The Strengthening Medicare Taskforce: No panacea, but great promise in technology driven care

Oct 16, 2022
A nurse with a blood sample entering test results into the computer.

As the Strengthening Medicare Taskforce considers how to ensure access to care is modern, patient-centred and easy, it should not under-estimate the possibilities that technology-driven care has to offer.

Following the outcome of this year’s Federal Election, Health Minister Mark Butler convened the Strengthening Medicare Taskforce (SMT).

At its first meeting, the Taskforce established five focus areas to guide its recommendations to the Australian Minister of Health and Aged Care.

The fourth focus area proposed by the SMT communique is “ensuring access to care is modern, patient-centred and easy, harnessing the power of technology.” Much of the work that has occurred during the COVID 19 pandemic has opened up the possibility that technology-focussed access to care could significantly improve prevention and management of ongoing and chronic conditions.

Harnessing technology to enable better patient care requires careful consideration of:

  • The systems, software and hardware that enable delivery of expert patient care by healthcare professionals
  • The design of that care to ensure it is efficient and patient-centred

Investment in digital health has been a cautionary tale for most health systems. However there are elements which, with successful investment and policy development will enable strong patient care.

Enabling access to appropriate technology by all health professionals is a starting point. In 2018, the APNA Workforce Survey more than 21% of primary health care nurses (the largest workforce in primary health care) identified that a lack of access to IT/computer resources had a moderate or major impact on their ability to carry out their role. Ensuring all registered health professionals have access to necessary hardware and training on relevant health software and systems is essential to unlocking the full benefits of digital health.

Continuing to invest in current systems: My Health Record (MHR) has the power to reduce the fragmentation of patient care. However, to achieve this requires ongoing investment and consultation as it evolves. It also needs to be supported by strong policy that ensures full use by all health professionals. Such policy must also provide access for all registered health professionals. Currently, very few allied health professionals have access. Allied health in hospital settings (with conformant software) can access the MHR and upload patient information. Allied health in primary care can view patient info in the MHR but cannot currently upload into the MHR. Although work is beginning to develop an allied health event summary in the MHR, a key issue in primary care is access to conformant software. Very few allied health software vendors are conformant which limits the access to the MHR. Thus, standards for software vendors in the AH marketplace is the other key piece of work that needs to be completed. The Chief Allied Health Officer has commissioned a literature review of AH digital readiness, but at the time of writing the psychologist of a co-morbid patient or the podiatrist of a patient with diabetes need to be able to play their role in streamlining patient care.

Accelerating interoperability of clinical software through clear standards for both hospital and primary health care software. Achieving this will also streamline disparate health services, allowing them to coordinate care better and, in doing so, minimise the journey time and other impostes on patients.

A good example of interoperability is the development of Lumos by the Ministry of Health in NSW, a breathtaking advance in connected health systems. Providing insights into the patient journey within the NSW health system, Lumos can link health service data from tertiary and primary health care settings to provide a comprehensive view of patient pathways, helping identify where patient outcomes and experiences can be improved. Whilst still new, Lumos offers a tantalising glimpse of what is possible in digital health and a template for a nationally coordinated approach. Not only does it help health professionals better manage care, it also compares patient populations with state averages, and provides information about how many patients are not accessing health services, enabling better practice from each part of the health system.

Ensuring health care professionals realise the benefit of digital health. The benefits of digital health will not be realised if health professionals see it as optional or if government policy continues to exclude them from it. The confidence and expertise of health professionals must be nurtured through strong IT curriculum input and ongoing professional development. The Commonwealth Department of Health must continue to invest in the excellent work of the Australian Institute of Digital Health, which is taking great steps to develop the digital health expertise of Australia’s health professionals, and crucially, to model the behaviours required for Australia to have a digitally savvy health workforce.

The next leap in medicine will see the use of personalised medicines, which will require significant use of diagnostics within primary health care and integrated/interoperable systems. Both Australia’s systems and the healthcare workforce needs to be ready for this. Ensuring that they are digitally capable will be essential to Australia and its citizens taking full advantage of this leap forward. The provision of health care that is technology-enabled and patient-centred requires us to rethink some of our traditional aversions to different modes of care. The use of telehealth is an example of care that could be expanded to improve access.

