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Talking HealthTech

Talking HealthTech

Discussions with doctors, developers and decision-makers in Australian HealthTech

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25 – Matiu Bush, Health Transformation Lab RMIT

Matiu Bush is both a clinician and a designer who founded One Good Street, a social impact platform to encourage neighbour initiated care for older residents at risk of social isolation and loneliness. 

Matiu is the Deputy Director of the Health Transformation Lab at RMIT, designing cultures of innovation and creativity in healthcare. 

He has a Master's degree in Public Health and broad clinical experience as an emergency, oncology and intensive care nurse and he is also a sexual health Nurse Practitioner.

He’s a board member of Better Care Victoria and the Emerging Leaders Clinical Advisory Committee.  He is a super active member of HISA, a Rotarian, and a mentor for undergraduates and post graduate science students.

 

Overview

[01:30] Neighbour initiated care lifts the social capital in neighbourhoods, it improves house prices and creates an alternative value economy.  The One Good Street is a platform to enable and scale those initiatives.

[05:00] Salutogenic Design can be used to avoid building tech that is beautifully useless.  It is about design that focuses on reducing stress levels and promoting wellbeing. Opposing the pathologising of humanity when you walk into hospital.

[07:30] Guerilla information provisioning uses nudge theory to teach people about their health condition in the peripheries.

[08:30] Citizen driven science looks at how to get citizens to help solve complex problems 

[10:15] The RMIT Health Transformation Lab uses “The Treatment” as their design mythology, which involves ‘deep hanging out’, or anthropology (the study of humans).  Just shutting up and watching.  

[10:30] They also use the Causatory reasoning method, which calls for ‘descending into the particular’ and ignoring generalisations. 

[11:30] The saluto-technical approach marries salutogenic design principles with new technology, in an effort to stop the fetishisation of technology in healthcare.  Otherwise we are so close to data but so far from the truth. There is a need to provoke the sector to do better so we don’t design technology that is beautifully useless.

[15:30] Technology needs to be designed while keeping the readiness of the health ecosystem in mind.  

[17:50] The Cisco Digital Maturity Index helps you determine the level of work that will be required to implement new technology in a health organisation, depending on its appetite and ability to adopt technology. 

[22:21] Matiu had a falling out with Mother Teresa in Tijuana…

[24:00] Sanctuary trauma is what happens when you go into healthcare and they are meant to look after you and they don’t.  This can be avoided by involving the third sector of healthcare - those groups like schools, volunteers, rotary, Australia Post etc that have a legitimate place at the table with clinicians.  

[25:00] Doing tech better in health will enable relational health - where doctors will ask more about your relationships to see a better ‘return on investment’ on your treatment, to help you stay healthier for longer.

 

Links

Talking HealthTech Podcast

Talking HealthTech Community

One Good Street

One Good Street Facebook Community

Health Transformation Lab

Rotary

Transpire’s Vodafone Dreamlab

Cisco Digital Maturity Scaling 

 

Transcript

[00:00:00] Pete: [00:00:00] Welcome to Talking HealthTech. My name is Peter Birch, and this is a podcast of conversations with doctors, developers, and decision makers that are playing in the Australian HealthTech scene today. 

Here with me today's is Matiu Bush.  Matiu is both a clinician and a designer who founded One Good Street, a social impact platform to encourage neighbour initiated care for older residents at risk of social isolation and loneliness. He's the Deputy Director for the health transformation lab at RMIT, designing cultures of innovation and creativity in healthcare. He has a master's degree in public health and broad clinical experience as an emergency oncology and intensive care nurse, and he's also a sexual health nurse practitioner.

[00:00:40] He's a board member of Better Care Victoria and the Emerging Clinical Advisory Committee. He's a super active member of HISA. a Rotarian, a mentor for undergraduates and postgraduate students and he's here sitting in front of me now.  Matiu thanks so much for joining.

[00:00:53] Matiu: [00:00:53] Pleasure, when you read that out I sound exhausting.

[00:00:57] Pete: [00:00:57] It's comprehensive and it's, and it's well learnt and it's [00:01:00] exciting to have you in front of me. I've actually, you've, come here after going to event. I saw you at an event a couple of months ago now, and it's taken this long to get you into the studio.

[00:01:10] Matiu: [00:01:10] Good to be here.

[00:01:10] Pete: [00:01:10] Thanks for coming in. Look, we've got so much to  cover as well, but look, we'll, start with something that I first heard about when,  I saw your talk, which was about the concept of neighbour initiated care. Tell us more about about that platform that you founded, The One Good Street and why it exists.

[00:01:28] Matiu: [00:01:28] So there's a GP who lives on my street. He's retired, he's 84 and when he falls out of bed, I go and pick him up. And that active neighbour initiated care saves an ambulance fee as well as an ambulance trip, as well as an admission into ED. And for someone who's 84 often they are triaged as a category three or four.

[00:01:47] So he probably deteriorates and doesn't have a tea or any food or anything fluids whilst he's there, cause EDs can be quite ageist. So for an 84 year old, that's a pretty scary experience. So that act of his daughter calling me and me going to [00:02:00] do that,  I reckon we save around $3,000 for the state budget in healthcare. It also helps the ED meet their four hour target, which is important because they want to get people in and out within four hours.

[00:02:11] Pete: [00:02:11] It's such a  simple thing to do

[00:02:13] Matiu: [00:02:13] Correct and I do joyfully because what it does, it lifts the street capital, the social capital in my street. My street's a great street to live in. That impacts property prices. When new people move in, they're like, gee, everyone's so friendly and everyone helps each other out. So there's an alternate kind of value economy happening when you do those sorts of things. And so I started to talk about that, and more and more people would say, I do the same thing. So I developed a platform that enables people who want to do great things for older people in the neighbourhood for that to occur. And that's called One Good Street.

[00:02:45] Pete: [00:02:45] Wow. What about Health Transformation Lab, what does that do?

[00:02:49] Matiu: [00:02:49] Yeah, so we're a newly formed lab that's anchor funded by Cisco, and it's part of RMIT's new vision of how to integrate with society [00:03:00] and industry and industry partnership. And so we're pretty radical. We'd call ourselves anti-disciplinary. Okay, so leave your specialisation and come on a creative journey with creative bravery and creative leadership, as we attack and approach and tease apart and grapple with the thorniest and most wicked problems in healthcare. So we're all hybrids. We're either a clinician plus something else. I'm a clinician designer. We've got an architect who's become an anthropologist, who's become a project worker and human centered design, an indigenous consultant and now works for us. We've got immunologists that are expertise in loneliness and isolation. So if you're a hybrid and you don't fit in anywhere else, you fit in in the lab because we actively seek a neuro diverse group where contestability is the hallmark. We don't want echo chambers. And so people come to us with healthcare problems. So a hospital might come and say, we've got a problem with discharge planning and getting [00:04:00] letters to GPs, and we'll tease that apart and map the ecosystem of the problem and then suggest very radical solutions to that. Looking at the latent capacity that exists in our neighbourhoods. So for example, thinking about discharging to rotary. So an 84 year old's discharge automatically a letter goes to GP, but it also goes to the local rotary. So they're there to catch them. Make sure there's food in the fridge. Make sure they take their meds that they get to their outpatient appointments.

[00:04:32] These are ways that we can tap into this network of support. Because in healthcare, we see people in tertiary hospitals, we discharge them, and if we discharge them to nothingness, loneliness, isolation, no support, no family, there's no return on investment, we're immediately failing and they'll end up back in.

[00:04:50] So that's the kind of solutions we bring. We think about, we use the cybernetics lens, which is really kind of radical, which I'll go through in a minute. We also think about [00:05:00] salutogenic design. When we're designing technologies, we don't want to make stuff that's beautifully useless.

[00:05:07] There is plenty of beautifully useless tech out there. That quantifies everything about you.

[00:05:14] Pete: [00:05:14] Beautifully useless, I can think of about a few different examples of that.  Okay salutogenic design. That's a cool name for something I don't know about so I'm going to get you to tell me you about it!

[00:05:26] Matiu: [00:05:26] Based on the Italian root word for Saluto or Saluto is health. Okay. Janet has generation or the genesis of the beginnings of, and it's all about design that focuses on reducing your stress levels and promoting your wellbeing. So it's kind of anti, it stands opposed to the pathologising of your humanity when you walk into hospital.

[00:05:49] So a salutogenic design, will focus on designing towards things and services and processes that help you manage your condition better, make it more [00:06:00] comprehensible so you understand what's going on, and also make it meaningful for you. And that can be from built form, interior design, lighting, collateral development, wearable sensors, technology, AI, machine learning, system design, even comms design with how your staff talk,  admin staff, for example, talk to patients. It can be wayfinding. Everything we do should be increasing a patient's manageability of their condition. Can we make this more manageable for them?

[00:06:31] Can we make it more comprehensible? The letters they receive a clear, they can understand what they're doing there in that outpatient department, and we invite meaning, how do they feel in that moment? And that I think delivers a much better patient experience.

[00:06:44] Pete: [00:06:44] So at the labs, some of those, are they, are there, are there been solutions that, an example of a solution that you can talk about? So something that has come out of it ? So two questions then, what does it look like when it goes into the lab, you know, a problem comes in, do people just draw on a [00:07:00] whiteboard  and then what's been some of the outcomes and the benefits of that.

[00:07:02] Matiu: [00:07:02] So for example, a cancer hospital came in and said, Hey, we want to build some kind of curriculum or university or school where people can learn about cancer. And we took that problem and we teased it apart. And on reflection, we were able to demonstrate that people want to spend as little time as possible learning about their cancer because cancer is a thief for them, just robs them of everything.

[00:07:26] So the last thing we want to do is allow cancer to rob more time for someone who's got a time limited illness. So we worked on a something called guerilla information provision. That is using a whole lot of nudge theory where you can inform and teach people about a health condition, but in the peripheries, and that can be with augmented reality. it can be with fridge magnets, it can be with decks of cards. It can be a whole range of other ways that subtly inform people that it's always at the periphery and when they need it, they can grab it, but it's not [00:08:00] forcing into them a whole lot of, collateral around cancer. And that's what came out with a whole lot of students who have developed all these great little prototypes of board games which built health literacy, but not intentionally doing so, of using augmented reality that allows you to observe from a really high level your entire cancer journey. But you don't have to engage with any of them. You can just marvel at how beautiful and how cool it is and share it with family and friends and say, hey, check this out.

[00:08:27] In doing so, you're exposing people to a range of things and you can nudge them in the direction of that. That's one example. Health, citizen driven science is another one. So for example, in the UK, they have trained  normal everyday people to look at mammograms and detect cancer And they get like 96% accuracy after awhile. Yep. So it gives you an idea of when someone comes to us and says, hey, we've got a problem, we'll look at it in different lenses. For example. a provider came and said, well help us understand citizen [00:09:00] science. How do we get citizens to help us out? And then we're able to expose them to a range of things. For example, there is a great company in Melbourne called Transpire who've developed an app where you can donate your phone data or phone processing overnight, and it runs computations from cancer research overnight. And in doing so, they reduce the overall time of producing the data that's required for the research.

[00:09:25] So latent capacity, they are the sorts of things that we expose people to and provoke. These are provocations to the sector. So you might come in and say, Hey, I've, here's our problem and we might take you to a completely different destination and more likely with a really unusual partnership where you didn't think of. So for example, we might say Australia Post is going to be the best person to partner in loneliness and isolation because who visits your house every day all around Australia. There's this capability. that's what we're doing. We're grafting in the solutions because the solutions aren't with those that are the [00:10:00] problem custodians. And most healthcare try and solve their own problems. And they marinade in it for years and years. And if you've been to enough health conferences in your time, you'll hear the same stuff repeated over and over again. So that's what we do. Come into the lab. They tell us their problem.

[00:10:15] We've got something called the treatment, and the treatment is our design methodology. And it's really unusual. We do, a lot of anthropology deep hanging out. That's how we found out about why you should never give a cancer patient anymore to read because, we mapped a lady, who was 84, and in her home she had 186 pages worth of patient information she had to get through. And we knew that whatever you do, whatever you design, you can't make that pile. So we use anthropology.  Deep hanging out. It's where you shut up and just watch. We also do a, use a Jesuit reasoning method called Causatory, where you descend into the particular, you ignore all of the generalisations that come before and you descend into the [00:11:00] particular, and a good example of that is using chatbots in health.

