10 June 2020
The ugly truth about disasters and digital health
Early on in this pandemic, the simple mention of COVID-19 in any story would double our user clicks. We even had a live COVID-19 blog in our sister publication, The Medical Republic, which did record numbers.
Now we are almost trying to avoid using the term, such is the fatigue now being experienced by most of our readers, not just in their day to day working lives as medical professionals but in everyday media.
If you want to get a sense of the mindless repetition in messaging that is starting to make us numb, then check out this YouTube video comparing how everyday consumer brands have come up with exactly the same banal approach to treating their customers during COVID-19.
It’s a worry, because in digital health, COVID-19 is the most important event in decades for showcasing just how effective the sector can be for solving major issues in our healthcare system, and just how good we are at solving them when we really want and need to. We can’t really afford for the term, and the experience, to start fading from our psyche.
The upside is that some of the steps forward we have taken for COVID-19 – telehealth for instance – will almost certainly be never be fully reversed now. Some progress is just going to stand. If there is going to be a downside, it is going to be what we do with these great leaps forward from here – or not do with them.
As important and obvious as the decision to introduce telehealth rapidly to general practice across the full spectrum of MBS items seemed at the time, word is that it was still a near thing. The government was in essence backed into a corner in letting this genie out of the bottle and it was some nifty last minute lobbying from certain highly placed individuals that got it over line in the end.
Some sense of how fearful the government was of the so called ‘woodwork’ effect of telehealth (in that everyone comes out to claim for anything), is the $600m that various government representatives boldly promised to add to MBS spend to cover it. That the MBS initially didn’t move at all in overspend, and when it did, it only moved up by $100m in the worst month of the pandemic, was wholly unexpected by the government (then again so was a $60 billion saving in JobKeeper).
Telehealth is by no means perfect. But it rapidly solved so many issues and introduced both GPs and patients to such an obvious system efficiency that it can’t be fully reversed now.
However, it does have to be sensibly managed in the short to midterm to avoid serious issues developing. The government is said to be keen on introducing it, but only as an AV consult, which is wholly missing the point and impractical. For all the audio calls that were done in April that helped create most of the $200m in MBS telehealth costs, many were efficient and necessary, and many weren’t. But the phone, and in the future other even simpler patient-doctor communication channels, are clearly efficient if you put the right price on a call and do things like make those calls as much as possible and stick with a patient’s normal GP. We could with not much effort (literally) still make telehealth into a mess, when we simply don’t have to. It should be a priority to work it out and telegraph those changes well before the September deadline reversing all telehealth back out of the system.
- Privacy and data security
Research out of the UK suggests that nearly 30% of people are more inclined to share their health data with government than prior to COVID-19. Before it lost most of its mojo to the “flattened” curve, the COVID Safe app was downloaded by over 6 million Australians. And whether doctors or patients realised it, most state governments authorised non secure data exchange of script information, and other patient data, in order to make COVID-19 isolation ends meet. The upshot is that there has been some shift in community and health sector sentiment towards health data privacy and sharing.
The progress is potentially only one idiotic data breach away from being almost fully reversed, so we need to treat this privileged position with the care it deserves. But be practical. It is interesting to also note that where state governments did not authorise sharing of script data via workarounds like taking photos of bar codes and emailing them to pharmacists, GPs in their thousands flaunted the rules anyway in order to help their patients out of a bind. There are obviously some lessons here in how strictly we have been adhering to things like ‘secure messaging protocols’ when in some circumstances, there may be far easier ways around what we thought were complex issues.
We have a whole article about how amazing government can be when they need to be. A huge question still is, can we somehow bottle what they did so we can pour some more of it out later when we really need to. It doesn’t feel like a lot of the ‘smash-the-glass’ protocols government invoked during the pandemic are going to be either sensible or feasible moving forward as standard operating procedure.
Government by its nature needs to have process and regulation, and it will always be driven by politics at the top. So, we aren’t likely to see spectacular implementations of new technology, including private-government partnership contracts formulated and signed literally within days in order to make things move. But there will be some substantive upside legacy from what COVID-19 taught the government:
- Most governments, federal and state, are no longer as afraid of the cloud as they were prior to COVID-19. In the face of the need to scale at speed, with low cost and high impact, government often turned to cloud based applications and vendors to solve a lot of their problems. That is going to change the momentum of the digital health sector substantively in the next few years.
- Healthcare tech vendors saw a government sector they probably did not realise existed: one that when it needs to be can be awesomely kickass and efficient. With that secret out, the pressure is going to be on all governments to live up to some of the new expectations they have set. For obvious reasons they can’t be as wild as they were during a pandemic in getting stuff done, but they can’t hide behind all the excuses they have used on vendors and public lobbying groups for decades in the past anymore either.
