In this exclusive fireside chat, featured at our recent FST Government Western Australia 2022 event, WA Primary Health Alliance’s (WAPHA’s) Chief Analytics Officer Bobby Patel, and Acting Executive Director Transformation, South Metro Health Service, Tim Leen, take us through what a digital transformation program should ideally mean for the healthcare sector, and explain the risk of digital proving a potential “handbrake” on healthcare innovation, why NSW’s health data linkage program is a model for all states, and why clinical healthcare practices are stuck in the era of Florence Nightingale and what it will take to jolt the sector into the 21st Century.

Moderated by Christian Rasmussen (St John Ambulance).

Moderator (Rasmussen): As a care provider, how do you define the latest objectives of digital transformation?

Patel (WAPHA): There are a couple of points I’d like to make. The first is around what is digital health? The ADHA describes it as electronically connecting-up points of care so that health information can be shared securely. In fact, the WA Department of Health extends that to also cover treating patients, conducting research and educating the workforce, tracking diseases and monitoring public health.

In the context of digital health, it’s important that we’re always aligned to the overall objectives of the organisation, and in any care-providing organisation, the primary objective is improving patient outcomes – ultimately, improving the care that that patient receives. There are a number of subsidiary objectives as well: improving the provider experience, optimising cost, and establishing and ensuring the right clinical pathways. I don’t think digital health should have objectives that are misaligned from any of that.

In fact, digital health objectives are all about access and equity around health and improving the linkage of data across the ecosystem, so that clinicians can provide better health to consumers at a point in time.

And, to extend that, the Health Informatics Society of Australia points out that digital health ultimately is just health to the consumer; it doesn’t matter if it’s digital or not. Ultimately, they just want a better health outcome.

Leen (South Metro): I completely agree with what Bob [Patel] has just said.

Won’t it be great when we get to the stage where we just talk about health without adding ‘digital‘ or ‘virtual‘ to it?

It’s about the patient or the most vulnerable person in front of us that has come to our door to access our care. We’ve got a long way to go when we talk about digital health, disruption and capability.

If you think back to [1859], when Florence Nightingale wrote one of her famous books, Notes on Hospitals, and she described healthcare as doctors coming around in the morning with their team with nurses by the bed, everybody was presented, the patients were then looked at, and a plan for the day is made, and then the next day, they’ll see how the plan went.

We’re in 2022 and anybody that works in healthcare [will see] not much has changed since.

That gives you a bit of a grasp of how far we have got to move with this. But it’s all about defining the model of care now – be it a piece of paper, be it an implement, be it a device, be it a digital technology, how do we improve that? How do we keep people healthy at home? How do we [improve] outcomes, reduce costs, and work together to provide the ultimate care for our patients, and make it a rewarding and fulfilling experience for our staff.

Moderator (Rasmussen): In a highly disrupted environment, what does the digitisation of major systems and acceleration of capabilities mean for core services and new operating models?

Leen (South Metro): It fills me with fear! What do you hope to do – and this comes back to our strategy and our alignment that some panel members and speakers before us mentioned – and what’s our ultimate goal, and how are we going to pull it all together to move in the right way? For me, it is exactly about creating alignment and a clear strategy, and it’s being brave and taking risks. We now do have the capability of digital technology, and we speak in the corridor about the things that we can do.

But, actually, how do we move people from the point they’re comfortable with currently to a new phase, as well as adapt to the new phase, because we can’t afford to add everything on without giving up something else?

So, for me, it’s about adapting the new processes and also celebrating past processes, but also putting them to bed and allowing us the funds and the advancement to go forward.

Patel (WAPHA): I wholeheartedly agree. It’s about taking risks and connecting sections of the health ecosystem. Ultimately, it comes down to improving patient outcomes and keeping that at the core of everything that we’re trying to disrupt and digitise. It needs to lead to a better experience, a better health outcome for patients, and a better clinician experience as well.

In primary care, there’s what we call the ‘quadruple aim’; most healthcare markets have such an aim: to improve patient outcomes, to improve provider outcomes, sustainable cost, and, lastly, to improve provider satisfaction.

Within each of those, we have to keep in mind that we have an unequal health system; there’s a real lack of equity. This is where the digitisation of systems can help to improve access and equity, particularly for vulnerable populations.

Moderator (Rasmussen): Is there a risk, perhaps. that digital health could deliver poorer health outcomes?

Leen (South Metro): Oh, absolutely! If you want to spend an hour with me, you see all this transformation; everybody thinks they’re going to transform the world.

Sometimes you feel like [digital’s] a handbrake… Because if you go down the wrong path, you’re wasting a lot of money, you’re not in alignment. And sometimes, it’s the person that’s the loudest in the room that gets the guernsey and gets the dollars.

You have to make sure you appreciate the most important thing and never lose sight of the vulnerable patient that’s in front of you asking for help. So, if it doesn’t benefit your patient, really, should we be doing it? In digital, anything we do actually triggers that question. And I suppose our funding model doesn’t really help our preventative approach to medicine. But that’s a whole other conference.

Moderator (Rasmussen): An allied question: Should healthcare digital innovation be led by clinicians or techies?

Patel (WAPHA): I don’t think we should discriminate against it. Good ideas can come from anywhere. And we should have systems that nurture and mature those ideas, especially if they’re going to lead to better health outcomes.

Leen (South Metro): That’s a really insightful question, because there is a huge gap.

There’s that gap between the translation, between clinicians, the patients and digital and technology.

There’s a role for a new workforce that we can create that is almost like a digital technical translator that has sound clinical experience to argue for the right models of care as well as a solid digital background and relationships to provide the best possible solution for our patients.

Moderator (Rasmussen): How does becoming a more interconnected health care organisation support more efficient decision-making and services?