[00:11:04] And lots of people say you've got to be specifically trained, these as highly specialised, you could never push this to code. But all of those generalised principles occurred before chatbots developed. So we need to delve into what chatbots can do and then generalise out from that new beginning. A word for a chat bots, a world full of AI, machine learning.

[00:11:25] Pete: [00:11:25] That's going to lead onto my next point because, you're focused on transforming health,  and technology is often seen as the solution to do that. How should we be designing technology to transform health?

[00:11:39] Matiu: [00:11:39] We've got to stop fetishising it. There's an absolute fetish for technology and people believe that technology will solve so much of healthcare, but you can have great tech grafted into a crap system that's a crappy outcome and patient experience and our systems aren't ready for the technology. That that's way ahead. [00:12:00] We've developed something called saluto-technical and the soluto-technical approach really marries that salutogenic design principles with new technology. So that's where whatever you design, is it more meaningful for the individual? Does it also respect the ecosystem? And I'll give you an example.

[00:12:17]There's mattresses now that can measure your heart rate, and if your heart rate changes, they can send an SMS off to family.  It won't be going to the GP cause he's he or she's never gonna look. So to family, and then family can respond. The tech is beautiful, but if your Chihuahua hops on the bed, you're going to be tachycardia and your family's going to get an SMS saying, hell, what's going on? And it's the Chihuahua.

[00:12:38] Pete: [00:12:38] See I get excited by these things and then I think about the practicality.

[00:12:41] Matiu: [00:12:41] That's right. So they're for people developed in isolation who don't have dogs. Also, they don't have partners. So if granddad or grandma decided to bring home someone to entertain one evening, and they're having sex you're going to get an SMS saying the heart rates are regular, right? So what they haven't done is had a real [00:13:00] human perspective. Actually they haven't had a life perspective of what it's like to live in somebody's house. And when you introduce technology into a house, it changes the relationships. So what we think is that saluto-technical approach is really mindful of the human, really mindful of the ecosystem. So I wouldn't put any tech that monitors anything into someone house unless its has a purpose for health outcomes.

[00:13:24] Otherwise we are so close to data so far from the truth. So I can have everything about you knowing about you, but there's, but then you're isolated and lonely. So we know you're using the fridge. So you're eating, you're drinking, your heart rate's regular, but you're not speaking, for example, cause you've got no friends and you're 84 and your life is miserable.

[00:13:44] So they are the sorts of things we try and provoke the sector to do better so that you don't design technology that is beautifully useless.

[00:13:53] Pete: [00:13:53] The, concept of so close to data and so far from truth that's almost like this [00:14:00] big mind blowing moment  from my side , I'm, extremely curious about that. We're collecting all this data. and, so much values placed on like, thinking from a health company or a vendor's perspective, it's all about the data play at the moment. How are we going to, extract more data of value from this data or collect more data? What do we do with it all? It sounds like we're not doing enough or the right thing.

[00:14:28] Matiu: [00:14:28] You've got ecosystems, health models of care that are really impermeable to it. So for example, at home, let's say with your grandparents, if we put tech in the house, it's giving us a lot of information. Some of it's incredibly useful, but it meets a model of care that's resistant and hasn't transformed itself. So that data doesn't go to the community nurses. It doesn't go to the care workers. So it's all the responsibilities put back on families to manage that data. When you've got data about your grandparent's house and their activity. Then you've, you've changed the power dynamic.

[00:15:00] [00:14:59] How much of that do you share when you see that they've been watching TV all day and done no exercise and  your mother phones them and she says, Hey, they're fine. They've had a great day, they'd been doing lots of things and you see the data and they'd been on the, on the couch day.

[00:15:12] You changing family dynamics and that's not addressed in the technology that is going into people's homes. So first of all, it, it pushes more responsibility on families. It also meets a care system that doesn't know what to do with it because it hasn't changed its model of care.

[00:15:28] There's no tech prescriptions. So if you came to see me with congestive heart failure, I don't prescribe for you a range of, bluetoothed blood pressure machine, scales, some apps, whatever it is, some sensors in the house, none of that goes out with you as the first line. What we do is send a community nurse out to, so you've got this, this model of care that just  hasn't caught up with what the possibilities they haven't transformed itself.

[00:15:55] So these, there's that. We're collecting a lot of data and now normally in a hospital, [00:16:00] a clinician will decide and if you like, prescribe or dictate what data should be collected and when. So for example, four, hourly two hourly, 15 minute obs, you know, we are used to doing observations within a particular context. When you put a whole data on people's homes and make them all smart and connected on the person, but also in their environment, there's no way of turning that up and down. So we can, I can imagine getting to a stage where people are palliative, people are dying and you're still recording heart rate and doing all this other stuff that it doesn't matter anymore. And that's where you can be so close to data so far from the truth.

[00:16:35] Pete: [00:16:35] Wow. That's pretty crazy. I mean, it changes then. You know, how technology is  developed, how it's solving problems, then we've got so many tech vendors in Australia, and growing globally, everyone trying to solve problems in healthcare, and at least in Australia, then well, you know, it hasn't caught up yet. And a lot of them are backed by private equity or backed by anyone that [00:17:00] that is looking for return on their investment. What do you, what are they doing until then? Do they just keep. developing and hope for the best?

[00:17:08] Matiu: [00:17:08] I mean, it's a marathon, it's a marathon journey. Lots of people in tech, vendors and startups in healthcare. I think they jump in and because they can see it. But then they made a system that can't see it because there's lenses and dare I say cataracts in the way of seeing  a future. So I think there's two things there is they their respect for the ecosystem and understanding the maturity of the ecosystem and almost benchmarking the organisations you're working with to understand the maturity. One thing a lot of startups come to me and say is, Hey, we thought we could just deploy and go. But three months later, we're still training staff. We do, we're doing the training, I'm doing the videos, I'm doing the PDF.

[00:17:48] Pete: [00:17:48] I've got to go there in person,

[00:17:50] Matiu: [00:17:50] Correct. And that's because they haven't understood the digital maturity of that organisation. And Cisco do a great maturity scaling, where you can benchmark, and I [00:18:00] would encourage startups when they go and they get their customer. Before the high fives and the beers, benchmark them on their digital maturity. Go to Cisco's website, find it out and see about benchmarking because you'll get a sense of how much more you're going to do because you're most likely gonna have to recruit a project manager to help with the integration of the technology.

[00:18:19] I rolled out virtual reality in a major, major hospital five years ago, and if I did not constantly manage those devices, they would always end up out of battery in the cupboard. So when we walk away, our technology can completely fall over. The one thing also is really work on user experience.  Because clinicians, often will have different ways of working and so it's always worth spending time on the UX of it, but understand that from a procurement point of view, hospitals don't pay for UX. If you're a major hospital and you're purchasing a whole lot of tech, you're going for the cheapest. You're not going for the one that clinicians love the [00:19:00] most because the UX is the best. So that's also about a UX maturity within the sector.

[00:19:06] So it's an absolute hard slog. You can either run away now, which I encourage you to just run away and go and work somewhere else. Cause it cause it's hell on earth. It's a blood sport. Or if you're going to hang in there, and watch Game Of Thrones and House Of Cards as professional development because all of those skill sets will come in hand.

[00:19:24] Pete: [00:19:24] Nice one. That's so true about onboarding and UX. I mean it's just two areas of such pain that, 9 times out of 10, that's where I'd see most HealthTech or any tech really, but predominantly HealthTech would fall over.

[00:19:38] I was reading your bio. As complete kind of left field... You worked with Mother Teresa?

[00:19:45] Matiu: [00:19:45] Correct.

[00:19:46] Pete: [00:19:46] Really? Like THE Mother Teresa not someone with the same name

[00:19:48] Matiu: [00:19:48] When I was 19 I was studying design in Sydney and the Somalian famine was happening. So I'd finished design school and then headed home, and all these starving [00:20:00] people were on TV and I was 19 so it had rather an impact. And I was in a bookshop and I saw this nun on the cover of this book. Anyway, I brought it read it and I wrote her a letter at 19 she wrote back to me and said, come and work with me. So I bought a one way ticket to Calcutta and started working with her in their home for the dying. And also there was, a whole range of stuff like orphanages and soup kitchens and medical dispensarys.  A whole range of things.

[00:20:28]I then went to Mexico into Tijuana and lived in the slums and Tijuana and worked with her there. And we ran a soup kitchen and, a feeding dispel like food dispensary, where we had lots of great benefactors in the U S that would donate a lot of, food. And we were supporting hundreds and hundreds of families per week in that environment.

[00:20:48] So she taught me a lot about what's very practical, but she also taught me a valuable lesson. She actually made a mistake. She made the mistake of using the poor people as the raw [00:21:00] materials for her expression and her philosophy on life. She robbed them of autonomy because she needed them to be poor and grateful because that fitted into her worldview. And I have always taken that away with me, that wherever I work with marginalised people, that the most ethical thing to do is provide choice. And lots of quality choice. But Mother Teresa didn't provide quality choice. It was either curl up and die in one of our homes with minimal medications, certainly know pain relief because of the belief that suffering is somehow worthy in the Christian philosophy. So therefore she robbed them of choice. And I dare say that's unethical.

[00:21:45] Pete: [00:21:45] Sure, wow.  And to go through that at,19-20 years of age, like to go through that learning experience...

[00:21:52] Matiu: [00:21:52] It's great, so four and a half years later came back to Australia and, and it was a great formation. I mean, plenty of practical things [00:22:00] just to start. So for example, I run air-con clubs, so when it's hot in Melbourne, then we open up our home to older people in our suburbs so they can come and spend time with our air conditioning. And we have solar panels that works well. What it does is simply reduces heat exhaustion for those people that wouldn't turn on the air-con because they have limited pensions and they're also really concerned about electricity prices.

[00:22:21] So when I ran the first air-con club, somebody brought a rabbit because they needed a rabbit cooled in the heat. And so from a Mother Teresa perspective, you just start, you start small, like the micro ambition of her where she just started, picked up poor person that was dying on the street. Found a house to store them so they could at least die with some dignity, and off she went.  And I think she knows scale up better than most startups, because I think she was in like 160 countries by the end of it. But what she did, she scaled up that Calcutta model everywhere. And so when I was in Tijuana, I remember writing a letter saying, you can't take your model from Calcutta and introduce it all over the world when they surrounded by [00:23:00] medicines that could support them. These people shouldn't be dying because you should be giving them antibiotics, or taking them to a hospital sooner. And that's where I came unstuck with Mother Teresa.

[00:23:10] Pete: [00:23:10] Oh, damn that's awesome. so what is, as we're winding to the end of this conversation then, looking to the future, say we say we nail it Matiu, what does healthcare look like in 5 or 10 years?

[00:23:26] Matiu: [00:23:26] If we nail it, it will be radically democratic. And it will include the third sector. And the third sector is Rotary. It is schools, it is volunteers, it is corporates. It is unexpected people involved. And that includes people like CommBank, Australia, Australia Post, so that they have a legitimate place at the table along with clinicians. So if you had. Stage four colon cancer. That part of your support team would include the community and that would be digitally enabled so [00:24:00] that there are platforms that all of the tech is just a tool for connection. So you would be well connected and it would be really meaningful for you. You'd enter a system that would not traumatize you. Sanctuary trauma is what happens when you go into health care and they're meant to look after you and they don't. You get traumatized. If we nail it, that won't be there. And it's more than just soft furnishing and lighting and some leafery. It's about a whole system transformation that's very, very deeply focused on the individual and their experience.

