Specialists weigh in on the Strengthening Medicare Taskforce report and the technology needed to make it a reality.
Allergy and respiratory specialists and other non-GP specialisations are barely mentioned in the Strengthening Medicare Taskforce report, despite one of the four key recommendations targeting the need for multidisciplinary care teams.
The Taskforce report proposes the need for integration between specialists, hospital services and primary care providers under the focus area of “Encouraging multidisciplinary team-based care”.
Dr Tracy Leong is a respiratory physician and director of bronchoscopy at Austin Health in Melbourne. She says that multidisciplinary team care is core to much of her work.
“When we initially think about who should be in the multidisciplinary team for lung cancer it is predominantly non-GP specialists. But there really should be some change towards having primary care practitioners as part of that team as well,” Dr Leong tells ARR.
The demand for this kind of integration is increasing with lung cancer being the commonest cause of cancer death in Australia, she says.
“Patients are presenting with it more frequently and these are patients who are not admitted to hospital. They’re living at home and they need a port of call in the community who will be up to speed with their treatments, with their care needs and also to provide them with psychological support. That’s usually the primary care practitioner.”
Dr Sam Whittle, a senior consultant rheumatologist at The Queen Elizabeth Hospital, South Australia, says there are a number of positives in the Taskforce report, but he notes the absence of physicians or other non-primary care specialists on the actual Strengthening Medicare Taskforce.
“Healthcare is best considered from a systems perspective. Without a whole-of-system approach to reform, meaningful and beneficial change is unlikely to occur,” Dr Whittle says.
Dr Whittle says attempting to change one part of the system without careful consideration of other components in the system risks failure and unforeseen impacts.
The report’s focus on patient centred care and collaboration is broadly encouraging but all stakeholders need to be at the table, he tells ARR.
“New models for closer collaboration between specialists, primary care and other healthcare providers are clearly going to be an important part of ongoing reform of healthcare in Australia. However, it is vital that specialists both community and hospital-based are involved in the conception and development of these new models,” he says.
DATA LINKAGE ‘A HUGE PROBLEM’
The kind of team care across all levels of health requires data sharing that is not supported by most software used in Australia. Unlike in the United States and Scandinavia, the Australian government does not mandate that health software should link and share data. It puts the onus back on clinicians to share patient history using outdated technology and Australia Post.
The lack of digital linkage between health platforms is “a huge problem”, according to Dr Leong. She says that most patient history data is exchanged with GPs using “old school emails” and that ePrescribing is still not available via Genie a patient management system used by around 65% of non-GP specialists.
The Taskforce’s solution to Australia’s digital health woes is to “modernise My Health Record”. This is despite My Health Record being largely underused, especially by non-GP specialists.
Dr Leong says she does not use My Health Record in her clinical practice and has anecdotally heard people express concerns about privacy issues with My Health Records.
“As a result of that you don’t have the whole population using the platform and so incompleteness of data is always going to be a problem,” she says.
Complete patient history is always beneficial, Dr Leong says. “The more information, the better.”
However, digital health experts are divided on whether My Health Record actually can be upgraded to provide complete patient history and share data in the way required by multidisciplinary care teams.
Dr Sanjeev Kumar, a breast medical oncologist at the Chris O’Brien Lifehouse and Westmead Hospital, says multidisciplinary team-based care is “absolutely fundamental”, especially in the provision of cancer care, but that current technology in hospitals doesn’t enable real-time data sharing with GPs.
“A difficulty in the provision of specialist care is when patients come to their first appointment but no one actually tells them, ‘Please bring all your medications in, please bring all your supplements in’. Most of my referrals … don’t necessarily [come with] the best history. But I need to know all the history and usually end up having to contact the GP,” Dr Kumar says.
According to Dr Kumar, the national My Health Record is rarely used by oncologists in his circle. It was put in the “too hard basket”.
“I’ve always thought of My Health Record as an impenetrable wall. But if it was something that we could have opened in addition to our internal hospital system, if it was easily accessible online with a secure login, and provided a list of medications and comorbidities updated by a GP then I think we would use it,” Dr Kumar says.
My Health Record was intended to be an immense electronic health record where, in theory, health data for every Australian was uploaded to a huge, centralised database and accessed as required. This database currently holds most data in a format similar to PDF documents. However, since its inception, cloud-based solutions and consumer demand for real-time data has opened possibilities for distributed technology models such as those in Denmark and the United States.
Distributed models don’t require one central database. Instead, technology securely connects patients and healthcare providers to a variety of databases containing current health records across all levels of care.
Dr John Halamka, president of Mayo Clinic Platform, has helped various governments plan their healthcare information strategies. He says US customers expect to easily access their real-time health records on their smartphone.
In considering the Taskforce report, Dr Halamka poses some thought-provoking questions.
“Has Australia put the data before the patient? Is this data centric or patient centric Would making the strategy patient centred, rather than data centric, change the ambition to retain a centralised library of historical health data?” he asks.
Tim Blake, Managing Director of Semantic Consulting, also questions the Taskforce’s technology recommendations. He says the report is “largely just hand waving” by a group of people who know change is needed but are unable to implement what is technically required.
“Digital health experts have been advising the Government on this issue for nearly a decade. I can show you a report I wrote for the Commonwealth Department of Health from 2015 where I recommended similar changes,” he says.
Mr Blake says significant cultural change would be required to move on the Taskforce report.
“Many clinicians today see documentation, and the sharing of that documentation, as far more of an administrative issue than a clinical one. Until we can change that mindset, it doesn’t matter how many (data sharing) interfaces we build.”
Despite limited consultation beyond primary care, the Taskforce report presents multidisciplinary team-based care as central to reform. Whether My Health Record can be upgraded to enable this remains to be seen.
