Panel discussion

Wendy Chapman

Thank you, Christine. It was wonderful to hear about that journey. So I'm going to ask the panelists to show their video right now, and I have a couple of questions that I want to bring to the panel. The first is really building on what Christine said about a hospital and the home, remote monitoring, and a lot of people mentioned that. With the access that patients and people in the community and their families have to help technologies, what are the opportunities that that brings to us in healthcare and what are the challenges?

And so, if we just go through each person. What's your view from the lens that you're wearing? Maybe start with Vincent.

Vincent McCauley
Thanks, Wendy. It's been quite a rapid and major change in clinical care, and I think the challenge has really been how do clinicians deal with that, the impacts on their cashflow, the impacts on their personal lives, the impacts on their patients and how they view their relationship as a clinician.

Christine Kilpatrick
You know, less COVID around, obviously. Zero. But we still need to social distance, so we still need to live with COVID. So we have to keep patients out as much from the hospital as much as we can, keep staff away as much as we can, which is safe and it's a complex issue. And so, how do we keep these higher levels of telehealth going?

Christine Kilpatrick
We're seeing that drop and we're having to push and trying to work out fundamentally what is it? Why are people somewhat reluctant. And I think there's something in that there's no doubt, in some places patients are better off being seen face to face. There's no question about that. But there are plenty of times they're not. Plenty of times they're not. And so, I think that's something we're really working on.

Hospital in the home, home based care, let's call it that, it's probably better. I think the trouble there has been medical staff in particular probably haven't trusted it, haven't quite understood, to be honest I used to be one of them, get their head around it. How can it be? And so, I think with wearables, with more digital monitoring of patients... and I think we need to have an after hours medical and nursing structure to support it. Then we'll get much better buy-in.

So it is a wonderful opportunity, but we have to work hard at it. And the Victorian government is onto this. They see home based care as a reform that hasn't happened before. They see telehealth as a reform that's not happened before, and they're certainly trying to help us, give us incentives to try and keep delivering on this.

Wendy Chapman
So, thank you. Rinaldo and Melissa, I want to target this question to both of you. The-

Rinaldo Bellomo

Look, as a clinician I can only see opportunities. I never see obstacles. I just never see obstacles. It's just a matter of wanting to do stuff. I mean, we've done some simple things at the Royal Melbourne. We've been sending SMS's to families that have had major cardiac surgery. Where the family might be Bendigo or Ballarat or far away and they're getting SMS's every step of the patient's journey with electronic information. The patient's been extubated, the patient's doing well, the patient's moving to the ward, and they can transmit that information to all the relatives. We've had people sending it to Denmark or Finland, that grandpa has done okay. And it's all happening and it's all automated and it's all very easy.

Adding video to that is only one little step away. I estimate that 5 to 10% of patients in the hospital could go home with sensors. I mean, why can't we send people home with an oximeter, a blood pressure cuff, and have a nurse instructing them how to put it on and use it and all the information is visible. You can see the patient's face, you can measure the respiratory rate, you can talk to them. We can add consumer focused healthcare. You can have groups of people with rheumatoid arthritis, or whatever other disease, sharing their experiences, understanding their problems, putting their problems in a context.

I mean, it's fantastic. COVID-19 has let the genie out of the bottle that people had been scared of. And it's out. Thank God it's out. It's phenomenal what can be done. Simply phenomenal. I mean, ambulances. People should be encouraged to call the ambulance with WhatsApp and FaceTime. So the ambulance callers, the dispatchers can see them, can see how distressed they are, what's going on, discuss things with them, have a sense of how grave or severe the situation is. How to distribute ambulances in a different way. I mean, it's endless. This is the best time to be a doctor and the best time to be in public health. Absolutely the best.

Wendy Chapman
Ah, thank you, Rinaldo. Melissa, are you still on?

Melissa Skilbeck
I am.

Wendy Chapman
Oh, good one. Oh, there you are. Wonderful. I lost you on my screen. So Rinaldo has this great optimism and all this opportunity that we have, and I think for a lot of people who are on the innovation side, who have great ideas, they're researchers, they're digital tech startup companies, feel like there are a lot of barriers and there's a need to really collaborate with the government. And your project was a good example of how it's not clear that a researcher who developed the idea that you guys implemented could've really made that happen. How do we work together across the different sectors to make these big ideas succeed?

Melissa Skilbeck
That's a big question, because that's one we ask ourselves an awful lot. I can verify that the researcher who came up with the original idea certainly didn't think of it, because it was actually a CRC in capital markets doing capital markets analysis of the stock exchange that came up with the seed of the idea that was then applied to prescription exchanges. So it's actually important to be picking up innovations across a similar system as opposed to particular sectors or professions as well. But it was a light bulb moment when we connected the two.

I think it is very hard and our federation is one of the challenges that we have to make effective platforms national, as so many of public health ones need to be. But if you can build a very, very strong case... and it's part of why I showed you both data and the personal in the SafeScript story, because you need to coalesce the political as well as the bureaucratic in a system such as ours where we needed to change a regulatory framework and a whole lot of behaviour voluntarily in order to improve care. We, in my division, focus on reducing harm. Where can we best focus our activities to reduce harm to the public in the areas that we're looking in, and to try and make sure that story is very clear. No one argues with the principle.

