I’ve spent more time in hospitals in the last three months than during the rest of my life combined.
Observing from the waiting rooms of clinics and quiet corners of hospital wards, I’ve been struck by two things – how hardworking and dedicated the doctors, nurses and orderlies are, and the fact that much of their work is still paper-based.
One doctor wrote notes on a coloured A3 piece of paper outlining the health status of a relative I was visiting. Paper forms on clipboards still dominate in many of our hospitals as the primary way of capturing patient information. All those details are presumably fed into a computer at some point, but the process seems far more manual than it needs to be.
Paging Dr Digital
“By and large we’ve replaced the pagers and fax machines with pagers and phones, but the paper remains ubiquitous,” says Layton Duncan, the co-founder of Sense Medical, a clinical care software developer that has produced Cortex, an app that runs on iPhones and iPads and replaces paper with digital forms.
Essentially, Cortex brings together information from a number of core systems that doctors draw on: a hospital’s clinical document repository, patient management and lab information systems and includes notes from anyone on the team treating a patient, from ward nurse to specialist.
Members of the team can leave messages on each other’s notes and message each other through the app, as though they were using Facebook. It is part of a new wave of apps digitising workflow in the health sector, says Duncan.
He has hard evidence to suggest Cortex could save the health sector millions and improve patient care. A three-month trial at Christchurch Hospital in 2017 saw devices running the Cortex apps used by clinicians in general surgery.
Compared to statistics from previous corresponding periods, the results were remarkable – a 20 per cent reduction in average length of stay in hospital and a 12.5 per cent drop in the rate of readmission. The total number of bed nights was down 15 per cent during the period.
Christchurch Hospital, which will launch an all-digital hospital management system when it opens its new $500 million, 10-storey Hagley hospital building in November, estimates that the trial achieved an $80,000 saving per month for a 30-bed ward.
Keeping everyone on the same page digitally seems to work, and that goes for specialist doctors working with general practitioners who are referring on their patients for treatment.
The clinical lead on the platform, Kieran Holland, says HealthPathways is aimed at solving the problems his own parents faced when they moved to Linwood, Christchurch and took over a general practice.
“When they didn’t know what to do for their patients, which was most days, they’d use a range of tactics, from talking to their colleagues, ringing around or sometimes just trial and error,” he told Tech Week attendees.
“The reality for patients was that they got different care depending on the experience and knowledge of their doctor. My mum said it took her three years before she felt comfortable practicing in Christchurch.”
Developed with the Canterbury District Health Board, HealthPathways has now assembled medical guidance on assessments for over 600 types of clinical conditions and is used by 43 health providers across New Zealand, Australia and the United Kingdom, which collectively service 28 million patients.
Uberisation of healthcare
The rise of digital consumer platforms like Uber, AirBnB and Google Drive was also forcing change in how patients were interacting with the health sector and accessing their medical data, Orion Health’s client and partnerships director, Belinda Allen, told Tech Week attendees.
“We are starting to build around ourselves what I would call digital walls. What that means is that personal interactions may not be so important. New models of care will be more acceptable,” says Allen.
“If it is late at night, I’m watching Netflix and I need to order a new prescription, I should be able to do that immediately.”
Human-centred design was now driving the approach to product development at Orion Health, the 26 year-old, the 700-strong Auckland-based company health software company that returned to private ownership in March after a tumultuous four and a half years trading on the NZX.
Another defining trend was precision healthcare: mining data about a patient to better tailor treatment to their needs.
“It looks at their genetics, their economic situation, their social behaviours. That’s a lot more data points we have to capture and interpret,” says Allen.
A research partnership with Auckland District Health Board and the University of Auckland saw Orion develop a risk calculator to more precisely predict the outcomes of surgery. Rather than basing it on the SORT surgical preoperative risk prediction tool used overseas, the researchers used local population data to more accurately predict outcomes for New Zealanders.
The human factor
Thorsten Engel, leader of the New Zealand healthcare practice at consulting firm Deloitte, told Tech Week attendees that the health sector was ripe for disruption due to problems with the status quo.
The “assess, treat, repeat” approach to healthcare was no longer working for many patients.
“The bulk of our burden is non-communicable diseases. They don’t respond very well to this sort of model,” says Engel.
Proactive interventions into people’s daily lives through “nudges” and coaching was now more useful though technology had a role to play in facilitating continuous health monitoring and interventions. Privacy was a barrier to sharing data encountered by health providers all over the world.
But it couldn’t be used as an excuse and progress was being made. In the US, hundreds of hospitals had joined Apple’s scheme to integrate data from its Health app available on iPhones and feeding in health tracking data from Apple Watch users, into their patient health records.
Slow to embrace change, the health sector was more likely to be disrupted from outside, rather than from within. One example of the structural change underway was the US$69 billion acquisition of US health insurance company Aetna by pharmacy chain CVS.
CVS would increasingly focus its 10,000 stores in the US on helping customers manage chronic conditions, using data analytics and smart tech to determine their exact needs.
“They can offer you a one-minute nurse check-in, a medication review with a pharmacist in store, and suddenly really help you make day to day choices,” says Engel.
“They know not to promote the peanuts to you because you have hypertension and not to promote the chocolate bars to you if you are diabetic.”
But for all the improvements in wearable health trackers and digital avatars, artificial intelligence and predictive modelling, the human touch was still the key to improving health outcomes in many areas.
Mental health, which is expected to be made a funding priority in next week’s Budget, was a prime example.
“Our youth suicide rates are appalling. Around 44 per cent of people who chose to take their own lives had some interaction with the health system before doing so,” says Engel.
“It tells you that ‘assess, treat, repeat’ just doesn’t work.”
The “structural problem” in mental health treatment would only be solved through more work helping people in communities and understanding their social circumstances.
Says Engel: “No avatar, AI or other high tech sort of thing is going to substitute for human kindness and engagement. The coal face is still about human touchpoints.”
Replay the Tech TV recording of the future of health tech discussion.