[00:24:31] But that scaled up, so it can not just deliver it for one person, but deliver it for ten. And that it's so ingrained in the model that it can do it for a hundred people every single day. And that's where we need to evolve. And it is organic. It's not just structures getting different parts right and then sticking them together. Healthcare is organic, as we are, and it should be relational. I think there'll be a much greater focus on relational health. So when I [00:25:00] see you as a patient, I'll be asking, talk to me about your relationships, because if I spent all this time fixing your knee, fixing your diabetes, and then I discharge you out into the community, I want a return on investment. And that only works if you've got really healthy relationships. So I see a much stronger swing to relationships and then enabling those around you to support you. And the tech just enables that. And I think with tech, the best way to think about it is we are the artists and the tech is the brush. And we're painting great futures for ourselves, but that we paint what we desire. We code what we desire. And so the tech never runs away. And then we can avoid this ridiculous malignant prophecy around technology and what it will do in health care in regards to everyone's losing their jobs, we'll have these stupid robots saying hello to us, stuff like that. You know, it's, the future will be far more, organically evolving and we will never ever make it. It will be constantly [00:26:00] evolving, and that's the beauty of it. And I think that's why a lot of people stay in healthcare because of the turbulence and the mess of it all, and also the brilliant outcomes.

[00:26:07] What we want is to reduce that heroic effort of clinicians who stay over time. There are people now who will stay, so it's  3:30 now. There'll be clinicians who will do three to four hours overtime to get the job done today. We want a healthcare system where they don’t have to do that, and if tech helps, great.

[00:26:27]Pete: [00:26:27] The challenge I think as well from,  what you were saying, you're talking about starting small and doing something that that's meaningful in a, in a neighbourhood or like back, to those  Initiatives, and the things that are really meaningful in a relationship perspective, are usually one or quite a small, a little impact. It's, it's then making that scalable is probably where a lot of people get unstuck too. Cause there's all these little pockets of, really good stuff,   and, if technology can enable that scaling, then that's when we start to really, It's some big wins.

[00:26:53] So, to close out then, how do people find out more about or get involved with, some of those initiatives?

[00:26:58] Matiu: [00:26:58] Brilliant.  So if you [00:27:00] look up onegoodstreet.com.au, that gives you a rundown.  Join our Facebook group, One Good street, and you'll see all the kind of stuff that we do. And some of it is just acknowledging what you already do. So there's nothing new because some of you are out there doing amazing things for older people. You look after a Nona, you do the gardening, you do all this stuff already.

[00:27:17] Australia does this in a flood, in a fire and a fun run. We just designing ways to do it more regularly and Australia needs help in scaffolding that; both ways. Patients, we as Australians find it difficult to ask for help. Which is why we end up with lots of lasagna in our fridge when we unwell.And we're like, can someone just change the sheets on my bed because I have broken my shoulder. So we've got to scaffold it.

[00:27:44] And so, join One Good Street and check out the Health Transformation Lab. our website we've got, it's fresh. It's very radical. when I look at it, I've been in design for quite some time and normally you get this double diamond kind of shape of [00:28:00] exploratory iteration on that kind of stuff, prototyping... We're way off script. So what I would say, if you're a clinician or a designer or somebody where you never fit in because of the way you thought, then we are going to be in new home.

[00:28:13] Pete: [00:28:13] Wow. That's awesome. There's so much to follow up on. It's been, it's been a fascinating chat Matiu, and I look forward to having many more like that in the future. Thanks so much for your time.

[00:28:21] Matiu: [00:28:21] Pleasure.

[00:28:22] Pete: [00:28:22] Thanks for listening to talking HealthTech. My name is Peter Birch. Go do some stuff on our socials and website. Share it with some people and give us a nice review and a five star rating because it all helps to spread the word and get people talking. Until next time I'm out of here.

November 18, 2019

24 – Julien de Salaberry, Galen Growth Asia

Julien de Salaberry is the Founder and CEO of Galen Growth Asia, whose mission is to build a sustainable and vibrant HealthTech ecosystem across Asia by scaling digital health innovation through industry partnerships.

He has over 15 years of experience in healthcare with leading brands including Eli Lilly, Boston Scientific, Baxter, GSK, Merck&Co., and he has a deep understanding of healthcare in both developed and emerging markets.

In 2012, he founded The Propell Group (TPG), a boutique venture investor firm, based in Singapore, which focuses on HealthTech startups and growth companies. Since 2012, TPG has invested in 23 companies including 4 successful exits.

In this episode of the Talking HealthTech podcast, Pete and Julien talk about the key trends in Asia Pacific HealthTech, and some of the exciting technologies coming out of Asia solving big health problems.  Julien also deep dives into some of the more macro issues impacting healthtech in Asia at the moment such as the US/China trade war, and the United Nations Sustainable Health Goals for 2030.  

November 11, 2019

23 – Frank & Lorraine Pyefinch, Best Practice Software

Frank & Lorraine Pyefinch of Best Practice Software are two iconic and down to earth players in the Australian Practice Management System game.  

Dr Frank Pyefinch is not only founder of Best Practice, but also originally the founder of Medical Director - the number 1 and 2 practice management systems for Australian GPs today, and have been for many years.  

As CEO of Best Practice, Frank brings with him a long and proud history working as a busy GP, and Lorraine as a registered nurse - so together they understand first hand the challenges and needs of the medical community when it comes to software and technology.

Overview

[02:07] Genie was first created because Frank doesn’t like Mac

[02:45] The first PMS in Australia (Medical Director) was created by Frank because the poisons act changed in Australia allowing typed scripts, which included computer generated ones. 

[06:38] The break-even point for MD back in the early 90s was 200 sites.  This seemed an ambitious goal at the time. Today Best Practice Software has over 4500 sites.  

[06:49] The name “Medical Director” came from Lorraine looking through Job Classifieds in Aus Doc magazine, and liking the attributes of a ‘Medical Director’.

[07:58] The original Medical Director logo was created by Lorraine with the kids etch-a-sketch in the back of the family car

[08:30] The first copy of Medical Director was sold on it’s launch at the AMA’s annual computer day conference in 1992.  

[09:00] In 1994/95 advertisements started to be inserted into the Medical Director software, which subsidised the program heavily.

[09:30] In 1999 Medical Director was sold to Health Communication Network (HCN).  Frank and Lorraine went to HCN with the business.

[10:30] Frank and Lorraine left HCN in 2003 as they were dissatisfied with the increasingly intrusive advertising being placed in MD to raise revenue.  They sat out their exclusion period in their contract, and during that time Frank went back to being a GP in Bundaberg while writing Best Practice.

[12:00] There were no standards for medical software at that time.  If there were, it’s likely the product would never have been built.  

[14:00] Frank and Lorraine have seen Medical Software evolve from a text mode dos interface, to a graphical user interface, to the introduction of tables and touch screens.  Now seeing a bigger emphasis on communication, and also now a shift to the cloud, which is driving the development of their Titanium product to be released next year. 

[15:07] Frank still does some programming in Best Practice even today, because he enjoys it.

[17:34] Some of the government brain waves aren’t clearly thought out, such as the PHN’s collecting data for the QI Pip.

[18:55] The biggest cause of support issues for Best Practice are Medicare claims not reconciling due to the archaic nature of the Medicare adapter.  BP is hoping Medicare shift to web services before BP release Titanium so they don’t need to integrate with legacy technology in the cloud.

[21:15] During the roll out of the then PCHR, now My Health Record, during the Royal Review, Frank and Lorraine provided the suggestion that Doctors should be remunerated for uploading summaries to My Health Record as it was additional admin work they were not being paid for.

[26:51] The BP Partner Program has been launched in order to give partners more controlled access to the BP database so they don’t need to hack their way in, and only get access to what they need - protecting the partner, the patient, the practice and BP. 

[31:10] Pathology requests in PMS systems is standardised as SNP and QML, two competitors came together in the early 90’s came to the PMS providers and standardised the format of the forms, which set a format for future pathology vendors.  This didn’t happen with radiology which is all over the place

[33:30] The ADHA is making strides towards their goal of interoperability, for example with secure messaging, although is Secure Messaging the best way to go about it, perhaps web services for a central repository would be a more modern way to go about it.  

[35:30] Titanium has not been released yet due to the sheer amount of work to build 30 years of product development from scratch into the cloud.  The business was also distracted by recent acquisitions which expanded their reach into Allied and NZ markets. Ultimately all products will be rolled into Titanium their cloud product.  

[40:15] BP are soon releasing their patient app, they see it as a future direction for practices wanting to engage more with patients 

[44:50] A big consideration for BP in rolling out the patient app was the potential risk of needing to support millions of patients using the app - shifting from a B2B approach to B2C.  

Links

Talking HealthTech Podcast

Talking HealthTech Community

Best Practice Software

Best Health Patient App

Best Practice Partner Program

Best Practice Titanium

Medical Director 

Genie

QI Pip

PHNs

Medicare

My Health Record

Sullivan Nicolaides Pathology

QML Pathology

ADHA – Australian Digital Health Agency

 

Transcript

[00:00:00] Pete: [00:00:00] Welcome to Talking HealthTech. My name is Peter Birch, and this is a podcast of conversations with doctors, developers, and decision makers that are playing in the Australian HealthTech scene today.

[00:00:12] With me today are two very iconic and extremely down to earth players in the Australian Practice Management System game.  I'm talking about none other than Frank and Lorraine Pyefinch of Best Practice Software.

[00:00:23] Dr. Frank Pyefinch is not only founder of Best Practice. But he's also originally the founder of Medical Director, the number one and two Practice Management Systems for Australian GP's today, and they both have been for many years. Dr. Frank Pyefinch is CEO of Best Practice and he brings with him a long and proud history of working as a busy GP and Lorraine as a registered nurse, so together they understand firsthand the challenges and needs of the medical community when it comes to software and technology. Best Practice has dominated the market for a long time as the first choice for GPs around Australia when it comes to selecting a PMS, and I look forward to [00:01:00] finding out why in my conversation with both of you, Frank and Lorraine how you doing? 

[00:01:03] Frank:  Hi. Well, good. 

[00:01:06]Pete: This is a first for me. I'm actually recording from your office. So had taken it out on the road, which is great. But I, I originally thought I was going to go to Bundaberg, but you've got a few offices I see. 

[00:01:16] Frank: We moved from Bundaberg about five years ago , and came to Brisbane because our two children had to come down for university and getting them to go back to Bundaberg was quite difficult. So every birthday and Christmas, it was down to Brisbane. After a couple of years, we decided we might as well just move here.  

[00:01:35] Lorraine: The main office is still in Bundaberg, so we've got about 65 staff working there.  We've got four offices all up, so we've got one here in Brisbane with just over 40 staff and another 9 down in Sydney,  and then, over in New Zealand, we've got more than 40 in Hamilton, in the North Island.

[00:01:55] Pete: So I always used to say that Bundaberg was the HealthTech capital of Australia, or the Silicon Valley of  [00:02:00] Australian HealthTech. 

[00:02:00] Frank: It was certainly in the 90s, , when Paul was still living there and wrote Genie  

[00:02:07] Lorraine: We have a funny story about Paul because you see, I clearly remember the night Paul came round to our house. After Frank had first started to show off the original Medical Director, and I remember them sitting in the study and I could hear Paul going "Oh wow, that's really good, Frank". And then he asked Frank the fatal question "does it run on a Mac?" And Frank said, " no, I hate Macs". And so Paul went, "Ya ha!, I'm going to write Medical Director for a Mac!", 

[00:02:34] Pete: [00:02:34] As I sit here, I look sponsored by Mac sitting in front of you.  Hey, look, so, there's a lot that we can cover off. Obvious question. You guys have a lot of history in this space. So where do you start? How did this all start? 

[00:02:44] Frank: [00:02:44] It really started in the late 8 0's , when Lorraine was doing a bachelor of health science at central Queensland uni, and so we had to buy a computer for her to do her course, and I got interested in it. And [00:03:00] started using it for a little database projects at home, like watching the rainfall every day and coding what bottles of wine we had in cupboard and things.

[00:03:11] And around about the same time, in about 1989 the Queensland Government changed the poisons act to allow prescriptions to be typewritten , as opposed to handwritten. And of course, type written also included computer generated. And so I thought this was really neat because I had something like 25 patients in a local nursing home.

[00:03:33] And almost every week I'd get a list of prescription requests for them, and I could sometimes sit for an hour after I'd finished at six o'clock at night writing out prescriptions for the nursing home, and I thought if I could put all these patient's names into a computer, into a database. And then put the drugs in against the names.

