The failure thus far of the Australian healthcare sector to reap the enormous potential for IT to improve the delivery and quality of medical services in Australia represents a massive opportunity for the Australian channel.
Whether it’s the personally controlled electronic healthcare records (PCEHR) system or the generous federal government subsidies to encourage the uptake of telehealth, it seems no matter how clever or potentially game-changing an initiative is, convincing decision makers within the medical profession has always been a challenge, and is expected to remain so for some time.
Typically in healthcare, disjointed data is collected across highly fragmented systems that are still often predominantly paper-based. For those that have evolved into electronic forms, most have poor interoperability with other electronic systems used by various payers, providers, or government agencies.
Yet with the push for universal digital records systems and generally better communications systems linking hospitals, GPs, specialists, insurance companies, health funds, the government and patients, healthcare organisations have little choice but to invest in new systems that make true interoperability possible.
According to Martin Greenlees, general manager with Sydney-based systems integrator Workstar, healthcare professionals are among the hardest to market IT solutions to. On the one hand they’re highly skilled and knowledgeable people who demand a particular level of respect, while they are also usually uninterested in IT, despite using extremely sophisticated equipment on a daily basis.
“The technology they use in theatres is phenomenal yet all of them struggle with a keyboard and a mouse,” Greenlees says, regardless of what seems generally to be a “strong sense of not wanting to be left behind”.
Workstar has made significant investments in education and training, which it sees as especially important for helping healthcare professionals to understand the value of technology and how to use it.
The company markets a customisable learning suite called Nexus, which Greenlees says has proved especially effective in helping healthcare organisations to build tailored education programs that are appealing and effective for doctors and other professionals. It has also worked to help affect behavioural change with the department of health and ageing.
Rhenu Buller, a senior member of analyst Frost and Sullivan’s health team in Australia, also emphasises the uniqueness of healthcare professionals as customers of IT solutions providers.
“[Healthcare] organisations are stuck in their ways,” she says. “To get a change of habit you have to follow the processes; training and proper change management are critical factors.”
Slow uptake
Both the PCEHR and telehealth programs have seen sluggish uptake, a problem which Buller thinks might have been averted had Australia not been in such a hurry.
“We need to take a step back; Australia developed healthcare systems very quickly,” she says. “A longer roadmap for IT adoption might have been a step in the right direction.”
Nevertheless, true to form, the current government has been remiss in promoting awareness and uptake of its expensive programs. Dr Mike Civil is a HIT (health IT) expert and spokesperson for the Royal Australian College of General Practitioners (RACGP). He challenges the proposition that health professionals, in particular GPs, have been slow to adopt technology.
He estimates around 96 percent of Australian GPs have some sort of clinical desktop system.
“GPs are pretty IT literate.”
However, he concedes the uptake of technologies such as telehealth has been a little disappointing.
“One of the big stumbling blocks is what software to use and how can doctors be sure it will succeed in communicating with specialists at the other end.”
The slow uptake comes as a surprise given the federal government has said the telehealth rebate will end in 2014; a strategy calculated to spur doctors into action, yet one which appears to be achieving minimum success, despite the fact GPs currently get paid the rebate simply for conducting consultations over Skype.
On the other hand, Chris Reeve, operation manager with Victoria’s Hume Rural Health Alliance (HRHA) has entirely practical reasons for not always embracing the latest and greatest. The group is only now moving from XP to Win7.
“We don’t like to be on the bleeding edge – we generally stay a generation behind because of support; we wait until first service pack is out,” Civil says.
NBN boon
Provided it eventually achieves a meaningful degree of penetration, the NBN is expected to deliver a major boon to ehealth in Australia. However, according to former nurse and now head of HIT with Polycom, Ron Emerson, advances in compression technology are helping to improve the capabilities of existing network technologies.
Polycom, he says, has developed compression algorithms that can deliver high definition, 720p and 30 frames per second, with speeds as sluggish as 512kbps. Encouragingly, the growing community of younger health professionals is providing significant impetus in improving the understanding and deployment of technology within organisations.
“The younger generation coming through is incredibly tech savvy,” says Workstar’s Greenlees.
Of course this has seen a rapid proliferation of mobile devices, a trend which Polycom’s Emerson says has meant his and many other traditionally hardware-based companies are fast evolving into software companies.
“Our approach now is device agnostic.”
Getting personal
IT companies are at the vanguard of arguably the most exciting emerging trend in healthcare – personalised medicine. Since the mapping of the human genome some 10 years ago, the costs of high-speed, computer-based sequencing technology has plummeted to the point where people are able to have their entire genetic map charted for around $1000.
This has massive implications, not only for healthcare itself, but also the IT professionals who service it. While initiatives like PCEHR will focus initially on standard forms of healthcare data such as x-rays, MRI scans and traditional clinical reporting, the falling costs of genetic testing means that complex DNA data will also be thrown into the mix.
Yet clinical patient information is just one part of the picture. Health data also includes financial information resulting from highly complex billing and claims processing, as well as a wealth of administrative and demographic data which must be collected and stored to meet legal and compliance requirements.
ARCGP is among the professional organisations working together and with the federal government to develop technology standards for the sharing storage and securing of healthcare data. Yet it seems it may be a while before any meaningful progress is made.
