The digitally enabled health system of the future

CSIRO has released a report on how digital technologies can help solve some of the pressing issues facing the healthcare system from an ageing population, rising rates of chronic illness and workforce shortages in rural areas, forecasting that technologies that are in their infancy today will become the norm in the next decade or so.

Written by leading researchers from CSIRO's Digital Productivity and Services flagship, The Digitally-enabled Health System report looks at how the Australian health system can reduce costs and deliver quality care through the use of digital technology.

Covering not just the high-profile acute care system but aged and community care as well, the report canvasses several technologies that CSIRO is currently working on, including the use of telehealth for rural healthcare delivery, predictive modelling technologies that are currently in use for patient flow forecasting in hospitals but can be extended to the community, and using the vast amounts of clinical data already collected in more meaningful and effective ways.

Lead author Sarah Dods, health services research leader at CSIRO's Digital Productivity and Services Flagship, says the organisation is looking at how the tools of the digital economy can make a difference in health service delivery in three different areas.

These include how we can increase access to services, particularly in rural and remote areas, through the use of broadband and mobile communications. This takes in well-known work CSIRO is doing with its Remote-I tele-ophthalmology service, which has recently been extended to the Torres Strait Islands, and the work it is doing in several projects looking at in-home health monitoring.

CSIRO is also targeting productivity in health service delivery by using demand forecasting and scheduling tools such as its Patient Admission Prediction Tool (PAPT) and new workflow decision support, automation and image analysis tools.

It is also working on informed patient care, developing tools to improve clinical data quality through finding better ways to share and access patient information.

CSIRO has a long history of research into broadband, particularly for developing new ways to use satellite broadband for better access to services and how best to exploit its long-term development of NGARA wireless broadband for rural and regional areas.

“We are saddened about how rural Australians lack access to healthcare, in particular to specialists, and nationally available broadband that offers reliable high speed connections across the country, whatever technology it uses, opens up some really good possibilities around rural health,” Dr Dods says.

“We are doing some work in that space and part of that is around delivering services to remote clinicians. Are there ways that we can help rural clinicians be trained so you can train them in place without them missing out on special opportunities? Are there ways that we can help train people to work beyond their scope of practice?”

This is an active area of research for CSIRO, particularly around wearable computer technologies. Extending the use of telepresence robots could also enable greater professional development opportunities for remote clinicians.

While it is in its very early scoping phase, Dr Dods says CSIRO is looking at how it could repurpose existing technology it developed for the mining industry to remotely guide healthcare workers in the clinic.

This involves a gesture-based, virtual reality device that engineers use to show remote mine workers how to use complex equipment.

“That could potentially [involve] a remote specialist back in the city who can describe and show [remote workers] what to do,” Dr Dods says. “They can hear what you hear and see what you see, and they can point and see what the problem is. You can see someone saying 'turn that bottle over and show me the label' to ensure correct medications.

“We are also looking at technology we developed to help kids around Australia experience the Australian National Museum remotely. We want to use that to help interns, for example, in rural areas to take part in city hospital rounds. That's very much a concept as well but it's a funky piece of technology and it's out there.”

CSIRO is also involved in projects using broadband to assist with chronic disease management, taking part in a federally funded pilot program under what was formerly known as the NBN-enabled Telehealth Pilots Program. This is a project across five states along the lines of the UK's Three Million Lives project, which is also investigating whether home monitoring can reduce hospital admissions.

One of the most important parts of the projects is to evaluate the economics of home monitoring, Dr Dods says. “When you look at hospitalisations, it actually does makes economic sense. We're not going to get telehealth properly into Medicare unless the government sees the economics for it.

“The economics part is not being looked at, and that is why we are doing a lot of this research. It is not medical research and is not health research: it's actual health service delivery research and economics is a big part of that.”

CSIRO is also working on its Smarter Safer Homes project, which is investigating the use of sensors to measure things like humidity levels, conversation levels and doors opening and closing in the home, which can help predict the health and wellbeing of older people in particular. For CSIRO, the idea is to extend this to inform other areas of its research, such as predictive modelling.

Predicting healthcare needs

If you can monitor an older person at home and consider them a “virtual resident” of an aged care facility, you can perhaps delay their entry into residential aged care but also predict if they are likely to enter hospital. For CSIRO, the research is also extending into hospital discharge predictions, particularly for older people who are physically capable of being discharged from hospital but cannot go home because they will be on their own. The cost savings in reducing length of stay in hospital are enormous.

“That leads on to the second area we look at, which is data-enabled health productivity, which is all about the numbers in hospital databases,” Dr Dods says. “We are already working in predicting patient admissions, patient flow, the question of do the beds match the demand, can you optimise your surgery scheduling, what can you learn from logistics and optimisation about the way people move through hospitals.

“Now we are starting to look at what happens when people are discharged from hospital. How many nursing home beds will you need throughout the year? We are slowly starting to work that up into mapping how people move into the hospital and then out of the hospital.

“That moves beyond prediction modelling based on reports of what happened in the past to look at what is happening now, which is real-time modelling. That is as far as many hospitals have got so far, but what we think is more important is what is going to happen tomorrow. That allows you to begin to do something about it today.

“It reduces staff stress levels, it enables far better planning and far better outcomes if you can plan properly. And that is all big data. It's all about numbers.”

The third area CSIRO is looking at is intelligent health information, which its SNAPPER and MedTex software products can assist with. These allow health services to take advantage of and better use terminologies like SNOMED CT and the free text entered into pathology and diagnostic imaging reports for better clinical decision support.

“We are looking at how to put that information to work,” she says. “We are starting to do some work on automated processing of pathology reports, which are narrative, but if we can link that back into a SNOMED format you can also look at the secondary use of that data.

“We can see a time ahead where if you are desperately waiting for the outcome of the test in a hospital to determine somebody's treatment plan, we will be able to flag whether the outcome of that test immediately fits in with the working diagnosis or not. We're not there yet, but there are a lot of problems caused because the tests are done and the results are there but people don't have time to look at it. We are looking at how we can get the computer to do a bit more of that work.”

This sort of work will also inform more tedious work such as reporting for activity based funding, in which hospital clinical coders are being asked to code everything that happened to a patient in order for the hospital to get paid.

“We are also doing some work in Queensland about reconciling radiology images with discharge summaries. It is all about having information electronically but not dumping it all into the doctor's inbox. That space is going to explode. And I think that that is where the PCEHR will start coming into its own, when there is a value proposition around how the information is getting used.

“None of this is earth-shattering and is not going to change the health system overnight, but it is part of laying the foundations for the revolution to come. And the revolution has got to come.”

The Digitally-enabled Health System report covers many of these issues, explaining what the challenge is, what is happening now and what is probable in the next 20 years.

“We believe that all the scenarios described in this report are wholly achievable based on the current trajectory of research and development in this country,” Dr Dods writes in the report.

“The challenge is that rising stresses on our healthcare system will make it increasingly difficult to invest the time and capital needed (both financial and human) to foster this type of innovation.

“The healthcare sector has only a limited window in which to act. The time to focus on bringing about the benefits of a digital healthcare system is now.”

Posted in Australian eHealth

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