Archive for the ‘Uncategorized’ Category

Big Data and Personalised Medicine

November 4, 2015

My recent presentation on Big Data and Personalised (for my US friends Personalized) Medicine.

I believe this is the most valuable input the information technology industry can provide to healthcare.

The challenge is to ensure we do it in collaboration with the healthcare industry and not in a siloed way as we have in so many other aspects of healthcare.

We also need to take some responsibility for educating the healthcare workforce on this important area. Having gone through med school and watching my son go through now they are struggling to come to grips with the value of data. It is an area the ICT industry understands, so we should play a more active role in helping them learn its value and how to use it. There may even be an opportunity to develop a whole new healthcare sector specialising in data rather than body parts 🙂

The Art and Science of Digital Medicine from TedMed Sydney 2013

April 30, 2013

I recently had the privilege to present at the inaugural TedMed Sydney event held on April 20 2013 at the University of Sydney. This was a satellite event for the larger TedMed event being run in Washington DC. It was a particularly exciting as I was speaking back at my old Alma Mater, I studied medicine at the University of Sydney. To make it even more special I was speaking in the same session as Professor Martin Tattersall. Professor Tattersall is a legendary physician at the Royal Prince Alfred Hospital where I trained. He is recognized for his clinical skills and his humanity. He was the oncologist who looked after my mother during her 2-year battle with lung cancer, and I will never forget the kindness he showed her and us during that time.

The problem with TED talks is that the go very quickly. I had prepared a speech, but on the day the adrenaline kicks in and the clock ticks down, and I suspect I may have missed a few of the salient points I wanted to say. So below I have my prepared notes, which I hope emphasise the point I wanted to make. When the video becomes available I will post it too, so you can compare the two.

The Art and Science of Digital Medicine

Dr George Margelis

I love gadgets, I am unashamedly a geek. My first Personal Computer was back in 1981, a Sinclair ZX81, since then I have gone through multiple iterations, and today I have 3 computers and 2 tablets on my desk with 3 redundant internet connections. So as you can see I am not a Luddite.

Today, to paraphrase Marc Antony in Shakespeare’s Julius Caesar, I have come not to praise technology, but to bury it.

Over the last decades many entrenched myths have developed about technology and healthcare. They are based on good intentions, and a common desire to do the right thing. However the net effect has been wasted money, wasted energy, and wasted opportunity.  But that is not the worst of it. The real problem is that people who we could have helped, if we had done it right, were not being helped. We were breaching the very basis of the Hippocratic oath, First do no harm. We thought we were doing the right thing, but in practice we weren’t.

The first myth is that technology will save the healthcare system. We have heard that it will save the healthcare system billions of dollars, prevent thousands of medical errors, solve the challenge of chronic disease, and even stop childhood obesity. Because, as my technology colleagues have told me, these are just the fault of a flawed healthcare system run by greedy doctors and poorly managed patients, all of which can be solved by the right app on their phone.

They are Wrong. Healthcare is a complex endeavor, balancing human physiology, psychology, sociology and economics. Technology is a powerful tool we can use to effect many aspects of healthcare, but ultimately healthcare is a very personal endeavor. No app or device alone will change that. In fact, technology has the potential to amplify our problems in a way humans just cannot. For the technologists their desire to simplify everything to data flows is their greatest weakness.

The second myth is that the development of new technology, that is new gadgets that we see being released on a regular basis will drive innovation in healthcare. New tablets, phones, sensors, imaging devices will lead to innovation. Again wrong. Innovation in healthcare is very different to invention. Each new gadget, is a new invention. It is only an innovation when someone does something better with it. A faster chip, a better screen, a new program are all great inventions, but until someone takes that capability and delivers a healthcare outcome using it, it is just another shiny bauble by the bedside.

The gadgets are not our enemy, they are our tools. As with any tools, in the hands of the right person they can make beautiful art, and in the wrong hands they can create havoc. It is our responsibility as the healing profession to ensure they are used well. The challenge we face is that the technology for gathering information has overtaken our capability to utilize it. It is up to us to speed that up, and at the same time simplify it. We hear about big data, it is up to us to turn it into good data.