Patel (WAPHA): We’ve been talking about this, in fact, on our tables a lot today, that interconnectivity of data between different departments for a better citizen experience. And the same goes for healthcare. In fact, I spent eight years on the private side of health before joining the WA Primary Health Alliance. And some of the problems are exactly the same, in that, if we had access to better-connected health data across the ecosystem – and, as a clinician, you’d agree, having that point in time when people are accessing the primary system as well as the tertiary system and drawing out those user journeys – we can provide plenty of insight in terms of better intervention, better parts of clinical care, and optimised care. And there are tremendous examples from overseas markets where this happens.

In fact, I was glad Peter spoke a little bit about WA health data linkage, which is absolutely a great project to have in WA. New South Wales has, in fact, taken it a step further. It’s a project called Lumos, where they’ve linked GP data – which PHNs [primary health networks] get access to as part of the agreement – to tertiary health data. That’s allowed the system in NSW to map and go back to GPs, who are the first point of contact for most people when accessing health care, [providing] that information that their patient has been into a tertiary system, and therefore the model of care might need to evolve for them.

I’m a big believer in a more interconnected data system. Of course, you’ve got to balance it with privacy, good ethics in terms of use, but the opportunities and the value far outweigh the risks.

I’d love to replicate what we’re doing in NSW in WA.

Leen (South Metro): In healthcare, the interconnectivity of data and systems is a matter of life and death, really.

Not too far away, up the road at Royal Perth Hospital on the 11th floor of A block, I talked about a project I was involved in. We connected 11 wards, remote-monitored our patients, pulled the data in from those patients – data about their biometrics as well as their imaging and their pathology – into one place and run an AI system across it. And this is in a hospital that’s still got a paper medical record system! Through this AI, we were able to predict 8 to 10 hours before a patient deteriorated before they actually deteriorated. It’s very easy to do, and you can imagine the better outcomes those patients had, the length of stay was less, and how satisfying that was for our staff; the staff that were in that environment built that model of care for themselves. And the interesting thing about it, when the patients heard about it, they were requesting one of these 50 beds when they came into hospital. When we talk about patient ownership, it creates that demand. And if patients know about things that we’re doing like that up the road, they’re asking for it.

Patients are voters. And that’s where we get leverage in healthcare.

Moderator (Rasmussen): In what ways can we apply health service delivery and transformation learning lessons to broader citizen-centric services?

Leen (South Metro): The silver bullet, no matter what it is, is patient engagement and patient empowerment. If we can make a system that enables the patient takes responsibility for their health and their healthcare, and we support them in the community, either through a surgical school, medical school, or something like that – there’s loads of technology out there for your health and wellbeing, anxiety and depression, to keep them healthy at home – for me, that’s the silver bullet. And even though it’s exciting what we do in hospitals, and in innovations in robotics and other things, really, what we should be pushing for is keeping people constantly healthy, giving them the nudges they need for their mental well-being and their physical well-being, so that they don’t need to access our healthcare, and so we can focus most of our healthcare where Bobby [Patel] works – in primary care.

Patel (WAPHA): I’m taking a slightly different angle on this one: ‘What are some of the learnings we can apply from other successful transformation projects in the context of what we’re trying to do for citizens?’

Some of the best outcomes come from when you draw these user journeys from the person accessing the service – and there are various examples across government services where a lot of digital strategies have been about the particular agency. Whereas, if you look at problems from a user perspective and try to solve around that, it will lead to a different outcome in terms of the services that we’re doing. By way of example, we’ve just been through a process of building a house with my parents; some of the duplication of effort and linking between various agencies, going to Land Tax [Revenue WA] and saying, ‘Yes, it’s done’, it seems quite disjointed. Whereas if we go, ‘Can we put the consumer at the heart of that and draw out user experiences that are based on actual citizen problems?’, I think we’ll sometimes find another solution. The best examples of digital health have done that really well, placing the consumer at the centre of the health outcome, and then saying, ‘What are the different initiatives?’ That coupled with the great experience.

Moderator (Rasmussen): Finally, on the point of the Florence Nightingale model you addressed earlier, Tim [Leen]. Why do you think we haven’t moved from that model’? Is it, perhaps, a lack of leadership?

Leen (South Metro): It’s really hard. We work in silos; that’s hard. Things are expensive; that’s hard. We want immediate results, we don’t go on a journey, we don’t talk about healthcare in 2050, and that’s probably what we should be doing. We want things to happen now.

Also, sometimes it takes a bit of bravery. I’ll give you an example. I led the Covid response for East Metro, which kicked off in March 2020. I remember the morning we opened the clinics, and we, the digital data and digital innovation team at East Metro, had developed an app to go paper-free. It was amazing. But we forgot to have our downtime solution! So, when we were opening the clinics, you can imagine there were about nine or ten different agencies all trying to take pictures to see who was looking out their window shouting at us, ‘Tim, get it going!’ And we had a digital failure every time it went down. It took us about an hour to get everything up and running. And it was panic street.

However, if we didn’t take that risk, and we didn’t prepare the way we did and were brave enough to say, ‘We’re going to do this!’, we wouldn’t have the technology we’ve got. From that piece of software that East Metro built, we’ve now got the linkage with phones, with all our vaccination clinics; our app provided the building blocks of that. And, in fact, if we’d have had paper there at the time, we would have used paper, because that’s what we were used to. So, sometimes it’s best just to remove it and get cracking.

We’ve got a couple of situations in health over the next few years where we’ve got new bills, and maybe that’s the time that we put in new models of care and just take it as a greenfield.

This is an edited extract from the Digital Health Fireside Chat featured at the 2022 FST Government Western Australia conference.