As Christine alluded to, there's a fairly significant allergy to IT in a lot of ways, both across sectors, but certainly in mine. The fact that we could make the argument that this was a proven technology, albeit in a different industry, helped reduce some of the fear. And it is genuine concern. Every politician and senior bureaucrat's got an apocryphal story of a bad IT project, as I'm sure every business does as well.

And that's why I agree wholeheartedly with Rinaldo's point. It's just the circumstances no one would've chosen has meant that a lot of barriers fell away. And I hope that means that the set of possibilities that people have seen is sustained after the crisis. We've certainly made the most of it in a number of technical fields. We thank goodness we had SafeScript, which was coincidental of course, but it meant that we released a whole lot of regulatory requirements to reduce administrative burden for primary health, and we'll test to see how we've gone, whether we need to reintroduce them or not at the end of the public health emergency order that facilitated it.

Likewise, the progress of electronic lab reporting, labs reporting to us notifiable conditions that enable our public health area to assess whether we have an outbreak in play, was one of those projects we chipped away at for eight to 10 years and in a handful of months appeared thoroughly implemented. And the significant impact it's having on the speed with which COVID samples are taken to the point where it's information for the public health team right now, is quite extraordinary.

So we can't rely on a crisis every single time, so the art is actually making the most and sustaining the gains that we've seen through this crisis, and hopefully building on the confidence that comes with people seeing things work.

Wendy Chapman
Thank you. All right, we only have a few minutes. This is going to be a rapid, round robin. I'm going to go to each one of you and I want to hear one sentence. And there are a number of fantastic questions in the Q&A section, so I'm picking this one.

There are a lot of worthy projects, a lot of great ideas, and I'm sure each of you with your different hats on get your door knocked on a lot. "Let's do this idea. We want to do this. Will you fund us? Will you partner with us? Can we do this at your hospital?" So what is one area that is the first question that you ask in filtering these ideas to decide if it's something really that you and your team would want to work on? So let's start with Vincent again. If I came to Telstra Health, what's the first thing you would [emphasise]?

Vincent McCauley
Thanks, Wendy. It's whether this has clinical impact and comes with a sustainable business plan. They both need to go together. Because if it's not going to make a difference, why bother? And if it's not going to keep making a difference, why bother? So they'd need to have both of those.

Wendy Chapman
Okay, thanks. Christine?

Christine Kilpatrick
Yes. I would say it has to be that it's got to make a difference to enough people, to a population of people, a large cohort of people where there is a problem and it resolves that problem. So I think that's got to be. I mean, there are the things like is it doable? Have we got the funds? There are other things. But the first one must be there first. Because these things are always hard and quite complex and time consuming and cost money, so it's got to be enough. Can't be just someone's pet project.

Wendy Chapman
Thank you. Rinaldo?

Rinaldo Bellomo
For me it's a dramatic increase in the speed of the acquisition of evidence, and the undertaking of tweaking of interventions with the data stream coming behind you to tell you what they do. We can accelerate knowledge acquisition dramatically.

Wendy Chapman
Thank you. Melissa?

Melissa Skilbeck
I guess similar answer again for us, it's a clear and sustainable reduction in harm to the public. If someone comes up with an idea to extract the fax machine from primary health, they'll get a particular interest from me.

Wendy Chapman
Okay, wonderful.

Christine Kilpatrick
And me.

Wendy Chapman
Well, this has been amazing, and there was one question in the chat that I think I'd like to close on and that was about the Centre and what are the different ways that people can get involved in the Centre, and how are we integrating ourselves into the environment with the health services and governments, et cetera. And so, we are creating a lot of different mechanisms for involvement and integration. One is clinical informatics academic directors that we are co-hiring with the health services in Melbourne. And those people will help lead the informatics research at their hospitals and within primary care, and help create those connections with us.

That group that's going to be formed will not only form an amazing peer group for each other, but will host communities of practice and help bring up these amazing clinician scientists who want to do digital health projects, or who are working on improving quality of care that require data or digital technology and need the mentoring and the apprenticeship in that model. So I think that's going to be powerful.

We are embedding people in the schools at the University of Melbourne to really help drive the research across the schools and the education activities that we develop. And so, we hope to work with many of you in building those.

We will have communities of practice that we will put up that people can join, and they'll have various flavours. And we need to work really closely with the groups that already exist; the Institute of Digital Health and the things that they're doing.

And then finally there's one more thing. We are creating a Living Lab and this is a way for patients and clinicians to be involved in the actual co-design and evaluation of the things that we are partnering with our partners that we're working on to try to translate to digital health. I mean to healthcare. And so, signing up to be in a Living Lab and be a real part of that translation.

So those are some thoughts and we will send these all out in a follow-up newsletter. Really appreciate your time on this Thursday evening. It's been wonderful. Thank you so much to all of our speakers, to Uwe and Shitij for the vision of creating the Centre, and to all of the members of the Centre who have helped create the vision. And now we just got to go figure out how to do it. That's all.