That is where you come in. The doctors, nurses, allied health workers, medical administrators. You need to identify the problems, and use the gadgets to make the improvements. You need to take charge, and stop believing that the latest device will solve your problems, because the people who make that gadget have no idea what your problems are

However, it is not all about the doctor. The greatest change in healthcare is the rise of the E-Patient. The E has many meanings. Empowerment is the key to better healthcare, so the Empowered Patient is one of those meanings. The key to power in the past has been access to knowledge. For centuries locked away in medical libraries and arcane journals that knowledge has now been freed by the power of electronics. So the Electronic Patient is another meaning, because thanks to the internet and the computers that have made the world’s knowledge available via the press of the button the doctor can no longer hide behind their shield of knowledge. Again, the electronics is but a tool. The real innovation is in people making that knowledge available and accessing that knowledge, and using it to improve their health. A journal article in itself will not make anyone healthier, but accessing it and changing your actions based on that evidence will. Technology can make the knowledge more accessible, but like the proverbial horse to water, it can’t make you drink from the fountain of knowledge. Education can, so the third E is for the Educated patient. Not in the classic K-12 sense, but in health literacy. No doubt the two are related, but unless we ensure the health literacy of our population is improved all our efforts in healthcare reform will be wasted.

The E-Patient along with the E-Doctor and the E-Health system can change healthcare. By combining the art and science of medicine with the art and science of technology we can develop solutions to our healthcare problems. Separately medicine and technology cannot. Each can make a difference, but when combined, with a deep understanding of what we want to achieve, the potential is limitless.

To do this we need to develop a clinically focused innovation model that combines the two. Doctors need to understand technology, and technologists need to understand healthcare. We need to make sure we are working towards a common goal, healthier and happier patients. To do this we need to collaborate. This sounds simple enough, but we come from very different worlds. For us to collaborate, we must first cohabitate.  We need to bring technologists into our domain, the hospital, the clinic, the labs. We need to introduce them to who we work with, our patients and their families.

They need to understand how we work, how we think, and how we accept that sometimes, despite our best intentions, we can’t solve all the problems. The art of medicine is as much to know when to stop, as it is to keep going.

In technology there is only one direction, forward.  We can learn from that, and develop the burning desire to continuously improve what we do. We can learn to measure more, analyse more, think more before and after we act.

At the intersection of doctor, patient and computers lies the brave new world of digital medicine. It is our responsibility to take charge of it and mold it into a tool that can deliver on the triple aim: Improve the patient experience of care, improve the health of populations, and reduce the per capita cost of healthcare. We can’t do it alone, but we can lead it, and it is our responsibility to do so.

April 4, 2013

David Lee Scher has a great blog I recommend to everyone. His insight as both a doctor as well as a technologist is awesome.

The Digital Health Corner

In previous posts I discuss how patient-centric care differs from patent-centered care and how patient empowerment must precede patient engagement.  I would like now to delve into what I consider critical elements of patient-centric care. They all involve technology to various extents.

1.    There must be buy-in from providers. I am including payers, healthcare systems as well as clinical providers in this category.  While I realize that much of healthcare is devoted to satisfying legal and regulatory mandates, there is great opportunity to improve the care experience (and dare I say outcome) of patients by changing the focus from provider to patient.  Physicians do care about their patients.  However, they are finding less and less time to devote to direct patient care. This same situation will repeat itself with non-physician providers as they assume more responsibility for patient care. Unless physicians support efforts to provide patients with tools to…

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What healthcare can learn from the Cheesecake Factory

August 18, 2012

If you have visited the USA chances are you have visited the Cheesecake Factory. I have and I have to say it was a great experience. However I never thought it would be used as an example for healthcare. The food was tasty and voluminous., and for those of you who knows me, that is a compliment. So when a recent edition of The New Yorker published an article by one of my favourite healthcare writers Atul Gawande titled “Big Med” looking at what healthcare can learn from the various chain restaurants in the USA, and I was very interested to read it.
Dr Gawande uses the experience of a Cheesecake Factory employee with the health care system to ask the question, why can’t we learn from world’s best practice in healthcare?
Why can the Cheesecake Factory provide consistently high quality outcomes in the way of food cost effectively whilst hospitals struggle to provide consistent quality services?
The answer lies in balancing standardisation and flexibility, and providing people with the right tools to enable them to access standardised protocols whilst making sure they have the requisite knowledge to make optimal decisions.

