Access to data fundamental to sustainable health system: Telstra's Tim Kelsey
It may be a brave government or a foolhardy one that commits to investing billions of scarce healthcare funds into digital technologies only a decade after having been seen to have squandered a similar amount, but that is exactly what the UK government did only a few weeks ago when it announced it would spend £4.2 billion ($A8 billion) to realise an ambitious vision of personalised healthcare in the National Health Service.
That vision, called Personalised Health and Care 2020, was heavily guided by Tim Kelsey, the new kid on the block at Telstra Health who has been lured to Australia from his role at the NHS just as the framework is embraced by the UK government.
Mr Kelsey, a former journalist who in 1999 helped set up the Dr Foster health analytics firm and published the Good Hospitals Guide, has long been an advocate for open data and transparency in healthcare and was in 2012 appointed NHS England's first national director for patients and information.
Last year, it was announced that he would head down under to take up a role as strategy and commercial director at Telstra Health, which in addition to acquiring first a licence to Dr Foster in 2013 and then buying the whole shebang in March last year, has been on a bit of a spending spree since Telstra announced the division about three years ago.
Telstra Health has gathered itself a very nice portfolio of companies, from market leaders such as aged care software vendor iCareHealth and a 50 per cent share in pharmacy software leader Fred IT, to a footprint in acute care software through Emerging Systems and a multichannel mix in HealthConnex, as well as launching its own telehealth service through ReadyCare and helping to build the National Telehealth Connection Service.
Telstra Health managing director Shane Solomon has outlined a long-term plan for Telstra Health to digitally join up all of the disparate parts of the health system in Australia and to assist in the fundamental transformation of healthcare as it enters a period of personalised and precision medicine, and Mr Kelsey has now arrived to help put that strategy into action.
“I'm here having spent the last three and a half years or longer actually looking at the ways in which you can transform service outcomes and their effectiveness to try and support Australia to do the same,” Mr Kelsey said.
“Telstra Health was set up by Telstra nearly three years ago with that objective. This is all about how can disruptive technologies – and quite frankly non-disruptive technologies – be put to work to make healthcare a sustainable social service.”
Mr Kelsey is no Silicon Valley-style digital evangelist, but he does believe that the only way we can deliver on the promise of personalised healthcare and precision medicine, which is already starting to make an appearance via genome sequencing, is through eHealth. Fundamental to the effectiveness of that technology is data, and the provision of that data to patients as well as their carers.
It could be said of course that the NHS has been down this road before and failed, with the National Programme for IT (NPfIT) a stark example. Opinions still vary but it is accepted nowadays that much of the £10 billion or so spent on the mammoth project was largely wasted.
The general consensus of opinion, which Mr Kelsey shares, is that the original approach to the project was wrong.
“The original approach that was taken to that proposal was very top-down, it was an imposed solution, it basically said everyone had to have the same bit of kit more or less and this was how they would all have to use it,” he said.
“There was no real dialogue with the clinical end-users or with the patients and the net result was it was almost universally rejected by the clinical professionals who were expected to use these EMRs.”
For the new framework, he said, the approach now being taken is the only approach that works.
“That is to take a very small number of core standards that need to be met by anybody that has the privilege of treating a patient in the NHS – the use of a primary identifier, subscription to various standards for coding and so on – and then to provide some level of financial incentives to local health economies to make the decision for themselves about who they partner with to deliver those standards, with the premium being on clinical leadership in developing those local relationships.
“Essentially, devolving the implementation to local health providers and economies with national incentives and with a very clear set of non-negotiable national standards.”
There have been many bridges burned in eHealth, not just in the UK but in many developed economies including the US and Australia, and in some cases it has got to the stage that digital technologies are seen as an impediment to clinical care and not an aid. Mr Kelsey mentions the University of California in San Francisco healthcare system, where some clinicians have openly rebelled against the intrusion of technology into their practice.
A more recent case is a newly opened hospital in Arizona, he said, which in its advertisements to attract doctors to set up practice touts benefits such as accommodation and pleasant surrounds. The ads also state in very large, bold letters that there is no EMR to bother them.
While technologies such as EMRs are often not implemented well and continue to be distrusted by many clinicians, Mr Kelsey believes that sharing data through eHealth technologies is the only way forward if we want to achieve the sustainable healthcare system that will be needed to support our ageing populations and reduce the burden of chronic disease.
At the core of building that sustainable system is what Mr Kelsey calls the principle of personalisation of access to information and related digital services, a philosophy that underpins the NHS England strategy and that he has brought with him to his new role in Australia.
