Why is puppy school more interoperable than my GP?

13 minute read

And are Best Practice and Medical Director akin to the Woolworths and Coles of medical services distribution?

This week I would love to get you thinking a bit more about data and digital, which typically a lot of you don’t do but you should.

(TMR founding editor Dr Kerri Parnell always told me I should never ever say “should” to a GP, so I’m off to a good start, I know.)

I wanted to say something that would get your attention enough to read a little more about this topic than you might normally do.

Hence the Coles/Woolworths/puppy school thing.

Spoiler alert, which I feel a responsibility to slip in early: Medical Director and Best Practice aren’t really the Coles or Woolworths of medical services distribution for GPs.

Well, not entirely.

But there are elements of the same commercial and market dynamics going on with these two vital software platforms for GPs which, in the context of current government policy on digital health, most GPs might do well to understand a little better

But first to puppy school.

Having lost a much loved very large and forever-puppy-like Labrador (he never stopped being a puppy even at nine years old) to cancer a few months back, we as a family were struggling with a big hole in our day-to-day lives (we also have a very cranky nine-year-old French bulldog who won’t stop howling at the loss of his long-term mate).

Nine-year-old Labrador puppy Digger

So we made a decision to go again, this time with a golden retriever.

Throughout my life I’ve had many dogs and never before gone to puppy school, which I now think is going to be one of very few lifetime regrets.

Puppy school had two profound impacts on me.

The first was that it was food for the soul, an otherworldly experience that I think outranks any attempt from me to find stress relief and a feeling that the world may be all right after all. I’ve never actively sort out these types of experiences but from time to time in life you find yourself somewhere, often with someone, where it just happens, and you’d love to be have been able to bottle it.

Within a few minutes of sitting with eight new puppies and their proud and mostly naïve new owners, complete with accompanying kids and chaos, you quickly lose all sense of what is bad in the world and start laughing uncontrollably a lot (I’ve already approached our teacher with a business idea for offering a ticket category for non-puppy owners which would offer a form of therapy almost certainly better than you’d get at a weekly exclusive Byron Bay hinterland health retreat).

The second impact is going to sound a bit strange but it’s sort of my life: I was astounded at just how digitally enabled our young puppy school teacher was, and at how she used her digital prowess and knowledge of data to seamlessly engage with us puppy schoolers and significantly enhance our experience and learning along the way.

There was an app if you wanted one with lots of ways to get more involved and engaged, a regular email post each class, ways and means to chat to our teacher post puppy class, asynchronously if you wanted, an Instagram site with tons of funny and educational material to back up each week’s class and, for me most interesting, live and seamless engagement digitally with the teacher during the class. Most typically at some point or other during the class, Jenny* (*made-up name) would ask us to pull out our mobile phones and she would Airdrop us all videos or data immediately relevant to what she was demonstrating. Interoperability in action, live.

Because I lead a strange existence, my immediate thought was “hang on, why is puppy school so much better at digitally engaging with me and helping me as a puppy school attendee than my GP is with me as a patient?”

It’s a question that a lot of GPs might do well to think even just a little more about given just how hard it’s becoming relatively to make a living as a GP these days.

And before you go getting all defensive on me, two things are pretty clear in this matter:

  • It’s not just the fault of GPs that their digital engagement is often way below par from any perspective of client engagement and commercial optimisation of business models in most other markets – I’ll get to the contributing external factors below because they are important.
  • A lot of GPs are actually pretty good at digital engagement to the extent that the available technology will allow them to be. But there’s a very big spectrum of both engagement and interest in using technology among GPs from woeful to great, which is important to understand better if GPs are universally going to get better at this game.

In terms of GP attitudes and aptitude towards digital engagement and understanding the value of data in optimising their businesses, there may not be a better person in a better position to understand what is going than Tim Blake.

Blake has spent a lifetime in digital health and these days he works with a lot of PHNs and GP practices in researching and working out what is going on really with GP digital engagement.

Turns out, why GPs are struggling with digital is not at all straightforward. They definitely need better co-ordinated help from external parties, particularly government, but also the software vendors themselves.

Find a mini deep dive on the topic in this interview with Blake by Wendy John. You can also learn a lot more on Blake’s website.

Following is a high-level take of what Blake has found over a few years of doing a lot of research around the topic of GPs and digital engagement.

Blake’s main theme is that the problem isn’t technology but how change is managed.

A key finding from his research is that GPs are all at different stages in their journey towards digital health maturity.

“Clinics in early stages of digital health maturity tend to be more focused on, ‘What is digital health? Why should I care? I don’t understand this. I’m not paid to do this work. Why should I bother with this?’” says Blake.

“At the other end of the spectrum, under the same set of conditions, you have health services who say, “This is great. We totally get this. Can you show us how to do it?”

Blake says they’re two different problems: lack of motivation on one side and a lack of good tailored information on the other.

This is largely disregarded by policy makers and software vendors. Everyone gets exactly the same training materials, regulation and messaging, mostly from government, and everyone assumes that is going to work.

Of course it isn’t working and Blake isn’t very enamoured of the federal government’s continuing one-size-fits-all approach.

“Not only is there a lack of nuance, there’s no interest in thinking through the nature of the problem or trying to understand that it might be more complex [people are thinking],” Blake tells TMR.

“ There is just this myopic push forwards that says “Let’s get it done”. Then everyone is surprised that the communication hasn’t been effective. That happens over and over and over.”

