Australia’s highly fragmented but otherwise functional healthcare system could collectively save taxpayers and the community around $6.5 billion in costs per year if it properly sweated digital technologies that have been in the process of being rolled out for the past two decades.
That’s the upbeat prognosis from systemic efficiency boffins at the Productivity Commission, which says Australia’s healthcare system is doing pretty well overall — it just needs to harness that persistently evasive network effect to get the machine properly humming by automating uncomplex tasks (administration) and letting more people dial-into healthcare through telehealth and clinical telematics.
The assessments and estimates are contained in the PC’s latest research tome “Leveraging digital technology in healthcare”, which takes a post-COVID look at all things digital in the health system and finds that the healthcare sector really can benefit systemically through well-coordinated use of computers, software and networked machines that go ‘ping’.
If all that sounds rather, well, obvious, that’s because it is, but it’s simultaneously worth remembering the torturous literally 20-year journey it took to arrive at this point in national infrastructure and the repeated false starts, delays and policy rehashes that came with each change of government, federal and state.
“At the federal level, the My Health Record system is now in place, after being rolled out gradually from 2012. There have also been investments at the state and territory level. All jurisdictions have developed or are developing state/territory-specific electronic health records to be used in public hospitals, and in some cases in outpatient clinics and community health as well,” the PC said.
“And the Australian, state and territory governments have collectively invested in digital projects via the Intergovernmental Agreement on National Digital Health 2023-2027.”
It is true that even digital health laggards like the ACT government are now finally switching to electronic medical records in public hospitals, but the rollout of what used to be known as eHealth in Australia has been far from easy.
For the My Health Record unified repository, policy has oscillated between the opt-out and opt-in and back again to opt-out models for the cornerstone national projects.
“While we have made major strides integrating digital technology into healthcare, there are still a lot of unrealised gains that governments can help unlock. Despite a $2 billion investment in the My Health Record (MHR) system, patient data is still fragmented,” the PC research paper says.
“Sharpening incentives for software providers to make information sharing across systems more seamless would help improve MHR’s coverage. The useability of MHR (currently described as a ‘shoebox of PDFs’) needs to improve in tandem with its coverage. Government should work to break down or ‘atomise’ data in MHR to make it more useful.”
The MHR construct is useful in a national context for spotting and addressing trends, but at the end of the day, this is primarily useful for federal authorities who, apart from Defence, essentially don’t deliver clinical services.
Here, the heavy lifting is still done by the states via the tapestry of EMRs that then feed back into primary care (general practitioners) through the likes of Patient Discharge Summaries that then travel onto individual practitioners’ platforms like practice-management software, where Australia has actually been a world leader in terms of integrating medical records, ePrescibing for pharmacy and payments processing and claiming from both private health insurers and Medicare.
It’s at this operational level the PC observes some of the biggest efficiencies that improve patient care (rather than just cutting costs) are still to be reaped.
“Better integrating digital technology into healthcare could save more than $5 billion a year and ease pressures on our healthcare system. Making better use of data in electronic medical record systems could save up to $5.4 billion per year by reducing the length of time patients spend in hospital, and up to $355 million through fewer duplicated tests”, the PC found.
“Up to 30% of the tasks undertaken by the workforce could be automated using digital technology and artificial intelligence (AI); precious time that could be spent caring for patients.”
A lot of that saving is based on clinicians having all the relevant information they need to hand when they need it, rather than ordering repeat diagnostics to build a new picture of the patient at every handover.
“Enabling transfer of records between these healthcare providers can improve the accuracy and continuity of treatment for patients and reduce duplication and inefficiency in the way they receive care. Not only would consumers be able to avoid having duplicative tests and scans, but they would also avoid having to recount their medical history to multiple providers,” the PC said.
The other big efficiency gain yet to be realised is getting care right the first time.
“Data sharing across healthcare providers can also reduce the incidence of adverse events. The transition between acute and community care, in particular, can be a vulnerable period in a patient’s care because of the potential for adverse events, including medication-related problems,” the PC said.
“Poor communication between hospitals and GPs can be a contributing factor. When GPs do not receive hospital discharge summaries, the risk of an individual being readmitted to hospital within seven days increases by 79%.”
To be fair, that step factor in improving the efficacy of care has always been the real goal of eHealth, but it’s a Herculean feat to achieve because of systemic and jurisdictional fragmentation.
Here, the PC observes that digital silos act in the same way as analogue silos (which is why ‘middleware’ is so damn lucrative).
“For GPs, among the different types of software available, Best Practice and MedicalDirector have historically had a significant share of the market. For hospitals, large generic IT systems offered by multinational software companies such as Joan Software, CERNER and EPIC, and more bespoke systems tailor-made for individual wards, hospitals or hospital groups, are used.
“These systems have different structures and standards, data elements and clinical terminologies, frustrating the health information exchange needed. Many systems also tend to have different interfaces, making it inefficient or impractical for providers to frequently switch between them.
“The result is that the information stored using the digital record systems adopted by providers tends to fall into same siloes as the analogue system, limiting the ability to view and track a patient’s journey across the system.”
What it doesn’t mention is that the medical industry is especially adroit at defending its lucrative silos. It invests millions in influencing standards and regulations to protect its own ecosystems. For policymakers, bureaucrats and patients, the price of mistakes is much higher than the price of efficiency, and this is measured in human life.
To use the rather tired ‘rail gauge’ analogy, it’s still safer for passengers to change trains rather than try and change the track and hope trains can run on it. That’s just the Federation, and you can tell how well it works by the extent and efficiency of rail travel in Australia.
The problem with national standardisation is that governments literally need to pick a winner and then all back it. The counterfactual to mandated standardisation is that you get robust competition and innovation rather than ossification.
The problem and payoff with the internet (which relies on telecommunications) is that it has, and continues to be largely unregulated and self-disrupting, even in health.
Here, perhaps unsurprisingly, the PC has found plenty of good news about the industry formerly known as eHealth. It seems the harder-than-hard to switch to remote consultation under COVID, where people just persevered and just used whatever actually worked, has paid off big-time.
“Uptake has increased enormously in recent years. In 2023, nearly one in five Medicare-funded general practitioner (GP) consultations took place over the phone or by video, as did more than one in 10 Medicare-funded specialist consultations, the PC said.
“Prior to 2020, the share of Medicare-funded GP and specialist consultations that took place via telehealth was less than 1%.”
That’s a 20-fold increase in just three years.
“The main benefit that patients gain from substituting telehealth for in-person care is the time they save from not having to commute, and from not having to wait in doctors’ waiting rooms. And calculations by the Commission indicate that the recent expansion of telehealth in the Medicare-funded sector has delivered large time savings to patients,” the PC said.
“In 2023, there were about 28 million Medicare-funded GP telehealth consultations and about 3.5 million specialist telehealth consultations. If it is assumed that telehealth saves patients about 65 minutes per appointment and that 80% of telehealth consultations would otherwise have been in-person visits, then telehealth saved about 27.3 million hours of patient time that year.
“If the dollar value of patients’ time is equal to the average earnings of full-time workers (adjusted for labour force participation) then telehealth delivered a total benefit to patients in 2023 of about $895 million.”
Equate that to getting a script renewed or a referral to another specialist and its not hard to see where the value point is.
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