[00:03:55] I'd be able to just go through and tag which ones I wanted to print and print them out. [00:04:00] And so I did that and started using it at work. 

[00:04:04] Pete: [00:04:04] When was that? There was back in the 80s? 

[00:04:06] Frank: [00:04:06] it was about 89 / 90 when I really started.. And then I started using it day to day with my regular patients as well, because once I've written that in, it could write scripts, it didn't have to be restricted to the nursing home patients. So I bought a computer and put it on my desk with a dot matrix printer. And in those days we had to supply our own prescription paper, which I had to get printed and so I started using it for all my patients. Then one of my partners started using it too, and we actually networked it by putting a cable up through the ceiling and down the other side and into his room.

[00:04:43] And so we had a little network of two computers and progressively it just grew from there. And I started putting other things in. I got a list of PBS medications from the pharmacy next door.  The pharmacist had written his own computer program for [00:05:00] point of sale, and so he gave me a big list of all the medications with their PBS listings.

[00:05:05] I was able to use that to create pick-lists of drugs and so on. And once I had that, it was possible to use that data in other ways, so I put things like listing allergies, and then I could cross check between the scripts and the allergies and it just grew. And yeah. Progressively, we added more and more things, and over the early 90's, through 90 to about 92 it became what was ultimately Medical Director the first release.  And how Medical Director really came about, was that a GP in Narrangbar, which is just North of Brisbane, heard about the fact that I was writing computer generated scripts and he was really keen to do the same. So he contacted me and said. Can I have a look at your program?

[00:05:50] So packaged it up onto a three and a half inch floppy disc and posted it down to him and he put it on and played around with it and said, you got back in touch and said, this is amazing. [00:06:00] This is just what I've been looking for. There's nothing else like it anywhere in Australia. And he said, you should be selling it.

[00:06:06] And I thought, hmm, I'm a GP. I'm not a sales person or a computer expert. It was just a hobby really for my own use. But we had a chat about it and decided.. 

[00:06:21] Lorraine: [00:06:21] I went to TAFE and did a short course on how to write a business plan because I thought we'd better have a business plan. They were  very popular back in the 90s so I wrote that business plan. I remember coming home to Frank one night from TAFE and saying very proudly: "so I've worked out our break even point, we have to have 200 sites to break even. Okay. And Frank said, Oh, that's a bit ambitious, isn't it?

[00:06:43]

[00:06:43] Pete: [00:06:43] How many sites do you have now? 

[00:06:45] Frank: [00:06:45] Four and a half thousand 

[00:06:49] Lorraine: [00:06:49] Medical Director was interesting because even the name. We came up with the name, I like to say I named the babies in the family, but we came up with the [00:07:00] name because at the time there were a lot of really gimmicky names, you know, 

[00:07:04] Frank: [00:07:04] Medi-mouse.

[00:07:06] Lorraine: [00:07:06] I was actually flicking through Aus Doc magazine and got to the classifieds back. And they had all these ads looking for a Medical Director, and I was reading the attributes of what a Medical Director was, and I thought, yeah, that's actually something, responsible, in charge, reliable, all those sorts of things.

[00:07:32] So I thought, well, that's the kind of this kind of image we thought, something that helps the practice and to make it more efficient, just even handwriting, because there were a lot of concerns about the medication errors and just being able to have a type written prescription, just removed any ambiguity over what of handwritten script might've might have seemed to whoever was dispensing. So that's sort of where it started. The logo, the MD logo, [00:08:00] I was sitting in the back of the car with the kids etch-a-sketch when we were coming back from holidays. Came up with the MD, the original, they don't use that one anymore. 

[00:08:10] Pete: [00:08:10] They've still got the name though.

[00:08:12] Frank: [00:08:12] So we started selling it in 1992. And in fact, we had a table at the AMA's annual computer day that they used to have back in those days. And, we were in a corner with a table and we had a printer and we were actually printing scripts on fake sample script paper, and we sold the first one on the day.

[00:08:34] At the at the trade display, and that was September 92 and basically it just took off from there and I think 94 we had passed out 200 site limit to, to break even, and I had to take increasingly longer periods of time away from the practice. And so I ended up in about 94 or 95, we teamed up [00:09:00] with some advertising people down in Sydney, and that's when we started putting the ads into Medical Director, which subsidized the program quite heavily.

[00:09:10] It was never free. People keep telling me that. We used to give it away free, but we never actually did, but it was heavily subsidized by the advertising. And over the period through 95 to 99 we build up to about 1500 sites. I think it was at that time, we sold the business to health communication network and we worked there for four years, but during that time I didn't do any general practice, and by the end of that time I thought we were starting to lose touch with the coal face, and at the same time we thought the product was being pushed in directions that we didn't want to see it going. In that it was being used as a cash cow with increasing amounts of advertising and more intrusive advertising 

[00:09:54] Lorraine: [00:09:54] When it was our business, Frank used to have pretty tight editorial control over [00:10:00] where and how many ads appeared, and so it was more of an exclusive spot at the pharmaceuticals paid for and we disagreed with, I think, the way that, that seemed to be a lucrative revenue. stream for for the business  and we didn't agree with what 

[00:10:17] Pete: [00:10:17] Yeah I mean, you obviously can't do that at all now. 

[00:10:20] Frank: [00:10:20] No, no.  It went from being the customers, being the doctors, to the customers, being the drug companys, which was not what we wanted to see. So in 2003 we both left and then had a year to sit out in the exclusion period from my contract. And during that time, I went back to general practice 12 hours a week in Bundaberg. And we decided during that period that there was still room for someone to come in and produce a product targeting doctors that had no advertising in it. And so that was why we started working on BP.  

[00:10:56] Lorraine: [00:10:56] And by then, our old product Medical Director  was the market [00:11:00] dominate... 

[00:11:00] Frank: [00:11:00] It had 85% market share at that time.

[00:11:03] Lorraine: [00:11:03] So it was, it had gone in that space of less than 10 years from probably less than 5% of doctors using computers in their surgery to being the norm for the vast majority. So, I mean, ultimately patient safety, by the fact that, prescriptions will legible had improved remarkably in that time.

[00:11:24] Frank: [00:11:24] And I mean, we've added so much allergy checking, interaction, checking disease interaction checking. So there was a lot of patients safety sort of features built into the product. And it actually reached a point where at one point the medical defense people were saying that if you weren't using a computer for prescribing, then you probably weren't practicing to the standard that is expected at the time. So if you had a misadventure due to with the handwritten script, you would probably lose the case.  

[00:12:00] [00:12:00] Lorraine: [00:12:00] I suppose we look back on it now, there were no standards for software in Australia at that time. They really aren't now, Frank created the standard, I suppose, he set the bar. If there had been standards in place, it might have actually been more difficult to do what we do. Because the way you look at some of the government mandated work and think, well, we probably wouldn't have designed it like that.

[00:12:27] Frank: [00:12:27] Well, it was very much designed by a clinician, and that's why it, I think took off because the workflows were very intuitive and very natural to the clinicians.  Once they started using it, it really improved their efficiency, improve the note-taking, improved patient safety. There was all positives. 

[00:12:48] Pete: [00:12:48] It sounds very much designed to solve a problem rather than designed to show off some fancy tech. 

[00:12:54] Frank: [00:12:54] Yeah. It was very much from a user and that's when I wasn't working in general [00:13:00] practice during the HCN period. I started to feel that it was losing some of its relevance because it wasn't keeping pace with what clinicians were using.

[00:13:11] And so while we lived in Bundaberg, I always working 10 hours a week. I did that for 10 years until we left in 2014. 

[00:13:24] Pete: [00:13:24] So, you know, you, you've built it up to, to what it is today, and your,  , there's a lot of people walking around in this, in this office, and you've got other offices as well.

[00:13:31] No doubt. You've.  paved the way and kind of set the pace for a lot of people, but you've also had  to keep up with we the industry and everything that's happening around it and use a needs and just general advancements in technology. It's a very big question for  people with such a vast experience, but what would you say some of the biggest things that have changed in that in that time period, from when you first created the thing to now? 

[00:13:54] Frank: [00:13:54] When I first created it, we were using a text mode dos [00:14:00] interface where everything basically was done by typing. There was no mouse. There wa s, none of the sort of touch screens or any of the voice activated stuff that you see today

[00:14:13] Pete: [00:14:13] You didn't say, Hey Siri...

[00:14:15] Frank: [00:14:15] Couldn't do that. Back in 1990. So we've seen it move from that to windows to becoming a graphical user interface. We've seen the introduction of tablets and touch screens and all the rest of it. We've seen much bigger emphasis on communication, which is something that's still evolving with secure messaging and that sort of stuff. Now we're seeing the move to the cloud, which is why we have so many people in the offices that we have.  Redeveloping. obviously, for the cloud, it has a whole raft of issues that you didn't have when you had an office based solution. And the security is obviously a major issue. [00:15:00] We've got quite highly paid people working on the design and the architecture to make sure that we get it right. In the old days, I did a lot of the programming. I still do some, but only on the legacy product because I don't understand the new technologies well enough to know that we'd be doing the best job possible. 

[00:15:18] Pete: [00:15:18] I didnt think you'd do any programming at all nowadays? 

[00:15:21] Frank: [00:15:21] I enjoy it, I love it. That's why I started doing it in the first place was because I really enjoyed it. So yeah, so I still do a bit of work on it. I do have a few special projects. I do a bit of decision support work along with some of the pathology labs. I like to keep working on the actual program, but I'm not doing any work on the cloud version, it's all young guys who have much sharper brains than I do 

[00:15:51] Pete: [00:15:51] We will get into cloud in a bit too, because I want to cover off a little bit on that , but just back to the needs of the customers being the  doctors, the clinician, general [00:16:00] practice, like today, what do you think of the big things that GPs need a hand wave or, are some of the biggest challenges that they face? Or just generally the environment in which we're in, which is creating challenges for them.

[00:16:14] Lorraine: [00:16:14] think there's certainly been a shift towards more corporatized medicines. So there's a lot of doctors that are working as employees of contractors to do the surgery. We certainly started in an environment when most practitioners owned their own surgery or were in a group practice.  So there's changes along there. A lot of them aren't decision makers anymore.

[00:16:35] So, you know, there's a different set of needs for non-practitioner owners. Certainly there's been, there's financial issues in medicine these days. For a long time, there was no increase in Medicare rebates, which meant that , for a good number of years, the income that  doctors could generate was limited. those challenges, I think, are always there. This aging, [00:17:00] of doctors 

[00:17:01] Frank: [00:17:01] Increasing  chronic disease 

[00:17:03]Lorraine: [00:17:03] Managing chronic diseases and other thing s, there's more emphasis on, it'd be interesting to see how PHNs go with that. There's still a lot of question marks around data security 

[00:17:15] Pete: [00:17:15] That's all linked to the QIP isn't it? 

[00:17:18] QI Pip Yeah

[00:17:20] Lorraine: [00:17:20] QI Pip Yeah. I mean, a lot of it hasn't been clearly articulated, so, you know, it's a bit of a work in progress. 

[00:17:28] Frank: [00:17:28] I mean, government often come up with brain waves that aren't clearly thought out, and we've seen it with the QI PIP where they using the PHNs to collect the data.

[00:17:45] So there's a lot of, not distrust of the PHNs, but not all GPs are willing to give the PHNs data, whereas they'd be more inclined to upload it to a central repository that was directly managed [00:18:00] say by the department of health or, or someone like 

[00:18:02] Pete: [00:18:02] that

[00:18:03] I mean the funding model in Medicare and everything around that space.

[00:18:07] Is there any thoughts you've got around, any progressions that have been made, particularly around technology?  There's a lot of people that have thoughts on how Medicare is supporting the changing needs of patients or clinicians or the way that healthcare is delivered.  Is that impacting you in any way?

