The implications of digital health and the emerging models of care

The impact of digital is transforming the Australian health sector by enabling new and emerging models of care, which will change the future delivery of health for the better.

However, the journey to this health utopia has been a ubiquitous challenge not only in Australia, but worldwide.

The emerging models of healthcare see patient centricity as key; where enhanced patient outcomes come from moving from preventative to precision medicine, aided by Big Data in solving issues of communication and safety.

Yet, the rapid evolution of technology, are constrained by regulatory compliance and privacy, the changing culture of workforces, and the innate fear of unknown are all barriers to removing Australia’s health from silos to an interconnected and precise medicine.

For Australia, it has taken a national approach to change. This has involved a hard-look at governance, legal frameworks and having democratic discussions – as seen with the recent My Health Record dilemma . These factors have been instrumental in driving us towards a national e-health system – that has scalability unmatched across the globe and where continuous improvement is taking place.

However, we aren’t there yet.

In continuing these need-to-have discussions, specialist advisors to the health industry William Buck, HWL Ebsworth Lawyers and Westpac, hosted a healthcare innovation boardroom lunch last month. This event is part of their continuing Health Innovation Series, bringing together innovators, business leaders, industry bodies and government to make a positive difference and address ongoing heath challenges in Australia.

Guest speakers at the event included Tim Kelsey, CEO of the Australian Digital Health Agency; Elizabeth Koff, Secretary, NSW Health and Karen Keogh, Healthcare Partner at HWL Ebsworth Lawyers. They led an open panel discussing the implications of digital health and the emerging new models of care and their impact on privacy, workplace cultures and transparent conversations.

Opening the discussion, Healthcare Partner at HWL Ebsworth Lawyers, Karen Keogh discussed the issues arising from digital health as we move from universal care to personalised care by 2030.

Personalised care is a vision which requires Big Data – by 2030, the future of health will move from ‘preventative medicine’, where decisions are based on the average patient, to ‘precision medicine.’ Precision medicine will understand the patient by looking at health population data, the patient’s environment and their genomes to give personalised treatment and improved outcomes.

Australia is making headway into realising this vision, where Big Data will allow at-risk individuals to target conditions before they become advanced.

In the last twelve months the National Digital Health Strategy has been released; NSW have set their strategic priorities for health and analytics, there’s been a rise in health apps and artificial intelligence is becoming a reality.

So, what’s the big deal about Big Data?

Karen says that lawyers are grappling with the privacy aspects and data sharing of Big Data in Australia.

“Data needs to be available and useful; we know data needs to be based on Australian data sets and we know the Government is investing heavily in digital health; the issues arise when Big Data risks people’s privacy,” says Karen.

“There are issues with security and storage of data – as well as how data is used and accessed. While the privacy laws establish a framework, this area is constantly evolving and changing,” says Karen.

Privacy concerns are warranted. In the first year of the Mandatory Data Breach scheme, the Office of the Information Commissioner (OAIC), has reported that the health sector reported the greatest number of breaches each quarter. Health service providers, such as hospitals and physicians’ offices, were the highest reporting sector, noting human error and cyber-attacks as the main reasons.

When it comes to the health sector, the concerns are two-fold. Not only are there risks to health data breaches, but also financial data which is embedded into the health data. For hackers, Big Data is a commodity and health services are an easy target. This requires health service providers to have a culture which focuses on staff and the issues where breaches can occur, it also requires good governance and strong infrastructure.

Yet, information is a major asset to clinical outcomes. Digital has the power for Realtime data linkage, speed and alignment of information and benchmarking; all which increases safety and outcomes for patients. The annual cost of medication-related problems in Australia is nearly $1.4 billion – equivalent to 15 per cent of total PBS expenditure – roughly 1.2 million Australians have experienced an adverse medication event in the past six months, with 50 percent of those being preventable.

So, how do we use data to benefit patients without compromising their security and privacy?

Having ‘messy’ conversations

Improving healthcare through digital technology, requires good governance that is open and transparent.

The Australian Digital Agency is responsible for all national digital health services and systems with a focus on engagement, innovation and clinical quality and safety. The establishment of the Australian Digital Health Agency in July 2016 has led to a more transparent approach to safety and security and the national strategy is supported at state levels, which are focused on best outcomes for patients.

Tim Kelsey, CEO of The Australian Digital Agency is an international expert in digital transformation of the customer experience in healthcare and believes digital technology is the most important enabler to improve healthcare across Australia.

Tim also believes that what’s critical in overcoming regulatory and compliance issues, are robust and inclusive discussions.

His experiences have shown that positive resolutions come from open debate and uptake is improved when taking small steps where everyone understands the benefits.

Tim says the biggest challenge for digital health is data sharing. Stating, there’s no silver bullet for information sharing across systems. He says, over the last ten years, the Government has built the digital maturity of public health systems. Highlighting the need to take small steps to instill clinical confidence by outlining the benefits.

One of these discussions has been in regard to the ‘opt-in opt-out’ debate of the My Health Record.

Tim says that My Health record is playing a critical role in improving healthcare for all Australians, with 90 percent of the population opting in. However, the road to this success included an important national debate; citing protections being strengthened because of this discussion – by both laws and provisions by the government.

As a result, privacy laws for My Health were strengthened. On 26 November 2018, the Australian Parliament passed the My Health Records Amendment (Strengthening Privacy) Bill 2018. Several clauses have given greater privacy and security protections, such as now allowing individuals to permanently delete their My Health record at any time, including their back-ups.

Tim says these discussions will be vital as we face a changing landscape, citing ethical issues of AI as the newest problem. He says discussions like ethics of AI are critical and while they are “messy”, everyone has a role to play in influencing the conversation.

Digital for digital sake

The states are also playing a key role in helping drive the national strategy. However, barriers to change aren’t just Big Data. For NSW Health, implementing technology that has future scalability and supporting the workforce, are fundamental issues on the digital journey.

The NSW digital health strategy is supporting the NSW Health move towards value-based healthcare delivery. This type of healthcare aims to improve the health outcomes that matter to patients. At the same time, it supports all health professionals including allied health GPs, pharmacies, public and private hospitals by being connected. All of this assists in providing an integrated quality service.

Enablers of value-based care are many and include the configuration of infrastructure, models of care and the use of data and information.

Elizabeth Koff, NSW Secretary for NSW Health, says there’s multiple data stores across the health system and integration of the Information from the systems is critical.

“Part of the challenge is enabling access and liberation of data and overcoming the academic approach where interrogation of data has barriers due to strict access criteria”

However, Elizabeth is clear; while digital health plays a large role in delivering the best experiences for receiving and providing care, when it comes to implementing digital approaches in healthcare it needs to be done by giving the best value to the patient – where people can make informed choices and whole communities can be supported.

While Big Data is a concern, at implementation level, Elizabeth says workforces are the biggest challenge. That’s because the uptake of technology needs an adaptive cultural change, and people need to see that technology aids, not replaces care.

However, rather than corporates and government driving the demand, Elizabeth Koff believes that it’s the consumers who will drive the change in Healthcare, but it needs to be supported by government.

Elizabeth says that when looking towards other countries, Denmark and Canada have the most forward-looking strategies and advanced digital health systems. These are ones which are heavily government-supported.

“Digital is the future of how we do business and the strongest enabler for future sustainability. But, there’s no point in having digital for the sake of having digital, digital services need to make it better for the patient.”