Everyone wants or needs a virtual front door of some sort these days so surely a master virtual front door navigational aid of some description isn’t such a bad idea?
It’s hardly surprising that the term single front door (SFD) seems to increasingly be morphing into the term virtual front door (VFD) across the system.
It’s most likely because we now have scores (and maybe even hundreds) of digital single front doors in Australia, which is starting to create quite a bit of confusion among both providers and patients, in part at least, because of the word “single” is in the term.
It’s no one’s fault.
It’s what you get in a highly fragmented and federated health system when the technology behind virtual connected care becomes increasingly accessible to all parties, and all parties urgently want to create virtual access to their services, either to address critical workforce issues in some way, or because everyone else is doing it.
The problem is, if every type of provider and agency starts doing it – ED departments, most often by jurisdiction (read geography), PHNs on behalf of local regional GPs, private health insurers, state governments, hospital networks, individual GP providers, GP corporates, pharmacy chains, and so on, how does a patient navigate such a rapidly growing maze of front doors to get to the right service quickly?
Enter Healthdirect, the origin story of which is really as our first major national attempt at a virtual front door, if you can call a national telephone-based, nurse-manned triage service, a virtual service (which, technically, you can).
The fundamental idea behind the creation of Healthdirect just over 18 years ago, when virtual care technology was, in relative terms pre-historic, was a great one. It was an agreement by the Council of Australian Governments (COAG – so that all states and federal government) to improve public access to free health information by centralising the old model of jurisdictionally managed health phone lines to create a national service with improved clinical consistency and economic efficiency through reduced administrative duplication.
Healthdirect’s first and flagship service, a 24-hour, seven-day nurse triage service became operational in July 2007 in all states and territories except Victoria and Queensland. It has since got both those states over the line in joining but by no means do all states embrace the service wholeheartedly.
Now any rationally thinking person would think that such a service, if well run (it is by most accounts and based on a lot of emerging publicly available data), would have evolved to be ‘the point of the spear’ for the rapidly growing network of locally conceived and built virtual front doors around the country. This would especially seem to be the case if you think about the idea of having one centralised service to collect and analyse patient access data and patterns across the country, now with access to AI to significantly enhance analysis and analytics.
Now that the technology has become so inexpensive and accessible, regulation post-covid has become much more sensible and friendly, and workforce issues so critical, management in provider organisations of all sorts across the country – especially those in rural and remote areas – want to build themselves good virtual front doors for their patients. And they probably should be doing this.
But that ‘tip of the spear’ organisational role that seemed a no brainer for our only nationally authorised and co-ordinated virtual care triage service, hasn’t quite happened (yet).
Why hasn’t it happened, should it, and could it still happen?
If you’re a provider or an agency who has built out a form of virtual front door, or wants to build one, and is maybe a little confused as to where Healthdirect fits into the picture for you, and whether they are a likely friend or foe in your particular journey, you probably have lots of questions.
Next Tuesday at 7pm, Health Services Daily is holding a free webinar to ask a panel of experts from across a spectrum of providers struggling with the state of our emerging virtual front door ecosystem, including the CEO of Healthdirect, what they think.
You can register for free if you like HERE. If you can’t make it on the night, we’ll send you a link to watch the event after the fact.
If you’re thinking that Healthdirect are supporting the event (they are) so it’s going to be rigged in their favour, we have a very clear directive that no question is off limits, and all the panellists representing providers and any concerns have free reign to speak their mind on the topic.
Smallish spoiler alert: I think Healthdirect are fine to let things fly because when you hear their updated plans and objectives on access, it’s hard to see how it is going to hinder any individual provider building their own form of front door, if that provider has the simple objective of making sure their patients get to their service faster and when they actually need that service.
CEO Bettina McMahon says that the fundamental principle they are trying to help co-ordinate nationally is creating connections that get a patient to the right service at the right time via the shortest possible route.
She points out that the system and the parameters around how a patient gets to the right service in a timely manner are complex so it’s understandable that some providers can become sceptical about whether some sort of umbrella triaging service will get things right.
Ms McMahon points to 000, our most important national triage service, and says that while nothing will ever be perfect, there’s good existing evidence for the concept of some sort of secondary uniform triage service, a triple number service (111 or 222 for example) which would be phone or digital – that would almost certainly improve access overall.
“It’s all about making sure people get the advice they need or the connection they need to the right care the first time,” she tells Health Services Daily.
It looks like a big part of the problem so far is that the system is evolving so fast now and is so fragmented into individual jurisdictions, each with their own decision-making power on how they manage patient access, that the process of trust is going to take time and more evidence base in the form of data.
For example, some hospital EDs in some states maintain that Healthdirect is sending them too many patients they don’t need to see, so they don’t like promoting the service (this despite the fact that their state is paying for it to help them).
Ms McMahon points out that in some of these cases the ED departments in question aren’t getting the full picture on the patient data they are working with, which can cause a lack of perspective.
“One problem we have is they only see the people we send to them, not the vast majority who we connect with lower acuity care or self- care which is avoiding any ED visit they might have otherwise gotten,” she said.
“But that’s on us really. We don’t do particularly well at the moment with passing on all this information to EDs about our triage profile [and in that respect] we’re in conversation with a couple of jurisdictions now about how might we pass our full triage assessment to the ED triage nurse so they have more visibility on what is going on, including our risk assessment.”
An example of what Ms McMahon is talking about might be the data the group gathered on flu season ED avoidance in NSW earlier this year.
Healthdirect is already trialling a statewide virtual front door for NSW Health.
Some of that data this year includes that approximately 8000 patients went to ED with flu-like systems in June and July of this year but that 3000 consumers with flu-like symptoms who called Healthdirect and thought they needed to go to ED were recommended an alternate care pathway.
Despite the flu season being worse in 2024, according to Healthdirect the option of alternative care pathways meant they teduced the percentage of callers recommended to attend ED for flu-like symptoms from 33% last year to 22% this year.
Some other questions providers have about an overarching triage service, especially when they have developed their own include:
- Is putting another upstream step in the triage process going to inhibit or ultimately enhance a patient’s journey to the right care stream
- How does Healthdirect fit into the concept of “no door is the wrong door”, and
- Is the fact that Healthdirect is building out a virtual GP and specialist offering going to compete with my services or compliment what I do?
All these questions and more will be asked at next Tuesday’s webinar.
Register HERE.