Issue 12 / 3 April 2018

I AM from a generation that knows the world without computers, a Luddite who makes a distinction between the “offline” versus “online” world and real friends versus virtual friends.

Technology has fundamentally changed how we interact and transact. As a tool, it gives us choice, convenience and control. It affects every aspect of life and gives people autonomy to choose how they buy their books, shoes or real estate (Amazon, shoesofprey, realestate.com). I no longer need cash or a credit card to make a transaction (PayPal, squarepay). Technology changes the way we communicate and consume information (Facebook, Twitter and LinkedIn). We expect customised and curated entertainment (Spotify, Netflix), and, increasingly, “biometrics” are changing our behaviour (fitbit and Apple watch). This is no longer a “brave new world” or the “digital frontier” – it simply is the world in which we live.

In the context of everyday life, Australians are prolific users of technology. The Australian Bureau of Statistics reports 13.7 million internet subscribers at the end of June 2017 – a 2.1% increase from December 2016. Sensis reports that 79% of Australians use social media, 59% of them daily. While the younger generation accesses Instagram and Snapchat, Facebook is still the most popular global network with over 2.13 billion monthly active users for December 2017, spending 20 minutes online per visit.

Deloitte Digital reports that 84% of Australians own a smartphone, with mobile consumers interacting with their phone 480 million times a day. One in three Australians have a fingerprint scanner, with 70% actively using it, and Australia leads the world in the adoption of biometrics and apps, being dominant in gaming (88%), listening to music (83%), social networking (79%), shopping (70%) and hotel bookings (70%).

In health and medicine, the notion of e-health has evolved over time with the dramatic and prolific use of digital solutions. Terms such as telemedicine, coined in the 1970s, meaning “healing at a distance”, were designed to overcome traditional barriers to care, such as distance, cost and stigma. Others think of e-health as the Electronic Health Record, introduced in Australia in 2012 as a personally controlled, secure online summary of health information, allowing patients to share health information with health care providers.

While both are important features of e-health, considerable research, including systematic reviews and randomised controlled trials, clearly highlights the role that e-health solutions could play in reducing administrative burden and improving patient outcomes in both self-management and the shared management of conditions as diverse as cancer, diabetes, cardiovascular disease and mental health. In the disability sector, assistive technologies simply transform people’s lives.

Increasingly, we have seen the Australian Government embrace technology, with the establishment of a Digital Transformation Agency responsible for cross portfolio collaboration, while the Australian Digital Health Agency is tasked with delivering My Health Record. In 2017, Australia’s National Digital Health Strategy – Safe, Seamless and Secure was approved by the Council of Australian Governments (COAG) Health Council putting the consumer at the centre of their healthcare. It aims to provide choice, control and transparency.

Despite strong evidence and the Australian Government’s commitment to innovation and transformation, medicine is yet to fully embrace digital solutions, in my opinion. I do not believe that our health professionals can be replaced by a “digital health solution”, but imagine what we could achieve if we were able to take the best of all worlds using technology in a model of collective impact – where government, industry and researchers entered into large-scale partnerships with consumers and carers to solve major system challenges in health – for people with a disability, patients living with a mental illness or chronic and disabling condition, or for our vulnerable populations at risk of poor health and mental health due to the social isolation and determinants that put them at risk.

In a perfect storm of research and policy meets practice, it feels that we may have a groundswell of opportunity. First, person-centric health reform driven by codesign where people with a lived experience shape all aspects of research, policy and practice is high on the political agenda, and platforms such as Twitter, Facebook and LinkedIn are giving people a voice to enact change. Second, big industry thought leaders such as Google and Apple, Microsoft and General Electric are putting their hats in the ring and bringing to the table transformational grunt that could drive large-scale systems change. And finally, a government brave enough to set a precedent that focuses on putting the consumer at the centre to translate research to policy and practice.

Health reimagined places the person in control; data being used to shape health care; smart decisions, driven by smart data, curated in a way that creates a customised care experience regardless of where the person lives, the diversity of their lifestyle, or what illness they have – or more precisely what risk of illness they might be exposed to due to genes or environment.

Paternalistic, top-down models of health care driven by pay-for-service should be a thing of the past. Quality outcomes, evidence-based medicine and shared care, where the consumer and the practitioner are partners in care, should be part and parcel of 21st century systems of care – with a focus on right care, right time and in the right place.

Participatory health has the potential to bring the best of science together with technology solutions that can use real-time data, owned by the person, to fundamentally change behaviour – in all aspects of health and wellbeing.  The Future of Precision Medicine in Australia, that is, the use of “the ‘omics”, argues that patient-specific data will be both far more accurate for diagnosis and far more predictive than current methods that rely on self-report and the early identification of symptoms.

