With quality, outcomes, and value the watchwords for health care in the 21st century, sector stakeholders around the globe are looking for innovative, cost-effective ways to deliver patient-centered, technology enabled “smart” health care, both inside and outside hospital walls.

Evolving policies, processes, and capabilities to deliver smart health care will not be easy, given global health care’s magnitude and complexity. For example, there could be significant logistical and technology obstacles to overcome. More and more inpatient services are being pushed to non-traditional care settings such as the home and outpatient ambulatory facilities. Members of the health care delivery chain often work in multiple locations (hospital, doctor’s office, retail medical clinic, diagnostics lab).

Patients may reside in a city or even a country away from their care providers. And health records frequently reside in different formats and on disparate systems. Clinicians may, therefore, have difficulty coordinating appointments and procedures, sharing test results, and involving patients in their treatment plan. In other words, care providers may be working hard but they are not necessarily working “smart.”

Adding additional layers of stress is of course Australia’s growing, and rapidly aging population. According to the Australian Bureau of Statistics in Australia in 2017, there were 3.8 million Australians aged 65 and over (comprising 15% of the total population) —increasing from 1.3 million (9%) in 1977. The number and proportion of older Australians is expected to continue to grow. By 2057, it is projected there will be 8.8 million older people in Australia (22% of the population).

This trend towards an older population brings with it a number of challenges including the rise of chronic diseases and a shrinking workforce. Indeed, according to the Australian Healthcare Week State of the Industry Report (2018) 57% of healthcare providers around Australia are already feeling the pinch of an aging population and a reduced workforce.

Over the past decades however healthcare locally, and globally has been in flux. Healthcare’s reinvention is being driven by two main factors: the search for economic sustainability and digital disruption. Health care spending is on an unsustainable trajectory, thanks to demographic shifts and globalisation.

But just as health systems need to meet growing need, while containing costs and limiting environmental impact, digital health has emerged to enable approaches that are dramatically more patient-centric and cost-effective, without expanding footprint.

Looking once again to the Healthcare Week State of the Industry Report, which surveyed over 100 Australian healthcare professionals, we see that technology is emerging as a huge power player in the healthcare scene with 87% of survey respondents indicating that healthcare digitisation is the way forward, with EMR, cloud solutions and big data highlighted as priority investment areas, while innovations like artificial intelligence and robotics will be making a splash in the coming years.

While healthcare digitisation has been epitomised as the way forward for 2019 and beyond, not everyone is ready. According to the same report, only 37% of Aussie Healthcare providers are equipped to deal with digital healthcare and digital transformations.

Why then, despite the well documented benefits of digital healthcare technologies for patients, clinicians and budgets, are so few care providers ready to effectively harness these transformative powers? The answer, while not clear, lies in a number of possibilities ranging from a lack of budget, a lack of understanding around benefits and opportunities, as well as competing priority areas.

To understand how digital healthcare can help meet growing need, and streamline care delivery, without adding beds, we take a look at three case study examples – from Metro South Health, eHealth NSW and St. John of God Health Care – who have already embarked on their transformation journey.

Metro South Health

Australia’s First Fully Digitised Health Service

Metro South Health is the major provider of public health services in the Brisbane south side, Logan, Redlands and Scenic Rim region which encompasses a population of some 1.2 million people, or about 23% of Queensland’s population.

While Metro South Health employs more than 13,000 staff who provide specialist healthcare to the region’s citizens, and includes five in-patient facilities – the largest of which is the Princess Alexandra Hospital in Brisbane; growing and aging populations have imposed pressures on healthcare delivery capacity that traditional bricks and mortar methods cannot effectively meet.

To more effectively meet the changing and diverse needs of the populations they serve Metro South Health has embarked on the Future Hospitals programme which aims to utilise technology, connectivity and EMR data to optimise care delivery. Below Cameron Ballantine, Acting Chief Information Officer at Metro South Health (MSH) about the process behind the rollout of Australia’s first fully digitised health service in more detail.

By 2027, MSH will serve a resident population of almost 1.3 million—the largest of any Hospital and Health Service in Queensland—as well as providing specialist services to people across the State. Over the next 10 years, growing demand for MSH’s health services will be driven by overall population growth as well as key population trends including an ageing population, areas of significant socio-economic disadvantage, and increasing populations of cultural and linguistically diverse groups and Aboriginal and Torres Strait Islander peoples.

