HealthPathways points the way to a lot more patient-centric system efficiency, but operating ‘outside the system’ has its challenges.
On 17-18 June this year in Canberra Health Services Daily, the Medical Republic and Wild Health are bringing together health industry leaders to have a pragmatic look at what we can do now to meaningfully reduce health system fragmentation, with a view to improving efficiency and patient outcomes in the near term, not in 10 years’ time.
The premise of the meeting is, we are likely never getting rid of our federated health management model that divides us between states and then between states and the Commonwealth and much of the funding framework which underpins this model.
So how do we work with it better using emerging health tech, particularly cloud-sharing and AI, by looking at examples of best practice across the system and how we can bring it to the middle for every state and territory to use in a more coordinated manner.
One theme the One Healthcare System Summit will be looking at is the role of agencies, not-for-profits and privately funded groups which are in varying degrees external to the core state and territory operational units that run hospitals and how the Commonwealth oversees primary care.
Many of these “external” providers have some ability to overlay their processes, systems and technology to many or all points of the system to efficiently join up disparate parts that the operators themselves (the states and the Commonwealth) struggle to connect.
An obvious important and rapidly evolving agency that HSD and TMR have written about a lot is Healthdirect Australia, which is doing a lot of work to reduce the disconnect that can occur between hospitals, primary care and their patients with an obvious and simple instrument – a digital directory and telehealth set up that can connect everyone in real time, even out of hours when necessary.
A particularly interesting project of this group is the concept of a 222 service sitting next to our national 000 service. The theory of 222 is, if you don’t know where to go in the system and you don’t have a life-threatening situation, you can go to 222 and not only find out, but be connected in real time to the service that is most appropriate to your immediate need.
You can read more about the 222 idea HERE.
The range of privately funded companies that in one way or another contribute to (and sometimes inhibit) the connectivity and efficiency of the federated system is huge.
Think of the major GP patient management platforms, the privately run secure messaging providers, some emerging cloud-based e-referral providers and so on, each of which variously offer opportunity and, in some cases threat, to those wanting to connect up our system with far more efficiency and better patient outcomes.
We will look at a lot of these providers in the context of the federal government’s “sharing by default” project in our June summit, in particular how the government is trying to wrangle and align the providers for significant advances in interoperability between all providers and the patients, regardless of whether they are tertiary, primary or allied care based.
Outside of the technology groups, there exist a few groups with great ideas to improve process and flow of vital information across the fragmented federated system but which struggle to realise their full potential because they’re not formally part of the system and the major funding models often do not support their (usually smart) operational ideas.
Most of these groups and their platforms start from a point of good system logic – that any good healthcare system should operate as one integrated system focused on the patient, and share information and processes accordingly.
A good example of such a group HealthPathways, a point-of-care clinical pathways and referral decision support information service for GPs, run by a not-for-profit called Streamliners, which originally started as a discussion group formed to solve issues of system fragmentation in the Canterbury health region of New Zealand.
HealthPathways is funded in Australia largely by PHNs and, depending where you are in Australia, sometimes by hospital networks and state health departments.
Like Healthdirect, the concepts behind HealthPathways are practical, simple and logical, if you were building a single integrated healthcare system from scratch
Like Healthdirect, HealthPathways has built a significant amount of IP in local connection knowledge for the system, in particular, who can GPs connect to once a patient has followed a certain clinical pathway.
It is a coalface clinical flow information and connection service, optimised for the specific needs of a region, with some ability to connect a GP in real time to identified surrounding services.
By rights if we hadn’t created an artificial divide between tertiary care and primary care, a service like HealthPathways may have naturally comprised a core part of a national integrated system of care.
But because the states fund and run hospitals, the Commonwealth funds GPs, and other parts of the system, such as aged care and allied health, which are variously disconnected from primary care from a funding perspective as well, developing such protocols did not emerge as a priority for any one part of the federated system.
That being said, HealthPathways has proven attractive to PHNs, selected local health districts and equivalents, and state health departments (not WA), which, is likely a pointer to the idea and the service being a naturally attractive one.
The problem is, with HealthPathways operating on the outside, and being run largely by a small private trust, its use across the Australian healthcare primary care landscape can be patchy.
Its funding and implementation in any one area depends on the individual decisions of either local PHNs or a hospital network, usually. Only a few PHNs aren’t using it for primary care (this component is called Community HealthPathways), but not many hospital networks around the country use it yet (Hospital Pathways), despite many of the state health departments investing in it in one way or another.
Should something like this somehow get agreed upon by the states and the Commonwealth and funded more formally nationally as a fundamental service for connecting community and hospital care to relevant services in real time?
It’s worth diving a little deeper into the service and how it works to provide some perspective on the question.
HealthPathways’ strength is that it is information built and updated for the specific local needs of primary care and hospital providers.
One of the best clinical decision support information resources for doctors in the world is a subscription service called Up To Date.
Up To Date covers most key clinical topics for a doctor whether a non-GP specialist or a GP, by deep diving on the evidence base for the key clinical topics thoroughly, using world leading experts and presenting the information in a practical easy to understand format digitally.
The service then updates each topic (hence “Up To Date”) against the latest peer-reviewed evidence base every couple of years.