[00:18:21] Frank: [00:18:21] Medicare itself is really just an insurance organization. So the claiming  we have automated within Best Practice as best we can, it is all done through a little, what they call an add that to. Which is quite old and it's not even, I don't think it's been upgraded for four or five years now. So they're not terribly forward moving. They have been talking for some time, the adapter has a lot of issues and we've had to do some pretty tricky programming to get the Medicare claims to reconcile at times. And it's one of our biggest [00:19:00] support issues and that we have from practices is. W wanting to know how they can get the Medicare to add up between what they've claimed that they've actually received.  They have been talking for years about replacing the adapter with web services, which is a much more modern way of transmitting data to and from Medicare, but it hasn't happened yet. We're hoping that it will happen in time for our cloud program because we don't really want to implement the adapt to in our modern program because talking to those sort of legacy products is actually quite difficult sometimes and trouble prone, which is then going to cause us more support issues. So we'd rather they'd move forward, but they've been very slow. Medicare and not pushing anything really. They're very reactive. 

[00:19:59] Pete: [00:19:59] What about, [00:20:00] dare I say My Health Record? I think I've,  got to a point in this podcast where I haven't asked one question about My Health Record.  But I'm gonna ask you guys about My Health Record and, whether it's your take on it or what's needed to increase uptake of it or how that's kind of working , what kind of thoughts have you got around that space?

[00:20:18] Frank: [00:20:18] I personally, as a clinician, was quite keen on the concept of My Health Record was, the original cases involve issues where people were away from home on holiday or whatever and got sick and they full record would be available to a clinician at that location. People were admitted to a hospital and unable to give a history if they were unconscious after a car accident, that sort of thing. The hospitals would be able to look it up, so there's lots of good that clinician could see in it, but the implementation has probably let it down. When they did the, was it the Royce review?

[00:20:58] Lorraine: [00:20:58] Royal.  [00:21:00] Richard Royal. 

[00:21:01] Frank: [00:21:01] Royal Review about four years ago now, after it had been released for about a year and the uptake was very slow. He, was commissioned to basically write a report saying why was this the case and what could be done to turn it around? And that's when they renamed it from PCHR to my My Health Record. Like that was gonna make a big difference. That as part of his report, he interviewed a lot of people who were involved with it, including us. And. We gave him some suggestions for increasing uptake. And our biggest suggestion was that the GPs get paid an extra item number for curating the online health record, because it does take a couple of minutes at the end of a consultation to check that the health summary, shared health summaries up to date and accurate, and then to upload it.

[00:21:55] And if you see 40 patients a day and you put an extra two minutes onto every [00:22:00] consultation, that's 80 minutes a day of unpaid work. And at the time, the health minister. Well, I think it was Nicola Roxon said that while it might push the level B consultation to a level C, and that was fine if that happened, but in most consultations it doesn't. If you've got a 10 minute consultation and you add two minutes, you don't go from a B to a C, you stay a B. So essentially GPS were being asked to do work that they weren't going to be paid for. And in the current climate and the climate at that time, no one had time to do extra work. And the GP is the person who actually has least to benefit from the My Health Record because they have all the data in the desktop system already.

[00:22:40] So curating it and uploading it is of no real value to them personally. So it's good for hospitals, it's good for paramedics, it's good for occasional visiting GPs,  if you're visiting somewhere else, but for your own regular GP, that data is already on his system. So being on the, My Health Record is of no [00:23:00] great value.

[00:23:01] So I think, they're not going to get uptake until they can sort that out. Basically. But I mean, it was also flawed in the sense that it was a very document based architecture that they used. So everything that gets uploaded is a like a PDF basically, and that gives it no flexibility. You can't do anything really clever with the data. All you can do is just look at the documents. You can't graph the data pathology results go up and they can't, you can't use that atomize data that you can do with ones that come into your local system. So it's not as flexible or as useful as it probably could have been. And they recognize that and they're in the process of redesigning it, but we'll wait and see what they come up with. 

[00:23:49] Lorraine: [00:23:49] I mean, it's always an ongoing challenge with government dealing with new programs and things like that. Often the people that are making these announcements, you know, there's been no design behind it. It makes [00:24:00] it really difficult  from a developer's point of view to actually understand what they're trying to achieve and how they're going to get there. And often, there's very little input into, into those specs. So from an industry point of view, I know MSAA spends a lot of time trying to, trying to encourage more discussion with, um, with developers.

[00:24:20] But I mean, we all We also see from a patient's point of view with regard to My Health Record, we think that, for example, our app that we're releasing in the next couple of months, Best Health, you know, that gives the patient a copy of the health summary, all of the key things that they would need to know.

[00:24:35] So if they are on holiday and need to see a doctor, they've got it there anyway. So it's probably more convenient. In that format. 

[00:24:42] Frank: [00:24:42] Doesn't help if you're unconscious after a car accident to get into your phone. Yeah. Phone is probably lost in the crash. And, um, even if it wasn't, no one knows you pin 

[00:24:57] Pete: [00:24:57] Well, [00:25:00] that's interesting.  what about partners? There's all these other vendors that focus on a very niche kind of area and you guys are the central hub for information. Everyone wants to play with you, I guess, because that's how they engage with their target market and also, hopefully leverage some of the information  there to ultimately improve patient outcomes. You've had a bit of a ramp up or at least I've seen work on your partner network and focus on that recently, so it seems like it's a big interest for you right now?

[00:25:28] Frank: [00:25:28] It's complicated. We've got something like 300 or 400 people who want to interface to was one way or another, or have or want to, and that was becoming unmanageable for a start. But then also some of the people who already were interfacing, were doing things in a slightly less than perfect way, I'll say. And so as part of the partner network, we've given them more controlled access. [00:26:00] So that they don't need to be, in a sense, hacking the database for their own purposes. We'll give them controlled access to what they need and keep them away from what they don't need. Because if you've got an online appointment booking system, you don't really need to be reading any clinical data at all. And then so the partner program tightened up and standardized things so that it was all much more secure because obviously patient privacy and the privacy act has changed and there's mandatory data breach notification and stuff all became real in the last five years or so. And so we had to make the program keep up with that.

[00:26:41] And as part of that, the tightening up of the security layer has that we've under done in the last couple of releases was necessary. 

[00:26:50] Lorraine: [00:26:50] Yeah.  I mean, we've always been open to Engaging with,  people who have niche products that we don't do. I mean, we stick to our knitting, [00:27:00] we don't think we can be all things to all practices.

[00:27:02] I mean, that's the interesting thing about general practice. They're so diverse and the needs are all very different. the way they run their businesses is all very different. So you can't be all things to all people all the time. Is the old saying, so we don't object to that at all, but, we have to be very confident that we know exactly what those third parties are doing and why, how... Because we are allowing them to access that info. Well, not us, but the practice does, and we've got to do whatever we can as vendor to make sure that our customers don't get themselves into any tricky situations. So the more you can protect the customer from making a mistake, the better.

[00:27:43] Frank: [00:27:43] Yeah. I mean, it's a hard balance. In some ways. We have always looked at the, the data belong to the practice. So we've always given them the ability to access it and allow third parties to access it. But some of the third parties have sort of taken [00:28:00] advantage of that to do things that would never really intended.

[00:28:04] And the practice has not always known what was being done with the data. So as part of our practice partner program, we now have a contract where they have to agree not to use any data for purposes other than 

[00:28:18] Lorraine: [00:28:18] other than what has 

[00:28:19] Frank: [00:28:19] been signed up for. 

[00:28:21] I mean, that's a small protection that it's just a signing a document, but at least we've got something in place. Whereas before we had nothing. And so. t's a difficult balance between giving people access to data and not giving them too much access 

[00:28:39] Pete: [00:28:39] Need to find that right balance.  so I surprisingly get asked, a fair bit, from, vendors that might have been developing something on how they can integrate with more practice management systems or can integrate better with the Is there,  I can put some contact details of the, the partnership program, for best practice in the show notes, if that's would be good to you way.

[00:28:57] Yeah. Easy. 

[00:28:58] Lorraine: [00:28:58] I'm surprised they [00:29:00] haven't already spoken to it. 

[00:29:01] Pete: [00:29:01] So I think sometimes it's, you know, you get lost in the way and how to do things

[00:29:06] Lorraine: [00:29:06] It's funny. You know, you hear all these. Buzzwords,  connectivity and, secure messaging and all that sort of stuff.

[00:29:12]I mean, we look back and over the last, you know, 25 plus years, we've been involved in every single,  trial for discharge summaries from hospitals, for example. And a lot of those trials were great. They were so successful, but they never proceeded. the ecosystem for health is quite complex.

[00:29:28] And unless. If you're talking about connectivity and unless you get, a lot of them are big overseas vendors, that have hospital systems and and system administrators within the health department themselves. Unless there's a will there to proceed with that kind of thing. It makes it very difficult.

[00:29:44] And yet there's so much money spent in the public health system, tertiary care, when in actual fact most of the interaction on a day to day basis is in general practice 

[00:29:55] Frank: [00:29:55] State based public hospitals seem to forget that general practice [00:30:00] exists basically. 

[00:30:02] Yeah ok, 

[00:30:02] Pete: [00:30:02] Well 

[00:30:03] Lorraine: [00:30:03] it's not the remit, but 

[00:30:05] Frank: [00:30:05] it's not, I mean, it's this sort of crazy idea we have of having a federal health system that runs primary care and then a state based system that runs tertiary care.

[00:30:15] And it's different in every state. They use different software, different systems. sometimes in the past, even between the hospitals in one state, they've used different systems and although that is gradually becoming less of an issue. Yeah. 

[00:30:30] Lorraine: [00:30:30] I mean, we like to, we like it when there's a national approach and they do it once and everyone uses the same format.

[00:30:37] Frank: [00:30:37] Unfortunately, we're facing the safe script thing for the real time prescription monitoring where every state seems to be going to go at sign way and use a different method for tracking real time prescriptions. Let's 

[00:30:51] Pete: [00:30:51] That makes things easy for you... 

[00:30:52] Frank: [00:30:52] It doesn't make things easy at all! And it's just typical of the way governments seem to run in this [00:31:00] country.

[00:31:01] Lorraine: [00:31:01] It's really inefficient from that point of view. I look back in the mid nineties two of the largest pathology companies in Queensland, so we had Sullivan Nicolaides and QML, which is Queensland Medical Laboratory.  They were really strong competitors, and there was a big divide between them, but they both got together and stumped up some cash and contacted the PMS software vendors, around at the time, including us at Medical Director and, said, we're going to do pathology results. And also we're going to standardize the way that  requests are made. And so they came up, to their credit ,with the same format of the form. And then whenever any other lab from any other of the state would contact us, we'd say, this is the format for the form, you've got to use that. And so suddenly pathology, we're all using the same format, and it was so simple. Whereas radiology is all over the shop cause they all still have their own, 

[00:31:56] Frank: [00:31:56] particularly in early nineties, most [00:32:00] radiology practices were just sub double digit numbers of radiologists and they didn't have the big conglomerates.

[00:32:08] Whereas the path labs have always been quite large and therefore, and there's not so many of them yet, and so it's easier to get them to come to some agreement. 

[00:32:18] Lorraine: [00:32:18] So I suppose after all this experience in the industry, our advice is do at once. Do it well.

[00:32:25] Right.

[00:32:26] Frank: [00:32:26] Sadly it's not happening though. Real time prescription monitoring is looking like being a bit of a nightmare.

[00:32:32] Lorraine: [00:32:32] And, and also PHNs, you know, they're all wanting data, but they're all ultimately collecting the same sort of data for the federal government. It'd be terrible if all they all decided they wanted it. It in a different format. It's kind of make it. The life of all software vendors, really  difficult, you know, where it's the same information really.

[00:32:52] Frank: [00:32:52] We've seen a bit of that in New Zealand with the PHO's collecting data, right? Even 

[00:32:58] Lorraine: [00:32:58] though they're all collecting 

[00:32:59] Frank: [00:32:59] the same [00:33:00] stuff, but they all have different formats and different ways of transmitting it. 

[00:33:05] Lorraine: [00:33:05] And the overhead, from our point of view is quite costly. So you don't want to do that.

[00:33:10] There's no need to do that. 

[00:33:11]Pete: [00:33:11] You're talking earlier about Government  institutions and associations looking at the ADHA, the Australian Digital Health Agency,  and putting it around the other way. what are the things that practice management systems can be doing to be helping the ADHA in their big quest for the big buzzword interoperability.

