the relationship with Hello Health was not alerted at the time of its initial deal to the RACGP expert committee on e-Health (now renamed The Practice and Technology Management Committee), who after finding out, were furious with the Board for not consulting them.
Part of that fury was because for the past 12 months, the RACGP had been taking money from the Australian Digital Health Agency to bring the cream of Australian software vendors together every few months, in order to collaboratively come up with a more robust software and technology standards and compliance regime.
According to sources at those meetings, at no time during those meetings was there any expression of dissatisfaction with the local industry, nor any discussion of the idea of introducing new competition, or the need for it. The local software industry was taken by surprise when the deal was first announced last year and were angry that it had not been consulted.
The RACGP has pressed on regardless.
Significant questions of governance, propriety and conflict now hang over this deal and the relationship between the college’s commercial arm, Oxygen, and the college.
The line between Oxygen and College
If Oxygen is a commercial arm, what is the nature of its access to the College’s assets in terms of its intellectual property from its own expert committees and years of relationships with existing vendors, its huge database that can access all GPs in the country at an email’s notice, and it’s long-term build up of relationships with key GPs who are influential in the software sector?
Does Oxygen have access to all these assets to do its marketing and consultancy work, and if it does, how is this fair to the rest of the software vendor community in Australia? Or, does the rest of the vendor community have to pay for the access to these assets that a foreign software vendor is being granted? And if it does, how does that assist their stated objective of “simply to improve the products GPs use at their desks every day”.
To what extent must the objectives of the College be met by Oxygen, and if these objectives are not entirely aligned, how does the College justify taking a dividend from its commercial arm if the objectives of Oxygen are not aligned?
In the case of the Hello Health deal, it looks at the moment like the objectives set out in the constitution of the college, would not be met at all. These objectives are outlined very clearly here: https://www.racgp.org.au/the-racgp/about-us/constitution
The constitution of Oxygen is not available on the RACGP site, but the College sets the objectives out here: https://www.racgp.org.au/running-a-practice/technology/workplace-technologies/racgp-oxygen/about-racgp-oxygen
Given the nature of the Hello Health business, relative to other businesses that could be chosen for the stated aims, it does not look like either set of objectives is being met.
Who makes these decisions, who gets to check them, and where, if you are a college member, are you able to check them?
What due diligence can be observed publicly on the selection of Hello Health?
This suggests very much that backing Hello Health rather than any number of other foreign vendors, might be in plain conflict with the college constitution. That is, by selecting a low-grade vendor, with virtually no track record compared with most other major overseas vendors, or serious capital backing, the selection might easily end up harming the chances of improving patient management system technology in this country, not, improving it.
The capability of Hello Health
It takes very little web-based due diligence on Hello Health to see that this is a very minor vendor, with no publicly available track record, and probably very little backing capital.
A search of one of the key reference/comparison sites for medical software in US (Software Advice) with variations on the phrase “cloud based physician/primary care EMR software” reveals that Hello Health is not to be found in the top 100 vendors.
Not even in the top 100? How can that be if the RACGP is serious about taking on established Australian vendors such as MedicalDirector, Best Practice and Genie, all of which compare favourably in comparisons of functionality to overseas vendors by independent consulting groups, and two of which, MedicalDirector and Genie, already have their own versions of cloud-based products?
Try to find Hello Health using a Google search on the same terms and see if it turns up even in the first few pages.
You would think that if the RACGP was going to select an outside vendor and were serious about “disrupting” the local industry with such a vendor, they would be talking to the top 10, and then, from a geography where health systems are not so disparate as Australia’s is from the US – that would more likely be the UK, New Zealand or Canada.
But if you are going to the US, you have a massive selection of highly rated companies, with a track record of significant and successful installations already, none of which Hello Health has revealed in any of their publicly available information, or in their deal with the RACGP.
All of the top 20 vendors in the US feature regularly in the major US trade press on health technology. Hello Health does not feature at all in some of this media, e.g., HealthcareIT News, probably the largest source of information, and it has only one story from 2013 in the highly specialised industry newsletter EHR intelligence.
Another major potential flag on the choice of Hello Health is the fact that it is not even represented at the last week’s most significant conference in the world on medical technology, HIMMS. There is no serious player in the US or global health that does not have some presence at HIMMS.
