01 Apr Collaboration and Connectivity Integrating Care in the Primary Health Setting
The attached Report is some 30 pages in length. To assist interested readers, we have summarised below the principal points made in the Report, together with an index reference where additional remarks and/or observations may be found.
Of all the industries whose consumers stand to benefit from the wider application of digital technologies, it is difficult to go past health, in particular in treating chronic and other longterm illnesses.
More than seven million Australians suffer from a chronic illness and nearly every one of them would be better off if the medical practitioners who treat them were more in touch with each other.
The impact of chronic illness on the individual can be devastating. The cost to the nation’s healthcare system is more than $60 billion per annum. Diabetes alone accounts for nearly a quarter of avoidable hospitalisations and eight per cent of deaths.
To address this challenge, the existing systems designed for “rescue” care by a single doctor need to be redesigned for managing patients over long periods of time in collaboration with an entire team of healthcare providers, such as dietitians, podiatrists, pharmacists, and specialists.
In designing these new systems, we need to rethink some of the old ways of working. These include inefficient referral processes that keep most of the patient’s care team in the dark; continuing to concentrate all elements of care in the hands of over-worked GPs; using telephone, fax, and hand delivery as the primary means of communication and continuing to use idiosyncratic ways of treating patients rather than proven best-practice processes.
The fundamental thesis of this Report is that to meet this challenge we need to provide far more systematic, process-driven care. However, these processes must be sufficiently flexible and adaptive to cope with the complexity of managing human wellbeing.
Digital technologies are the key to such a transformation, but only if used in the right way and of the right kind. The big failures in healthcare reform usually result from trying to drive systematic care with processes that are too rigid or technologies that are not sufficiently open and adaptive.
The central insight of process redesign is that digital technologies should be used to enable new, value-adding processes, rather than to support old, existing processes that add no value. Unfortunately, much of health care is characterised by the use of these technologies to automate existing processes rather than as an enabler for redesigning the business and making non-value-adding work obsolete.
Process redesign and identification of non-value-adding processes are therefore the starting point for transforming health care. As explained in this Report, of all these processes, those involving collaboration and sharing of knowledge are in need of greatest reform.
But what kind of digital technologies will drive this transformation? To understand the answer to this question, we first need to change our “way of seeing” health care from one of doctors and hospitals to that of a knowledge enterprise dealing in knowledge and communication.
The knowledge enterprise, like Google and Amazon, is characterised by networked information and systems that are open and adaptive. Yet the business models used in health care are based predominantly on industrial enterprises with tightly regimented processes and closed and siloed systems.
There are three keys to the success of a knowledge enterprise. The first is connectivity. In all knowledge industries, competitive advantage accrues to those who invest in connecting power rather than large monolithic systems with limited connectivity.
The second key to success is the development of open networks of businesses and users. Open systems are designed to accommodate the heterogeneity and incompleteness of information, the diverse nature of information sources and the enormous variety of individuals and organisations that are part of health care.
The third key is to use the internet model as the foundation of system and business design. This model provides services that are accessible anywhere, anytime, via any medium; that are developed with a mix of private and public funding and where the value propositions of individual stakeholders drive investment and innovation.
Often, technology reforms in health care attempt to impose rigid computing models and standards on a system that fundamentally needs to be highly agile and adaptive. While health care can benefit from more standardisation, the complexity of the system and our level of medical understanding require that it allow for variations in practice, accommodate uncertain information and be able to adapt to new knowledge and technologies.
For this approach to work, government and other payers need to provide the right drivers and incentives through careful and consistent “market design”. This is not an issue in a normal market but in a universal healthcare system — where beneficiaries and payers do not align — the incentive structure is key to driving adoption and process change.
Finally, effective change management needs to take place. The recently established Medicare Locals can play a key role here, using digital technologies and services to enable change at the patient and practice level and to provide the information necessary for identifying opportunities for system-wide process improvement.
If we do all this, private companies and other stakeholders will drive innovation into health care, eventually processes will be transformed either by will or by disruption and we will have a sustainable healthcare system providing better outcomes for more patients more equitably and more efficiently.
In conclusion, this Report demonstrates by way of example that this approach can work. Through the development of a cloud-based chronic disease management service, cdmNet, a number of productivity and health gains