Centre Launch

Our November 2020 launch heard from speakers from industry, the health sector and government about why a connected health system is even more important in a post-COVID-19 world.

In just a few short months, COVID-19 has propelled digital health from “nice-to-have” to a burning platform, exposing gaps in health systems worldwide. It's also swept aside barriers to digital innovations for decision makers previously "allergic" to IT. The pandemic has raised challenges, opportunities and many, many questions.

What are the critical ingredients for a successful Electronic Medical Records System, and how can harnessing this data transform clinical trials? How has completely unrelated research into capital markets played a leading role in preventing prescription medication? Some hospitals are now sending patients home with sensors, or keeping their families up to date via SMS after major surgery – when will clinicians  and paramedics start using video to diagnose, triage, reduce hospital admissions and provide home-based care? Is telehealth here to stay?

Find out by watching our launch webinar, which includes a lively panel discussion, here:


  • Dr Vincent McCauley, Chief Medical Officer Telstra Health
    he role of digital technology and innovation in health systems transformation
  • Christine Kilpatrick, Chief Executive, Royal Melbourne Hospital
    Introducing Electronic Medical Records in hospital systems
  • Rinaldo Bellomo, Professor of Intensive Care, and Director of the DARE Centre at Austin Health and the University of Melbourne
    The evolution of our ability to use electronic medical records in acute care
  • Melissa Skilbeck, Deputy Secretary, Victorian Department of Health and Human Services
    The development and co-design of SafeScript.

Transcripts below. Captioned videos to come.


  • Welcome

    Shitij Kapur
    Dean,Faculty of Medicine, Dentistry and Health Sciences at the University of Melbourne

    Good evening, everyone. My name is Shitij Kapur. I'm the Dean of the Faculty of Medicine, Dentistry and Health Sciences, and it is my distinct pleasure to welcome all of you here today. In an ideal world I would much rather we all be in person, but obviously we live in a less than ideal world, so I am delighted that you're with us.

    Let me begin by acknowledging the land on which we are. Now, the beauty of a digital world is that you could be in many places in our great country. You might even be across the water somewhere. But wherever you are, it's likely that you're on the land of the indigenous people. So we acknowledge the stewardship of this land. We pay our respects to their elders: past, present, and we look forward to our shared future together.

    It is in that spirit that I think we open the Centre for Digital Transformation for Health, and it is a distinct pleasure to have reached this day. I started here as a dean, I think four years and some ago, and at that point in time I felt the need to bring together the various, I would say, peaks and islands of excellence we had in the area of digital health together. So I'm delighted that we're at that point today. I'm delighted that we have a team that has helped bring all of us together, and I'm delighted that that team has very widely consulted with many of you and that we are at this point in time.

    Now, I have to say I personally find this combination of webinars and panels rather hard, because I'm used to seeing people when one speaks. This almost seems like speaking into an abyss. But nonetheless, I think it is a great moment. And it's particularly great because I think health needs digital, and if there was any proof of that, I think COVID is the proof of it. It is a proof of it in various ways. First, a lot of healthcare has pivoted to digital. Almost the entire response has been driven by data and modeling, and more importantly, it has affected not only COVID response but everything else in health. So I think if there was a proof one needed, or a trigger one needed to change one's ways, nature has provided us that.

    The challenge, of course, is how to respond. And in many ways the Centre for Digital Transformation of Health is our response to that challenge. You shall hear a number of keynote speeches today which will exemplify in different ways the role of digital wealth in our future. So I won't take much of your time, because actually I'm excited about the talks that are yet to come and are ahead of us. So let me, with those words, actually welcome Professor Uwe Aickelin, because this is a joint collaboration between the Faculty of Medicine, Dentistry and Health Sciences, and the Melbourne School of Engineering and its School of Computing and Information Systems. It's in many ways the marriage of digital and health.

    So with that spirit, let me hand over to Professor Uwe Aickelin.

    Uwe Aickelin
    Head of School, School of Computing and Information Systems, The University of Melbourne

    Well, thank you, Shitij, for these kind words. I'm not sure you can see me, but I'm sure you can hear me. I'm Professor Uwe Aickelin. I'm the head of School of Computing and Information Systems and it is really my pleasure to be here. I'm really happy, actually, that we have got this Centre off the ground. You can see the big smile on my face.