Transparency of selection due diligence
Hello Health software has virtually no presence in the US market, and its software, as described on its own website, is currently entirely unsuitable for the Australian market.
So what are the criteria upon which the RACGP makes its claims and selected Hello Health, and how does that criteria match with the RACGP’s constitutional objectives?
Will the RACGP reveal to its members and the local vendor community the key tenets of its due diligence on Hello Health and Myca? If not why not?
Why, indeed, is that due diligence not made available to members so they can be assured that the decision to back these companies is a sound decision, with, as the RACGP claim, the best intentions of better servicing of healthcare and GPs in mind.
Who selected whom?
Last year in the health industry technology newsletter, PulseIT, a spokesperson for the College stated that Hello Health had approached the RACGP about entering the market, indicating that it may not have even been a part of a selection process.
The college is now backing away from this statement in their announcement by saying that Hello Health was chosen as the result of a visit by RACGP representatives to the US in 2017 to investigate the medical homes model, telehealth services and AI in health.
Which statement is true?
TMR has asked the RACGP on what grounds did the board choose this company to “disrupt” the Australian market as it is saying they want to do?
The RACGPs reply to all our questions was:
“The statement about Hello Health was posted in shareGP – a closed community – for our members, there[fore] I won’t send it to a wider audience.
I would also like to decline the opportunity to answer your questions. We do not have anything further to add.”
What due diligence has been done on local suppliers?
We guess that if you are so frustrated with your local industry that you seek to find an outside vendor who can disrupt that industry you would have done reasonably recent due diligence on the local vendor community. And that this due diligence was reasonably robust. Otherwise, why waste everyone’s time – RACGP officers, local vendors, and the vendor you are looking to bring in seeking to disrupt the industry – with an outside vendor?
There is no evidence of such due diligence being done on any of the major local vendors nor of any new vendors that have appeared on the scene in the last few years as “new and cloud only” vendors, some of them, such as Clinic-to-Cloud, seemingly being well backed and successful. If the RACGP board did not even ask their expert committee for a view on this deal, which expert actually assessed the deal? There aren’t any experts on the board itself. One member of that committee told TMR that there was no assessment at all that the committee was aware of.
This evidence may exist. But it is not publicly available and the RACGP will not answer questions about such due diligence.
Is this just a money thing?
The big question for all members of the RACGP: “Is this just a money driven deal, with very little or no due diligence, or even thought, behind the deal?”
In other words, has the RACGP board endorsed a deal that is more about making a quick buck, than about actually advancing the utility of its members, as it keeps on saying in all its statements about the deal?
If there is no real local vendor due diligence, or indeed any meaningful comparative due diligence on Hello Health, compared with a myriad of other very capable, and well-backed vendors with a good track record, then it feels like its simply about money.
If that is the case, then surely this deal risks being entirely in conflict with the constitution of the RACGP.
It might even be that this deal could harm the local market significantly, to the ultimate detriment of its members. As an example, currently every local patient management software system vendor, is assessing their position about providing any help or information to the RACGP.
Certainly the software and technology standards and governance workshops have ground to halt. Why would a local vendor offer any help to the RACGP or engage meaningfully with the RACGP on this most important of interoperability topics, if that vendor knows that anything they give the RACGP can now be used against them? As it can.
The Hello Health deal is now murkier than it ever has been.
Unless the RACGP gets transparent and quickly around this deal, its credibility around anything it attempts to do commercially can rightfully be called into question.
This deal, is a landmark of non-transparency and of unclear objectives that don’t align with the core purpose of the RACGP.
But who has oversight and governance control of such a deal? Where is the check on the RACGP board if they have done the wrong thing here, and where will it be in the future if they do the wrong thing again?
There does not appear to be any oversight.
The only possible body that could audit such a deal and ask questions might be the Medical Board of Australia (MBA), the body that ostensibly has granted the RACGP its right to access its very powerful and influential IP. But hasn’t the MBA granted the College that right so they can conduct training, standards governance and ongoing medical education. Where in the RACGP constitution does it state that the RACGP can use all its power, IP and access to the GP community to do commercial deals which have no checking process, which are entirely opaque to the membership and the public, and which, without such checks, might actually damage the members and healthcare in the long run?
Disclosure:
Jeremy Knibbs is a consultant and occasional director of a few telehealth and patient management system startups, including being a non executive director of the cloud-based PMS vendor start up, MediRecords.