Complex Decisions and Innovation

May 21, 2011

Day 5 started off early again with a talk by Tonya Hongsermeier on Complex Adaptive Systems. A Complex Adaptive System
is made up of a large number of self-organizing independent agents that seek to maximize their own goals but operate according to rules and incentives in the context of relationships with other independent agents. She provided a god set of examples of the transition from linear through complicated to complex in healthcare. Linear is ordering a test, complicated would be doing a simple colonoscopy in a low risk patient, and complex would be managing a septic patient. The issue arises on how to get people to understand they are in a complex adaptive organisation and how to manage the relationship, and utilising the technology to remove some of the complexity where possible. An interesting thing was the healthcare modified data information knowledge wisdom pyramid, where the knowledge starts as know about to know how. The role of good decision support is to provide the most likely solution as the easiest option to select. However this logic is not linear.

The next speaker was Roberto Rocha on Translating Knowledge into Practice for Continuous Improvement. Improvement requires complex CDS, it’s not the simple stuff that is causing the problems, however the deployment needs to be simple.

The goal is science-driven health care or a learning healthcare system to enable moving from reference to action and ultimately to executing

After the break Kenneth Mandl spoke on HIT Architectures for Health Care: Innovation and Transformation. Ken is from the Children’s Hospital in Boston which has done some very innovative things, including Indivo, the basis for many personal health record systems including Dossia. He spoke of the need for a Learning Healthcare System as the goal for health informatics. He spoke of the App Store for Health concept and the need for user interface development and allow people to choose the interface that works for them. Rather than just interoperability he suggests substitutability should be the next stage. They even have set up a Smart App challenge. He went on to talk about how the Personal Health Record may be the disruptive innovation and compared it to the current HIE models, which have been unsuccessful. He commented on the Australian PCEHR project as a very positive step, and whilst it faces some technological and sociological challenges, it does move us forward. A great example of linking the PHR to online disease specific social networking sites, in this case tudiabetes.org showed that people were keen to share their information and also enter their data.

The next session was on the governance of clinical decision support. Governance leads to a common vision, coordination and transparency, and provide the organisation the ability to manage expectations and be agile enough to respond to unanticipated demands. Within Partners, which is a collection of world leading providers, which raises its own governance issues, he described the journey of getting to a stable governance model and the various issues involved, which led to much discussion. He was followed by Dr Goldberg who discussed how CDS is integrated with EHRs. He described the various currently available CDS tools, and how they affect the systems they are running on. Some early results from the use of Smart Forms which combine CDS logic with user interface design and prompting of behaviour have been shown to be very beneficial.

The day was wrapped up by Blackford Middleton looking at why we need leadership in health IT. The provider’s dilemma is that we still hurt people while delivering healthcare, and the variation in healthcare remains huge. The question of how HIT saves money, and it essentially comes from improved effectiveness, reduced duplication, taking away reworked, be they test or administrative tasks. The improved quality of care decreases the costs associated with adverse events. Data sharing reduces redundancy and associated labour costs, telehealth reduces costs, and the PHR improved admin efficiencies. He went through the masses of data available, much of it from work at Harvard. From the purchaser’s perspective, the rapid growth in costs with 25% of the cost being administrative costs. The evidence for CDS is great in places where it is done well; the challenge is how to scale it out to the rest of the country, if not the world. We need to research more completely what we need to do, where CDS can intersect with HIT usage.