“Australia is really interesting in the sense that state and federal systems run on many different platforms,” says Frost and Sullivan’s Buller. “There are no national standards.”
This is making it harder for health organisations to justify investment in solutions for clever health analytics, despite the fact prices have come down, she adds.
“We are moving into much more advanced [data] analysis but we are also seeing challenges with hospitals having to justify the spend in terms of ROI,” she says.
Healthy partnerships
Healthcare has always been one of the most data-intensive industries. And provided programs such as the PCEHR get off the ground, those volumes are predicted to increase by orders of magnitude in Australia.
Resellers have an opportunity to help healthcare organisations upgrade their systems so as to allow for greater interoperability for data sharing and communications. Naturally the cloud has a role to play in all of this, however, none of the experts interviewed by CRN indicated that cloud solutions are high on the list of IT priorities for healthcare organisations, perhaps because of sensitivities around privacy and security in healthcare.
The big vendors all have skin in the healthcare game, with the likes of SAP, IBM, Oracle and 3M at the top. But more genuine competition is needed to bring costs down to more acceptable levels.
Buller suggests one of the ways healthcare organisations can address this is to enter into partnerships with technology suppliers. These could be structured around things like joint research initiatives which result in vendors accruing intellectual IP.
“We see partnerships being one of the key ways in which vendors and end users can manage costs.”
Resellers also have an opportunity to develop solutions targeted at particular specialisations. For instance, the federal government has eight national health priority areas: arthritis and musculoskeletal conditions; asthma; cancer control; cardiovascular health; diabetes mellitus; injury prevention and control; mental health; and obesity.
These health categories are among a total of 50 addressed by an online service called HealthEdata, launched in August by Deloitte Australia. Delivering detailed and customised information relating to the local health landscape, its objective is to arm healthcare providers with research of unprecedented depth and quality covering things like the number of people projected to present a certain diseases at a certain time and during which periods of time.
“There are growing mountains of data out there, but they are disparate and often inaccessible to the industry as a whole,” says Lynne Pezzullo, lead partner health economics and social policy at Deloitte Australia Access Economics.
Mental health of course presents numerous unique challenges for health professionals, particularly around the need for immediate access to care as well as the quality, high-resolution sorts of video communications promised by decent telehealth systems.
Mental health advocacy groups are also especially heartened by the promise of improved mental services for patients in remote locations, especially farmers which have long been identified as a high-risk group for depression and other related problems. But no one is under any illusions as to the time, effort and investment required.
And of course for the channel, there is a wealthy of the opportunity to earn respect as trusted advisors able to help healthcare customers navigate the complexities of selecting and deploying standards-based technology solutions for better health outcomes.
Resellers servicing hospitals need to be especially mindful of the need for continuity. Unlike in the corporate world, the unexpected disruption of systems so common during major upgrades threaten lives in the health system.
Still, errors made by healthcare professionals themselves remain one of the leading causes of death in the hospitals of developed countries including Australia. And this is something that well designed and deployed IT systems can practically address.
Nevertheless, health organisations seem to oscillate between profligacy and frugalness when it comes to IT. On the one hand they typically run over budget when it comes to major projects – be they for IT or otherwise – yet when it comes to signing off on new initiatives, negotiate aggressively on price.
Britain’s $12 billion National Programme for IT recently joined the pantheon of the world’s most egregious abuses of tax payers’ money. A Labour initiative dumped by the conservatives, it is an eerie warning for what could happen to Australia’s digital records program. Of course this would be a massive shame, not least for Australian resellers operating in the healthcare and/or data analytics space.
Not only does personalised medicine promise to improve the accuracy of diagnoses and allow for more targeted causes of treatment – such as working out with more certainty the correct dosage of medication for a particular patient – but also in terms of developing pre-emptive as opposed to reactive approaches to managing health.
Health revolution
Key to this exciting transition is the development of robust communications networks to support the rapid sharing of this data in person or in remote consultation. Dr Ramana Panda, founder and CEO of Queensland-based digital health specialists Telehealth Networks, says telehealth has the potential to completely revolutionise healthcare delivery in Australia.
He recalls recently conducting a three-way consultation over video link with a dermatologist in Sydney and a 75-year-old man with skin legions in his surgery on the Gold Coast.
“It normally takes 4 months to see a dermatologist specialist on the Gold Coast. With this system connected to a specialist somewhere else in Australia, they can log into the system with an iPad, laptop or whatever.”
According to Panda, many – if not most – of the doctors that have applied for the government’s telehealth subsidy have used Skype as their entry point to get on board.
While some might argue that a physician connecting to a patient over Skype is a step in the right direction, being paid the maximum $6000 government grant after conducting a consultation over the free service, in addition to receiving 150 percent of the standard Medicare rebate might seem a little excessive.
Besides, Panda stresses that Skype has serious shortcomings, especially when it comes to security, a politically and socially hot issue when it comes to anything related to digital health.
“There are examples where security has been breached; dedicated systems have better security.”
It’s a fact which may well serve to benefit the Australian channel. After all, if there’s one thing that medicine - and society - teaches doctors and other health professionals, it’s to be risk averse.
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