Dr Foster now on offer as Telstra outlines eHealth plans
Telstra's new healthcare division has secured the exclusive rights to provide the Dr Foster risk-adjusted quality measurement tool for hospitals in Australia.
Telstra's head of health, Shane Solomon, said 17 hospitals in Australia were currently using the tool and the Victorian government had recently contracted Dr Foster's Quality Investigator platform for its major hospitals.
The five-year agreement also includes the option to extend the relationship into Asia. Telstra will take on the management of Dr Foster's existing customer base in the region.
Dr Foster was established in 1999 by two journalists as a way to publish information on the quality of UK National Health Service hospitals. Named after the 'Dr Foster went to Gloucester' nursery rhyme, it has published an annual Good Hospital Guide since 2001, and in 2006, the NHS became a joint venture partner in Dr Foster Intelligence.
The company now provides analytic services to around 85 per cent of NHS hospitals as well as to some in Europe and the US. It uses risk-adjusted death rate methodologies developed and maintained by Professor Brian Jarman of Imperial College in London, which runs a Dr Foster Unit.
Mr Solomon said that in the last three or four years, the tool had developed the maturity to enable quality improvements rather than just accountability. He said KPMG, where he previously worked as national health lead before joining Telstra's new health division, had originally brought it out to Australia for a trial period.
“It's an application that takes the normal data that is collected on people in hospital, so there's no extra data needed, and by using Imperial College [methodology] they do a risk adjustment,” he said.
“So if you are older and have a history of diabetes or renal disease, and you are coming in for a cardiac operation, your chances of death are higher. They risk-adjust every individual based on that combination of factors.
“That's the main issue that clinicians have with measuring quality in hospitals. They say, 'Of course more of my patients die because more of them are sicker or they're older.'
“Imperial College has got that covered through the risk adjustments, and Dr Foster takes the data set and adjusts it for individual conditions like a cardiac event, and it tells you that while you should have expected deaths of X number, you have actual deaths of Y. Then you can investigate why.”
Mr Solomon said the system had the capability to drill down into the data to find out where and why problems were occurring or not measuring up to certain benchmarks. “It's not just a macro reporting system,” he said. “It's a tool for hospitals to see which individual procedure or diagnosis they are doing well or badly, and then start analysing exactly how.”
Dr Foster also has a global comparative component for teaching hospitals, so Australian hospitals can compare themselves to similar tertiary facilities in Europe, the UK and the US.
“What we are interested in is tools that can transform how you do things,” Mr Solomon said. “There is nothing in Australia that will give you a risk adjusted measure of quality. And it's not once a year; it is intended to be every month or six weeks or however often you get that data in. You can see progress as they have a very clever way of notifying at the top of the screen which areas you are doing particularly bad in.
“If you keep hitting the ceiling then some alarm bells will go off. In the UK, they have decided to use it as a device for improvement rather than a device for condemning people.”
Telstra's eHealth strategy
As reported recently by Pulse+IT, Telstra Health has developed a wide-ranging strategy for its entry into the healthcare market. It has identified six major challenges in healthcare that it believes it can become a major contributor to solving by building an eHealth ecosystem.
These challenges are:
- Creating a safer, efficient and more convenient pharmacy system
- Improving integration of health information
- Using care coordination to reduce hospital and aged care admissions
- Consumer self-service – providing consumers with greater control over their own health
- Increasing access to specialist healthcare regardless of location
- Improving efficiency and productivity across the health system.
To target these challenges, Telstra Health plans to build on its existing strengths in connectivity and secure data storage by assembling specialised eHealth capabilities in the areas of provider applications, telehealth, care co-ordination, consumer health portals, enabling technologies and data analytics.
It has already set about this task by investing in or purchasing a number of companies and products, including pharmacy systems vendor Fred IT; the assets of DCA Health, which include the Argus secure messaging system, aged care software solution TCM and community care software solution Communicare; online appointment booking and directory service HealthEngine; acute care solution provider IP Health; and US consumer health portal provider Get Real Health.
The partnership with Dr Foster is part of the challenge of reducing hospital and aged care admissions. Telstra Health is also planning to use its high profile to help smaller players get in the front door for new products and services.
“We have identified what we think are six really big-ticket issues in health and if you can put together the six capabilities, you can bring to the mainstream health system a solution,” Mr Solomon said.
