Road to recovery: Winning the hearts of doctors with technology

The current state of the Australian health sector is scattered between some practitioners having access to the latest system while others do not, creating a lot of inconsistent communication.

It seems like it was light years ago that during a visit to the local general practitioner (GP), we saw them take out a pen and paper to jot down notes about how you were feeling, their diagnosis, and then a prescription before they sent you on your way.

These days, the handwritten notes are typed into a computer.

But the transition for most GPs between the two did not occur overnight, nor did it happen willingly, according to Dr Marcus Tan, CEO and medical director of HealthEngine.

"Doctors, by definition, are fairly conservative," he said.

It wasn't until the '90s, when the federal government offered GPs incentive grants to establish electronic records, that paper records gave way to computerised systems. Tan said that while many GPs took up the offer, the issue was that for several years, it was used in a very ad hoc fashion, with some only turning to their computers to print out scripts while continuing to make handwritten notes.

"General practitioners are a very heterogeneous group of people. There are different levels of sophistication in technology from a practitioner sense and a practice sense. Some practices are early adopters, while there are others that are not so much. Even within clinics, some doctors were very keen and others not so much," he said.

"But given over a period of time, 85 to 95 percent of general practitioners are now computerised in one way, shape, or form, most of them have a practice management software they use all the time, and very few are using handwritten records."

But while GPs received assistance from the government, other medical practitioners, such as medical specialists and hospitals, were left in the cold. This has since left the health system in greater shambles, he said, as communications between GPs and other medical practitioners are often inconsistent.

Tan said, for instance, that fax machines are still regularly found in GPs' offices because specialists still rely on faxes and even snail mail. At the same time, when discharges are returned from hospitals, GPs are often faced with the frustration of not being able to upload it to their records -- if any discharge is received at all.

"From a GP's perspective, yes, we've been computerised, but nobody else is. The adoption of technology outside of GPs is pretty poor. It's great we've got this secure messaging system that connects us to other providers, but a majority of these other providers are not online. Therefore, we end up having all these legacy systems in place," he said.

Increasingly, though, as the grey-haired doctors retire and younger "technophile" doctors take over, the hunger to use up-to-date systems is growing.

In fact, Frost and Sullivan Asia-Pacific recently said the healthcare IT market is the fastest-growing market across the world. Within APAC, after Japan, Australia is the second-largest market of health technology adoption.

Natasha Gulati, Frost and Sullivan Asia-Pacific connected health industry manager, said that large public hospitals are the highest and most frequent spenders on healthcare IT solutions, but many smaller hospitals in Australia's rural and remote areas hardly spend anything on health IT.

In turn, Gulati noted that while health IT penetration in the country is expected to continue to rise, it will mainly be in the form of facility upgrades and high-tech adoption across existing hospitals.

"Dependable and reliable health data sharing is still a distant dream for Australia, although concerted efforts in this direction have begun," she said.

Under the former Labor federal government, AU$1 billion was spent in the e-health program creating the Personally Controlled E-Health Record (PCEHR) project aimed at improving patient care by making it easier for healthcare providers to access and share information about a patient throughout the medical system.

The current Coalition government has allocated an additional AU$140 million to keep the project going until it implements the recommendations of a review into the project.

However, since the launch of the project, the number of doctors who have created documents in the system has been underwhelming. As of November 2013, the government reported that while 900,000 healthcare professionals had signed up to use the system, only around 5,000 documents had been uploaded.

Toby Hall, CEO of St Vincent's Health Australia, recently told attendees of the Connect Expo Future Health Summit that the lack of government incentives and funding is holding back digital health initiatives.

"We've actually got to win the hearts and minds of people and say: 'This is a better way forward.' That's not going to happen until people see the benefit for them in that," he said.

"You're not talking amazingly complex technology; you're talking an issue which is actually more to do with will.

"We've got the platforms there. People aren't willing to use them."

Tan similarly noted that quite often, doctors would not feel obliged to take up a new system if they do not feel comfortable, or if they feel they will not benefit from it, which is a reason why the uptake of PCEHR by the industry has been so insignificant.

