The AHDA-run Connected Care Council is thinking seriously about the complex problem of incorporating disadvantaged patients into plans for interoperability.
Healthdirect Australia CEO Bettina McMahon says health service designers tend to see disadvantage as a one-dimensional issue and this is a problem because more often than not it isn’t.
This is what makes dealing with disadvantaged patient groups difficult and it is possibly why, until now, the Australian Digital Health Agency and the Department of Health and Aged Care have tended to shy away from seriously incorporating the disadvantaged patient properly into all our grand plans for better digital interoperability.
“The impact of disadvantage accumulates through the intersection of multiple factors that drive disadvantage, [such as] non-English-speaking background (NESB) plus disability or low socio-economic status plus mental health,” Ms McMahon told Health Services Daily this week.
“Disadvantage ebbs and flows.
“Victims of family violence and people with mental health conditions are two groups that are vulnerable at a point in time but can’t be stereotyped as ‘disadvantaged’ or ‘priority communities’.”
Ms McMahon was representing one of many peak groups a couple of weeks back when the ADHA’s Connected Care Council met to discuss how the Agency and other groups can do more to build the complex needs of disadvantage health groups into the government’s plans for better overall system interoperability. This was the eighth time the CCC has met.
The jury is still deliberating on exactly what the CCC’s role is moving forward in helping guide and implement a series of ambitious projects in digital interoperability that the Agency and the DoHAC are trying to project manage on behalf of the country.
Is it a collective that can effectively and quickly dictate action through its proximity to the Agency and its coalface data sharing and standards projects? Or, is it more a place where disparate but important groups that make up pieces of the country’s interoperability puzzle can meet, share perspectives and ideas, and socialise them for others to get better perspectives in solving problems?
Making interoperability work much better for disadvantaged populations is possibly the ultimate test of what the CCC can and can’t achieve in this respect.
As Ms McMahon points out, disadvantage being multi-dimensional means that at once interoperability should be front-and-centre of government thinking in improving the situation, and at the same time possibly it might be the most wicked of all the problems our health service designers face, in terms of incorporating appropriate digital system changes to capture these patient populations.
There are lots of important questions for the CCC and Agency to be contemplating here:
- Have we been missing a trick if we are only now stopping to think about how we build the needs of the disadvantaged patient into our plans?
- Are we prepared to significantly slow down what has been good basic process in order to try to incorporate such needs into our plans, which we likely would?
Given everyone loves to talk about system equity and these questions go to the beating heart of system equity, the CCC may have unwittingly opened a can of worms by now starting to focus on the problem.
All of this said, the fact that the CCC has put the issue firmly on the table and has admitted how important and big the issue is, has to be a good thing.
Part of the discussion this month focused on the needs of culturally and linguistically diverse (CALD) communities and key barriers and challenges they experience when trying to navigate the health system to access the right services.
The Federation of Ethnic Communities’ Councils of Australia (FECCA) spoke about current challenges impacting CALD communities including language and literacy barriers, discrimination and stigma, socioeconomic factors and access to support services.
FECCA also provided CCC members with an overview of the Australian Multicultural Health Collaborative and its advocacy work to improve the health and wellbeing of Australia’s multicultural communities, including research, policy development and the work of the National Multicultural Consumer and Carer Network.
Other groups contributing ideas included representatives from National Disability Services, Sane Australia, and some PHNs.
No one we talked to and none of the meeting summary suggests anything concrete in terms of actions on policy came out of the meeting.
But for such a long “left off the table”, vital and complex topic, that’s unsurprising. Just getting peak groups together in the one room to talk about it is an important step.
It’s what the CCC does from here in follow-up that everyone should be keeping an eye on.
The loose and open nature of the CCC means it’s unlikely that we will see any formal action on the topic from them.
But now the topic is out in the open, it’s probably beholden for the Agency and DoHAC to use some of the thinking and ideas from the CCC session to do something concrete to progress the problem.
Ideas from the CCC meeting might point to some doable starting points.
As an example, Ms McMahon says that of the proposed strategies and tactics to address disadvantage, ability to pay – and the stigma attached to asking how much a service will cost – is often missing.
“There was agreement that transparency on pricing was critical to avoid people self-selecting out of care or attending ED which is free,” Ms McMahon told HSD.
“Consistency in communicating pricing (and through digital systems that consumers could access like directories) was seen as an enabler.”
Is this an important and basic starting theme for the action people in the ADHA and DoHAC to work on perhaps?
If all the CCC ends up doing is bringing together good minds to think on important topics like this, it’s going to be worthwhile construct, so long as people are watching and taking notes.
You can see a summary of what the CCC meeting talked about and download the graphics in this story, which summarise all the things that happened in the meeting here.
If you’re interested in getting involved with the CCC on this or other topics you can start here.