[00:33:28] Frank: [00:33:28] They have made some, some strides towards that, especially in the last couple of years. And I know Tim Kelsey made secure messaging one of his priorities and we have been involved in the trials that they did one or two years ago which have resulted now in  a further round of funding.

[00:33:47] For  all of the vendors to implement the new work. And so there is progress being made. I guess my thought though is secure messaging really the best [00:34:00] way to be doing it. And should we be looking to something like the. Prescription exchanges where they use web services to put documents into a central repository, which then can be accessed by different people.

[00:34:13] So say a referral to a specialist rather than going point to point with secure messaging could be sent centrally and then downloaded by the specialist or by one of a group of specialists that the patient decides is the one that they want to go to. Yeah. I mean, secure messaging is coming. But whether it's what we really want, I'm not entirely certain.

[00:34:37] Lorraine: [00:34:37] The directory is always been the sticking point because they were, there was no national directory to make sure you 

[00:34:44] Frank: [00:34:44] Every secure messaging  company has it's owndirectory, and they didn't communicate. It makes 

[00:34:49] Pete: [00:34:49] it hard to, to connect with the whole point. So 

[00:34:53] Lorraine: [00:34:53] that's work being You know, I'd done now district that a federated one.

[00:34:58] That's good. That's 

[00:34:58] Pete: [00:34:58] Good. Look, lastly, [00:35:00] to wrap things up, I'm looking at what you guys are working on because there's a lot of  people out there working at the best practice office here on your new thing coming up and, I'm glad, that you mentioned cloud before because Titanium has been on your website for a long time.

[00:35:14] Frank: [00:35:14] It's 

[00:35:14] Pete: [00:35:14] been, there's been a lot 

[00:35:15] Frank: [00:35:15] of construction for a long time. 

[00:35:18] Pete: [00:35:18] So it's an interesting looking at cloud in practice management land. It's, is that a deliberate strategy from you guys of kind of seeing how things play out or understanding what the market needs, or is it just about building like the right thing for 

[00:35:33] Frank: [00:35:33] the market

[00:35:34] I think there are a couple of things. One is that when we started the titanium project, we weren't really designing it for the cloud. We were designing it as a web application, but not specifically as a cloud application. And so about two years into the project, we kind of changed direction of it.

[00:35:53] And as I said, the security and  the, sort of concerns in the cloud are quite different to what we [00:36:00] were originally doing. So it changed direction halfway through, but the other issue that's holding it back a bit is the sheeramount of work that needs to be done to be able to fully replace Best Practice.  It's a really rich, functional piece of software, which has taken ultimately nearly 30 years to get to where it is if you count the Medical Director time as being a sort of 

[00:36:25] Lorraine: [00:36:25] precursor first run.

[00:36:30] Frank: [00:36:30] So just getting that functionality takes time. Unfortunately practices in different ways use every bit of functionality that we've given them because we put it in there for a purpose. And we've seen that the practice needs this or that, and so we've put it in and we can't take it away from them.

[00:36:50] So getting to that level of richness where we can actually move people from BP premiere to Titanium is just taking a long time. We [00:37:00] also, in a way, got distracted a bit when we took over the Houston business and took over vip.net and Ultimately bought BP allied, which used to be called My Practice because there was a lot of catch up work that needed to be done on those products to get them to our level of quality.

[00:37:20] And. We've done that, we've achieved that, but that did divert resources for a couple of years into work that we hadn't originally anticipated doing. And I mean, sure, we gained some resources when we took over Houston, but,  it was a bit of a diversion for a time. Ultimately, those products are all going to be replaced by Titanium, so we have to include New Zealand, we have to include Allied all into the Titanium, work load, which again, adds time. So it's, it's just slow. 

[00:37:53] Pete: [00:37:53] So that, that'll, that'll cover tran Tas... 

[00:37:57] Frank: [00:37:57] yeah. 

[00:37:57] Pete: [00:37:57] Yeah. 

[00:37:59] Across the [00:38:00] dutch. 

[00:38:00] Lorraine: [00:38:00] Yeah, 

[00:38:01] Frank: [00:38:01] that's right. I mean, yeah, we pretty, 

[00:38:03] Pete: [00:38:03] that's a  valeant effort in itself. Just covering to 

[00:38:06] Frank: [00:38:06] aim is ultimately to only have one product, but through  configuration and preferences and whatnot, we can, make it appeal to GPs,Allied Health and Specialists.

[00:38:18] And we do see that some of the allied health may need a lot less functionality than the GP practices use. So it may be that we actually release a sort of Ttitanium for allied health before we release titanium for GPs.

[00:38:35] Get 

[00:38:36] Pete: [00:38:36] That's 

[00:38:37] Frank: [00:38:37] a 

[00:38:41] Pete: [00:38:41] valeant effort in itself just to be able to do, to cover all of those needs.

[00:38:47] It's, it can stretch, you know, many kilometers wide and you only get it a couple of centimeters date in covering all the needs of not just GPS, which like you say, 30 years of, of, of expertise. That's, that's. That's why [00:39:00] you are where you are. Um, but to build it again from scratch and then include specialists in 

[00:39:05] Frank: [00:39:05] an allied The other issue is that during the time that we're working on it, we still have to maintain the existing products because they, people are using them.

[00:39:18] Things are changing at have asking for work to be done on the secure messaging and so on. And we can't stop doing that. And so BP premiere is getting richer and titanium is, the workload is getting bigger with every passing day. So. That is also a bit of an issue. Amazing. 

[00:39:38] Pete: [00:39:38] Well, look, I, I'm not going to keep you too much longer from all of that work that does need to be done. before we bail, are there any parting thoughts or any kind of final on or things that we didn't cover off? 

[00:39:47] Frank: [00:39:47] Um, we didn't talk much about the app. I don't know if 

[00:39:51] Pete: [00:39:51] you tell me more about the, Cause you've got a patient app that's is being worked on.

[00:39:56] Frank: [00:39:56] It's actually  been out 

[00:39:57] Lorraine: [00:39:57] trials for you 

[00:39:59] Frank: [00:39:59] for months [00:40:00] in a small number of sites for user testing. And it's proven to be quite popular in those sites. So we're actually looking at a full launch in October, the first release of the app includes It's all about communication between the practice and the patient.

[00:40:22] We see that as being a bit of a future direction and the practices and patients will, um, be more easily able to communicate. So the way we've designed it. For example, um, when a GP checks a result, they can directly from the checking results screen from the inbox, they can send a message to the app, which goes securely, and the patient will get a notification on their phone, but they will have to have the pin numbers and whatnot not to get in and read the message.

[00:40:55] So it's much more secure than SMS. And so we'd be using it for [00:41:00] appointment reminders, we can use it for actual reminders for things like that. cervical screening and what not. We can use it to inform people of their results. We can use it to send documents and in particular health fact sheets, patient education material, appointment reminders.

[00:41:21] Ultimately though, we're aiming to do things like, prescription ordering. So repeat prescriptions. Requests for specialist referrals. If the people don't really need to be seen, if it's a routine annual ophthalmology review or something, and it'll be optional for practices as to how far they take those things, but it gives them the, the option.

[00:41:49] So it's another option in communicating. I mean, people don't want to send letters anymore because it's way more expensive than sending an SMS and the patient app, the [00:42:00] communications costs from it will be much less than even SMS. So it's giving  practices a better way of of doing things and a more secure way

[00:42:11] Pete: [00:42:11] Are practices asking for an app because there's a few apps out there that do, I guess a similar thing on the, surface of what you've described.

[00:42:21] If 

[00:42:21] Frank: [00:42:21] They do, we think this kind of rolls it all into one easy app. I mean, ultimately it will. Well, it will allow you to make your online appointment through the practices online appointment system. It'll be a kind of, you get a message from the GP to say, I want to talk to you about your results. You can immediately on the same app.

[00:42:46] Make your appointment. And then you get the reminder come into your app a day later. Whenever the picks appointments do, you can check in at the front desk. Again, if the practice don't want everyone to be physically seen by the receptionist. And [00:43:00] some practices insist on that. There are others that use checkin kiosks.

[00:43:04] So this will essentially replace a checking kiosk, cause you can use it, the app to check if you have 

[00:43:11] Lorraine: [00:43:11] it doesn't restrict patients from. Seeing more than one practice. And the reality is, is that, you know, a lot of people don't always have, you know, they might have a family GP, but they might also use a, you know, bulk-billing clinic when they go and get a sick certificate or something like that.

[00:43:27] So 

[00:43:27] Frank: [00:43:27] some people have one in town, me at work, of course, and then one out the 

[00:43:32] Lorraine: [00:43:32] home. So, so if they're using, if those surgeries are using best practice in theoretically, um, the, the patient will be able to register it both, but nominate one as their main one, but then they'll consolidate anything that's been, you know, if, if they've been diagnosed with something at one, it'll actually update their app.

[00:43:52] Frank: [00:43:52] Ultimately, when Titanium finally makes it out into the real world, you could have your physio and your [00:44:00] podiatrist everyone on the way. Can all be in the one app, so you don't need an app for the physio and an app for the ophthalmologist and two apps for the General Practices, which was originally when we were discussing the, the app that was an option was for us to sort of white label it so that the practice could put a sign in logo on the front and every practice could have an app that interfaced.

[00:44:23] But when we thought about it and how people might use it, it made more sense to have just one app with our branding on it. And allow that to have multiple surgeries to connect. 

[00:44:35] Pete: [00:44:35] And that'll be a bit of a shift for you too, because if it's going to be something that's, that's patient facing with your branding on it, that's new for you guys to 

[00:44:44] Frank: [00:44:44] It's new for us

[00:44:46] I mean, we've discussed at length the issues of supporting patients because in the past we've only ever provided support to. And practices and users. So the implications of having [00:45:00] potentially 12 million people, um, using the app, that won't happen, but even 1 million, it's. If they have a minor problem, it's a lot of support.

[00:45:11] So that's why we did a sort of restricted release before doing the full release and to try and make certain that there's no issues that are going to come back and become an unmanageable problem. And at the moment it's looking good. So we're happy to release it in October 

[00:45:31] Pete: [00:45:31] So much happening. A lot of new innovations a lot of, history there too, so much to, to digest. I'll put some links and some information in the show notes of the podcast. Frank and Lorraine, thank you so much for your 

[00:45:44] Frank: [00:45:44] Thank you

[00:45:44] Pete: [00:45:44] 

[00:45:46] Thanks for listening to talking HealthTech. My name Peter Birch.  Go do some stuff on our socials, visit the website, share it with some people and give us a nice review and a five star rating because it all helps to spread the word and get people talking.   Until next time I'm outta here. 

November 4, 2019

22 – Maree Beare

How many places are your healthcare information kept? Wouldn't it be great if you could view it all in one spot? Healthtech start up Wanngi is taking on the bold journey to attempt to do just that.

Maree Beare is the Founder of a HealthTech startup called Wanngi, an online health wallet that is implementing a social movement to empower people with their own health information. Maree was recently recognised in the top 50 list of Women leading Startups that are disrupting Healthtech 

In this episode hear more about Wanngi and what they are trying to achieve, the benefits of consumer generated data in healthcare, and the challenges of implementing and integrating a start-up healthtech in Australia.  

October 28, 2019

21 Adam Meredith

Dr Adam Meredith is the CEO, Founder and Inventor of Migraine Stopper, a device that turns off migraines.  

Adam is a Chiropractor by trade, with his own group of practices known as the Spine and Health, a Posture Based Chiropractic Centre.

In this interview, learn how migraines come about, some different treatment methods and the theory behind the Migraine Stopper device.

October 21, 2019

20 Anna Johnston

If you work in the healthcare industry you have a huge responsibility when it comes to managing sensitive patient information, whether you’re a big software vendor or a single physiotherapist, everyone needs to follow the same rules, and there are some pretty serious consequences for not doing it properly.  Do you know what your obligations are and if you’re doing a good job? Check this episode out to find out!

 

Who is Anna Johnston

Anna Johnston is one of Australia’s most respected experts in privacy law and practice.