Australia is a nation that has adopted different formats of health service delivery. A good example is care delivered by phone. Whether it’s mental health crisis services such as QUIT to assist smoking cessation, Beyond Blue for better mental health, Blue Knot for complex trauma, COPE for the emotional challenges of becoming a parent, Kids Helpline for any issue facing a child or teenager or Lifeline for any personal crises or those having suicidal thoughts – Australians are clearly happy to use telehealth services where they meet their needs.

A fundamental benefit of telehealth is the ability to project care beyond the four walls of a clinic. Telehealth has the ability to put a health professional in every Australian living room, ensuring timely delivery of care, escalation where needed greater access to appropriate health care.

To this end, a range of health practitioners are already involved in telehealth and the potential for its use in the management of chronic disease is significant. Throughout the COVID pandemic, general practice was able to provide telehealth consultations under the MBS to support patients during lockdowns. Crucially, this was also provided to practice nurses. While welcomed by general practices and the teams working within them, these temporary MBS telehealth items have since been wound back. Registered nurses, the majority of the nurses working in general practice, are now unable to use telehealth, despite their significant role in chronic disease management. GPs also report being concerned about audits on MBS telehealth item use, further dampening use of telehealth. Access to telehealth consultations continue to be important for nurse practitioners as it enables them (as it did during COVID-19) to be the treating clinician in the telehealth arrangement.

A good example of a comprehensive telehealth service being provided outside of general practice is healthdirect Australia (HDA), an online service provided to “make health information and advice available to everyone in Australia. {Their} mandate is to facilitate easy access to the right care at the right time, overcoming potential barriers, such as geography, culture or socio-economic situation”. The telehealth helpline is staffed by registered nurses who are available 24 hours a day, 7 days a week to provide advice as to whether to see a local GP, manage the condition at home, or go to an emergency department. This is an ongoing program that regularly manages not only medical emergencies, but also chronic and complex care. In addition, the Pregnancy Birth and Baby program run through HDA provides support for parents on the journey from pregnancy to preschool. Maternal child health nurses staff this line and provide personal advice and guidance. During the height of the pandemic, HDA “supported the Australian Government Department of Health and Aged Care’s early response to COVID-19, establishing a 24-hour clinical and information line to answer questions from the public. At its peak, the helpline received over 30,000 calls a day and … managed regular volume spikes as the situation changes nationally and from state to state”.

Virtual hospitals were also established during COVID 19. For example, Northern Sydney Local Health District’s Virtual Hospital treats around 350 patients who are COVID -19 positive in their homes, unless they require a transfer to hospital. It is located on the Royal North Shore Hospital campus, and has a team of doctors and nurses who triage and treat the patients via telephone or videoconference. Patients can also phone into a call centre and speak to a registered nurse, if they have concerns about worsening symptoms or are anxious. Each day, the team calls the patients, who are categorised into high, medium and low risk – and discuss their symptoms and welfare needs. However, there is significant support for these to continue into the future. Dr Paul Collett, medical lead for the hospital said that “we are looking carefully at how we can manage patients in the future in the community with the aim to care for people out of hospital or if they do require admission, preventing readmission”.

As the SMT considers how to “ensur[e] access to care is modern, patient-centred and easy, harnessing the power of technology” it should not under-estimate the possibilities that technology-driven care has to offer. It is by no means the panacea for all chronic and complex care but it holds great promise, particularly and significantly if ALL health care professionals are enabled and funded to use it, and if it can be used throughout multiple primary health care settings to bolster the health of Australia.

The first three articles in this series can be found here:

Retaining the primary healthcare workforce pipeline.

All healthcare workers are on the front line. Let’s get them on the front foot

Commonwealth must resist lobbyists and embed team-based care

Read the Communiques from the Strengthening Medicare Taskforce.

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