The wrap up discussion pointed to the differences and similarities between the US experience and mine in Australia and others from Canada. We all recognise the issues of cost, but we also recognise that the value of clinical expertise needs to be supported. There was much discussion of where to next, and what else we need to cover. Telemedicine came up as did personal health records, so it seems Australia is heading in the right direction.

Overall it was great session, very informative and the faculty were very helpful. A special mention for Blackford Middleton who went out of his way to be inclusive, was full of knowledge, and showed great interest in what is happening around the world. It would be great to get this course delivered down under for our health folk to understand what is needed to make ehealth happen. They emphasised it is a journey, and they need to persevere.

Innovation and Improvement the Harvard Way

May 20, 2011

Day 4 started with the head of patient safety from Partners talking about the value of experimentation in patient safety development. Much of this was driven by the work of David Bates which showed that when Brigham and Women’s Hospital experimented with CPOE in the 90s they showed huge decreases in medication related adverse events. Since then they have experimented with some other things, tiered Drug Drug Interaction alerts have led to significant increase in uasage of these alerts. Before the experiment there was an over 80% over ride rate, but with the tiered system the rate for tier 1 was basically zero because you could not over ride it, but the tier 2 events where clinicians had the option to override, the positive response to the alert doubled. They experimented with barcode usage and showed huge improvements. The willingness to experiment differentiates them and demonstrates their leadership. Starting with a hypothesis and testing it seems to be the key secret, and giving people the freedom to think of hypothesis. Experimentation drives innovation learning and improvement.

The second speaker came from the Harvard Business School Richard Bohmer, a physician and a Kiwi. Amazing how many areas doctors have gotten into at Harvard. He started with a claim by Brent James from Intermountain Healthcare “Our business is clinical medicine”. He looked at the changes needed from a management perspective. Terms such as changing production mode seem out of place in a healthcare discussion, but he actually made it sound reasonable. Some interesting stuff from 1984 which looked at the role of uncertainty in physician practice. He emphasised the need for well developed science in healthcare, almost like an engineer. He spoke of the four habits of high value delivery organisations. Specify, design, measure and learn.This talk was teh highlight of the entire event, it seems the guys at Harvard Business School are thinking about healthcare in a way few others can.

After the break William Lester an engineer who decided to go back and study medicine spoke on Population Management with Health IT. Another brilliant speaker with amazing information and to use the quaintly American term “we were drinking from a fire hose”. He dived into the issues around disease management, something close to my heart. Population/patient selection, metrics and clinical effector activity was the core theme. His quote “It’s all about the workflow, silly” followed by “It’s the technology, silly”. In reality it is both, it’s how you link them up. Engagement is the key for bringing providers onboard, and you need to use every tool you have, including leveraging their competitive streak.

The next speaker was from a 300 provider clinic who spent $24 Million on setting up their EMR, and showed how it improved their clinical and financial success. It came down to thinking about how they use, providing clinicians with some flexibility, but not too much, and as they had a large capitated population they were able to drive continuous improvement clinically and financially. The interesting statistic was that they expected a big hit in productivity on implementation, what they actually experienced ws a 15% drop for 2 weeks followed by a return to above their baseline.

After lunch Partner’s head of Quality Data Management, basically the guy who was responsible with what they do with the huge amounts of data they have collected in their data warehouse. Yet again a physician who still does some clinical work and in the rest of his time massages a huge data warehouse to drive improvement within Partners which seems to be the secret to Partner’s success. He was followed by Micky Tripathi from the Massachusetts Ehealth Collaborative who spoke of the experience of getting a HIE type structure up and running in HIE type clinical data exchange.

The final session was a panel of two thought leaders from non healthcare arenas. Richard Swanborg from ICEX and Tom Koulopoulos from Delphi looking at innovation. Tom defines innovation anything that creates value and change behaviour.It is teh gretest enabler of behaviour change, he used the mobile phone as an example. He now sees industries using IT as the centre of their innovation, not of the IT, but of the business. He spoke of the three eras of how we use IT. It started with information, went to integration, and now moving to predictive analytics. Innovation was the key message.

