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THE basic structures through which health care is delivered in Australia are much the same now as they were in the 1970s.
Yet, over the same period, the health care burden has shifted massively from acute conditions requiring rescue care to long-term chronic conditions requiring preventive and longitudinal care. The sustainability of the health care system is under strain from an ageing population with a health workforce struggling to meet the growing demand.
The health care system cannot continue in this form. Greater, more effective collaboration among teams of health care providers and their patients has been promoted as key to its survival.
If we are to achieve this transformation, we need to rethink some of the existing ways of working, such as point-to-point referral processes that keep most of the patient’s care team in the dark. Some elements of care that could be distributed to others are often concentrated in the hands of overworked GPs, many of whom rely on telephone, fax and hand delivery as the primary means of communication.
Digital technologies are the key to enabling this process change, but only if they are of the right kind and used in the right way. Current health care reform in Australia is in danger of getting this wrong.
Often we attempt to transform health care processes and improve practice routines without the aid of any enabling information technology (for example, in the otherwise good work of the Australian Primary Care Collaboratives Program).
Where we do introduce information technology, we often do so without sufficient consideration as to how it will add value to the participating care providers and other health care stakeholders (for example, some of the early attempts to introduce e-health into clinical practice).
Experience from other industries shows without addressing these key issues, such change is destined for failure. Conversely, building the technologies without first rethinking and redesigning the business processes leads to expensive infrastructure of little or no transformative value.
The central insight of process redesign is that digital technologies should be used to enable new, value-adding processes, rather than to support existing processes that add no value. Of all these processes, those involving collaboration, sharing of knowledge and patient follow-up are in need of greatest reform.
What digital technologies and solutions could be used to support such redesigned processes?
If we are to learn from other industries (such as news media, retail books, music and social networking), these systems need to be highly connected, agile and adaptive. The complexity of health care requires this even more, so that enabling technologies allow for variations in practice and are adaptable to new knowledge and treatments.
Connected, adaptive digital technologies are already in use (such as Google, Facebook, Amazon, eBay, and the myriad mobile applications). They proliferate in most areas of society except where they can do most good, namely, health care.
All this is not too hard and can be started today. In primary care, practices can begin by considering the kind of systematic processes and routines they could use — and those they could eliminate — to streamline the management of their chronically ill patients and ensure they all get best practice care. They then need to put in place the digital technologies and solutions that will enable this process reform, focusing on those that facilitate connectivity and flexibility.
By redesigning their business processes using connected digital technologies, practices will eliminate overheads and paperwork, increase productivity and improve collaboration, with better outcomes for all their patients.
These connected models of care will enable government, private companies and other stakeholders to drive innovation in health care at considerably less cost to the taxpayer than our current approach.
Eventually, just as in other industries, these new models will transform clinical and delivery processes to provide more equitable and efficient care with better outcomes for more patients.
Professor Michael Georgeff is adjunct professor in the Faculty of Medicine, Nursing and Health Sciences at Monash University and chief executive officer of Precedence Health Care. Dr Stan Goldstein is Associate Professor (conjoint) at the School of Public Health and Community Medicine, University of NSW, and Head of Clinical Advisory with Bupa Australia.
COI: Precedence Health Care is an Australian-based company that provides an online service to health care providers to manage patients with chronic diseases. BUPA Australia is a private health insurance company.
This article is based on a report, Collaboration and connectivity: integrating care in the primary health care setting, published by the Australian Centre for Health Research in January 2013.
Posted 15 April 2013
As the owner operator of a small Australian transcription service I’m having to advise more and more clients that their new “whiz bang” Electronic Medical Record (EMR)/ practice software system has all but removed MS Word from the transcript/documentation process. In addition, the ability to export data easily to transcription service of choice and/or import completed Word transcripts into relevant patient record is either a convoluted process or does not even exist.
These key components appear to be rushed through or glossed over during the EMR sales pitch.
The word processing modules built into most EMR systems are basic at best and downright substandard at worst. The solution proffered is to have the offsite transcriptionist log in remotely to access the EMR data and return transcribed documents. Often touted as the perfect cure all, remote log in systems and hospital/clinic firewalls delight in not “playing nice”, such that time lags and drop outs are the order of the day.
Little wonder then that offsite transcription that worked so well “pre EMR” has become synonymous with delay and frustration.
Failure to integrate user friendly data exchange and MS Word compatibility into EMR systems often equates to unacceptable disruptions and costly post installation modifications to make things work in the remote transcription setting.
Standardisation across the board to easily export data and import MS Word transcripts would do much to improve what is currently on offer.
How hard can it be?
Jon, you are right that attitude and culture change are the key requirements for success of such projects. One thing that is lacking is a culture of clinically led technology innovation. In Australia there is no systematic way for clinicians to be involved at an early stage with ehealth. Those of us who are involved have stumbled into it through various pathways. However for young medical graduates there is no structured way in which they can be involved in medical informatics.
What we need is a career path for clinicians to become active in medical informatics so that more clinicians can be involved in the development of such innovations.
I think the point here is that the required solution is not technologically complex but the best evidence shows that it does require important changes in attitude to sharing of responsibility and information.
The secret I think is to implement systems that guide people in adopting these changes and put resources into educating, training and encouraging care teams of practitioners and patients.
Financial incentives exist for chronic disease and could be extended to prevention and other health care processes.
COI statement – I work for Precedence Health Care
It has taken to long for the emphasis of ehealth to shift from the engineering challenge to the clinical challenge. We have seen many technology driven solutions to clinical problems that don’t exist. The lack of clinical input and leadership in the ehealth discussion in this country has been the major reason we have not progressed.
Despite the fantastic work of our good friend Mukesh Haikerwal the problem remains that those who are designing the ehealth systems and policy have both feet in either the technology world or the financial world, but have very little to do with the real healthcare world. As a result we have seen some interesting inventions but very little clinical innovation.
What we need is clinically led innovation in the use of technology, based on clinical need not political initiatives.
I will be presenting on this at TedMed Sydney on Saturday 20th April at the University of Sydney. If you are in Sydney come along http://www.tedmedsydney.com to get tickets.
How do those of us in the big teaching hospitals communicate well when a dictated letter using outdated technology takes 8 weeks to end in our pigeon hole for review? I shudder to think how much longer it takes to actually arrive at the general practice. The system cannot cope, and patients suffer, all for the want of a few typists, or technology that works.
It worries me that such a dream remains elusive; years have gone by, as Dr Georgeff knows with no real progress and until the barriers to such integration are identified and removed nothing will change. The doctor is often to blame as many are aged, but systemic problems including financial ones remain. It isn’t simply the process of caring, which is the end point of this process, that should be blamed. Patient management in a practice setting is relatively straightforward, as should be its integration into the wider health community. So why have we seen no progress?
This is an important analysis, in my opinion. I do not mean to devalue the huge amount of work that many good people have invested in ITC in health care in Australia, but when you compare what we have in Australia with what we know is technically and managerially possible as in Kaiser Permanente in the US, it is clear that huge opportunities for improved, linked up care are there for us to exploit. This will cost a lot, but if we can do the NBN we could do this too.