    I've been working in this area myself as it happens. I work in artificial intelligence for medicine and I've been doing this for about 20 years. I know from my own experience the work only has impact if the engineers and the IT people work together with the clinicians and the medics, and I think this Centre will allow for that to happen. It's been a massive investment from across the university. I think we're going to get some really results out of this new Centre.

    Really, I don't want to say much more other than introducing Wendy. Sorry, I should say Professor Wendy Chapman, who is the director of the Centre, who I am also really delighted that we managed to get aboard for this, because I'm convinced she will do a fantastic job. She is the associate dean of informatics and digital health in the faculty of medicine, and she also happens to be a specialist in quite informatics related things, like AI and LT. So I think actually she understands both sides really well.

    Wendy Chapman
    Director, Centre for Digital Transformation of Health

    Thank you, Shitij and Uwe. It's a pleasure to be here and we welcome everybody this afternoon. I'd like to offer a special thanks to the attendees of the Melbourne program of the Digital Health Institute Summit, which starts tomorrow, the Melbourne program does, and we're very grateful for the institute's support of our launch.

    So now to the proceedings. A reminder, this webinar's being recorded. We'll have presentations from each of our speakers, and then we'll go into a panel discussion and have question and answers following that. You can contribute your questions at any time using the Q&A tab. In fact, put them in early so that we can look through them as we go through the talks and sort through them and pick. You can also up-vote on those that you like so that we get the most compelling questions at the top of the queue.

    Due to an urgent personal matter, Mary Foley, the keynote speaker that we had planned on hearing from tonight, is unable to make it. We wish her all the best and we are really grateful to have in her place the Telstra Health CMO, Chief Medical Officer, Vincent McCauley. But before I introduce him, I'd like to take you through the vision of the Centre.

    [plays Centre video]

    So I'm walking across the Oval to pick up my daughter from school, and it's the first week back, she's very excited to be there. And I realize, as I'm walking across the Oval, that I've got shortness of breath. I'm wheezing, my chest feels tight, and I can't breathe. And I know that that's the start of an asthma attack for me. Last time I started to feel this way it dragged on for a few weeks and I was quite sick. So what I do is go home and call my GP.

    Dr Shiv Shanthikumar, Respiratory Physician:

    By the time she gets to me it's weeks later. And she talked to her GP at the time, but I don't have access to that information.

    I'm just trying to remember. I don't think that I actually took my preventer that morning.

    I need to know, was the weather bad that day? Was the pollen count really high? Did she go to a new place?

    I know some of my triggers, but it's sort of hard to know what was going on with the weather completely that day. It could've been something in the air, but it could've been something else.

    It's difficult for me to give her the care she deserves with all these pieces of information missing. Sadly, this story is not unique. It's one that's very common in our healthcare system, and it happens to patients with all different sorts of chronic healthcare issues.

    James Kane, tech developer, Two Bulls:
    Luckily we all carry smartphones and those devices can capture incredibly useful information. I can connect data from wearables and case histories to ensure everyone is looking at the same thing.

    This would be possible without the need for the development of new technology, and it would mean that we go from our current disjointed system to a future where healthcare is connected.

    With the right information I could go see my specialist to work out what's going on exactly with me at that point in time, rather than waiting till later on when things have settled down.

    I could have access to her daily symptom scores, as well as environmental data.

    We can bring together accurate patient data, research, best practice quality control, to ensure better health outcomes.

    So imagine a healthcare system which keeps improving with the increased feedback. So not only do we improve care to her, but that information also drives improvement in the whole system.

    It'd be really great to have the right data to work with my GP so that I can be as healthy as possible.

    The potential for connected health is right in front of us.

    [Video ends]

    Wendy Chapman:
    All right, thank you. So that's the first time I've created, well asked somebody to help create, a movie for something I've done. Beautiful movie and I think it really helps you understand what's motivating the Centre that we are launching today.

    So let me talk about the Centre and what we are going to focus on and our strategy.

    The Centre for Digital Transformation of Health is an investment made by the University of Melbourne to bring together people from across the university, from Medicine, Dentistry and Health Sciences, to engineering, computing, and information systems. And we all have shared goal of leveraging digital innovation to transform healthcare. We have a charge to not only do education and research, but also to work with patients, governments, industry, and health services to connect digital innovation to health. This is the academic leadership team who have crafted the vision and strategy that we're formally launching today.