It was a very interesting day, and as much as it hurts me to say, the Kiwi Richard Bohmer was the class act.

Can EHealth in Australia be private?

March 7, 2011

I spent Wednesday in Melbourne attending the workshop arranged by the ACHR and GAP on the paper by Associate Professor Leanne Rowe "Primary Health Care and The Private Patient Journey: Towards a new generation of private health care in Australia”.

The goal of the event was to get the full range of stakeholders in the room to discuss how private health insurers, private hospitals and primary care could work together to deliver better healthcare.

The first challenge was in defining who is a private patient in Australia. We agreed that the patient who is admitted into a private hospital for a procedure by a private practicing clinician whose procedure is paid for by a private health insurer is a given. As we start looking at the average patient who rocks up to their GP clinic, it can be well argued that they are also effectively a private patient. Whilst their insurer may well be the federal government trough Medicare, from the perspective of the patient and the provider, especially in the much more common non bulk billing practices out there now, it is a series of private transactions.

So the private patient remains a mysterious entity. In a fee for service model as we currently have in Australia, effectively every health transaction is a private transaction between a provider and patient.

How does ehealth play in the private healthcare transaction world? In reality technology has been used for tracking transactions for many years. Even the least technically literate practice is likely to have some sort of electronic system for billing, be it a basic MYOB accounting application, or a specialised healthcare system. Accounting took up technology very quickly, it made a lot of sense to them. With the advent of services like HICAPS for private insurance billing and ECLIPSE for Medicare billing healthcare providers also took advantage of it.

However the same capability to manage clinical information for private patients and sharing it with their care team hasn’t had the same uptake.  We keep on hearing about silos in healthcare, and the silo mentality around healthcare data propagates this further. I hope that the Personally Controlled Electronic Health Record may be the critical factor that breaks these silos. To do this, it needs to be adopted not just by patients, but also by providers, public and private. I believe the best way to do this is add a little carrot, maybe a couple of cents extra for transactions that have also sent data to, or used data from the PCEHR. In a private payment world, maybe those few extra cents will drive adoption in the beginning when there isn’t too much data there. Over time as the data builds up, clinicians will see value in the data, and will be more likely to use it without the extra incentive. Its the beginning which is the hardest, so makes sense to spend a bit of money up front to get adoption ramped up quickly.

Does healthcare really need broadband?

February 27, 2011

This week I attended and presented at the Communication Alliance’s Broadband and Beyond conference in Sydney. It was a actually a hard decision, as at the same time over in Orlando Florida the 50th annual HIMSS conference was being held, and I was originally going to attend that. But I believe that it is really important to keep the message around technology enabled healthcare strong in Australia, so there I was.

For those of you not based in Australia, the government has committed some $40 Billion to provide a fibre to the premises network to the majority of Australia, with a very fast wireless and satellite alternative for the rest. In this case the majority is 93%, and if you have any experience of Australian geography, you will realise this is a big deal. The rollout is being done by NBN Co Limited, an entity formed by the government to do so. You can read more about them on their web site.

The Broadband and Beyond conference had a number of speakers from various sectors, but what was interesting, especially on the first day was the number of times healthcare popped up. My old friend Professor Michael Georgeff spoke about the CDM Net project he has been running, which has used broadband connected healthcare workers to improve the compliance of people with chronic disease to evidence based care plans. Ian Opperman from CSIRO showed how broadband was used to connect hospitals separated by distance and adverse geography to share resources such as specialists, and I spoke of the work we have been doing in home telehealth with elderly people with chronic disease and the various other inflictions of age.

So the question arose, do we really need a 100Mb connection in everyone’s homes to deliver healthcare. There are some very cool examples of health applications being delivered on peoples I Phones, which uses relatively low bandwidth wireless signals, so why are the NBN folk and many of us in the industry so insistent that the NBN is necessary to deliver the healthcare services of the future?

