My Closing Address at HIC 2017

At the kind request of HISA, the Health Informatics Society of Australia, I am pleased to publish the transcript from my closing address at the conference held this week in Brisbane. Enjoy...

Good afternoon delegates – what an extraordinary conference!

In my opening address on Monday, I expressed that there has never been a more exciting time to be a digital health professional. After spending 4 days here at HIC 2017, I hope you are in enthusiastic agreement that it is indeed exciting times!

Reflecting on the last 3 days there were certainly some standout, thought–provoking presentations.

Dr Kahol from the Indian Public Health Technologies Trust reminded us that innovation in healthcare doesn't need to be expensive, complicated or years in the making. Vast populations of India's rural poor necessitate a focus on human centred design and what is available and possible rather than focusing on the limitations of these poor and often remote communities; Dr Kahol emphasised that engaged communities are more effective in enabling real change in health and wellness with the assistance of technology that is simple, effective and affordable.

Matthew Holt from Health 2.0 shared his futurist insights into the 3 big transformations impacting healthcare globally: patient empowerment and e-enablement; a move away from episodic care to continuous care; and a move away from enterprise IT to social & sensors, mobile services and analytics and cloud; Matthew also shared the looming disruption to healthcare from chat bots, virtual reality, augmented reality, robots, 3D printing and the sensor revolution.

Dr Ken Carson from FlatIron Health in the US took us on a data pilgrimage in oncology where big data and human genetics are enabling prospective studies in cancer research in addition to the traditional retrospective studies. Dr Carson highlighted the difficulty in aggregating EHR data into a single, common data set when EHRs are often characterised by significant unstructured data as well as non-standardised structured data.

As informaticians, we understand the importance of structured and standardised data to the future success of digital health.

Prof Johanna Westbrook immersed us in a fascinating discussion on cognitive informatics – which hopefully I am correctly summarising as understanding clinical work processes within the context of human cognition. Prof Westbrook shared with us some intriguing study results associated with observing clinicians in busy clinical settings where interruptions were virtually a constant. These interruptions ultimately lead to errors, amplified by factors such as amount of sleep and memory retention. This presentation highlighted that clinicians needs vary dependent on conditions and that resilience engineering is needed to ensure that health IT systems dynamically factor in such conditions to ensure that clinicians make safe decisions, even if constantly interrupted in their work flow.

Dr Helen Bevan from the UK proffered that eHealth leaders can learn from characteristics of social movements and how these movements were catalysts for significant social change. Dr Bevan asserted that digital transformation within healthcare delivery organisations requires large groups of clinicians to be united in a common cause to move clinical practice in a new direction (I’m of course paraphrasing). Included in this recipe for meaningful transformation is a “fierce urgency of now” (quoting Dr Martin Luther King Jr).

My takeaway from Dr Bevan’s presentation was that we need to take care of relationships and then the results will follow.

Day 2

Dr Sean Powell wowed us with his presentation on bio-fabrication and its disruptive potential. The use of 3D scanning and 3D printing technologies is allowing the fabrication of human organs and tissue – a 3D printed biodegradable polymer scaffold, when filled with a hydrogel primed with the recipients stem cells is able to regenerate the required replacement body part!

Alana Henderson – patient advocate  – to me this presentation was a highlight of the conference. Alana shared her very personal story of her journey through the healthcare system. After paying for a copy of her medical record, Alana described the record as a work of fiction with 72 errors, not to mention an array of serious omissions. Alana highlighted the importance of communication as being the ‘heart’of patient-centred care.

It reminded me of the seminal keynote presentation in 1999 by Dr Donald Berwick, former CEO of the US Institute of Health Innovation, where he too shared his personal journey relating to acute care provided to his wife. In this presentation, like Alana’s, Dr Berwick implored clinicians to protect human dignity and communicate meaningfully with patients – ‘nothing about me without me’ was his call to arms. Yet here we are nearly 20 years on and Alana’s story echoes the same anguish that Alana described as an experience more traumatic than the stroke she suffered.