She has qualifications in law, public policy and management, and 26 years’ experience in legal, policy and research roles.  Anna has a breadth of perspectives and a wealth of experience to dealing with privacy and data governance issues.

She is the former Deputy Privacy Commissioner for NSW, so she knows the regulator’s perspective and since 2004 is the Director for consulting firm “Salinger Privacy”.

Anna has been called upon to provide expert testimony before various Parliamentary inquiries and the Productivity Commission, spoken at numerous conferences, and is regularly asked to comment on privacy issues in the media.  

Anna holds a first class honours degree in Law, a Masters of Public Policy with honours, a Graduate Certificate in Management, a Graduate Diploma of Legal Practice, and a Bachelor of Arts, plus a number of other relevant and well regarded certificates and industry associations. 

In this Episode you’ll learn

2:08 - About Salinger Privacy

4:55 - Privacy Concerns in Data (with a focus on health tech)

8:15 - All about, privacy reviews, data flows, data governance, and privacy design

14:28 -AI - How does it fit ethically, legally and is policy keeping up with innovation 

16:40 - AI - GDPR, challenges for AI with diagnostic decisions  

20:10 - AI - Transparency, Accountability and Consent

26:00 - Legal Obligations with Data Privacy

Key TakeAways

  1. When it comes to privacy law in Australia, the same laws and consequences apply to everyone dealing with healthcare information - whether they are a big institution of a single doctor.
  2. While Data Privacy breaches do happen they are often the result of lack of education and or the best intentions in mind, not so much because of malicious intent
  3. Often AI is trained on data that was collected not for the intention of training the machine, so the concept of informed consent is a tricky one 
  4. The simple “tick this box to agree” actually isn’t enough and more emphasis needs to be put on clearly communicating clearly with the person who’s data is being collected
  5. The expectations of patients data privacy holds the health and medical industries to the highest levels of scrutiny meaning that breaches are to be reported to the Price  Commissioners office and the patients whose privacy has been breached

 

Links

Anna Johnston Twitter - @SalingerPrivacy 

Anna Johnston LinkedIn - https://www.linkedin.com/in/anna-johnston-ba188410a/

Notifiable Data Breaches Scheme - https://www.oaic.gov.au/ndb 

GDPR - https://www.oaic.gov.au/privacy/guidance-and-advice/australian-entities-and-the-eu-general-data-protection-regulation/ 

MSIA - https://msia.com.au/ 

Salinger Privacy - https://www.salingerprivacy.com.au/ 

My Health Record (Formerly PCEHR) - https://www.myhealthrecord.gov.au/ 

NDIS - https://www.ndis.gov.au/ 

National Health and Medical Research Council - https://www.nhmrc.gov.au/ 

 

Transcript

[00:00:00] Pete: With me today is Anna Johnson. Anna is one of Australia's most respected experts in Privacy Law and practice.

She has qualifications in law, public policy and management and 26 years experience in legal policy and research roles. Anna has a breadth of perspectives and a wealth of experience in dealing with privacy and data governance issues. She's the former deputy privacy commissioner for New South Wales.So she really knows regulatory perspective well, and since 2004 is the director for consulting firm Salinger Privacy Anna holds a first-class honours degree in law, a masters of public policy and honors a graduate certificate in management a graduate diploma of legal practice Anna Bachelor of Arts plus a number of other relevant and well-regarded certificates and Industry associations, Anna no longer practices as a solicitor so I am allowed to tell the occasional lawyer joke apparently which is great because that's what I'll probably do Anna thanks so much for joining.

[00:01:06] Anna: Thanks Peter great to be here.

[00:01:07] Pete: I think we came across each other because you were doing some stuff with MSIA a before the Medical Software Industry Association.

[00:01:15] Anna: Yes, I presented at their annual conference recently and then also ran a workshop about privacy by Design so for anyone in that space of Designing health-related technology how to understand the kind of the skills and strategies that will help you build privacy compliance into the design upfront rather than trying to retrofit later.

 [00:01:39] Pete: Love to get into more of that detail a bit later on in the conversation too. So, you know you're well well primed for the health Tech space and it's kind of cool to have someone on the show that you know is involved in many different Industries. You're not a vendor you’re another player in this kind of big space in an area that's super important these days in our area of Health Tech being data privacy and security and whatnot.So I'm super excited about this conversation. So tell me a little bit more about Salinger Privacy what you guys do and where your clients operate?

[00:02:13] Anna: Sure. So well basically we do all things privacy, so we do consulting, training, and we offer resources and one of the things I love about working in the Privacy space is It's just a fascinating intersection between law ethics and Technology. There's you know, there's always something new. There's always a new technology you coming around the corner that we have to get our heads around and help our clients manage that intersection between their Legal obligations ethics customer expectations and then you know what the technology can and what the technology should be allowed to do so, we work across as I said Consulting, training, and resources and we are an Australian business, we've got clients across Australia occasionally we dip our toe into the waters of New Zealand as well. But our clients come from their quite the mix. So, quite a lot of government clients but also businesses from the big end of town, to the nonprofits and also the small and very much Tech startup space.So we have clients everywhere from the kind of you know top ASX companies down to you know, one person’s got a great new tech idea with working out of their spare bedroom at the moment kind of space.

[00:03:28] Pete: Nice as to how much of it do you reckon is in that Health space?

[00:03:34] Anna: Yeah health is really common as probably the second biggest sector after government. Although of course, you know often government is also in the health sector. So sometimes our clients will be the health service provider. So someone directly in that Health Service provision space and they just want to make sure they're dotting their I’s crossing their T’s in the way that they're collecting and using their patients data, but more typically where, not so much that direct service provision, but all the organizations that use and collect and hold and store health information. So sometimes that's insurance companies for example, sometimes it's governments working in public policy organizations getting into the data analytics space so focusing particularly on you know health and disability data for example, and then there's been some really big-ticket kind of projects we've worked on. So we worked on the Privacy impact assessment on the original design for My Health Record, back when it was originally called the Personally Controlled Electronic Health Record the original setup of the National Disability Insurance Scheme. So we've been involved in privacy impact assessments very early on in those very very big-ticket government projects which touch on health and disability data in particular.

[00:04:55] Pete: So in health in particular then what are some of the biggest privacy concerns you see today that the pop-up.

[00:05:02] Anna: So what I think is quite interesting about the health sector and it makes it different to other sectors is the health sector is a standout but in a bad way, unfortunately, so the health sector consistently tops the list of sectors reporting notifiable data breaches in Australia.So and when we talk about a notifiable data breach we're talking about when personal information has either been lost. Subject to unauthorized access or subject to an unauthorized disclosure

[00:05:33] Pete: because it was those relatively recently wasn't it that want kind of recently that was something change that meant that companies needed to be more transparent with that kind of thing.

[00:05:43] Anna: Yeah absolutely so the law was changed in February 2018. To make notification of it. So if you have this kind of data breach and if it's likely to result in serious harm to one or more individuals. It's now the law in Australia that you need to notify both price commissioner's office and those affected individuals, so your patient.

[00:06:03] Pete: It's not just big companies or small companies.

[00:06:05] Anna: So in the health sector at covers any health service provider regardless of their size.

So you might be a one-person physiotherapy business, you know or an independent Locum you uncovered by the federal privacy act. So regardless of your size all Health Service Providers are covered. Outside the health sector, there is an exemption for small businesses. But that exemption does not apply to health service providers.

So the health sector is already called out for I guess expectations of a high level of privacy protection for businesses no matter their size in the health sector just because of you know, patient's expectations. And so I think one of the things that makes the health sector different is patient expectations, so it's not that the type of privacy risks or privacy issues are different for health technology, for example, technology design as for any other type of Technology design, but the difference is that patients expectations about the protection of their Health Data are much higher. There's just this sort of intuitive if it's my health information. It must be kept absolutely private, but also the consequences of privacy breaches tend to be higher when you're talking about health information compared with say, you know, The Accidental disclosure of someone's credit card details. Yeah, there are some financial risks. But those risks can be resolved, you know relatively straightforward way. I don't want to minimize those risks, but it's quite a different story in terms of the repercussions individuals can face if their health information is disclosed without Authority. So that might be it could be discrimination embarrassment implications for their employment implications for insurance and all the rest.

That's what makes the challenges for people working in technology into the health sector and technology so much higher not that as I said, not that. The nature of the Privacy risks themselves are terribly different. It's just that the expectations are higher and the consequences are worse if you have a data breach.

[00:08:17] Pete: So you mentioned that you guys do privacy reviews. What is a privacy review exactly?

[00:08:24] Anna: So we did two different kinds so one is called a privacy impact assessment and the other is generally called a privacy audit or a privacy compliance review and the difference really is where you're at in the design process for what we're reviewing. So if you are at the design stage of a new project new technology project, for example, we get in at the design stage and do what's called a privacy impact assessment. If you want us to review something that's already up and running.

So your business as usual. We basically call that a privacy audit but regardless of which one of those we doing. We ask the same kind of questions and regardless of whether its the design of the software. It might be the design of a business process. It might be the design of a paper form. It doesn't have to be, you know, a high-tech project to need this kind of review.

So regardless of the nature of the project we tend to ask the same questions so you know can and should we collect this data can and should we use it for this particular purpose who can we disclose it to? How do we keep it safe? So when we look at a new project, for example, we look at two broad things one is data flows and the other is data governance.

So when what I describe as data flows what we're looking at is. What personal information is being collected? How is it going to be used? Who will it be disclosed to so those three points collection use and disclosure and for each of those we then ask is this going to be appropriate meaning is it going to be lawful?

So is it going to comply with the Privacy principles that govern collection use and disclosure but not just is it going to be lawful? Is it going to meet your customers? You know your patients expectations. Is it going to be proportionate to a legitimate business need and is there critically, is there a more privacy-protective way you can achieve that business objective? Yeah, so always trying to come up with you know, helping our clients come up with the most privacy-protective design of a technology of a form of whatever it is but in a way that still achieves the businesses objectives.

So once we've settled those questions about authorizing the data flows and making sure that there are lawful and appropriate then we look at data governance. So we usually start with looking at transparency. So have you communicated clearly to your customers about those data flows? You know how their personal information is going to be collected used and disclosed so that they actually understand what's going to happen.

You know, I talk about the no-surprises rule no one likes to be surprised what's going to happen with their data and if they have if they're going to have choices is there a really easy way for them to manage those choices? You know, is it as straightforward as a swipe left or right on the app to say yes or no to something and one thing that's really important is in terms of transparency is for organizations to separate out what we see is three different things but often bundled together. So those three things are your privacy policy a collection notice explaining. At the point of collection what it is you're doing with the person's information and a consent mechanism if you're going to rely on consent, so those three things serve three quite different purposes, but especially online.

The design practices often companies will jumble the three all together into one long legalistic confusing document and then they make users just tick agree

[00:11:55] Pete: Tick a box and you can and you can click the link. Click the link to go read it that you it's not down the bottom.

[00:12:02] Anna: Yeah, and we know no one ever reads it, I don't even read them. So we so in terms of data governance. We look importantly transparency. And then finally we look at other data governance questions, like have your staff being trained. Do you have a clear pathway for managing any requests you get for patients to access their data or correct it do you have a clear pathway for managing privacy complaints. Do you have a data breach response plan in place to your staff know what to do in the event of a data breach, so. All of those things that of data flows and data governance form part of whether we're doing a privacy impact assessment of a new project or a privacy audit of an existing business process and again, whether its software or something else, we look at both data flows and data governance as part of our privacy review.

[00:12:53] Pete: And if I think about it from my experience. Often, you know, if I'm thinking as a health Tech vendor not many of them go out with any kind of massive intention on I don't know to steal patients information or doing something cynical with the data, but I've seen in the past two, it's not about the intention of what they're going to do with it, but it's almost the perception of what's going to happen or so having that kind of review or someone outside of the business to do that sounds like a pretty sensible thing to do.

[00:13:23] Anna: Yeah, absolutely and certainly my experience having worked in you know, in a regulatory role in the primes Commissioner's Office the vast majority of privacy complaints and the vast majority of privacy breaches and data breaches are not coming from a point of malicious conduct or deliberately people doing the wrong thing.

