There’s nothing like a crisis to get humans thinking harder and co-operating more effectively for the greater good. Hardship breeds innovation.
So for all the awful downside of the COVID-19 crisis, one silver lining is that there has probably never been a time in recent history when the digital healthcare community has come together to solve complex issues of patient care more effectively than now.
Individual GPs, all the governments, software vendors, the colleges, service providers, GP corporates and the pharmaceutical industry are all rapidly innovating, and co-operating like never before to expedite more effective systems to manage the crisis.
Following are just some of the innovations and examples of co-operation that have emerged in the last few weeks, all of which are likely to have a long-lasting effect on the efficiency of our healthcare system.
- Hard proof for extending telehealth rebating
There is no question the extended telehealth rebating is proving a game changer for practices in managing the COVID-19 crisis. So far, it’s proven so effective we are expecting the rebates to be extended to make telehealth even easier for patients and doctors. The Department of Health has known for years that telehealth will make the system more efficient for everyone. But it’s been scared to implement any generalised GP rebates for fear of cost blowouts.
The COVID-19 experience is already providing data about just how much more efficient you can make a GP by allowing telehealth items. And the government’s fears around cost blowout on telehealth are being dampened by new appointment system technologies (see below) which are automatically checking and auditing a GP to make sure the calls are aligned carefully to the criteria for a rebate. It now seems unlikely the government will have much excuse to ignore some of the important breakthroughs in efficiency that allowing some telehealth has brought so quickly into the system.
If this all happens the many telehealth vendors out there are likely to start looking at a completely different future. Without a rebate, most are struggling or in loss. Interestly though, the GP practices aren’t reporting significant extra use of their existing telehealth systems. They are just getting on the phone or doing face-time calls! That might be saying something.
- Fully electronic and mobile scripts now, not in one year
If you want telehealth to multiply its efficiency, then you’d quickly move to make scripts for patients fully electronic. That project is already under way through the Australian Digital Health Agency, FRED IT, and the various patient management system and dispensing vendors around the country, and it is likely to be realised within another 12 months. But that’s not soon enough to help with the coronavirus crisis, so a few tech savvy GPs have got together and provided the state and federal governments with a very simple and innovative plan to allow patients and self-isolators to stay at home and still get their drugs.The plan involves relaxing all state regulations surrounding the need for paper scripts to be used to obtain a script from a pharmacy. Instead, this GP group is recommending using the existing electronic script exchanges and the patient management barcoding system to expedite fully flexible patient scripts within a few days. A doctor simply generates the barcode for their patient over a telehealth call and emails or sends a photo to the patient who onsends this to the pharmacy along with an appropriate ID. If you do this, all self-isolating patients can remain in their homes and still get their scripts. It just needs the AHPPC to call a hold on the current state regulations around paper scripts.
It’s likely to happen, because under the waterline this is occurring anyway between doctors, patients and pharmacies. The health ministers haven’t got a good reason not to do it. And then in a year, when all the PMS and dispensing vendors have developed and tested the new token based electronic system, we can introduce a more robust next-generation system. On the back of this, some other innovative groups, such as Tonic Health Care, has already launched pharmacy-to-patient courier services to facilitate the process.
Some groups are pushing for the PMS vendors to do this work within 8 weeks by the way. It’s just not practical of feasible. They have a lot more on with COVID-19 to keep things just up and running. And imagine if they got it wrong. Which they would if they were rushed. And they aren’t getting paid for this development work either, yet will likely get stressed like everyone else over the next six months.
- More effective use of booking engines
The booking engine vendors have outdone themselves in the past few weeks, responding within a week to the crisis and developing new software for all their systems which can pre-screen patients for COVID-19 symptoms. First off the block, HotDoc, reported that in its first week of its new screening booking software it had processed an amazing 600,000 patients, all of whom were pre-screened for their practices for COVID-19 symptoms. HealthEngine has also reported almost universal client usage of their screening module.
