Healthcare technology is surging ahead, but needs cohesive policy to boost Australia’s outcomes

Systemic thinking needs to adapt if e-health is to truly deliver.

As the person leading the Australia-New Zealand business of one of the world’s leading health technology companies, Kevin Barrow spends his days thinking about ways to help healthcare providers use new technologies to improve patient care. Yet even the most innovative technology, he notes, can only drive systemic change when policy levers are adjusted to ensure adoption and long-term viability.

That’s often easier said than done, explains Barrow, who has been involved with the medical technology industry for 20 years – including nearly three years as Managing Director for Philips ANZ and General Manager of Philips Health Systems ANZ.

“If you reflect back on the last 50 to 60 years, there really has not been a change in the way healthcare is delivered,” Barrow explains.

“In terms of how the care model works, people are not well supported in the general community; they get sick and go to a GP or hospital, get treated and discharged, and after a while they come back again. It’s very episodic, and almost like a production line – and it’s very difficult to co-ordinate between physicians in the hospital, allied health professionals, and the GP.”

Towards ubiquitous e-health

One of the core precepts of the electronic healthcare record (EHR) and the ecosystem around it – a long-running effort whose development was recently bolstered through the creation of the Australian Digital Health Agency (ADHA) – is the portability of electronic healthcare records shared by a range of health providers in different care situations.

Australia’s e-health journey is – in comparison to other countries – still somewhat in its infancy despite being an agenda item for some time. It’s fair to say policy, jurisdictional and technical factors have limited the efficacy and reach of the cornerstone My Health Record (MHR). MHR is now being managed by ADHA Chief Executive Tim Kelsey – formerly of the UK National Health Service – and a team including Chief Medical Advisor Meredith Makeham and newly appointed Executive General Manager Ronan O’Connor, who oversee the technical architecture for MHR.

By handing the reins to a multidisciplinary crew, the government is consciously taking both a technology and policy-driven approach to accelerating EHR momentum.

Success is likely to fuel the coordinated adoption of ancillary technologies such as telemedicine and new diagnostic technologies, supporting clinicians with tools such as artificial intelligence (AI). The pay-off for the long-haul development has always been clear; better outcomes for patients, better and more effective use of public money and greatly enhanced evidence and visibility to inform critical decisions.

AI-driven healthcare tools in particular will draw on large volumes of past diagnostic results to create common indicators that can be used to flag potential medical problems much sooner than a human alone might be able to do.

This is an extension of the sort of ‘predict and prevent’ based projects that Philips has been involved with under Kevin Barrow’s leadership, such as an ambulatory care program run with West Moreton Hospital and Health Service.

Technology outpaces policy

Such advances promise to become a powerful new weapon in the clinician’s arsenal – but there are a range of policy challenges to be addressed first. One of the biggest, says Barrow, is working out funding mechanisms that allow for both the introduction of new technologies, and incentivise clinicians to make the extra effort involved in adapting their work processes to use them.

Kevin Barrow

“A couple of areas need work,” Barrow says frankly, “and one is really the funding mechanism.”

“If, for example, in the case of long term chronic disease management, if a hospital wants to provide better specialised support to its patients in the home, they are not really being incentivised to do that.”

Direct policy amendments have compounded this challenge: the freeze on Medicare rebates, for example, has many healthcare practitioners arguing they now need to focus on seeing more patients, as quickly as possible, to recover revenue shortfalls.

Other policy changes, such as the government’s termination of the Telehealth Financial Incentives Program in mid 2014, have disincentivised time-pressured GPs and specialists from embracing telemedicine and remote monitoring technologies that are crucial to supporting long-term remote care programs.

Often telehealth equipment is incorrectly dismissed as being nothing more than fancy versions of consumer videoconferencing tools available on all computers and smartphones. This ignores the broader picture around connected healthcare, which also involves continuous connectivity from medical instruments that can be a vital lifeline from care providers to patients in their homes.

Automatic blood pressure monitors, blood sugar tests, ECGs and other equipment together with psycho social surveys all provide crucial information to support the face-to-face encounter with patients. Without that complementary data, Barrow warns, doctors’ ability to remotely manage patients is seriously restricted.

But if the data can be provided in real time, remote care becomes a very tangible option – helping improve care to chronic, homebound patients and freeing-up precious resources for already-overstretched hospitals.

“We spend millions of dollars transporting patients around the country,” Barrow explains. “If we can better deal with these patients in situ, we can avoid that cost and we don’t have to drag patients around the state. This model works well – but it requires not only technology but commitment from clinicians, and different care pathways as well.”

Bridging the distance

In the longer term, growing digitisation of patient care offers the potential for a range of completely new healthcare paradigms that promise to bring down costs and improve access to specialist expertise even when it’s far away.

Philips has been deeply engaged in these opportunities, recently launching a health platform, the HealthSuite. The HealthSuite digital platform offers both a secured cloud-based infrastructure and the core services needed to develop and run a new generation of connected healthcare applications. The platform is purpose built for the complex challenges of healthcare, featuring deep clinical databases, patient privacy, industry standards and protocols, and personal and population data visualisations. This is opening up new methods of healthcare delivery that have been previously impossible to deliver.

One such application is Philips’ eICU platform that allows access to specialist expertise in distant areas .The Philips eICU solution enabled critical bedside instrumentation, predictive algorithms and high definition video feeds to monitoring critical care patients anywhere in the world.

Through a collaboration between Macquarie University’s MQ Health and Emory Healthcare in Atlanta, this solution allowed US specialists based in Sydney to look after patients at Emory Healthcare in Atlanta, USA during the US night time. This system increased the overall level of care available to intensive care unit (ICU) patients during a time when most American specialists are home – demonstrating the transformational power of telehealth to develop completely new models of care.

Such a system could be equally powerful when applied in a country like Australia, where the urban-regional care divide is particularly pronounced. Yet the commitment to this kind of change can be hard to achieve without concrete data around areas like efficacy and cost-effectiveness, which are critical to driving policy change in an area as complex as healthcare.

While Barrow enjoys bringing Philips’ change-enabling technology to the table, he has been particularly motivated by the partnership opportunities available within an industry whose principals remain committed not just to digital transformation, but to improving and saving people’s lives.

“As individuals we’ve all seen examples where the health system is not communicating internally very well,” Barrow says.

“You may not have all the building blocks, but you need to find partners that do have them and work with them to solve the problems. There’s a real appetite for that at Philips that I find quite energising.”

That appetite is a key reason why Barrow chose to remain within the ANZ region, working side by side with healthcare providers and policymakers to deliver real outcomes for patients.

“All of these things have to be done with collaboration,” he says. “It’s just a matter of ensuring that we in public and private are investing in the right activities, and have the right funding mechanisms to achieve the outcomes we seek. We don’t need some major revelation to move forward; we just need an understanding that we need to run the system a bit differently working closely together.”