HealthPathways operates the same way for a local GP but the information it is providing is, in a manner, far more practical to the day-to-day clinical workflow: it connects the GP to a regularly updated data set of local relevant healthcare resources – everything from social workers, to community centres, aged care homes all the way to specialists and hospitals.
Where HealthPathways exists and is used the platform has other important benefits for a local healthcare region: in order for the pathways to be developed, understood and maintained, requires a broad range of local clinicians and key administrators to form ongoing working relationships which tend to create other synergies and benefits for local care.
The utility of such a resource nationally run and funded feels obvious given that a big challenge that exists for the delivery of consistent, reliable local care is just how much variation tends to exist in care alongside access to local services.
As part of its process HealthPathways joins GPs to the hospital system because it requires collaboration between the hospital specialists and local GPs to design and share local resource solutions.
HealthPathways CEO, Stella Ward believes that through collaboration, not just with hospital providers but with clinicians and providers in other locally available institutions, HealthPathways is playing a significant role in relationship building across the different levels of the local health system.
“It’s not just about getting a pathway and putting it into place,” says Ward.
“It’s about developing relationships. It’s about bringing clinicians together, and hopefully consumers as well, and creating a learning health system environment that is responsive to local needs while ensuring clinical standards to support integration within the system.”
While a fragmented system with various points of distributed funding power has only managed to fund HealthPathways in a patchy manner there are signs that a more organised national approach might one day emerge.
Queensland Health has organised funding across the the entire state and Victoria is talking to the group as a part of a current review of putting in a statewide approach to clinical pathways.
One problem is achieving more comprehensive use of HealthPathways, even in regions where it is funded, is that local GPs often aren’t aware of the service or haven’t interacted with it.
This most likely happens because GP engagement with their local PHNs can be hit and miss – in some regions there is great engagement, in others not much, depending on a whole lot of historical variables and in how each PHN is run.
This is all despite the service being supported by the RACGP and ACRRM.
Another important aspect of the application of HealthPathways across our system is that it exists for the most part outside of the major daily workflow tool of a GP: their electronic patient management system (PMS).
It is a standalone web application which a GP needs to start up and run outside of their PMS – usually Best Practice, Medical Director or Zed Med.
Of all the logical workflow integrations that potentially could increase system efficiency that should exist within these GP platforms you would think that HealthPathways would be a key one.
For one thing, like Healthdirect, HealthPathways isn’t just a static information source. As a web application it tries to create direct connections in real time to other services where it can to optimise the workflow efficiency of a GP for faster and more effective patient outcomes.
But digital connectivity in our healthcare system is an expensive and complex game. Ideally you do not want to be sitting outside of the GP PMS because the PMS is their key workflow tool.
If HealthPathways was fully integrated into all the major GP PMS systems it seems entirely likely that a lot more GPs would know about it and use it.
But all these PMS platforms tend to “gate” external applications like HealthPathways by requiring an initial payment for integration and an ongoing commission – reportedly between 15-30% — of all revenues generated by the application.
HealthPathways of course doesn’t generate revenues outside of its funding from PHNs and hospitals. This would make it a low priority for integration for all the major PMS vendors because “gating”, which is essentially requesting a toll for access to their network of GPs, is a key part of their business model.
The future of “gating” for important information applications like HealthPathways may be about to get brighter though.
The Department of Health and Aged Care and the Australian Digital Health Agency are full tilt at the moment on the concept of “sharing by default”.
A few weeks back parliament passed legislation – The Modernising The My Health Record bill – which is a pointer to the government wanting to make important system information (patient data largely) flow much more freely in the system where it will make everything more efficient. They initially are demanding that the big private pathology companies upload patient results in near real time for faster provider and patient access.
As a quick “by the way”, the major PMS vendors aren’t villains in this picture for not integrating HealthPathways for free. Their core functionality is billing and prescribing, and through this they created functionality that all GPs need for core workflow. To do this they all spent years and a lot of money building software platforms at great expense, all of which form a major part of the information sharing and interoperability infrastructure of the country.
To fund their journey they’ve all had to create suitable revenue models, and the “toll” system is a natural one you see all over the world in software platforms.
It’s just that seemingly useful and fundamental information providers such as HealthPathways don’t suit the model.
Will the government, driven “sharing by default” agenda, see a need to override this model in cases where system efficiency and patient outcomes are so obvious that the business model will need to be adjusted for the greater good?
Either that or the government might see the upside in funding HealthPathways to get on to the PMS platforms.
“Sharing by default” is all about how cloud-based technology now offers Australia a massive opportunity to connect its disconnected healthcare system below the water line using digital channels of secure seamless information sharing.
It has obvious efficiency implications for all points of the system compass in the next few years, including connecting not just primary care better to tertiary care but to aged care and important local allied care providers.
It will be another major stream covered at the upcoming One Health System Summit in June.
HealthPathways CEO Stella Ward will be there, talking about the service and how it can be better optimised.
If you’re interested in coming you can see the current agenda, pre-summit leader workshop details, speakers and panelists and get tickets HERE.
If you are an HSD reader you can use the HSD reader discount code for a 12.5% reduction on all ticket types: HSD125