Couple precision medicine with the internet of things – that is, real-time data captured through biometrics, smart devices, social networks, artificial intelligence, robots and blockchain – and participatory health, or the empowered consumer, owning and using their data, becomes a reality.

The potential rewards for public health could be stunning, at a time when obesity, mental health and complex comorbid health conditions are placing considerable strain on not just our health and hospital health care systems but also across our social services. The mental wealth of our nation, and the creation of mentally fit, healthy and resilient children and young people, and indeed ensuring healthy ageing, is critical to the country’s economic and social wellbeing.

The world of technology that we are increasingly engaging with moves very quickly. Researchers, practitioners and policy makers can barely keep pace with its uptake. Research relating to health and its relationship with technology use is invariably out of date before it is published. If researchers and service providers are failing to keep pace, what hope do policy makers have?

To dismiss the role of technology in health care is at best ignorant and at worst dangerous. We have an incredible opportunity to explore, through research, development and codesign with lived experience, the role of technology and the potential it can play in delivering services to those who are most vulnerable.

Jane Burns is Professor of Innovation and Industry in the Faculty of Health Science at the University of Sydney.

 

To find a doctor, or a job, to use GP Desktop and Doctors Health, book and track your CPD, and buy textbooks and guidelines, visit doctorportal.

 

 

 

2 thoughts on “Technology: rewards for public health stunning

  1. David G More MB, PhD, FACHI says:

    I would very much like to see a bibliography supporting these claims:

    “While both are important features of e-health, considerable research, including systematic reviews and randomised controlled trials, clearly highlights the role that e-health solutions could play in reducing administrative burden and improving patient outcomes in both self-management and the shared management of conditions as diverse as cancer, diabetes, cardiovascular disease and mental health. In the disability sector, assistive technologies simply transform people’s lives.

    Increasingly, we have seen the Australian Government embrace technology, with the establishment of a Digital Transformation Agency responsible for cross portfolio collaboration, while the Australian Digital Health Agency is tasked with delivering My Health Record. In 2017, Australia’s National Digital Health Strategy – Safe, Seamless and Secure was approved by the Council of Australian Governments (COAG) Health Council putting the consumer at the centre of their healthcare. It aims to provide choice, control and transparency.

    Despite strong evidence and the Australian Government’s commitment to innovation and transformation, medicine is yet to fully embrace digital solutions, in my opinion. I do not believe that our health professionals can be replaced by a “digital health solution”, but imagine what we could achieve if we were able to take the best of all worlds using technology in a model of collective impact – where government, industry and researchers entered into large-scale partnerships with consumers and carers to solve major system challenges in health – for people with a disability, patients living with a mental illness or chronic and disabling condition, or for our vulnerable populations at risk of poor health and mental health due to the social isolation and determinants that put them at risk.

    As a credentialed expert I do believe these claims are only weakly supported at best and actually rather less that confirmed to say the least. Things are not anywhere near a clear cut as claimed and Australia has had all sorts of problems – e.g.Still trying to get success with the myHR after now 7 years!

    David.

  2. Anonymous says:

    My experience of IT has been one of extravagant promises followed by failure of products and then demands for more funds to fix the problems of the flawed systems, with no accountability by the IT companies. In fact they seem to end up with around 5 times the income of the original budget. The various phases of what is now called My Health Record is the outstanding but not the only medical example. Brace yourself for many more projects to follow with IT costs stealing from medical treatment budgets.
    My empathy as a treating doctor is enhanced by direct contact and forming the “doctor-patient relationship”. Remove the humanity and expect customers to get the digital flick in future, whilst doctors focus on their work-life balance during the work day in front of their screen answering the demands of customers they will never meet and won’t even know if they are real or virtual.
    Placing patients in charge of something as complex as their health does not auger well when despite ample good information available most have a bad diet and don’t exercise, so are obese and likely to develop diabetes etc. In such a system we should expect the anti-vaccination movement to ensure vaccination falls below 50% and most other public health measures to be eroded too. Fear and apathy will probably undo hundreds of years of public health and caring medical treatment gains, as mistrust sweeps through social media and patient controlled digital medicine.
    Caution is appropriate to assess the systems before it is too late to reverse those which are flawed. Whatever happened to robust pilot studies to test new concepts and unpredictable responses?
    My mother used to tell me a good quote which is applicable:” The road to hell is paved with good intentions”, and we should also be mindful of the medical quote “First do no harm!”

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