Amid talk of reform, experts at the Future of Hospitals Summit said the real fix was in trusting patients and carers as partners in care and not just upgrading the technology around them.
For all the talk of reform, Australia’s health system remains stubbornly provider-centric. But it was in the final panel of the day at last week’s HSD Future of Hospitals Summit when a statement summed up a theme that resonated throughout the day and highlighted a core challenge.
“Imagine if we were a patient-focused health service? Imagine if we were. And we were actually looking at that as being the driving force of what we’re doing with the health service,” said Rob Grenfell, Grampians Health’s chief strategy and regions officer Grampians Health.
“That’s the disheartening part of our system. It’s disintegrated, in that sense, and patients are hurting because of it.”
Mr Grenfell was one of the panellists in the discussion A cultural shift: making change work for everyone.
The challenge, panellists agreed, isn’t just technical. It’s cultural. Fixing the system won’t come from another round of upgrades but from a shift that recognises patients, families and carers as active members of the care team, not passive recipients of it.
One way empowerment is starting to take shape is through access to data and giving patients and carers the same information clinicians see.
In the panel Emerging sweet spots for hospitals between policy, technology and funding trends, Dr David Hansen, CEO and research director at CSIRO’s Australian e-Health Research Centre spoke about how digital health records would help patients take a more active role in their own health.
“So I think that’s where some of the changes, in particular, as we drive My Health Record and increased standardised record capture and exchange through the system is really, really exciting,” he said.
He gave an example of the work they were doing with Queensland Health around health for gestational diabetes in pregnancy, where they have given women an app to input their diet which goes to the hospital for the clinician to check.
But more importantly, it means the women can monitor their own data.
“So they’re starting to correlate themselves, what they’re eating, and the impact of that on their blood sugar level. So it’s really how we empower patients, particularly with chronic disease, to look after themselves, and the more information we can give them,” said Dr Hansen.
The increased power of wearables.
Beyond digital records, another wave of empowerment is coming from patients themselves and the devices on their wrists.
In the panel discussion Funding that can create and sustain connected care models at scale, Jayne Barclay, national director of Healthcare Platforms at St Vincent’s Health Australia highlighted the rise in patients driving health conversations with their clinicians, particularly thanks to the use of wearables.
“I was talking with one of our cardiologists this morning, we were talking about wearables, and particularly about the number of patients she started to see come through the door because they’ve got alerts coming from their personal wearable, telling them about funny things with their heart,” she said.
While patients want to be involved in driving those interactions, the current referral pathways between specialists and GPs make it difficult for them to take that step.
“How could they interact in different ways and be a bit more accountable for their care?” she said.
Richard Taggart, chief executive, eHealth NSW agreed that the knowledge gained from wearables needed to be harnessed.
“About 50% of people who have hypertension do not know that they have hypertension, and yet, these devices can tell you that you’ve got suspected hypertension and you should go and see someone about it,” he said.
“If we can prevent even just a small percentage of people going on to develop heart disease or having other cardiovascular issues because they’ve had an alert, that’s a game changer in the future for me.”
He said this was a key consideration at eHealth NSW.
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“We’re considering the technology to refer consumers into our facilities, and how we engage consumers earlier in that journey with apps and wearables and so on,” he said.
However, Simon Tatz, general manager of Policy, Advocacy and Workforce Advancement at AIDH said wearables were already being used, but reform, particularly around funding, hasn’t kept up.
“Clinicians spend a lot of time on data and getting patient data, and they’re not remunerated for it,”: he said.
“That could be a substantial reform using digital health to change the way we both pay clinicians and pay them for their time, and also the fact that there is now greater interaction between a patient and a clinician through the use of digital health data.”
The rise of virtual health
If wearables show how consumers want to be more involved, virtual care shows how the system can respond. Victorian Virtual ED director Dr Loren Sher spoke about how they’ve grown virtual care in Victoria in the Setting the scene: Are we all heading in the same direction? panel.
She said their philosophy centred around asking what their patients want and what their consumers need.
“Patients want to stay at home, they don’t want to come into hospital,” she said.
Using that mantra, they asked GPs what they wanted. They said often their patients sit on waiting lists for specialists for month and end up in emergency because they’re not able to access someone in time.
To help manage the wait list, they developed the Victorian Virtual Specialist Consult Service. They now have 29 different specialties, and they co-consult with the GP, the patient and a specialist with a one-off consult.
“You go from needing a specialty appointment to, in most cases, only 12% of patients need to then have a specialty outpatient, ongoing appointment,” said Dr Sher.
Healthdirect’s chief medical officer, Dr Nirvana Luckraj highlighted how well virtual care worked, particularly for out of hours care.
“We ran a 12-week proof of concept model, and we were able to show the paediatric space that up to 90% of patients that were directed to us we could keep at home,” she said.
“So we then took that piece of work and replicated it in the adult space… It’s a bit low in that space, probably around 70 to 75% recognising that adult patients are often a bit more complex.”
However, Associate Professor Annie Lau, a health-informatics researcher at Macquarie University, said it was important to recognise who was providing care when a patient doesn’t end in hospital.
In the Emerging sweet spots for hospitals between policy, technology and funding trends panel, she said often it was the family members or carers who took on those extra responsibilities including managing technology or managing their care.
“I think that in order for virtual hospital services to work, whether it’s a hybrid model or a standalone model, it is really important to take upon the extra responsibilities we’re asking family members and carers to do when the patient’s admitted at home during virtual hospitalisation, the pseudo nurse role,” she said.
Trust the patient
Across all these examples, one principle kept surfacing: none of it works without trust.
In the panel discussion The Coalface: access block, bed block and ramping vs new care models, Ben Harris, the director of policy and research for Private Healthcare Australia, the peak body for private insurance fundssaid ultimately we needed to put more trust in the consumer.
“Patients and consumers need help. But they are not helpless. They are not stupid, they are not ignorant. We have the means for people to hold their own health information, yet we all hang on to it, and I can’t imagine how much money we waste trying to get the same information to people all the time,” he said.
“What we need to be doing is trusting our patients, trusting our consumers, and making sure they hold the information which helps all of the providers in the system to do it better and more efficiently.”