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Zoltan Kokai, Executive Director of Information Technology and Capital Projects, Eastern Health
Commentators have stated that digital disruption in healthcare is one of the greatest opportunities to positively affect the sector in years. Headlines such as “DIGITAL DISRUPTION IN HEALTHCARE: The $8.7 trillion opportunity in digital health”, provide wonderful and interesting insights for the possible future of healthcare.
Given that digital disruption has so much promise, are there barriers that are preventing digital disruption from taking hold in the Australian health sector? In answering this question in the Australian context, it is important to understand the current situation in the Australian healthcare sector and the challenges before considering methods for delivering digital disruption.
Australia’s Digital Health Strategy titled “Safe, seamless and secure: evolving health and care to meet the needs of modern Australia” identifies the many and varied innovations that have been introduced in healthcare organisations across the country as they progress their digital maturity. These include digitisation through the introduction of My Health Record, electronic medical/health/digital records (EMR), secure messaging, electronic referral and discharge summary capabilities to name a few.
Eastern Health is a major public metropolitan health service in Melbourne with 7 major sites, over a $1 billion in revenue and servicing an ageing population of 774,000 people across 2,800 km2 in the eastern suburbs of Melbourne. It has worked with State and Federal government authorities, private sector vendors, local and international alliance partners and its primary care/primary healthcare community in co-creation activities to drive digital innovation over many years. More recently, Eastern Health implemented a comprehensive Cerner Millennium EMR solution suite in October 2017 at Box Hill Hospital. Box Hill Hospital is a digital hospital with over 620 multi day beds that completed its redevelopment in 2014. The hospital has many digital innovations within its facility but has also connected with its community through secure messaging, electronic referral and electronic discharge summary strategies. Eastern Health’s strategy to focus on digital transformation within its hospital and into its community, places it in a unique position to understand digital disruption and its challenges within an Australian public healthcare organisation.
Eastern Health’s digital hospital transformation which has proved to be positively disruptive, include:
The information and insights available from data mining the emr also form the basis for clinical data analytics and the broader application of health data science
• The mitigation of medication errors through electronic medication management, including drug and allergy alerts;
• The mitigation of transcription errors into the medical record with the integration of medical devices (connected to the patient) to the EMR with early warning scoring to identify patient deterioration;
• Alerting algorithms that use data points from patient clinical observations to alert for critical medical conditions such as sepsis; and
• The use of personal health devices in the home for monitoring patients with chronic disease to prevent hospitalisation.
While, using major technology platforms such as Cerner Millennium enables the transformation of clinical work at the patient bed side, the use of data stored in the EMR provides a significant opportunity for translational research and hospital reform. The information and insights available from data mining the EMR also form the basis for clinical data analytics and the broader application of health data science. This area may possibly hold the greatest opportunity for digital disruption in Australian healthcare. The disruptive potential, however, is yet to be fully explored and realised.
In order to achieve success the following challenges impacting digital disruption in the Australian health sector need to be addressed:
• Effective and simplified regulation that supports the patient’s rights while facilitating improved use of data. This includes unifying laws that safeguard patient data use particularly in relation data integrity, information privacy, data sharing and security. This builds consumer trust in the regulatory environment that supports the patient’s information;
• Sustainable operation of ICT platforms including elimination of legacy systems within the challenging economic environment (this issue is not unique to Australia). This builds trust from all stakeholders that the systems that house critical information are resilient and robust;
• The need for safe and high quality systems that are reliable, resilient, secure and support clinicians daily work that mitigate clinical risk rather than add to it. This builds clinician trust in the digital method and addresses adoption barriers to new technologies; and
• Including the patient’s voice in digital transformation decision making particularly in light of increased patient expectations and improved patient literacy. This builds patient trust that the information provided is responsive to the patient’s needs.
Digital disruption in healthcare promises to be an exciting opportunity in the years to come. Areas of digital disruption, innovation and transformation are maturing across the Australian healthcare system at varying rates. While Australia has progressed along the path of many countries with introduction of EMRs and interoperability between hospital and community based information systems, the power of digital disruption is likely to come from clinical data analytics and the potential this has in translational research. More importantly, as the health sector has amassed a high degree of trust when delivering patient care, so must there be a high degree of trust in digital disruption risk management. It is only when there is a high level of trust amongst the patient, the clinician, the hospital and primary health system that digital disruption is likely to accelerate.