- COVID-19 has seen a spate of highly effective and innovative public-private partnerships that are likely to show the way for more of the same. Barriers have been broken down.
- There is a renewed faith in the ability of government. It’s a faith that government needs to realise is an emotional bank account that they can’t squander by going back to all the old ways they did things. Government needs to adapt to what it learnt quickly and invest some of that emotional capital they’ve earned wisely.
- Perceptions of ‘Interoperability’
If COVID-19 changed only one thing for digital health in Australia, then showing up how we may have twisted ourselves in knots for decades over the issues and complexities of sharing health data, for the wrong reasons, might the most important thing.
If you take the HIMSS definition of interoperability, and cast it across all the problems we solved rapidly in Australia because we needed to, when we couldn’t do it for decades prior, you tend to look at the problem of interoperability in a different light.
Interoperability is the ability of different information systems, devices and applications (‘systems’) to access, exchange, integrate and cooperatively use data in a coordinated manner, within and across organisational, regional and national boundaries, to provide timely and seamless portability of information and optimise the health of individuals and populations.
When push came to shove in COVID-19, years of attempting to solve ‘secure messaging’, of big global vendors ‘blocking’ sharing to varying degrees and of regulatory requirements for certain standards of privacy protection, meant just about nought. We went around just about all of it in all sorts of ways, which at once raised eyebrows about contravening traditional standards and thinking and then, proffered questions around whether there might be more practical middle ground on some of these once seemingly intractable issues.
One question that was raised prior to COVID-19, but now should be firmly on the agenda of those in charge of improving healthcare interoperability in the country, is: why are we so obsessed with sorting out ‘secure messaging’ as a first step to better interoperability? Should we have a more holistic and practical approach that takes all the lessons from this pandemic and applies them at a higher level of thinking to the problem?
As a side note to that, should the ADHA ditch its seven pillar strategy (pillars 1 and 2 being the My Health Record, and Secure Messaging) and adopt just one pillar – interoperability (which happens to be pillar 3) – to which it can apply all the practical learnings about interoperability from COVID-19?
- The Cloud
If you happen to be a medical software vendor and you’re over hearing about ‘the cloud’ and how you will need to move with the times eventually when really, not that much has happened so far, and you’re getting a little tone deaf to what you now could easily perceive as another boy ‘crying wolf’?
The wolf is here. And there is a lot in the open paddock to eat in healthcare in Australia.
The reason we can now cry wolf with a lot more confidence is that the government – see above – now sees what the cloud means to healthcare, has tasted it, and wants more where it came from. Increasingly, cloud applicability and integration is going to be the norm now, because the government is finally moving on cloud, and it is specifying it in its contracts.
There is also overwhelming pressure starting to build on legacy healthcare systems, one of them being the desktop patient management systems of most GPs in the country, via surrounding health apps that are integrating to these systems to a point where the line between the functionality of the core system and the cloud integrator – Hotdoc, HealthEngine, et al – is getting blurry. If the major patient management systems don’t move now, something is going to give in this niche.
One thing likely holding this particular niche of the software market back is the corporates, none of whom are in a good enough cashflow position to fund the migration of their systems. But with both government and private players at their heels for change, things are going to start changing.
The irony might be that government may lead the cloud revolution in healthcare. During COVID-19 they negotiated several contracts with private cloud-based vendors which were groundbreaking, and which were surely a portent for other system vendors.
A good example is the contract that cloud patient management system vendor MediRecords landed with government-based health information and triage provider Healthdirect. From the inside – I am a non-executive director of MediRecords – the story of this contract and what it achieved for government within such a short space of time is eye opening.
When COVID-19 hit HealthDirect had a huge problem. Its call centre was immediately overwhelmed, and it was running technology that couldn’t scale. How could the group, literally within days, expand its service by adding thousands more ‘seats’ which would direct users to geo located, appropriately qualified professionals? And how could they do this with a real time system that was coordinating and sharing data and notes across Australia in hundreds of locations, so they could respond in real time to any patterns that were emerging via use?
You can read the full story here, but essentially the answer was a combination of the MediRecords cloud suite with Amazon Connect functionality. The contract was negotiated and the products adapted and integrated within days. It worked on day one. The adapted solution is now being rolled out for other providers and HealthConnect is considering using the scaling technology for other services it provides.
Patients have changed. They love the utility of telehealth. They like that their doctor writes them a prescription either in clinic or on the phone and it somehow gets delivered the next day. They don’t mind the government tracking their movements in the name of better health. They feel the government is doing a pretty good job with healthcare overall based on the management of COVID-19. They’d love to do more digital with their doctors now.
How long are we going to have our patients in this adoptive forward leaning mood? It’s hard to tell but in all our plans we should be taking their new headspace into account and leveraging it to the best of our ability.