    So what do we mean by connecting digital innovation to health? Well, you saw with Caroline's story that there's this very fragmented system that we exist in. And there's a reason that healthcare hasn't been digitally transformed the way other industries have. It's a very complex system and to bring about that transformation we need all kinds of expertise and experience from diverse stakeholders to change not only the technological foundations of healthcare, but the culture and the processes before we can really change the outcomes.

    The mission of our Centre is to bring together all the pieces in our corner of the world. And we think that we have something special in this corner of the world because of the connections that we're building. And so, we believe that at the end of the initial investment in the Centre, we'll be able to be a beacon and have leadership that's internationally reaching.

    Our vision is connected health for people like Caroline. Using the learning health system as a model, we plan to collect and link clinical data so that we can learn from our experience. We'll analyse that data and develop new models of care that serve the needs of patients and fit within the workflow of clinicians, and then finally we'll measure the outcomes that really matter.

    The University of Melbourne has invested in this space and brings to the partnership the ability to connect researchers from the University to health services to be able to bring broad expertise in all of these different areas so that we can work together towards this broad goal.

    I think we all know the promise of digital innovation to transform health, because we see those transformations in our daily lives. But the reality is often that innovations are published in academic journals and don't go further than that. Innovative apps are never used or evaluated, and especially never evaluated in real health settings. So we want to help speed up the translation of digital innovation to health.

    If you think about the pathway for drug development, it's a very clear pathway. It's been established for years. Everybody knows where they fit and what to do. But with digital innovation there's a big gap, and it makes that translation of innovation into healthcare slow.

    We aren't the only innovators in this space, but we hope to do something unique; to build the capability to develop, validate, and evaluate digital health innovations so that we can speed up that translation. We are going to work on the data side of it to transform health data to be connected and research ready so that we can create a collaborative, streamlined research environment where data driven research can flourish. Because we already have a lot of great researchers in this space; a lot of people trying to leverage data, but the ecosystem is just not there yet for us to work on. And we want to help build up the workforce; address the needs that they have so that they can thrive in this new world and become the new innovators, and build innovative educational tools for experiential learning to teach informatics and digital health to our workforce.

    We hope you will join us to help bring together the pieces in this grand journey so that we can achieve true collective impact. So I thank you all for joining us today, and if you'd like to stay connected to the Centre and follow our work and share your ideas, look out for our newsletter which we will mail to you. You can email us at health-informatics@unimail.edu.au, and we'll be sending a survey to query you about how you might like to get involved.

    Okay. Well, without any further ado, I'd like to introduce our keynote speaker, Vincent McCauley. Vincent joined Telstra Health in July 2015 as Chief Medical Officer advising on areas such as eHealth, clinical governance, and pathology. He has vast clinical experience in respiratory and emergency medicine, and he's been a researcher, he started a company. He has very broad experience. And I was very pleased when he said he's involved in health standards and it reminded me that one of my colleagues in the U.S., Ken [Reuben 00:15:17], had said, "You must meet Vincent McCauley when you get there." And so, very happy to run across him in this way.

    He's the Chair of Integrating the Healthcare Enterprise Australia, and a member of the IHE International Board. He's also a professor of digital health at Flinders University. He's driven by his goal to create a secure, highly connected and interoperable eHealth infrastructure underpinned by sustainable business models. Backstage at the digital health revolution is a messy place, and Vincent's had a ringside seat for the best part of two decades. So let's hear from him on the role of digital technology and innovation in health system transformation.

  • Vincent McCauley

    Vincent McCauley
    Chief Medical Officer, Telstra Health

    Thanks, Wendy. A great pleasure to be here today and I must say that Mary Foley was quite devastated that she was unable to make it, and really only had to make that decision this morning for personal reasons. So real apologies from her and I hope that I can stand in her place and do it justice.

    I'm not going to show a slide deck. I'm sure that you will see plenty of those, but I wanted to focus on some of the areas that Telstra Health, where Mary is the CEO, have been looking, and how that may have changed over the last couple of years.

    Just looking back at where we've come from, it's been a huge journey. When I started in medicine in the 1970s, when they discovered that I was also doing computer science at the same time, the level of support from the faculty of medicine was underwhelming, to say the least. We've come a long way in that process so that now digital health is a thing, and it wasn't back then. And that's only a career ago. So we've made enormous strides to change in that time.

