THE basic structures through which health care is delivered in Australia are much the same now as they were in the 1970s.
Yet, over the same period, the health care burden has shifted massively from acute conditions requiring rescue care to long-term chronic conditions requiring preventive and longitudinal care. The sustainability of the health care system is under strain from an ageing population with a health workforce struggling to meet the growing demand.
The health care system cannot continue in this form. Greater, more effective collaboration among teams of health care providers and their patients has been promoted as key to its survival.
If we are to achieve this transformation, we need to rethink some of the existing ways of working, such as point-to-point referral processes that keep most of the patient’s care team in the dark. Some elements of care that could be distributed to others are often concentrated in the hands of overworked GPs, many of whom rely on telephone, fax and hand delivery as the primary means of communication.
Digital technologies are the key to enabling this process change, but only if they are of the right kind and used in the right way. Current health care reform in Australia is in danger of getting this wrong.
Often we attempt to transform health care processes and improve practice routines without the aid of any enabling information technology (for example, in the otherwise good work of the Australian Primary Care Collaboratives Program).
Where we do introduce information technology, we often do so without sufficient consideration as to how it will add value to the participating care providers and other health care stakeholders (for example, some of the early attempts to introduce e-health into clinical practice).
Experience from other industries shows without addressing these key issues, such change is destined for failure. Conversely, building the technologies without first rethinking and redesigning the business processes leads to expensive infrastructure of little or no transformative value.
The central insight of process redesign is that digital technologies should be used to enable new, value-adding processes, rather than to support existing processes that add no value. Of all these processes, those involving collaboration, sharing of knowledge and patient follow-up are in need of greatest reform.
What digital technologies and solutions could be used to support such redesigned processes?
If we are to learn from other industries (such as news media, retail books, music and social networking), these systems need to be highly connected, agile and adaptive. The complexity of health care requires this even more, so that enabling technologies allow for variations in practice and are adaptable to new knowledge and treatments.
Connected, adaptive digital technologies are already in use (such as Google, Facebook, Amazon, eBay, and the myriad mobile applications). They proliferate in most areas of society except where they can do most good, namely, health care.
All this is not too hard and can be started today. In primary care, practices can begin by considering the kind of systematic processes and routines they could use — and those they could eliminate — to streamline the management of their chronically ill patients and ensure they all get best practice care. They then need to put in place the digital technologies and solutions that will enable this process reform, focusing on those that facilitate connectivity and flexibility.
By redesigning their business processes using connected digital technologies, practices will eliminate overheads and paperwork, increase productivity and improve collaboration, with better outcomes for all their patients.
These connected models of care will enable government, private companies and other stakeholders to drive innovation in health care at considerably less cost to the taxpayer than our current approach.
Eventually, just as in other industries, these new models will transform clinical and delivery processes to provide more equitable and efficient care with better outcomes for more patients.
Professor Michael Georgeff is adjunct professor in the Faculty of Medicine, Nursing and Health Sciences at Monash University and chief executive officer of Precedence Health Care. Dr Stan Goldstein is Associate Professor (conjoint) at the School of Public Health and Community Medicine, University of NSW, and Head of Clinical Advisory with Bupa Australia.
COI: Precedence Health Care is an Australian-based company that provides an online service to health care providers to manage patients with chronic diseases. BUPA Australia is a private health insurance company.
This article is based on a report, Collaboration and connectivity: integrating care in the primary health care setting, published by the Australian Centre for Health Research in January 2013.
Posted 15 April 2013