“For example, we do work with HCF on home monitoring, but for that to happen there are about five different companies involved. The coordination of making a simple thing like that happen is huge. We think if you can put that together into one bundled solution, then the mainstream health system is more likely to accept it.”
Mr Solomon said Telstra was on the lookout for companies to work with, including software solutions that can be integrated into a package.
“We are looking for what is the best in the market, either because it's great technology or it's going to grow or it has a good market share already and proven customers,” he said.
“Then we are looking at how we can put those together. Anything that fits, we are interested in. We are starting from scratch, and Telstra might not seem like it from the outside but it has a degree of humility about what it can do and what it can't do.
“There is a lot of commitment within Telstra as we go into the health space that we don't kill innovation or entrepreneurship that has made the smaller company successful. We are buying not just a product but a capability set. DCA Health we love because of the people – they are innovative, they are responding and have been able to absorb companies and make them grow and the worst thing that we could do would be to integrate them in a way that that stopped.
“While we want to make the connections between these different things – applications, devices, solutions, whatever – we want to keep the entrepreneurship that is in those companies.”
Mr Solomon said that while Telstra can use its traditional strengths in cloud storage and connectivity, the whole idea of getting into the health market was “not just to sell traditional products into that new industry, but to become a significant contributor to building up eHealth.
“It's a myth we have to dispel when we talk to people,” he said. “They ask how is Telstra going to make money – you just want to sell mobiles, don't you? And the answer is no. The actual applications themselves make money, there is a market, they are valuable. We are in it to build an eHealth business.”
Mr Solomon said he also wanted eHealth to be brought in from the margins of the mainstream healthcare system and Telstra can do that due to its scale. And while it is happy to purchase some clinical software products, he said Telstra certainly doesn't want to become a new Cerner or iSoft.
“Our focus is on home care and the integration of information. That's where we see the future is. Cerner and iSoft, while they are great products, they take an incredibly long time to implement. Having been in hospital-land, there is a high level of change management that everyone underestimates. We are interested in the systems that integrate information within hospitals and outside of hospitals.”
While Mr Solomon would not be drawn on Telstra's plans for the GP market, he did say the company was looking to increase its presence in areas like telehealth, beyond its current involvement in a number of telehealth trials of home monitoring and video conferencing.
Mr Solomon said no company or organisation had yet to properly crack the telehealth market. As a carrier, Telstra is involved with three home monitoring trials, but is mainly limited to the connect and carriage stage at the moment. The cost of these services vary widely, from $500 to $10,000 a year per person, he said.
“What Telstra hopes to do is offer something that is low-cost enough to be ubiquitous, has good decision support, and is configurable in different circumstances. We have a couple of full-time people going around age care facilities and asking what can we do.
“The unique position Telstra is in – because we are new, and we are starting from scratch – is we can look around and say you tell us what you think you'd use and what are those criteria, and we'll go searching. We'll see what's out there globally and what can we bring in and what can we package that is going to work.
“At the moment because we are just collating the capabilities, it is going to take us while to make those connections within our strategy. We are not interested in just a bunch of stand-alone products … and we are not just interested in buying companies willy-nilly.
“You see three or four applications or companies every week and you see what a great product that is, and you think you can really see that working, but they could never get to a scale or to the right level in the system, the chief executive level or the director of medical services level.
“I'm hoping that some of the value that we add is to be able to offer that scale and the backing. Telstra wants an eHealth business at scale and we haven't finished yet.”
National eHealth programs
Mr Solomon said Telstra Health was planning to submit to the PCEHR review, and said it was supportive of the system as a concept.
“We are very supportive of the PCEHR, particularly because we are all about the integration of information sharing and information is a fundamental. The foundation platform that has been put together – the interoperability, the IHIs etc – is great.
“We've bought into it in a way as we've got Argus secure messaging, Fred IT runs the NPDR, and we think there's a lot more potential there. Without going through our whole position, we see ourselves as being a good corporate citizen with the PCEHR, whatever form it takes in the future because it's in line with where we want to be.
“I think integration of information can only help with an organisation like Telstra that takes connectivity seriously. We have views on how it can be unlocked and better used, but we see what has already been done as almost a precondition for what we want to do.”
Posted in Australian eHealth