It's accidents and it's oversights and its people simply not understanding what their obligations are. Understanding that there are alternative ways to design things. So absolutely. Yeah. I very very rarely see privacy breaches arising from deliberate misconduct. Yeah. It's much more coming from a place of ignorance and sometimes people trying to do the right thing, you know trying to be helpful in trying to help the clients but accidentally doing the wrong thing.

[00:14:20] Pete: Yeah, that can happen in health care too. Can you just send this across to me? I really need it because of this particular situation or something. Yeah.

[00:14:27] Anna: Yeah. Absolutely.

[00:14:28] Pete: It seems to be the right thing to do. It's a balance. So I'm thinking about that In our world AI artificial intelligence that's a big point of discussion regarding privacy for me anyway at the moment. How well do you think policies keeping up with the rate of pace of innovation in Australia more broadly as AI is really Innovative space and there are other things going on too, how’s policy keeping up.

[00:14:50] Anna: I think there's a constant challenge whether it's AI or any other kind of new technology.

There's always this challenge of Law and policy keeping up. The first point I'd make is that privacy laws are designed deliberately. They're drafted deliberately to be technology-neutral and format neutral. So the idea is that they shouldn't actually be always playing catch-up. We've tried to anticipate in the drafting of our privacy laws technologies that haven't even been thought of yet and our starting point with those laws is Broad framed general kind of principles and it's all about respecting humans autonomy and dignity. So sort of one answer is the law is keeping up because it's it was already anticipating new technologies and that those new technologies should be being managed Under the Umbrella of existing laws and policies.

But at the same time obviously the law is constantly being challenged in terms of how workable it is in practice and certainly with artificial intelligence the ethical and legal implications are something that not just in Australia but governments around the world are grappling with right at the moment. So there are projects trying to come up with legal and ethical frameworks to cover AI here in Australia the federal department of innovation and industries been working on something there are projects in the EU there are projects in the US There's a lot of activity going on at the moment and lots of those projects around the world are focusing on things like the fairness of AI as well as transparency.

So in particular in Europe some of your listeners. May have heard of the GDPR are already. So that's a privacy law in Europe that was recently reformed the general data protection regulation and one of the reforms that was introduced is what you might call a right to algorithmic transparency. So that means that's kind of the laws way of trying to ensure that algorithms developed from AI from machine learning and from AI will be fair and accountable in terms of the impact of decision making that is made or decisions made based on those algorithms. So there's kind of a right to human review of computers decisions and there are rights to ask companies to pause or stop the processing and we would call that using or disclosing someone's personal information in order to ask for an explanation of well you know, how is this algorithm? Working so why you know, why was I denied health insurance or why is it why my premiums going up and my next-door neighbors are going down for example.

[00:17:49] Pete: and its even more like as we're moving to space where artificial intelligence is assisting the process of Diagnostics and looks at an image and says this patient has cancer or not.

You know that having that in a black box is not you know, and then just you know, let's ask the computer and wait to see what. Is it so much ambiguity there?

[00:18:12] Anna: Yeah, absolutely. And in a legal sense, I think courts will increasingly struggle with this as well. If someone is challenging a decision, so it might not be the you know, the diagnosis but maybe it's the health insurers decision based on the diagnosis.

You know, we're going to pay your claim or we're not going to pay your claim or whatever it is. You know based on some kind of calculation of risk of that disease developing for example, or you know, if the algorithm can't be explained to a court if it can't be explained to a judge. How is anyone going to be able to determine whether that algorithm was working in a fair and accurate way so one of the really critical privacy principles is it's called the data quality principle or the accuracy principle and it says that each of us has the right to ensure that only accurate relevant up-to-date complete not misleading information is used in decision-making about us and that obviously.

Becomes more critical, you know the rubber hits the road where the decision is going to impact us negatively. So the decision is going to be you don't get the insurance or we don't pay your claim. You don't get the job. You don't get access to housing you don't get access to credit for example, and so if you've got decisions made in a black box and no one can explain how they're made because. Yeah, there was some machine learning going on in the AI system came up with its own algorithm. How can anyone test how can a court test whether or not that decision making and the data on which it was based was, you know accurate Fair relevant up-to-date Etc. So that's certainly one big challenge for AI that the sort of the transparency and the accountability for it and I think the other Big Challenge or the other area where AI poses a challenge in terms of compliance with Privacy Law is the lawfulness of the data flows in the first place. So, you know, it's when I was talking about when we do a privacy review we're looking at the data flows meaning what personal information is collected, how it's used who it's disclosed to and in the world of AI your ability to lawfully collect use or disclose data. It's extremely hard to rely on consent as your lawful mechanism consent isn't is by no means not this by no means the only lawful mechanism. There are lots of ways under the Privacy principles that allow companies and governments to collect use and disclose personal information. But quite often consent is what organizations try to rely on but in AI it's really challenging. So if you think about do you do example AI is being used to diagnose some health conditions? Yeah, much of the data. Used in the first place to train the machine learning that will create the AI will create the algorithm that training data what we call a training data will have been collected for some other purpose. So it will have been years worth of data collecting about real hospitals being treated in real patients being treated in real hospitals. That and that becomes the training data set for the machine learning. So it's fairly likely that the patients in the past were not asked to consent but that time to sometime in the future use of their data for this quite different purpose.

[00:21:56] Pete: That’s something that wasn't even thought of at the time.

[00:21:59] Anna: So it’s not just about treating you at some point in the future a machine will use your data to train another machine to recognize patterns in data, so but even now if we started to ask patients for their consent, you know as well as us treating you in hospital today. Do you consent to your information being used for AI development in the future? How could a patient today possibly give informed consent? Because the whole point of machine learning and AI is to kind of throw all the data in the mix and just see what pops out it's not a kind of if you like old-fashioned kind of you know, he's a research by hypothesis. This is the question we're asking here's exactly how we're going to conduct the experiment. Yes. So it's not like a clinical trial whereas a patient. I know what my disease is. I'm being offered a new kind of medicine. I've been warned about the possible side effects, and I've had the chance to say yes or no AI and machine learning at based on quite different kinds of research practices, which don't usually involve. That kind of one-on-one sit-down discussion with an individual. It's based on very very large data sets to create those training data sets.

It's based on historical data. And typically you don't go back and you don't have the ability to go back and ask for everyone's consent. It's very difficult to rely on patient consent as the lawful basis for health information to be collected used or disclosed for AI purposes. As I said, it's not the only possibility but quite often companies work on the assumption that consent is going to be their legal mechanism and it turns out not to be.Kind of the pragmatic solution for them, but I don't think that that's something that's particularly. Well understood yet.

[00:23:52] Pete: What is the solution then like if consent isn't it? Like how does a company doing AI in health or any area I guess operate?

[00:24:01] Anna: so there are other legal mechanisms and one of them is and it depends, you know, which Privacy Law you're talking about which jurisdiction you're in but there's usually some kind of research exemption and that usually, again it differs kind of from state to state and federal and Country to country but the research exemptions usually have some role for human research Ethics Committee which gets to weigh up the ethical considerations. Think about where the public interest lies and that committee usually has the power to waive the requirement for consent.

There is this kind of structured way to work through thinking about those issues and the National Health and Medical Research Council has guidelines on you know how to set up a human research Ethics Committee and what a properly constituted committee looks like and all of the factors that they need to, you know, there are guidelines about how they need to reach their kind of decision making, so it's not as simple as simply you know, those the tick a box mandatory terms and conditions.

That's not going to constitute a valid consent in Privacy Law. So that's just not the right legal mechanism in the most in the majority of cases for artificial intelligence kind of development. 

[00:25:25] Pete: Wow so much complexity to factor in and you can going through even just the tip of the iceberg of all of that you can see a lot of work underneath it and questions and kind of vagueness that kind of speak to the reasons why the rate of innovation moves so much faster than other areas that are important like Policy. That's really interesting. Hey look so moving on what should Australian health tech software vendors be most concerned about when developing a solution today then.

[00:26:01] Anna: I think first of all make sure you're thinking about both your legal obligations and your customers expectations, you know, the law is by the law. I'm talking about the Privacy principles built into Privacy Law the law tries to codify your basic ethical obligations, but it really sets the minimum kind of standard and often your customers expectations will set a higher standard than just legal compliance. So legal compliance is obviously necessary, but it really should just be considered the minimum Baseline not the entire set of things that you need to think about. I mentioned before the role of consent is in reality quite fraught so if you are relying on your patients consent to do something with their health information you absolutely need to make sure that that consent is actually going to be valid under privacy law you know, it will hold up to scrutiny. So you can't under Privacy Law. You can't say that you're relying on a patient's consent if they actually had no choice to say. No, it has to be voluntary. It has to be informed it has to be specific

So it can't be included in mandatory terms and conditions, for example, an opt-out model is not consent. For example, so as I said consent is not the only legal mechanism. There are plenty of other mechanisms. But if that's the one you're relying on you need to be really careful to get that right and another thing is to make sure that your technology has been designed with privacy in mind. So we talked about this concept of privacy by design which is all about baking your privacy controls into the design of systems from. The beginning rather than trying to you know retrofit them in later and I think well what I find usually is a lot of effort goes into the cybersecurity side of things, you know, keeping out the external Bad actors and that's obviously incredibly important but our particular kind of expertise and our skill set is focused more on the internal actors so when you are whether you're designing tech your configuring it implementing it you need to think about your customers but also about your staff or your trusted users your trusted insiders. So making sure that Tech is designed so that its staff or other authorized users only see the absolute minimum amount of personal information about your customers or your patients that they really need to do their job, you know, the legislation says that you have to do this a lot of people come back and say oh, we've got a code of conduct for our employees. We make the more sign it so that's okay. The law says that that is not enough and you know case law comes basically the law that comes from Court decisions and tribunal decisions backs that up that just having you know, letting all staff see all patient records but saying oh, but they signed a code of conduct that's not going to be enough

You won't be complying with your privacy legal obligations if that's all you're doing. So you need the same things like role-based access controls, but there's a whole bunch of other privacy controls that can be built into Tech design and it will depend on the kind of product you're or service that you're designing

But depending on what it is you're doing, you know, if you're if you've got a data analytics project and using a data warehouse, for example, we would look at filtering out certain data fields. And then we'd look at masking other data fields from the view of particular user groups. If you think about something like an E-health record system, you would limit the search functionality to prevent misuse, you know, the kind of scenario we’re usually looking at is, you know, could a staff member look up health information about their partner or their ex-partner or their next-door neighbour so you might put in a test that users need to pass before they can even access customer records. For example, rather than just enabling any user to do a global search against any customer or patient name, so there’s plenty of different things you can do. So we use 8 privacy design strategies to help guide Our advice to our clients when we're reviewing technology design software design and sometimes the solution lies in the design of their technology itself, but quite often it's outside the technology so the solution might be or a mix of you know, staff training policies and procedures back to that transparency issue. So how you communicate with your customers. There are lots of different angles we can come from when we're trying to mitigate privacy risks.

[00:30:50] Pete: Wow there's a lot to cover I'm sure there are many people listening and thinking this probably a few things that could be applied in their business in the healthcare space, whether it's they're providing the service or the software that sits behind it.

I think it's evident that it that it's something that's important to everyone from that single physio, you mentioned right through to the big organizations have got a lot more structure and process to handle this stuff and even they get it wrong a lot too. So having a dedicated focus in that like you guys is particularly interesting so

Thank you for sharing your thoughts and insights on that particular topic.

[00:31:30] Anna: Great. Thanks for having me on the show.

 

October 14, 2019

Talking HealthTech

Conversations with Doctors, Developers and Decision Makers to promote innovation and collaboration for better healthcare enabled by technology. Because collaboration begins with conversation.
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Peter Birch

Peter Birch

Peter Birch has worked in management roles in healthcare organisations for over 15 years; big ones and small ones, innovative start ups and slow moving beasts, he’s seen all different kinds. Pete has experienced first hand the exciting developments and the frustrating stagnation's of all the ups and downs in health, as well as the impact to businesses, investors, doctors, and patients.

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