The power of these simple adjustments to these important tech services to GP practices cannot be underestimated in this crisis. While GP practices are still getting many panicky patients coming in with no symptoms, or worse, with serious symptoms, these systems are starting to significantly contribute to reducing the problem. The systems are adapting too. In the first week one appointment engine was reporting clients lying in their screen to get an appointment when they were asymptomatic, but an audit loop has now been established in some systems for a practice. In time, given their broad coverage of the sector, such pre-screening technology seems likely to make these issues for practices significantly more manageable.
The power of polling patients prior to consults is likely to play a more significant role in increasing the efficiency of practices and the overall system.
- More effective engagement with pharma for education
As of last week, almost every pharma company, painful as it must have been, did the right thing and withdrew their face-to-face sales forces from the field. This at once released practices from any possible hassles with existing appointments, which they likely don’t have any time for just now, but perhaps more importantly stopped the possibility of a rep spreading the virus among doctors, or a rep getting the virus from GPs, who are at high risk.
At the same time, the pharma companies can’t attend any meetings, so, other than any direct email databases they may have, they currently have no way of communicating with doctors important things such as updates on drugs indications, PBS and TGA changes, and the introduction of new products.
So all the companies are now working out how to get these most important communications to doctors in way that keeps our GP force optimised for frontline patient duties. They are turning to all sorts of interesting new ideas such as virtual repping and meetings, using the big medical news publishers, such as us, to embed messaging where it is in a GP work cycle, and, to some very important concepts, such as optimising when doctors actually want or need to see a drug rep, and allowing the doctors to set the times, and the ground rules.
What may be fascinating for some pharma groups is they are going to see what happens to sales when they don’t have a face-to-face sales force. Few have been brave enough to do that before unless a drug has passed its use-by date. And that isn’t a great test. One suspects that post COVID-19 education from pharma companies to doctors is going to take a step up in sophistication and efficiencies for both parties.
- Cloud patient management system proof points
Below the waterline of government service delivery in the crisis, one thing has become very obvious. Cloud service delivery is massively effective for primary healthcare, and if a system is up and functional deployment can be within days.
There are a few government initiatives which will likely be revealed within a few months which are going to change the way people think about cloud utility in primary care, even for GPs who have been reluctant to embrace cloud-based systems, especially patient management systems.
For example, one project with one vendor enabled a government group to co-ordinate more than 6,000 contractors distributed across the country to assist the public with COVID-19 information and record vital clinical data centrally in the one system. The time from idea to deployment of this system was only two weeks.
That aligns with the work from HotDoc and HealthEngine, which although talking to desktop-based patient management systems in GP offices, is cloud based. The power of the cloud has been demonstrated in healthcare through the need for some groups to take a risk on the technology to cut through previously complex and expensive problems. Post COVID-19 it seems very likely that all the big PMS vendors will escalate their cloud development to avoid the sort of issues that desktop systems create in a crisis like this.
- Upgrades to patient management systems
All the patient management system vendors have worked around the clock to adapt their systems for COVID-19 requirements and processes. Key among them, the pre-screening systems from the booking engines, but there are many others as well. Overall, this crisis is going to escalate cloud development of all the major vendors and we are likely to see this technology start to have the impact it has already had in other key sectors, such as finance and travel. These developments are going to align with the development of things such as paperless scripts, and pre-screening mobile technology. We are likely to see a significant step shift in efficiency for practices.
- State and federal health ministers working as one – now there’s an innovation
Who’d have thought? But that’s adversity and human nature for you. Might the states and the federal government finally learn something from how significantly more effective the AHPPC has been in getting obstacles moved and making the system more efficient for everyone?
Sure, a single government body integrating all of healthcare is probably still not going to occur (although it should). But surely this experience is going to give momentum to the concept of creating something far more integrated between the current, and horrendously inefficient, divide the system currently has.
Declaration of interest: The author is a non-executive director of a cloud-based medical software company