A key strategy for MSH in delivering health services more effectively was the full digitisation of their entire health service which includes five hospitals; the Princess Alexandra, Beaudesert Hospital, Logan Hospital, Redland Hospital and the QEII Jubilee Hospital. This digitisation was completed in July 2018, making MSH the first fully digital health service in the country.

We’ve just completed our integrated electronic medical record rollout over the entire health service, which our Executives and Board see as pivotal to the future of how healthcare is delivered. With this rollout, we’ve just become the first fully digitalised health service in Australia.

The Benefits of New Methods

Since digitising medication errors at the leading tertiary facility dropped by 44 per cent, emergency readmissions within 28 days of discharge were 17 per cent less, drug costs per weighted activity unit were 14 per cent lower, hospital-acquired pressure injuries dropped by 56 per cent, healthcare associated infections lessened by 37 per cent, while the early identification of deteriorating patients increased by 59 per cent.

The Princess Alexandra hospital has about 1,000 beds – we’re a large tertiary hospital, but currently Queensland is still some 2,500 beds behind what it needs to cover the population growth of the State. The bricks and mortar approach to delivering health simply can’t sustain the need that the population has. We needed to diversify and digitise.

Ultimately what we’re looking to do is keep people out of the hospital and keep those beds available for people that really require them. There was an interesting study completed by a Medical Officer here some years ago, and he found that over an average seven day stay for an inpatient in hospital, that they are probably with us for two or three days more than they actually needed to be. This overstay was specifically related to the lag time in information sharing across such a large and complex organisation like MSH.

Instead of focusing on physical infrastructure investment to meet needs MSH is working smarter, not harder. By digitising operations through ieMR, integrating new digital ways of working, focusing on connectivity and secure data sharing MSH has become more efficient, reducing lag-times and even, in certain areas, nullifying them entirely.

eHealth NSW

The Largest Rural eHealth Programme Globally

The eHealth NSW’ Rural eHealth Programme will deliver a new approach to the way healthcare is delivered across rural areas of NSW. The vision for Rural eHealth is to use the power of electronic information to help ensure that patients get the right care, involve the right clinicians, at the right time, to deliver the right outcomes.

The Programme aims to improve the way appropriate tools and resources are managed and delivered to clinicians, staff and most importantly patients, by focusing on delivery and support provided across corporate and infrastructure programmes.

The Rural eHealth Programme is responsible for delivering the latest clinical software and technology to six Local Health Districts (LHDs) dotted throughout an area covering 650,000km2. With some Local Health Districts larger than entire European countries size, connectivity and access have presented unique challenges that ICT innovation is well positioned to help overcome. Below Grant Rogers, Rural eMeds Chief Medical Officer at eHealth NSW discusses the benefits of digital healthcare in a rural setting.

Electronic Medication Management (eMeds) systems support the improved quality, safety and effectiveness of medication management with NSW hospitals. This includes providing support for doctors, nurses and pharmacists to prescribe, order, check, reconcile, dispense and record the administration of medicines.

The State’s eMeds systems ensure that the delivery of medications to patients is supported by electronic systems, providing access to patient information and clinical decision support in real time. The eMeds systems aim to improve patient safety and modernise patient care by improving the way medications are managed at the hospital boundaries and in the hospital itself.

The State’s eMeds Programme supports Local Health Districts (LHDs) to implement and improve a range of processes and systems to deliver the vision of eMeds within the NSW public health system.

While the biggest benefit for the State of implementing eMeds is increased patient safety through reduced errors, improved information visibility and improved communication with patients regarding medication, in a rural setting the eMeds Programme supports much more.

The Rural eMeds Programme, part of our eHealth Strategy for NSW Health: 2016-2026 is actually aiming to get eMed applications to the six rural sites (Far West, Western, Northern, Mid-North Coast, Murrumbidgee and Southern NSW) and to better support the 1.3 million people living in these far-flung areas of NSW through fast, reliable mobile applications and access to information.