Although not all of her healthcare experience was traumatic, Alana expressed the need for change to bridge the communication divide between the healthcare system, clinicians and patients. Alana planted two seeds of change: firstly the need for hospital EMRs to be accessible by patients and their advocates in hospital; and secondly the need to adopt a case management approach to care that facilitated quality control by patients and their advocates.

I applaud Alana for her courage and hope that the health system responds positively to this call to action.

I also had the pleasure of attending the Innovating Health Series Workshop where the workshop participants responded to 5 questions on innovation in healthcare:

1.     What are the practical things you and your organisation are doing to address innovation and change?

2.     What should be the priorities in innovation and change and healthcare moving forward?

3.     How do you go from ideas to action?

4.     How do we unlock areas of innovation and work around barriers inherent in the health system?

5.     What leadership do we need to see innovation and change happen?

All of us can ponder these questions in our respective organisations and I would encourage you to join the conversation at innovatinghealth.com.au – a partnership between HISA and Accenture.

Bernard Salt – how entertaining is this guy? Thank you Bernard.

Bernard regaled us with his entertaining perspectives on Australia’s shifting demographics.

I for one will certainly never look at smashed avocados the same way again!

And KIPPERS - Kids In Parents Pockets Eroding Retirement Savings. What a mortifying light-bulb moment.

But back to Bernard’s presentation…

Bernard’s slide on the growth in population aged 65+ over 100 years to 2050 drew gasps from the audience and it highlighted what we know to be a tsunami of baby boomers, who for the next 30 years will place huge demands on services including healthcare. According to Bernard, baby boomers have a sense of entitlement to these services born out of decades of hard work. I expect that as technology advances, the demand from baby boomers and subsequent generations will involve high quality, largely socially funded healthcare and regular physiological maintenance. 

What Bernard should have overlayed on that graph was the projected increase in life expectancy to 2050 which further amplifies the issue.

The key takeaway for me was that we have no choice but to do more with less – we have to innovate. 

I would go one step further – I think we need to disrupt healthcare – and as I discussed in my opening address – this disruption is inescapable – the convergence of relentless advances in digital technologies and the equally relentless advances in the biological sciences.

Day 3

This morning we had our talented emerging clinical leads panel - an opportunity for a millennials right of reply to the rampaging baby boomers;

As we discovered, the 3 panelists were in fact from generation X and generation Y, which probably explains why they unselfishly expressed an obligation they felt to pursue and embrace digital health in order to cope with those pesky baby boomers;

The panel reminded us that EMRs need to enhance the doctor-patient experience and not detract from it; The panel wisely pointed out the criticality of clinical work force planning, urging us to re-imagine the physician journey to clinical practice, especially for millennials who are unlikely to want to work 80+ hours a week;

Tim Kelsey the CEO of the ADHA, embraced his new family of health informaticians in his presentation on the ongoing journey that is national eHealth; Tim reminded us of the very tangible benefits that await the Australian healthcare system through digital transformation and reinforced what I think is an overarching message of hope that this country can not only make ubiquitous digital health a reality, but there is clearly a significant ground swell of support – politically, socially, intellectually and professionally (again I'm paraphrasing).

Tim shared with us the achievements of the Agency over the last 12 months including the release of the national digital health strategy and the increased use and utility of myHR, mercifully affirming my opening remarks from Monday.

Tim pointed to the opportunity for the MyHR to save $7,515 per patient per year once opt-out is implemented and I'm sure we are all excited to do our part to make that target a reality;

Tim recalled the words of an aboriginal health worker that 'digital inclusion is a basic human right' a sentiment echoed by the United Nations. It is impossible not be in violent agreement with this aspiration.

I must of course pay homage to the Hacking Health event – where I was honoured to be one of this year’s judges. Hack-a-thons have to be a permanent feature of digital health innovation; Our governments, universities, research centres and large healthcare providers need to champion, incubate, support and sustain this agile approach to often complex problem solving in healthcare;

In closing can I thank each of you, the enthusiastic delegates, the outstanding presenters and the amazing team at HISA for a sumptuous feast of digital health and innovation over the last 4 days.

Thank you - Thatcher out!