“There are of course very significant differences in the way Australian and English healthcare are structured, but the truth is the problems are actually very similar,” he said. “What is interesting to me and I need to look more fully at the data, is that there are some things that moving faster here and some things that are more challenging.
“For example, there are more chronically ill people in Australia proportionally than in England. Not that it makes a lot of difference but it is an important starting point when you're thinking about where can digital technologies really add most value.”
Mr Kelsey told the Australian Healthcare Week conference in Sydney today that there are three operating principles for sustainable healthcare as he sees it: transparency, participation and collaboration.
“Transparency is at one level about data sharing between doctors and nurses and between the treating clinical professional and a patient, but it is also about public reporting of outcomes and prices,” he said. “It is not about the central performance management of doctors, which is an angle which worries people because there is a real question of fairness in the publication of those kinds of data, but it is about giving those clinical professionals access to the tools that they can use to support themselves in delivering the service.
“It is also about supporting patients and the public to make more informed decisions. We need to have a nuanced debate about that as we did in the UK. In the UK we are a long way towards starting to work with clinical colleagues on how best and most fairly to report quality in healthcare. We know it's an essential ingredient in the improvement of quality in healthcare.
“But at another level, something that I know that is very supported by policy here, is to make sure that the data in the first instance is flowing to support clinical practice across the different care settings. The first path to transparency is that quality measurement.
“The second part of transparency is giving voice to people and that voice being recognised as legitimate in clinical practice. This is all about allowing people or providing them with the opportunity to give feedback on services, for those comments to be shared with other patients.”
To help achieve this, the NHS has introduced the Friends and Family Test feedback tool, which he likens to things like the net promoter score. “Two years after we launched that, more than 13 million people had engaged in that process,” he said.
“Already it's a very important source of insight. There is lots of good evidence that says that if you enable transparency of the patient or customer voice in healthcare and other public services, you actually increase the professional insight into how it can be improved.”
My Health Record
In terms of participation, not only does data have to be made available but patients must be given the opportunity to access it, he said. Australia has started down this road through its commitment to providing people with access to their own data and records through the My Health Record initiative.
“At one level it is absolutely about giving people access to their data and helping them extract value from it,” he said. “We are at the foothills of that at the moment and there are lots of issues to be worked through, privacy being perhaps the most important of them and security another.
“But it is no longer a nice thing to have – it is essential that people are able to understand the pattern of their medication consumption and be able to start booking appointments, start getting their lab results online, interacting with their treatment where that is necessary. This is all about data on that level. Most people probably think of it as this is like access to an app store or access to digital platforms, but really it is about access to data.
“This is all about sharing data and extracting value from it. The importance of programs like the MyHR in general or just giving access to MBS and PBS data to the patients from whom it comes is fundamental in my view to the transformation of services in Australia."
Mr Kelsey said the UK has prioritised, above almost all else, providing people with access to their GP record through the summary care record project. "I'm glad to say that was achieved last April, so every citizen in England is able when they want to, to go online and access their GP records, to book appointments, to order a repeat prescription and shortly to get lab test results at the same time as the doctor. All things that need to happen here too.
“I feel very confident that with the emphasis from the political side but also from the sheer entrepreneurial interest in providing those kinds of digital services that Australia will get there quickly."
He also gives as an example NHS Choices, which he first designed in 2007 and which, while like the summary care record has had a long, slow path to maturity, is now seeing 50 million unique visitors a month.
“That is one of the areas that Telstra Health will be concentrating on,” he said. “How can Australians be supported universally – everyone, all of them, everywhere – with access to digital health services in a way that is appropriate to them.
“That is not something that Telstra Health alone will solve of course but it is about building a collaboration and building on some of the assets and services that Telstra Health currently provides. There will be announcements about that in due course but that is going to be a major focus for us.”
The final operating principal of a successful digital health service is collaboration, he said. This is not just about technical issues such as interoperability and solving the “bizarre” situation as he calls it of hospitals that are not able to speak to GPs, but about bringing everyone together to contribute to the necessary innovation that will support collaboration.
“It is the private sector, it is the not-for-profit sector and the public sector solving the problems of health in Australia and not just what the government can do. I think that's a massive shift in the next decade or so. It is recognising that you have to be collaborative and there is a big role that Telstra Health can play in that conversation.
“The urgency is not just because we have to solve the financial and quality problems that exist in the current health services and healthcare, but it is also because we face the advent of personalised medicine, precision medicine and genomics. Without the digital basics in place, both in terms of digital records on the one hand and also informed citizens who are capable of interacting with those digital tools, we can't do precision medicine.”
Posted in Australian eHealth