The success of digital health depends on the ability for voters and politicians alike to see measurable outcomes along what is a long and often difficult journey. PwC’s Richard Royle explained his own experience after a decade in digital health at a speech at the Global Digital Health Partnership Summit in Canberra.
I started my digital health journey less than 10 years ago and wanted to understand what a fully digital hospital environment looked like. Australia had none, so I visited hospitals in the US and saw excellent implementations, not to mention disastrous ones.
In that time I discovered that Australia had no digital hospitals because basically, no one was prepared to take the risk, either professionally, personally or politically. Senior hospital executives in Australia, in the main, had read about disastrous attempts at digitisation, and we had our fair share of them as well.
Senior government officials didn’t want to stick their necks out, and politicians were nervous about the political fallout of failed attempts that waste public money. Moreover, private operators could not see any return on their investment.
In essence, even though there were many examples of successful digital implementations, particularly from the US in the early 2000s, no one in this country, neither politicians nor health professionals were prepared to show leadership and take the risk.
a key focus
The federal government began to address the national digital health agenda in 2005 through the establishment of the National Electronic Health Transition Authority (NEHTA) with the aim to identify and develop the necessary foundations for digital health. Led by a conservative federal government with support from the health minister, it then gained support from the states.
Its foundations included an agreement on the standard language to be used (SnoMed CT) as well as the establishment of an Individual Health Identifier number for all Australians, which commenced in 2010 (with support from the then Labor government). This created significant political challenges – the privacy lobby didn’t want a single number for the government to use across all aspects of health and social services – so the IHI became a separate database.
It’s interesting to reflect that privacy and data security were seen as key areas of concern over 10 years ago in relation to digital health, even before the world of orchestrated cyberattacks. Today, of course, this remains a key area of focus for any digital health endeavour.
In 2011 I oversaw the establishment of the first fully integrated digital hospital in Australia through a $47 million grant from the federal government. Since it opened in October 2014 it has become the benchmark for successful digital implementations. The key to its success lies in strong leadership from the top of the organisation which has a clear vision, and comprehensive clinical engagement to work with doctors, nurses and allied health professionals to demonstrate that a digital record can not only improve clinical outcomes, but also assist clinicians to improve their clinical practice and reduce errors.
long term view
In 2013 there was a change in Federal Government in Australia and the incoming government was hesitant about continuing to invest in the digital health journey. I was asked to chair a review into digital health at that time which resulted (amongst other things) in the establishment of the Australian Digital Health Agency (ADHA).
One of the challenges for any government in any country around digital health is the need to take a longer term view of the journey – it is akin to a government deciding to invest in major infrastructure like freeways and bridges – except in this instance you can’t cut a ribbon and physically see the investment for the voters.
What’s really important in the digital health journey is to achieve agreed outcomes in a staged manner that can be readily seen by politicians and voters alike.
In Australia, the My Health Record will become an opt-out system at the end of this year – one of the recommendations from my 2013 review. When this happens, every Australian will have access to certain health information about themselves which previously they have not been able to see on their digital device. I believe this will fundamentally change the game for digital health, as consumers will become increasingly aware of the power of digital data in relation to their own health management.
Until now, consumers in Australia have been accustomed to using their digital technology for retail, travel, banking and a range of other uses, but not for their healthcare.
Many major corporations are now investing heavily in digital health in its broadest context. Companies that produce smart home technology will be rolling out healthy lifestyle records to connect home equipment with wearables and personal retail history for consumers – this should at some point link with the consumer’s medical history to enable a more proactive view of managing personal health.
Predictive analytics and genomic medicine will move quickly over the next few years to start to shift the dial from reactive healthcare to proactive treatments. Clever apps that assist people with chronic diseases will raise awareness of the positive power that digital can bring to people’s own health.
Health is a very personal issue for everyone – making digital health personalised is increasingly possible in the digital world and will revolutionise what we know as medicine today.
One of the challenges in this emerging industry of digital health is accessing a knowledgeable workforce: there are plenty of technicians who can give you the IT speak but not many who understand the strategic opportunities that digital health can bring and the leadership necessary to make it happen.
As a result, I’m working with the Health Informatics Society and chairing a senior group to establish a digital health executive networking forum and a certification system in Australia to move towards developing digital health as a recognised professional service – not dissimilar to the NHS digital academy that Rachel Dunscombe is now leading. I’m hoping that it will rapidly develop into a regional forum for Asia/Pacific, given the increasing interest in digital health around our region.
One of the other challenges in digital health, and it is an international problem, is health system software interoperability.
Health professionals’ biggest complaint around digital health is the existence of information silos, where data cannot be transferred from one health provider to another. I believe it is an important area where governments can play a critical role.
As part of the journey towards what I call a standard national rail gauge for digital health, governments can work with the health and health software industries to agree on standards for system interoperability.
It will be a long journey but I believe is critical for long term success in digital health.
This is an edited version of the speech given by Richard Royle at the Global Digital Health Partnership Summit in Canberra.