"It requires clinician buy-in, and, at the end of the day, if clinicians and GPs particularly don't feel comfortable with it, they're not going to take it up; there's nothing in it for them to take it up," he said.

"Motivation has to be aligned in all of these projects."

Instead of waiting around for the changes to occur, organisations such as not-for-profit healthcare provider Mercy Health have taken it upon themselves to make upgrades to their systems. Working with Dimension Data, Mercy Health completed the deployment of its entire datacentre environment into the cloud over 13 months -- a move that has since saved the organisation an estimated AU$1.2 million.

Doctors, by definition, are fairly conservative.

— Dr Marcus Tan, HealthEngine CEO and medical director.

Mercy Health chief information officer Dmitri Mirvis said the organisation's IT system was in need of a long-overdue upgrade, with hardware past end of life and software that was out of date. Some of the benefits the organisation saw as a result of the adoption of cloud services included the reduction in the number of calls to its help desk, fewer hardware faults, and less bugs in the system.

"It allowed me to focus the IT department to improve service level management and replace what used to be infrastructure with new application delivery without increasing headcount, instead of supporting fire fighting," he said.

"As an IT department for a healthcare organisation, we wanted to provide new capabilities to our users instead of commoditise activities in the background, which is what infrastructure tends to do."

When asked what impeded the upgrades from occurring sooner, Mirvis said it was mainly due to competing budgets with the rest of the organisation, where mainly new beds for the hospital often took greater priority.

In an effort to help improve existing systems within Australia's health sector, as well as bridge the relationship gap between practitioners and patients, HealthEngine launched an online health directory nine years ago. To date, the directory lists 70,000 Australian practices and practitioners, including GPs, dentists, and physiotherapists. It is also a portal to allow patients to make appointments, and so far 21 million appointments have gone through HealthEngine.

In recognising how fragmented the current health system is, Darius Wey, HealthEngine's head of marketplace, said an integral part when designing the online appointment system was ensuring that the platform would be able to plug in to existing practice management systems in the market, which are currently being used by practitioners.

"In the GP space, is there are about five or six [practice management systems], in the dental space there is a similar number, and in allied spaces there is as many as 15, which are all done by private companies," he said.

"Some of them don't have their APIs, so from our perspective as an online platform system, we have tried to be platform agnostic as much as possible, because we want to integrate with as many solutions out there.

"Ultimately, that means we have to work with each individual company and build a generic layer of integration."

To overcome the existing fragmentation, Healthpoint and the Royal Australian College of Practitioners recently developed the emergency response planning tool (ERPT) to enable GPs to be ready to respond to any major disasters or pandemics, such as Ebola or swine flu. Currently, 30 percent of all GPs in Australia have signed up to the system.

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Dr Penny Burns, senior lecturer at the department of general practice, University of Western Sydney, said it is not often that GPs are included in the tactical response during pandemics, as many would turn to secondary care for it. If they are included, it's rather ad hoc.

Burns further highlighted that GPs are particularly well placed to handle medical conditions after a disaster occurs.

"There are studies out there that show GPs really do save lives. So increasing the number of primary care doctors can actually decrease death rates. I think it's important that GPs are included so that they can continue to monitor their patients' health at a time when they're really stressed," she said.

"They can also help identify who is the most vulnerable in the community, because they know the community. One of the biggest things that patients want after a disaster is their own medication, and GPs know those, so it makes sense to link them in."

Burns added that the real challenge now is to get everybody enrolled in the system. Although so far, the coordination that exists overall in primary care is fairly consistent, it's just a matter of improving communication with secondary care, she said.

"I think coordinated care is working among GPs, because they do have the ability to have that holistic view of a patient. Research even said that if you have a GP, you'll live longer because of the coordinated care," she said.

"But sometimes, there are communication challenges with secondary care, but there are definitely efforts in hospitals trying to improve that. When the electronic health record comes in, I think it will really make that a lot easier."