With no end in sight to the federal-state standoff in initiating much needed changes to our hospital funding paradigm, experts at the upcoming Models of Care Shaping the Future of Hospitals summit believe that technology is our key available lever to address some of our most intractable hospital issues.
At next month’s New Models of Care Shaping the Future of Hospitals Summit in Sydney on October 16 (Promo Tickets HERE), our “from the coalface” panel of experts will start proceedings by outlining the long list of seemingly intractable issues facing our hospital system as a set up to examine what practical strategies are available to hospitals to make any inroads they can into these problems in the near term, with or without systemic changes to funding models.
Our coalface panel will include Dr Vikram Palit, CEO of emerging new technology e-referral network Consultmed, Ben Harris, director of policy and research at Private Healthcare Australia, Emma Cornwell, executive general manager of health services at Australian Unity, and Associate Professor Amith Shetty, clinical director of system sustainability and performance with Health NSW.
Hospitals are measured and paid in large part based on inpatient metrics – length of stay, bed occupancy, throughput and in-patient procedure efficiency and cost.
Virtually none of this talks to the significant trend in connected care technology that is rapidly evolving around our hospitals to offer relief on issues like ED avoidance and bed block.
Yet despite our current hospital funding model providing virtually no meaningful incentives for post-discharge continuity of care within the community, or for managing a patient virtually before they enter a bricks and mortar institution, technology is so far proving to have good system ROI, according to several of our panellists.
In planning for the summit, our panel identified the following key issues as areas where better connected technology care intervention would provide increasing system ROI, even absent funding changes:
- Improving ED avoidance/diversion through better awareness and using fast-evolving, single front door triage services to expanding virtual care networks
- Reducing bed block – especially for aged care and NDIS – by identifying relevant, alternative pathways prior to the patient entering hospital
- Increasing patient access to specialists through new web data sharing technology and helping patients become better informed on specialist costs
- Better integration of fast-emerging private health services for at-home and virtual care
- Pushing hard on state governments to get serious about connecting their hospitals far more effectively to general practice
Dr Shetty told Health Services Daily that a lot can be done today to create effective pathways for patients that don’t end up with them in a bricks and mortar hospital.
“We can identify how they fit in, and then see how we can deliver this care outside, and then try to plug those holes by keeping connected to those people on those paths,” he said.
Dr Shetty said that HealthDirect, rebranding as 1800Medicare, was proving increasingly effective at identifying a patient’s needs and working out such pathways.
“We were sending 56 to 60% of callers in the HealthDirect pool to ED. It’s now down to 18 to 20%,” said Dr Shetty.
He believes that by using AI and increasingly sophisticated data analytics, 1800Medicare is becoming rapidly better at defining an alternative and effective pathway for patients who might have once gone to hospital but can now be diverted to a virtual hospital service, a GP service, a bigger footprint of Urgent Care Clinics and several other community-based or virtual-care-based offerings.
1800Medicare is about to undergo a massive branding push to the public via the federal government. If awareness does lift, and it keeps working the way Dr Shetty is seeing, ED avoidance will improve in net numbers and work across a broader geographic footprint of the country.
More awareness of the service to patients is likely to make a meaningful impact on admissions over the coming year or two, suggested Dr Shetty.
Unsurprisingly, the summit’s expert panel identified a significant amount of work that needed to be done outside the hospital system:
- Make it easier for patients to access and pay for specialists.
- Start integrating rapidly emerging private health services in home and virtual care to public hospital needs where we can.
- Connect isolated and internalised hospital PAS and EMRs to the outside world via emerging, web-based applications. In particular, connect them to the local GP communities.
In terms of simple and practical ideas that hospitals can adopt in the near term without too much hassle, Dr Vikram Plalit’s ConsultMed group is rapidly breaking down connectivity issues between hospitals, specialists and ultimately even GPs, at a cost that is practical, and with very few technical integration issues.
At-scale technologies like ConsultMed can make a dent in the key emerging issue of declining access to specialists, which is a part of the private hospital sector’s financial stress.
Some data points on specialists and referrals which should worry system planners:
- Specialist appointments are down about half a million per year from prior to covid.
- The out-of-pocket costs of specialists are rising way faster than CPI post covid. PHA uncovered what they think is a record initial specialist consultation in Australia of $1200.
- The cost of a lot of high-volume procedures in Australia is completely out of synch with overseas averages; knee reconstruction in Australia, for example, costs an average of 1.9 times what it costs in Europe.
In a febrile cost environment like this, “access” and “equity” start to become significant emerging issues for a health system that has for 40 years under Medicare prided itself on the idea of equity and access.
Dr Palit said technology can’t solve all the problems, but it can connect GPs to specialists to hospitals a lot more seamlessly, and create better information interplay between the various parties by managing a patient via services like the virtually enabled “advice and guidance” .
The “advice and guidance” ConsultMed integration is a web-based service facilitating expert clinical advice, triage and assessments, allowing specialists to review a patient’s situation and information remotely.
It uses secure, bi-directional communication and asynchronous messaging to facilitate expert clinical advice, triage and formal assessments, enabling local clinicians to manage more care in the community. It’s a digital alternative to faxes and leaving phone messages.
Dr Palit says “advice and guidance” now has an evidence base to suggest it can lead to a 20% reduction in unnecessary hospital presentations and an up to·50% reduction in missed outpatient appointments or Did Not Shows. Scaled in hospital networks, that represents big improvements in access and system savings.
But awareness and system fragmentation is a problem.
So far, the uptake of ConsultMed and equivalent, new, web-based asynchronous remote virtual services is ad hoc across both the public and private hospital system. ConsultMed has more or less grown through word of mouth, with integrations now in the Sydney Children’s Hospital Network, SW Sydney LHD, the Alfred hospitals in Victoria and soon, some Queensland sites.
Part of the problem is how the states’ health departments engage with and allow their individual hospital networks to trial and implement new systems.
Other web-based technologies are starting to make important inroads across our hospital networks, but again, mostly on an ad hoc basis.
Some examples include Telecare’s (recently acquired by Teledoc) virtual specialist in and outpatient service, which is taking off across the regional hospital networks of a few states.
Telecare is growing because its major competitors are hugely expensive FIFO specialist services and longer and longer regional and remote patient waiting lists. (Telecare will be presenting some case studies at Future of Hospitals Summit).
Another interesting web solution for small and remote regional hospitals is MediRecords.
MediRecords started as a cloud based start up aimed at taking out the major general practice patient management systems, but not long into its life it pivoted to providing a highly specified cloud EMR that any virtual provider could use to link records across clinics and geographies.
It became a major provider of cloud-based services to the Queensland Department of Health five years ago and most recently was picked as the main EMR and inpatient and outpatient integration for an entirely revamped, cloud-enabled defence force healthcare system which can link GPs, allied health, hospitals and defence force personnel in real time, sharing data seamlessly.
One spinoff from the project has been an inpatient and outpatient admissions and management integration that can talk directly to surrounding GP and specialist networks.
Note: The New Models of Care Shaping the Future of Hospitals Summit will feature case studies of a series on new care models, including cloud-based e-referral and in and outpatient systems, virtual specialist services, virtual EDs, hospital in the home, connected at-home technologies and more. If you’re interested in attending, you can get a 20% discounted ticket HERE. The speakers and program are HERE. Note: healthcare providers and vendors pay a different price, but both are discounted. If you have any other questions on the meeting you can contact greta@healthservicesdaily.com.au .