Widespread involvement by clinicians is crucial to success. We need to find a better way to engage clinicians and therein is the nub of the interoperability problem.
The system of primary care as we know it is broken. It needs to be fixed. Fixing it means reform but repeated attempts by governments to reform Australia’s hugely complex system of health service delivery have failed.
For more than two decades the catchcry of health reform advocates has been the need to develop an “integrated patient-focused primary and community healthcare system”. Meaningful progress towards realising that goal has proved elusive.
The power of the internet combined with cloud computing and Software as a Service [SaaS] has suddenly brought the horizon of possibilities for delivering integrated patient care much closer to reality.
The Australian Digital Health Agency, employing 560 staff, has been funded to drive the widespread adoption of interoperable health systems needed to support the reliable, secure, effective exchange of data between multiple non-conformant digital systems. The ADHA’s Interoperability Plan was published on the Agency’s website on 11 July 2023.
The plan’s strategic focus is on achieving interoperability using standards like fast health interoperability resources [FHIR] and health level 7 [HL7], and the development of a national health information exchange [HIE] to integrate with other state-based HIEs being developed.
Early work includes the Digital Health Standards Catalogue, the publication of standards and specifications for a Digital Health Developer Portal, a system of governance to ensure software developers adhere to interoperability standards, and the implementation of an HL7 FHIR-based API gateway to the My Health Record.
In addition to the $2.5 billion already spent on the MHR the government has allocated a further $1 billion in the 2023 budget for a “redesign” of the MHR system over the next seven years!
This is a colossal task. It is fraught with huge risks and technopolitical complexity. The barriers to progress are formidable and they must not be underestimated.
Widespread involvement by clinicians is crucial to success. Yet, engaging them has proved to be very tough, so far, and will continue to be so. We desperately need to find a better way to engage clinicians and therein is concealed the nub of the interoperability problem.
It will be many years before the ADHA’s numerous complex programs of work will have a beneficial impact on the development of a national system of connected care; one which supports comprehensive enhanced care coordination through the seamless exchange of data between disparate health systems thus enabling providers to share patient information easily.
The hyperfocus on interoperability has long diverted critical attention away from considering alternate approaches to building a ubiquitous infrastructure which clinicians, service providers and their patients, can use to engage with each other.
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We need a new starting point to help solve the connected health care challenge while remaining focused on the overarching objective – “an integrated patient-focused primary and community healthcare system”.
Secure message delivery solutions such as HealthLink, ReferralNet, Argus and Medical Objects, have been a well-established feature of the Australian digital health landscape for many years. However, by today’s standards they are inflexible as they only have an asynchronous point-to-point capability.
The deployment of an agnostic, bi-directional, cloud-based, Smart on FHIR-enabled, communication system is urgently needed. This will accelerate and open up more flexible, integrated, communication capabilities between GPs, non-GP specialists, nursing and allied health professions, as well as between public and private hospitals, residential aged care facilities, and other community healthcare providers.
Deployment of the cloud-based e-referral Advice and Guidance [A&G] solution by Consultmed is now emerging with the potential to be a powerful driver of health reform. It is elevating to new heights efficient communication and collaboration between GPs, non-GP specialists, hospitals and other health providers. Its widespread adoption by the clinical community will bring collaborative team-based patient-centric care to the fore, thus leading to better integration of the primary and community care system and, quite probably, to the steady, iterative, evolution of the patient’s shared care record.
Acceptance by clinicians will be paramount to success. Clinicians must see the value of integrating any new system into their clinical workflow. If they perceive a new system to be burdensome or disruptive to established workflows they will resist its introduction.
No amount of carrot-and-stick incentivisation, so often employed by bureaucrats to encourage uptake of a new system, will succeed.
England’s NHS has demonstrated significant operational efficiencies over the last decade by leveraging A&G in outpatient services. The Mater Adult Hospital South Brisbane is also showing similar operational efficiencies with its recently introduced Request for Advice service.
It is time for the rest of Australia to follow suit.
While it may be early days it is refreshing to see that A&G is now being implemented across some hospital networks and accompanying PHNs. Most importantly this is being achieved without the exorbitant costs, inevitable budget blowouts, and the hiring of big management consulting firms.
The Australian health market does not need American tech giants, like Salesforce, implementing massive, monolithic customer relationship management systems. Despite the excessive cost of such systems, they deliver minimal benefit to health services and little meaningful measurable return on investment.
A glaring example is the NDIS debacle, where costs for Salesforce software and services at the National Disability Insurance Agency, initially valued at $27 million, have now ballooned to over $140 million. These costs are expected to rise further amidst serious concerns over procurement mismanagement.
Not surprisingly this is not an isolated case.
It is instructive to pause and consider the billions that have been sunk into the My Health Record and the relentless fees pocketed by Accenture and some large consulting firms adept at bleeding government departments dry while delivering bloated, ineffective systems that fail frontline healthcare workers.
The all-encompassing big-bang approach, too often lacking in transparency and accountability, has failed to deliver. It will continue to do so; due to the complexity of the wicked problems yet to be solved, the diversity of multiple conflicting cultures at play across the health ecosystem, and the political imperatives challenging the vested interests of many powerful competitive technology vendors.
The blank cheques, so often made available to global consulting giants with little accountability, should cease. Smarter, leaner solutions now exist, and they should be embraced without hesitation by the ADHA and government health jurisdictions.
We are now witnessing the transformative emergence of collaborating community networks of referrals, Advice & Guidance and virtual care models.
The vastly improved, secure and easy, bi-directional communication capability and seamless integration into existing clinical workflows, now available through the Consultmed e-Referral A&G solution will greatly increase productivity across the entire health system; from asking for advice on a treatment plan, to clarifying a patient’s test results, checking on the appropriateness of an outpatient referral, or identifying the most clinically appropriate service to refer a patient to within a region or a hospital.
Consultmed has clearly embraced a novel innovative pathway to overcoming some incredibly significant barriers which, for far too long, have obstructed the introduction and deployment of a shared medical record. As increasing numbers of clinicians and service providers collaborate, through eReferral Advice and Guidance, new horizons are appearing with connected care fast becoming a reality.
Dr Ian Colclough has over 50 years experience in health informatics in a career spanning medical practice and public hospital administration, systems analysis and architecture, sales management, marketing and business development in the corporate health and ICT sectors in Australia, South Africa and the UK.