    One of the things that hasn't changed so much is our ability to translate research into clinical care. I think back to the discovery that bacteria were the primary cause of a gastric ulcer by Marshall and Warren in 1982 in Western Australia. In fact, that discovery had been made somewhat earlier, in 1875, when there was the first description of bacteria in the gut wall, in the gastric wall. And in fact, they published a Polish book in the late 1800s which described that bacteria as the cause of a gastric ulcer. But because it was in Polish it didn't actually see much in the way of takeup. And so it wasn't until Warren and Marshall, well they had to demonstrate that bacteria were a causative organism and develop a cure for it in the form of antibiotics that that became accepted. But it took a long, long time. And I was in clinical practice at that stage and it was many years later that it was actually accepted by physicians on the ground that that was in fact the case, and the awarding of a Nobel Prize to Marshall and Warren in 2005 before it was actually fully accepted by everybody.

    So that journey from research to implementation at the clinical care decision point has really been a very big gap and one that this Centre will help to close. And that has certainly been one of the areas that I've been focusing on throughout my journey towards digital health.

    Mary Foley leads the biggest digital health system developer in the country in the form of Telstra Health. We have 1,200 employees right across Australia and software systems that we've deployed across all areas of health, from aged care to primary care, hospitals, and increasingly in telehealth. And that company has been a major transforming agent that has really seen the need for these sorts of capabilities to be able to take research and convert it into something that can be built into a digital system and delivered at the point of care.

    There have been many pressures on our healthcare system in recent times. We've seen a move from acute disease as the commonest issue that we have to deal with, to chronic disease becoming a real burden to the healthcare. And most of the presentations now either have a chronic disease component or are just due to chronic disease. I was at a presentation this morning from Australia's person of the year presenting about the effect of diabetes two and how that has transformed and become a major chronic disease right across the world and certainly in Australia.

    We've seen increased demand. Western Australia figures recently showed there was a 49% increase in ED attendances over the last decade. We have an aging population, which has led to huge amounts of increased load on the healthcare system, and in association with that we have an aging population of carers many of whom are going to retire in the next 10 years. The baby boom generation. So that ratio of carers to demand is actually falling and we don't have any way of dealing with that other than through technology.

    Associated with that we also have had enormous cost pressures. Technology is expensive. We've seen the costs of MRI and other machines that go ping, and we've seen how new medications are extremely costly to develop. Some of the medications that have come on the market recently take more than a million dollars for a single patient's treatment. And we will see that happen more and more as medications are developed that are truly magic bullets, like the recent treatments for melanoma which are achieving very effective cure rates but are very expensive. So those cost pressures have certainly been affecting clinical change and how rapidly we can take that forward.

    In addition to that of course, in the last year we've had the driver of COVID-19. That has led a transformation in our healthcare system from a usual way of caring to remote care and hospital in your home. We've seen virtual care become a norm and technology that supports that has really taken off. Telstra Health was fortunate in having offerings in all of those areas, and we've seen demand absolutely outstrip anything that we could provide. We've been doubling our capacity in a matter of a few weeks or months to meet that demand, and it has been really phenomenal.

    We've seen a similar sort of transformation in jurisdictions overseas. In Canada they introduced telehealth a few years ago, and that led to quite significant transformations in their healthcare system. So that process that took place over some years in Canada we've seen take place over a few months in Australia. So that rate of change has been really phenomenal and makes it very difficult for people. People feel uncomfortable with that rate of change and they're not too sure exactly where they're going to fit in a transformed system.

    Virtual care has become everything. We've seen virtual care everywhere: hospitals, primary care, aged care. And that will continue, at least in a reduced form, as we go forward. I don't see us going back from virtual care, at least for a substantial part of care delivery. And part of that transformation and rush to get things done that we were struggling to get done before has been things like eScripts, where a process that was anticipated to be completed by the end of 2022 was completed in a couple of months, by the middle of this year.

    So we've had things that have been ready but needed a big push to get them out there and available, and COVID has provided that. It may not have been comfortable, but it's certainly been effective.

    Unfortunately, COVID's highlighted issues in our workforce, particularly in aged care. But as we've seen in Victoria, the rate of infection of our healthcare staff has been very concerning. So we've got some work to do in those areas, and I think we're adapting and learning very quickly from those challenges.