Optimising Rural Care for Patients and Clinicians

To date the Rural eHealth and Rural eMeds programmes have been very successful; due mostly to the passion we’ve seen for the programme from staff. Staff across all six LHDs are working in partnership, removing barriers and collaborating to resolve issues and develop solutions that will help provide that superior care for those living in rural NSW.

This of course required some strategic change management to ensure it was effectively rolled-out to all stakeholders, including patients. Key to this roll-out was trying to get the clinicians involved very early on as we were trying to build the final product. This processes allows them to see the way the programme flows, understand what impact this would have on them and allows them to look at and reassess their own workflow practices as well.

Taking this one step further, it also makes clinicians feel that their part of a bigger solution and allowed them the opportunity to provide input which meant when go-live time came, the process was seamless as they’d been part of the journey all along.

St. John of God Health Care

Supporting Patients by Successfully Rolling Out EMR

It’s unquestionable that the future of healthcare lies in digitisation – with artificial intelligence, data capture and analytics playing an integral role in healthcare service delivery. However eHealth solutions and digital innovations are often met with objections from patients, carers and clinicians alike. To help make this process seamless St John of God Health Care appointed their first ever Chief Medical Information Officer in 2016.

St John of God Health Care (St John) is Australia's third largest private hospital operator, with 24 hospitals and facilities comprising more than 3,400 beds. To support their new state-of-the-art facilities, St John has partnered with Telstra Health to deploy an EMR platform. First rolled out at the new Midland, Perth site, the EMR platform will form the clinical ‘digital backbone’ of the $360-million facility, which includes a 307-bed public hospital and a 60-bed private hospital on the same campus.

Discussing the opportunities and challenges of EMR roll out is Alexius Julian, Chief Medical Information Officer at St John of God Health Care.

A few years back St. John initiated a consultancy with Boston Consulting Group to gather thoughts from thought leaders within the industry and our organisation, so our doctors, our nursing caregivers and our corporate caregivers. From this process we gleaned two key things.

One was that we needed to get better at data analytics and provide more information internally because at that time the insurance companies actually knew more about our activities than we did. The second of those was that we needed a clinical information system in order to better capture that data. The creation of my role, a CMIO, was also a recommendation out of that consultancy.

At the time of that, St. John had already committed to and were implementing the Clinical Information System at our new Midland Hospital which is in Perth and it’s the second public/private partnership that St. John has entered into, with Hawkesbury in Sydney being the first.

In the process of becoming a fully digitised hospital (at the new greenfield site in Perth’s Midland) we have developed a number of digital healthcare innovations, including our Scanned Health Record .

The Scanned Health Records, which are already in use at our Midland and Geelong locations, scan all notes after an admission with digital versions stored on a computer or mobile device and all physical records stored offsite, saving considerable space in the hospital, and allowing that space to be better utilised. From a clinician’s perspective this also means that a patient’s past history is all literally accessible at the touch of a finger, and that multiple people can view the record at the same time. It also allows for remote coding of the records.

Digital Benefits and Future Opportunities

While we at St. John are still in the early stages of our digital healthcare journey, we’re already seeing a number of benefits and changes to process efficiency emerging.

While initial responses to our EMR application have been mixed, probably due to the fact that we didn’t implement the Clinical Information System to the best of it’s capability to begin with, we’re now working on raising awareness and getting staff to the point were they’re relying on it a lot more to really see those benefits that we were hoping for.

Our other digital innovations, the Scanned Health Record for example, are something that everyone absolutely loves. You don’t need to look for files and notes anymore, it’s all there on a mobile platform, and it has encouraged most of our clinics to go paperless so efficiency has hugely improved.

More broadly for St John Health, we’re looking at opportunities to shape healthcare delivery through technology, data capture and analysis.

For some time we’ve had running now a programme called Project BART which essentially focuses on using all of the data that we currently have and could potentially capture in the future to shape care and care models.

If you’re interested in hearing more about digital healthcare innovation, and the future of fast, efficient, cost effective care delivery, then join us at the Digital Healthcare Summit 2019.

The event, running as part of Queensland Healthcare Week brings together over 60 expert speakers from the likes of Metro North Hospital and Health Service, eHealth Queensland, Queensland Health, Metro South Health, West Moreton Hospital and Health Service and Gold Coast Health.

To learn more about the event grab a copy of the event guide now!