The cost of digital health tools seems a lot, but think about the cost of not implementing them. This is a long-term investment.
A leading digital health researcher has challenged software vendors and developers to look beyond solving a clinical problem, to make sure their solutions fit the system they’re trying to fix.
Professor Clair Sullivan, director of the Queensland Digital Health Centre at the University of Queensland, told a roomful of vendors at the recent Medical Software Industry Association summit in Brisbane that there was no point solving a clinical problem if it could not show value to the system as a whole.
“A lot of developers say ‘I’ve got a solution for that problem’. And often they have, in fact, solved it, but what has happened is that solution doesn’t fit into the system,” she told the delegates.
“This is at the crux of the barriers that [we face], because our existing healthcare system is so complex and large that unless you understand the system, your solution is not going to [represent value].”
Professor Sullivan cited research her team conducted in 2023 looking at the impacts on medication prescribing errors of moving from a paper-based system to a digital prescribing system.
“What we saw was incredibly reassuring – a fairly dramatic reduction in reported medication incidents,” she said. “Before digital we had to review one chart to find an error. After the transition to digital we had to review five charts to find an error.”
As a clinician, that transition to digital prescribing was “incredibly valuable” because it solved a clinical problem.
“But I needed to mature and understand that from a system [point of view] the [transition to digital prescribing] was hard to value because our funding models do not reward prevention of medication errors.
“Our funding models reward activity,” she said.
“I realised that simply showing better clinical outcomes probably wasn’t going to be transformative at a system level, and I needed to think like a system person, not like a clinician, if I really wanted to create change.”
Professor Sullivan and her team took their research further, hypothesising that more digitally mature hospitals would have better outcomes, using a range of measures across the Quadruple Aims.
“We saw no change in length of stay, hospital readmissions, mortality or inpatients falls,” she said.
“But we did see improved staff retention in digitally mature hospitals, and an increase in inpatient activity, a reduction in infections, and … a decrease in medication [errors].
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“So, we’ve become more sophisticated [in our thinking]. We’ve moved from a passionate clinician trying to improve the system to somebody that understands things like [the value of] activity.”
The challenge then becomes creating a funding model for digital health interventions that makes sense in the current healthcare system.
“The investments required for digital health are very large,” said Professor Sullivan. “And this is awkward when we have a system that’s needed to do the basics of healthcare … with multiple demands upon the budget.
“Rather than being an IT investment that will return costs, we need to start thinking of digital health as an asset – something that you invest in because it provides transformative potential.”
Professor Sullivan challenged the software vendors and developers at the summit to move away from thinking of digital health as something which needs to recover its costs.
“We don’t build a new high school because we expect it to make a profit,” she said. “We build a new high school because it creates thinkers and learners and transformation of society and the community.
“[Let’s] think of digital health as a transformative asset which lays the foundations for artificial intelligence in healthcare, precision medicine and delivery of the Quadruple Aim – better clinical outcomes, more efficiency and lower costs, improved provider experience, and improved consumer experience.”
Part of the challenge of creating a framework for a business case for digital health was learning to assign dollar values to concepts such as AI in healthcare, consumer experience, staff retention, and hope, she said.
“If your staff is in a place where there is potential for precision medicine, for example, there’s actually a value you can ascribe to that because you get lower staff turnover,” said Professor Sullivan.
Building a business case for a digital health solution that provided value to the system as a whole required health economics, not accountancy, she told the software industry delegates.
“It requires a view beyond payoff,” she said.
“In an ideal accounting scenario, the profit goes back to the payer. In a complex system transformation such as we’re talking about, the benefits often accrue to different players.
“The financial return may be to the consumer and not to whoever pays for the technology.
“Is that a bad thing? Probably not, because if your consumer is receiving a financial return or saving, they’re more likely to use the system.
“It’s a different way of thinking.”
The other important factor was what Professor Sullivan called the “counterfactual model”.
“It’s expensive to do [digital health], but how much will it cost you not to do it?” she said.
“If you’re not going to use digital technology in 2025, you will not be able to do artificial intelligence in healthcare, and you will not be able to do precision medicine.”
Professor Sullivan concluded with a challenge for the medical software industry.
“This shift in thinking isn’t easy,” she said. “But if we really want digital health to become mainstream, that’s the way that we have to evolve.
“If you are in the business of creating solutions for healthcare, I want you to not only think about the fit of your solution to the problem. I want you think about the fit of your solution to the system.
“I started out trying to solve a particular clinical problem, and realised I wasn’t going to get very far unless I broadened my thinking and understood not just the problem I was trying to solve, but the system I was trying to fix.”
The MSIA summit was held in Brisbane on Friday 25 July.
