The art-of-the-possible for Digital Health in Australia (TODAY?)

While in the middle of recovering from my fairly difficult tussle with COVID, I made a (probably) 'too grumpy' post about the telephone not constituting #digitalhealth

In closing that rant, it was again (probably) ill-advised for me to declare I'd '...redesigned the entire process utilising all that is possible with linked data and systems.'

In any case, as promised what follows are those thoughts.

The caveat is that in imagining a near-future, or alternate-now, I chose to remove the many 'people' and 'organisational' encumbrances of multi-jurisdictional politics, siloes among domains, funding criteria, privacy fears, cybersecurity attacks by nefarious individuals, societal distrust of government etc... to simply focus on what we could do with current technology; if we wanted to.

The system knows before I do

Let's start before any symptoms are noticeable enough for me to suspect I need a test. I already have an older model continuous heart rate and pulse oximeter watch and a smart phone, as do many people. Those two sensors alone, whilst not clinical grade... might alert me through an integrated health app (provided by my telco or by the Government) that there have been some abnormalities that may be symptomatic of a virus. Sufficient to get a RAT or PCR test. You see, in this alternate world — we're not too bothered about the clinical spectrum and whether my watch has the integrity of a hospital ECG. We're only looking at a coarse signal at the coarse end of the diagnostic funnel — but I do know that any electronic sensors are more sensitive to vital fluctuations than the human mind.

My identity precedes me

Without delay, I make my way to the drive-through testing clinic. As my vehicle approaches the queue, the number plate is automatically recognised and the vehicle insurance looked up to identify listed drivers, which narrows the facial recognition requirements for?corresponding driver license photo lookups, which quickly identifies me and pre-populates the details needed for the screening process. When I reach the check point, the person simply makes sure the automated process has picked up the right person before linking the test... if not, they can simply choose an alternate name from the shortlist. Human in the loop! Fallbacks if needed.

I don't need to be 'digitally literate'

This doesn't require me to be a digitally literate citizen, doesn't matter what my physical condition is, nor whether my phone can handle a website 'form,' and more. Suitable for all ages. Suitable for the entire country. Transparent technology that does all the work for the citizen.

Such linked data through integrated systems, with my consent, could bring massive benefits of not only convenience, efficiency, and data security, but importantly validated error free inputs.

My concerns are alleviated

Then I receive a text confirmation and some instructions (as happens currently). Except... the link takes me to a digital human COVID navigator. Someone like the World Health Organization's artificial intelligence empathetic health worker Florence, who '...can share advice on mental health, give tips to destress, provide guidance on how to eat right, be more active, and quit tobacco and e-cigarettes.' [More ]

Now I can talk through the non-clinical questions and personal concerns I have. I can take my time. No question is too stupid. I'm not locked into a symptom checker. Oh, and I can converse in my most comfortable language for communication. With permission, I can also allow the #AI health worker to access my phone health-tracking app (or apps), to answer questions related to that.

The system anticipates my needs

Meanwhile, in the clinical realm, the positive result from the PCR automatically triggers machinations to assesses my risk and need for treatment based on factors relating to the results themselves, but also in the context of the other clinical data that has been aggregated about me. The system releases only my necessary details and highlights them at the nearest pharmacy to my home residence, along with my concerning risk factors. A text message hits my phone to explain that it is recommended I take anti-virals given my underlying conditions, asking me to confirm if I would like to, then allowing me to pay online or with my phone for the non-reimbursed component, after-which said drugs turn up. If I don't respond, the pharmacy can then 'call me' to confirm I've understood.

All possible today.

Keep the human in the loop

In healthcare, the human needs to stay in the loop, always. For instance, an automatic prescription might only be suitable for certain cohorts of the population. Where co-morbidities or drug interactions are present that require greater clinical oversight, of course this gets escalated and managed appropriately.

Yet we don't need to replicate the models of the past if we want to embrace a digitally powered future. We need to think in parallel processes. We need to think about actionable insights and confidence in data. The citizen and the system need to share the risk of increased convenience made possible through technology.

The citizen and the system need to share the risks, versus benefits of convenience, made possible through technology.

Which of these is your mindset?

Before all the naysayers jump in, consider some excellent advice from James Clear this week [More ]

“One type of person approaches a situation with the mindset of, ‘How can I make this work?’?

Another type seems to approach each circumstance with the mindset of, ‘What are all the reasons this wouldn’t work?’

Both people will be forced to deal with reality, but the first person will only have to solve problems that actually occur while the second person will often avoid taking action entirely because of the potential problems they have dreamt up before starting.?

There will always be reasons to not do something. Be a problem solver, not a problem adder.”

Closing challenge

Sure, there are lots of problems and friction points with the health system.

Technology is not one of them.

If, like me, you want to change the world, let's start solving some of the caveated items at the start of this post. There we will unblock the road to the better use of technology to make healthcare more human, and realise a vision of digital health in Australia that produces better outcomes for every person or institution involved.