The problem is that in healthcare we have always innovated to make do with what we have. When all we had was phone lines we used phone based health monitoring services to deliver care. It wasn’t optimal, actually some of the research suggests it wasn’t even effective, but it was all we had at our disposal, so we made do with it. With some tweaking and compromise we made it work for some people, and then used that as an example of how we can deliver services more cost effectively. Sure it was cheaper than sending a nurse out to the patient’s homes. It was more convenient than getting the patient to go the healthcare worker, but it was a compromise. When we started getting some better connectivity, usually some very basic type of data connection, we added to the service. We put in some rudimentary data collection tools, some direct from devices, others where we asked patients to key in their blood sugar readings or other data. We had some very rudimentary educational content we could push down, mainly text. Yes it was a bit better than the phone system, especially when we decided to use Interactive Voice Response (IVR) on the phone to try and make it more efficient. Seriously has anyone had any luck with those systems getting basic customer service yet alone healthcare?

Today we have some better connectivity, and some very cool stuff is happening in healthcare. The CSIRO example of remote consultation between emergency departments The ability to not only monitor vital signs but also see a patient in their own homes via video conferencing. Once you take away the need to compromise on bandwidth you enable healthcare workers to find better ways of connecting with their patients in a way that makes life better for patients and also for themselves.

Healthcare is all about communications, and human communication is a high bandwidth low latency activity. The only way we can deliver the same quality of service as we are accustomed to in face to face healthcare is through a network that is high bandwidth and low latency. To me that sounds like what the NBN wants to deliver to all Australians. Can we deliver healthcare without it, possibly, but many people will have to put up with significant cost and inconvenience to do so, because we will have to compromise the quality of our service to do so. However, if we have access to high bandwidth, low latency, always on and reliable connectivity, then I believe we can deliver much of the healthcare we deliver today in expensive carbon consuming buildings directly into people’s homes at a time that suits them.

The idea that getting healthcare no longer needs to be a hassle is very intriguing. Imagine what would happen if people accessed healthcare when they needed it rather than have to make decisions about whether it is too much trouble for them, their family and their caregivers to try and get access to the same service? Just maybe they will get healthcare earlier, rather than wait for things to go wrong. Maybe they will be able to play a more active role in their own healthcare, because we haven’t waited till the pain is too great, or the tumour too big, or the artery too blocked. If by utilising the connectivity inherent in those tiny glass fibres we may be able to shift healthcare from a reactive service to a proactive service.

So my answer to the question of whether healthcare needs broadband is that we can struggle on with our current way of doing things without it, as long as we are willing to accept that as a result many people will miss out on the skills and value of our healthcare workforce, because they are in the wrong place. Or we can change the system, connect it via broadband, change the way we work and deliver more services to more people in the comfort of their own home or community. It really depends on whether we believe investing in good infrastructure to enable us to provide a better service is a good idea. I say yes, but if you are happy with the way things are now don’t complain when you or a loved one are told you have to wait.

Wireless Health and Real Health… What is the difference?

February 22, 2011

On Friday the 18th of February I attended the inaugural Wireless Health conference at beautiful Bondi beach in Sydney. If you have to go to a conference, Bondi in summer is the place to go. The conference was organised by the folk of BCS Innovations, a local consultancy that has spread its wings to the US market.

I was asked to give the opening presentation, focusing on innovation in wireless health. I may have disappointed a few people because I started my talk by criticising the name of the conference and how the term “Wireless Health” is a misnomer. If any of you were offended, I apologise, but with my tongue a little bit in my cheek.

Over the last decade or so we have seen a bunch of new names be conjured up for the use of technology in healthcare, the ubiquitous ehealth, the more recent mhealth, health and medical informatics, health IT and so on. The problem with this varied and seemingly random use of new prefixes and suffixes for health is that it forgets what we really do. We provide care to people with health issues, so first let’s stop talking about health as a term in isolation, and talk about healthcare. Secondly in focuses on the technology component not the service delivery component.

