28 June 2019

Is this man just a little bit crazy?


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 (over 70 year olds), and radically reduce the size of the impending chronic care crisis and its concomitant increase in serious hospital admissions 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 points out.

One Good Street 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. Up to 50% of those aged over 60 are at risk of social isolation and there is a strong evidence base now pointing to the detrimental effects of such isolation having been implicated in mortality comparable to smoking obesity, lack of exercise, high blood pressure, antibiotic resistance and serious mental health conditions.

The key to One Good Street  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 out there. But an initiative which isn’t really closely related to the heavy lifting needed in terms of better connected health information in 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. A spectrum that stretches from the most complex and expensive EMR at the epi-centre of a modern hospitals connectivity and efficiency, which is of course a necessary part of the overall system, outwards, through the various patient management technologies in primary care, specialist and even allied care, and eventually into the community itself. And Bush points out that 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 says that the most useful medical data on one of our most vulnerable and costly demographic of patients, is 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,  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 system is set up to work. It’s a system that increasingly is underpinned by the government funding 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. It’s needed to build more and better hospitals that are needed 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 far 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 much of the audience seemed very enamoured by Bush’s pitch, said that 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, minute expense and 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 EMR system, or even the GP population of region, is anathema to how lots of us view how to solve ongoing issues in this complex eco system.

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

Acute medicine is what hospitals do best and it isn’t going 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 ton of money by avoiding entry to the more expensive and difficult end of the system of older complex patients. And what a neat side effect. Seniors who are less lonely, isolated and presumably have more fulfilling latter years of their lives.

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

It’s not ultimately driven by a need for investment – money – and therefore has no currency (pun not entirely unintended) for the movers and shakers who run the show to understand how and where to insert it into the system.

This is not to say that government, tech vendors, and everyone in between 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, even many of the tech vendors. It’s just that there isn’t anything that makes this sort of idea available to be easily integrated into the spectrum of services that the whole healthcare system connects.

But initiatives like One Good Street 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 Victorian Dept 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 HERE. Matiu BushMatiu is the Deputy Director of the Health Transformation Lab at RMIT, designing towards cultures of innovation and creativity in healthcare