…How can we transform healthcare?

Report by HISA’s Nigel Chartres and Dr Josie Di Donato

Genuine intent and achievement to transform care virtually, in a connected and codesigned way amplified the theme of the 2018 Australian Telehealth Conference in Sydney.

From Start-Up to Scale-Up

Opportunities for using technology that enables virtual, connected care were more and more apparent at this year’s Australian Telehealth Conference (ATC). Telehealth is no longer videoconferencing alone. It is no longer on the periphery and exclusive technology for the supported care of people living in the remotest parts of the world. Telehealth has stood the test of time and broadened the frame for healthcare delivery no matter where you live and no matter how far the nearest healthcare provider is located.

Telehealth has emerged beyond the veil of pilot and demonstration projects, as a key tool for achieving virtualised and connected care.

A key challenge noted was how to robustly re-design services, across a broad spectrum of disciplines, so that improved consumer and clinical experiences are sustained on a large scale.

Innovative approaches in thinking, in conjunction with contemporary frameworks for dealing with complexity can enable tangible progress in achieving connected, effective, successful and sustainable systems.

There were three key messages that resonated across the two days of the ATC:

  • Re-invent the Vision – convert the vision from an idea, to a tested idea that scales to ‘business as usual’
  • Re-define the Issues – technology is not the issue; telehealth saves precious time, money with minimal carbon footprint
  • Put it together – scale-up fast as scale will change healthcare’s game plan

Re-invent the Vision

from successful demonstration projects towards large scale sustainable & integrated Contemporary Care Services

Visionary platforms showcased at ATC18. New models of care need to be introduced with faster momentum, in order to meet fast growing demand for healthcare services at acceptable costs. Hunter New England have demonstrated it can be done. Telehealth models span extensively across the patient journey.

A future-focused coalition towards a practical platform model for driving change across the current diverse telehealth systems landscape is needed. The platform model will move forward by looking at what is working well, leveraging existing infrastructure and connecting with current successful demonstration projects and programs. This approach of ‘weaving the cloth’ to collaboratively link in with national initiatives, such as My Health Record (MyHR) and the many jurisdictional based systems. For example, in Berrigan, New South Wales, all health services are now connected using MyHR.

The Australian Digital Health Agency plan to deliver secure messaging by late 2019. A national address book for clinicians will enable a federated structure and provide the basis for an integrated eReferrals system to be implemented throughout. National initiatives will assist to galvanise health workforce transformation required for working with connected systems. In conjunction with national initiatives, key jurisdictional strategies, such as the New South Wales Integrated Care Strategy, are essential for enabling smarter connected systems to be realised and delivered.

Other innovations, aimed at building national collaborative models, include

  • Dr Sabe Sabesan showcased how scaling work in one Centre spawned the Australasian Teletrial Model (ATM).
  • SilverChain Group’s impressive Enhanced medical mixed reality (EMMR)
  • Avnesh Ratnanesan was very clear that we must learn from patient experience if we are to keep patients at the centre of all we do
  • QUT’s Belinda Ward and Pepper, the social robot, gave the audience a lesson on practical deployments
  • Chris Ryan posed the idea of a health system where travel was optional

Re-Defining the Issues

moving forward with collaborative co-design approaches for turning obstacles into opportunities

Complexity as an opportunity rather than obstacle. Major issues impeding progress towards connected, integrated service delivery models and systems are not caused by technology. Rather, the issues are linked to disincentives, barriers to change, dealing with regulatory impediments and cultural attitudes.

We need to change the metaphor!! Realistic and pragmatic ways to work through and move forward, is recognise the complexity and turn perceived obstacles into opportunities:

Adopt the NASSS Framework – the Telehealth Designer’s Checklist. The Non-Adoption, Scale-up, Spread and Sustainability (NASSS) Framework, as devised by Professor Trish Greenhalgh, of Oxford University, (previously cited) offers a useful tool set for assessing situations and guidance on how best to move forward for improvement. Essentially, the framework assists in addressing complexity by:

  • Identifying and understanding complexity;
  • Reducing complexity, where possible;
  • Co-developing and sustaining a clear compelling vision;
  • Demonstrating leadership and working with teams on issues;
  • Building collaborative stakeholder networks;
  • Cultivating challenging stakeholder relationships;
  • Carefully managing stakeholder conflicts; and
  • Improving policy and regulatory contexts.

Co-Design the Future. Coupled with the NASSS Framework, change the future of healthcare by changing the conversation. The new conversation is co-design. Co-design cultivates long term, high quality, iterative and collaborative relationships, across the disciplines and in partnership with consumers. Co-design as a discipline focuses on understanding the service journey from a consumer perspective so that co-service design provides the capability to:

  • Identify real needs;
  • Prioritise solutions;
  • Democratise solutions; and
  • Imagine futures.

The discipline also embraces the need to use good techniques and tools to: empathise; define; ideate; prototype; and test. Leanna Woods showed us how Mr Informatician and Mrs Distracted can work well together, to achieve convergent thinking and collaboration.

In realising co-design and co-service design, well focused thought leadership, in conjunction with the right technologies and good training methods will produce accessible, navigable, intuitive, consistent and responsive systems. The establishment of the very successful ‘Young Well Cooperative Research Centre’ led by Prof Jane Burns focused on co-design, with people as partners in research and policy.

Put it Together

realising a sustainable virtual connected contemporary care services ecosystem

A national ubiquitous shared framework requires leadership and orchestration. As the foundations are already in place the vision is now within reach and so “do it once” for Australia.

The Hunter New England Telehealth Models are moving from doing only 8% of what is possible towards a full strategy of saturation. Education, support, advocacy and partnerships are critical to the success of the strategy. Complacency is dealt with through an excellence framework.

DOCTO is Australia’s first online telemedicine hospital. The organisation is guided by good medicine and user experiences. Services are totally funded by consumer payments and no government funding is received. The service is growing by 20% each month.

The Telehealth Victoria Community of Practice are also implementing at regional scale whilst incorporating many variations. They are adapting an overall model based on lessons learnt, through shared learning to deliver ongoing improvements. The benefits are starting small, moving to scale and achieving consistency of practice. For more information on this approach visit www.telehealthvictoria.org.au.

The Ontario Telehealth Network (OTN) is a shining example of the long-term success and sustainability of collaborative shared visions delivering practical reality. Novari Health have been part of the OTN success and are now in Australia looking for opportunities to deliver similar success. For more information visit www.novarihealth.com.au.

Path Forward

Many enthusiastic courageous people are doing amazing work. See ATC18 for the movers and shakers across Australia making telehealth business as usual health!

Make sure to register for ATC19 for first-hand exposure to the latest evidence and ideas for designing and delivering a better future for all Australians.

Nigel Chartres

Volunteer Project Manager & Strategic Consultant, HISA

 

Nigel Chartres is a consultant, futures strategist and systems thinker, with extensive experience in all aspects of management, strategic business planning, stakeholder engagement, project management and solutions delivery. He has formal qualifications in science and business systems and through memberships of professional organisations continues to develop innovative approaches for addressing complex issues and problems.

Dr Josie Di Donato

Advocacy and Leadership Director, HISA

 

Josie’s role at HISA gives life and animation to HISA’s values and strategic priorities through busy communities of practice; a journal club that equips us with an evidence-based repertoire of Australian research in health informatics; position statements and white papers that advocate HISA’s stance, and finally, courage and fortitude to challenge current thinking and practice. She is a big picture thinker and brings deep and broad experience across healthcare in academia, primary care, rural and remote, public hospital.