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The healthcare revolution
Jeffrey Braithwaite
Jeffrey Braithwaite, President-Elect of the International Society for Quality in Health Care, and Founding Director of the Australian Institute of Health Innovation, gives a preview of what Australia’s future healthcare system should look like: AI-assisted, remote care for an increasingly older and chronically ill population.
Consulting a doctor from the comfort of home for your suspected cancerous tumour or a fractured collar bone; and artificial intelligence (AI) interpreting the subsequent medical image in the blink of an eye. These are the tip of the innovation iceberg in the revolution of the Australian healthcare system brought on by technology, and hurried along by the impetus of the COVID-19 pandemic.
The revolution is being built out of innovations everywhere you look. If we are scientifically smart and sociologically astute, this will add up to real and sustainable transformation.
"We will know we have succeeded when every Australian has access to the care they need, where it suits them and at a cost and in a form that is sustainable to the individual and the health system".
Not that long ago, it would have been inconceivable that appointments with general practitioners and specialists would not be held face-to-face. The old saw said you only had to look in a waiting room to see why everyone was called a patient – they had to be. But the COVID-19 pandemic catapulted telehealth from the edges of clinical practice to a nationwide front-and-centre-response.
This is a particularly good news story for those who are older or living with disability, and now no longer needing to leave home to consult a healthcare provider. With the use of technology, they can receive advice and obtain prescriptions and referrals in a time and place that suits them.
The shift to telehealth is not on its own truly revolutionary – it is more of a natural evolution, because the technology has been around for a while.
The backstory that it’s part of – the problem that needs to be solved – is worth recounting. Already a million Australians are aged over 80 years and this is on the rise. A woman aged 65 years today can expect to live almost another 25 years, and a man perhaps 20.
This is good news, but it also places a huge load on the health system. Older people, even healthy ones, need more care. One in every two Australians is now living with at least one long-term chronic condition such as diabetes, heart disease, kidney disease, arthritis, asthma or cancer. Regular and more frequent contact with health professionals is needed to support such people – and not just treat them, but help them manage their own health and avoid acute episodes that may result in hospitalisation.
Health systems and medical researchers, alongside many clinicians, had for some time advocated the normalisation of telehealth to lift the burden of frequent out of home healthcare. It took the self-isolation and physical distancing requirements brought on by COVID-19 to drive the policymakers to move barriers and enable the change; and of course, for the Federal Government to fund it.
Canberra did that overnight. But that innovation is only a modest down-payment on the real revolution encapsulated in the march of astonishingly clever machine learning in healthcare. Not only are AI models now able to interpret medical imaging with great accuracy, AI enabled decision-support technologies are unlocking the possibility of truly personalised medicine like never before. If we support clinicians through AI we can get faster and better diagnoses, tie together huge data sets including genomics data, and genuinely take on board patient preferences, we will be witness to a prodigious leap forward in care.
But what’s often lost in the headlong rush to exploit technology is that it all comes at a cost and health systems and governments will need to think and act strategically to stay ahead of the curve. Telehealth funding models were devised in haste due to demand brought on by the coronavirus pandemic and will require fiscal retrofitting to be sustainable.
In the future, funding models should anticipate change and lay the foundations for well resourced, equitable and safe implementations – whether in times of crisis, or more considered eras.
Yet there’s something more. We have to figure out how to package all this change into a modernised health system for everyone. At the crossroads of people, technology and funding is the development of what we call a learning health system. This is one that is able to unite these innovations and adapt to them in real-time – because change is not a thing, and never a destination, but a journey.
So, system-wide, clinically oriented and patient centred outcomes will be possible like never before – if we exploit technology well. Last century we were asked to think global and act local. In the 21st century a better aphorism is to reimagine change over and over again, off into the distant future.
A learning health system is what is going to make this work. For Psek and his colleagues, this is one which can “… utilize sophisticated technologies … to integrate clinical operations, research and patient participation … to continuously generate knowledge, improve care, and deliver value.” Or, in ordinary language, make the health system better each day than the day before.
It’s a set of arrangements that leverages learning – whether via sophisticated information technologies, or data mining, or machine learning, or genomics. This will enable us to more quickly and more precisely match the best available approaches to treat every patient’s unique and individualised needs. Essentially, we will be putting all the information that is needed in the hands of clinicians and patients so they can make much better decisions.
Australia’s healthcare revolution is not about small intubations brought about by any one new technology nor a knee-jerk reaction as experienced due to COVID-19. As important as that is, it won’t last forever. But the continuous revolution I have in mind comes from the significant changes to our population demographics, our opportunities with technology that we haven’t even invented yet, the dedication and professionalism of our healthcare workforce and our ability as a prosperous nation to support new funding models to pay for it all.
It was Buckminster Fuller, the American architect who said “You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.”
Let’s do that continuously. We’ll have healthcare that will flourish for decades to come.
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In 2016 I published a blog article titled Moonshots for Australia: 7 For Now. It’s one of many I have posted on business and innovation in Australia. In that book, I highlighted a number of Industries of the Future among a number of proposed Moonshots. I self-published a book, Innovation in Australia – Creating prosperity for future generations, in 2019, with a follow-up COVID edition in 2020. There is no doubt COVID is causing massive disruption. Prior to COVID, there was little conversation about National Sovereignty or supply chains. Even now, these topics are fading, and we remain preoccupied with productivity and jobs! My motivation for this writing has been the absence of a coherent narrative for Australia’s business future. Over the past six years, little has changed. The Australian ‘psyche’ regarding our political and business systems is programmed to avoid taking a long-term perspective. The short-term nature of Government (3 to 4-year terms), the short-term horizon of the business system (driven by shareholder value), the media culture (infotainment and ‘gotcha’ games), the general Australian population’s cynical perspective and a preoccupation with a lifestyle all create a malaise of strategic thinking and conversation. Ultimately, it leads to a leadership vacuum at all levels. In recent years we have seen the leadership of some of our significant institutions failing to live up to the most basic standards, with Royal Commissions, Inquiries and investigations consuming excessive time and resources. · Catholic Church and other religious bodies · Trade Unions · Banks (and businesses generally, take casinos, for example) · the Australian Defence Force · the Australian cricket teams · our elected representatives and the staff of Parliament House As they say, “A fish rots from the head!” At best, the leadership behaviour in those institutions could be described as unethical and, at worst….just bankrupt! In the last decade, politicians have led us through a game of “leadership by musical chairs” – although, for now, it has stabilised. However, there is still an absence of a coherent narrative about business and wealth creation. It is a challenge. 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There were workshops, consultations with industry leaders, and conferences across industries to pursue a national microeconomic reform agenda. Remember these concepts? · global competitiveness · benchmarking · best practice · award restructuring and enterprising bargaining · training, management education and multiskilling. This agenda was at the heart of the business conversation. During that time, the Government encouraged high levels of engagement with stakeholders. As a result, I worked with a small group of training professionals to contribute to the debate. Our contribution included events and publications over several years, including What Dawkins, Kelty and Howard All Agree On – Human Resources Strategies for Our Nation (published by the Australian Institute of Training and Development). Unfortunately, these long-term strategic discussions are nowhere near as prevalent among Government and industry today. The 1980s and 1990s were a time of radical change in Australia. 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