The ultimate example of such as an approach according to Blake has been My Health Record.

“The history of My Health Record has been one of, ‘Let’s implement. Then, okay, that hasn’t been very successful. Let’s do the next thing. Oh, that hasn’t been very successful either’.

“There’s very little reflection about why adoption hasn’t been successful, and there’s very little interest in learning why it was unsuccessful.”

Blake’s other big theme in his research is the difference for doctors between digital literacy and data literacy.

Digital literacy is about how technically we make use of digital tools and how confident we are use them according to Blake.

“Data literacy is a core understanding that data has a role in my in my career, whatever it is, because I can use data to improve.

“It is fundamentally about understanding both ‘the numbers’ and also the stories, because data can be qualitative as well as quantitative. Data provides evidence about the impact that we have, or have not, had so that we can create a continuous quality improvement loop.

“What we found in all our research with PHNs and with all the data we now have, is that when data literacy is in place, people are much more motivated to become digitally literate.”

Blake’s premise here seems to be that digital transformation in healthcare is naturally complex and that there are elements of everyone needing to take some responsibility in making things happen for GPs: the GPs themselves, government in being more nuanced in how they manage and communicate change to a population of doctors at very different stages of digital and data literacy, and the vendors, who, because of commercial dynamics, are (subconsciously perhaps) protecting old business models that are holding back GP productivity and well being.

This brings us back to the Coles and Woolworths (CW) question.

Best Practice and Medical Director are not the predatory, monolithic and tricky corporate plays we see with CW. They were both started by a doctor with the good intent of improving the productivity and well being of GPs and over the years both platforms have achieved this for a lot of years.

But as so often happens, commercial imperatives and market dynamics intervene over the years to twist purpose to some extent.

CW’s power comes from control of distribution. That’s actually the same for Best Practice and Medical Director. If you want to really get to a GP (other than advertising in this fine news service) you need to put yourself on one or both of these platforms because both are on the day-to-day working desktops of about 90% of the GPs in this country.

They are gatekeepers and over the years both vendors have worked out, like Apple, Amazon and all the big global digital platforms worked out, that you can gate access and demand a toll for passing through the gate.

A large chunk of the revenues of both platforms comes from third-party providers such as HotDoc, HealthEngine and HealthShare paying them for access.

CW controls only 65% of their market. Compare that to Medical Director and Best Practice which control upwards of 90% between them.

Notwithstanding, beyond the fairly banal comparison I’ve made above around distribution, gated access and market share, the comparisons to CW and how those companies have behaved largely are not there.

For one thing, both Medical Director (which is owned now by Telstra Health) and Best Practice (which is minority owned by Sonic) are by themselves not generating enough capital to easily keep up with the investments needed by government to keep GPs properly aligned into key payment and regulatory systems such as Medicare via Services Australia’s new cloud access requirements.

Although they undoubtably constitute a duopoly, the economics of each company transitioning their models to technology (largely cloud based) so that GPs would be far more empowered to run their businesses like my puppy school trainer, is fraught with commercial danger. Their slowness and resistance is perhaps understandable in a commercial sense. Neither of them is stupidly profitable, as CW arguably are (see 31% return on equity Senate kerfuffle last week).

That being said, the technology that GPs now have available to them, compared to even my puppy school trainer, at least in terms of being able to share meaningful information in real time with other parts of the system and their patients, is now seriously holding back the productivity (and probably profitability) of general practice.

Enter the Department of Health and Aged Care (DoHAC) which, since the election of a new government two years ago has been on a quest to radically change the playing field for doctors and patients in terms of information sharing and productivity.

DoHAC is saying it will move soon on radical reforms that should lock in each of these vendors, and all other health software vendors in our system, to making changes to their technology which will allow vastly improved means of GPs communicating in real time with specialists, hospitals, allied health and their patients.

DoHAC is saying it will start legislating for some of these changes as early as this year.

All of this sounds like it will be good for GPs in one way or another eventually.

But there are plenty of significant dangers in the journey from here.

For some vendors changing their platforms to enable seamless and free sharing of data with other providers and patients could prove catastrophic to their business models if handled the wrong way.

Given the current share of Best Practice and Medical Director, the quick demise of either probably wouldn’t be good in the short term at least for the GP sector – although there are some cloud-based software vendors already established who would happily fill any void left by such an occurrence, which might make things a little smoother.

One obvious danger that Blake points out is how government approaches digital and data literacy initiatives for GPs.

If it’s a one-size-fits-all approach like My Health Record, Blake sees some serious problems emerging.

And then there is you, the GP, and how you look at this rapidly approaching disruption to how you do roll day to day.

Jonny Depp says famously in the iconic movie Once Upon A Time in Mexico “Are you a Mexican or a Mexican’t?”

Blake might ask the same question in terms of motivation of many of his GP clients: are you in or out of this change?

If you believe Blake’s research, attitude to change might be the big thing that makes the difference to your future success as a GP in this major disruptive episode to the GP sector.

Note: Tim Blake will be one of our featured moderators at Burning GP on 14 June this year at the Mantra on Salt Beach at Kingscliff and will be talking about his research on the digital future of general practice as a part of his moderation role. You can see the full program for Burning GP and get tickets HERE. There is a 20% discount for the first five people to buy a ticket using this promotional code BGPTB20

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