So once I got that off my chest, I proceeded to look at who needs healthcare, why they need it and how we currently deliver it. The recent COAG announcements about yet another reshuffle of hospital funding models remained in my mind, so I emphasised the need for us to stop thinking of hospitals as the nirvanas of healthcare delivery, and start focussing on the needs of the classical patient. Like it or not, healthcare is something we increasingly provide to those who are getting older. The bell curve of services versus age is way over to the right. So we need to better understand what they want, and deliver it as a customer friendly service. Whilst in retail they may say “the customer is always right” you very rarely hear the same said about patients.

Following me were 2 very smart gentlemen from the USA, Dr Stan Pappelbaum and Jay Kunin, both from the San Diego area. Dr Pappelbaum was the CEO of Scripps Health an innovative health provider in the southern California region. He spoke about the transformation occurring in the USA under Obamacare. It has its problems, and the funding is in doubt thanks to the recent congressional elections, but 40 million more people are now eligible for health cover, which to us in Australia sounds like a good thing. Jay Kunin had a more technical background, having worked with the original developers of Electronic Medical Records in Boston many years ago. Like me he disagreed with the term wireless health (which is why I called him a smart gentleman). He emphasised the need for innovation not just in gadgets but also in business models.

In the afternoon we got to hear from Peter Farrell, one of the original founders of ResMed, an Australian medical device success story. Peter is not known for pulling his punches. He did provide us a great insight into what is needed to go from a good idea based on research to a thriving business with presence around the world.

The enthusiasm of the participants was very satisfying, especially for those of us who have been involved in this space for a long time. The inevitable question arose of why it has taken off yet. This led to the old blame game, it’s because the doctors are resisting, it’s because the government fears change, it’s because the data is not strong enough. All are seemingly valid reasons. For my 2 cents worth, I think it is because we don’t pay healthcare workers the right way. We know what good practice looks like, we understand the need for delivering to evidence based care plans, but we still reimburse for piecemeal fee for service treatment. Whilst we maintain that payment model, we will keep the current system. Health care workers are both astute managers of their and their families’ wellbeing, financially and socially. Sure they understand the flaws in the system, but if that is what they need to do to put food on the table and pay the mortgage, well that is what they will do. No one can blame them for that.

Medicare Locals came up again in the recent announcements from the prime minister. She said we would double the number of Medicare Locals out there. Considering to the best of my knowledge there are none now, that doesn’t mean much. However when we start to get our heads around what a Medicare Local is, we may start to see it not only as a tool for improving collaboration and improving quality of care, but also as the first step in a revamping of our reimbursement model. I watch with great interest.

Why does change work at St Vincent’s Hospital Sydney?

February 18, 2011

I attended the NSW HISA event at St Vincent’s hospital in Sydney this week where we heard about their 5 year odyssey to implement an Electronic Medication Management System on their wards. The speaker Silvia Fazekas presented a wonderful example of why what is recognized as the most complex change management project in the entire ehealth space, medication management has been successful there while it has failed in many other places around the world.

To me the main difference was in the people. As I commented during the presentation, there is definitely a degree of personality involved in change management versus process. Yes you can develop a change management methodology, but unless it is delivered with the sort of passion that Silvia demonstrated in front of a packed out room, it is very hard to do.

Silvia pointed out the need for strong executive leadership, and St Vincent’s has been famous for it’s executive leadership from it’s early days when 5 nuns came over from Ireland to set it up. Today it’s CIO David Roffe is well recognized as one of the healthcare CIOs who understands that his job is to make life better for his clinicians and their patients.

So passion seems to be the most effective way of ensuring success in change management, and unfortunately it is a hard thing to bottle. If we could clone people like Silvia, then we could roll it out across the country. So the next best thing is to develop contagious passion, and that comes from above and below. Executives who can talk with passion about how health reform will improve our lives is a great start, but we also need users to talk about their needs and wants as far as their healthcare is involved, and get those stories out.

Passion based marketing of EHealth may well be what we need to do to make it successful. It may seem low brow but in reality human being respond to emotion more than they do to logic, and nothing is more emotional than healthcare.


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