Building holistic models of care on a fragmented foundation

Valerie has just had a medical check-up on her toilet seat at home — her second one that day.

Her urine stream was filmed by an in-built camera and monitored for glucose. Meanwhile, sensors checked her stools for colour and consistency.

It may seem quirky at first glance, but this RPM (remote patient monitoring) technology forms part of a wider, utopic vision of modern health care and ‘precision health’ in Australia. A vision centred around the concept of wellness rather than illness; value instead of volume.

Valerie’s smart toilet may be integrated with her electronic health record (EHR), which means her doctor could see all the data it collects. Valerie could also see it herself when she logs in to her online patient portal.

In turn, Valerie is empowered to become an ‘active partner’ in her own holistic wellbeing, spotting the early signs of cancer and diabetes before any major symptoms present.

However, many health devices and apps we use are not integrated in this way — neither with the EHR, nor with one another. In fact, they often have different data formats and protocols, which stops them from doing so.

This robs them of their potential to enable new, more holistic models of care, said Luke Baxby of Deloitte.

“The system is being inundated with new and emerging technologies from a growing ecosystem of vendors — it can be difficult to navigate,” Baxby said.

“It stops discrete pieces of data being brought together to generate improved health insights.

“We know that data is the foundation for the future of the health system. So, it is important we get this right.”

In a clinical context, data is often spread across various technologies — pathology, diagnostic imaging, dispensing and electronic medical record systems — with staff having to log in and out of each system to get the full patient picture.

In an everyday context, 52% of smartphone users collect their own health information, via the 165,000 health and fitness applications available for download.1 This signifies a lot of disparate health data which, pulled together, could be vital for early diagnoses.

As well as a missed opportunity to prevent rather than cure illness, this ‘fragmentation’ issue can be dangerous, with valuable data lost between machines or interfaces.

It can result in inaccurate diagnoses and treatment, and, in turn, medication-related harm — a problem that already causes 400,000 annual hospital admissions every year; costing $1.4 billion in taxpayer spend.2

To overcome fragmentation, Baxby said healthcare leaders must first develop a clear vision of how they want their services to look — and then work with vendors to innovate accordingly.

“What’s critical is that technology is considered in the context of the overall health system.

“It is not a technology-first strategy. But a health-first strategy,” he said.

“Planned well, new technologies can enhance the flow, exchange and interpretation of patient information across the healthcare system. This creates a significant opportunity to improve health system performance.”

However, coming up with an overarching vision of health care isn’t easy, particularly when the sector itself is fragmented.

“With multiple lines of accountability and incentives across the care continuum, developing a coherent vision that supports the government’s digital health strategy is not a trivial task,” Baxby said.

“If we are starting with the vision first, then we need to break down the siloes that exist in policy, clinical governance, procurement and professions. New funding and business models may need to be considered here, along with more collaborative decision-making.”

An additional challenge is the ‘moving target’ of modern-day healthcare infrastructure delivery, explained Isaac Bromley of EY.

“The hospital of the future will be different to the one we recognise today. Some may not even have walls,” he said, acknowledging the growing momentum behind virtual hospitals.

“The health sector is in a constant state of flux, with rapidly evolving innovation, an ageing population, and shifting patient and consumer expectations.

“Planning and budgeting for health care in this context will be a real challenge; and health capital planners will find themselves grappling with an ongoing dilemma: invest in more of the same or in something altogether different?”

Bromley said the key to handling this moving target is to consider a range of asset and non-asset solutions and invest in flexible buildings.

“Technology must be able to adapt to emerging megatrends, whether it’s a totally new innovation or an existing one that has been retrofitted. We need to start thinking about the end game upfront and coming up with functional designs that can be flexible to rapid changes in the healthcare environment,” he said.

Despite the time and investment it could take to iron out fragmentation, experts believe it is worth all the effort.

“Imagine how streamlined your processes will be if you have a united system, working towards a common goal — and the technologies to support it,” Baxby concluded.

Luke Baxby is a Partner at Deloitte Access Economics; Isaac Bromley is Director of Infrastructure Advisory at Ernst Young.



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