    One of the things that's been helping with that has been the formation of the National Cabinet, which has been quite effective in overcoming fragmentation and introducing national thinking, at least in most jurisdictions.

    The real challenge is, how do we maintain the momentum that has been pushed forward by COVID and other pressures? One of the big contributors to that is going to be creating accessible, high quality data. Data that has to be based on standards. Standards have been one of the things that I've worked on for more than two decades, both in Australia and internationally, and those standards are now effective, ready, and they have, in many areas, shown what a big change they can make. We need to use them more widely and make them, in some areas, mandatory.

    Associated with standards we need common terminology. And again, we've taken big big strides in that. We now have a national clinical terminology service, and many of the health software companies, such as Telstra Health, are also rolling out their own terminology services that mean we have consistent, accessible, shareable, interoperable clinical terminology like SNOMED and the like. And that interoperability of systems has to be achieved through a high level of governance that oversights how those systems work, and also how things are taken forward when they don't work. How do we deal with system failures? Which will inevitably occur. The more complex system we build, the more things there are to go wrong and we need processes to be able to detect that and fix them.

    And what will having accessible, high quality data do for us? Well, it will enable predictive analytics and AI. Things like predicting deterioration of patients before they actually deteriorate. Things like making clinical information right across the sector, from all points of care, available at the point of care that's being delivered to a patient at that time. I think back to my times in the emergency department at Royal Prince Alfred Hospital on a Friday night, being posed with a patient that's come in and been attending the hospital on a weekly basis for the last five years with a chronic disease, who I've never seen before, who I believe has a stack of notes that's at least 10 meters high but of which none are available because they're locked up in the outpatients department where they were the day before. 

    So you're faced with getting a five year clinical history from a sick patient, and to institute immediate care with very little knowledge about exactly what the problem is, only what's been happening to them. That is no longer the case. In the vast majority of our care situations, we now do have at least some clinical data. And moving to a higher degree of that clinical data and higher quality, will effectively enhance patient care. And we're development the new care models. Telehealth, hospital in the home, remote monitoring. They will both reduce our costs and also improve patient care by having a more global view of patient information.

    We've developed some really smart systems. We're going to hear about SafeScript, delivered by Telstra Health partner and partially owned, Fred IT. And we've been really pushing SafeScript. As the president of the Medical Software Industry Association, some 10 years ago we first developed the idea of SafeScript in combination with the federal and state governments, and it's taken a long time to get out there but is a proven and very effective system. And I'm pleased to hear that you're going to hear about that from the DHHS.

    The National Cancer Surveillance Register has proved very effective. Three years in the making. Difficult incubation but now a world first. And we've actually been looking around at other world areas and we're seen to be the leader in this area. UK is now, having decided that there was nothing available in this area that they could use and they can't build it themselves, are now looking at our National Cancer Surveillance Register as an option or as a model for them to take forward.

    So we've got some really world leading platforms that we can build upon and use effectively for patient care. And we're in the process, the whole of the software industry, of replying to a federal government tender for management of infectious diseases on a national basis. Again, obviously the focus has been COVID-19, but this will prove really valuable as other pandemics come to the fore, as I'm sure they will over time.

    Decision making we've seen move from the IT department to CEOs and Chief Medical Officers and Chief Medicine Officers, and that's been a really valuable change in that now we are seeing systems being deployed that are immediately applicable to clinical situations and which clinicians feel safe and can see immediately how effective they are.

    And tech is being used to marshal research for clinical care. We've seen a number of [inaudible 00:30:22] in this area. Wendy mentioned Ken Rubin's work that's been happening on an international basis, it's called BPN Plus. It looks at empowering clinicians to actually be able to develop clinical systems that integrate with our existing EMR's and other infrastructure. And we've launched a process in Telstra Health to look at how we can bring that to the marketplace in the near future. But being able to shorten that timeframe from clinical research to clinical implementation is really the focus of that transition.

    And it's that transformation potential that digital health offers; that this Centre will promote and launch. It will provide a way of focusing industry on the high value tech changes and not be distracted by those that are sexy or in some way technically interesting but actually don't deliver the clinical benefits that we are looking for, and also inform policy and budget, which is really important. As a cold faced clinician I did not realize the importance of that, other than treating the Federal Minister for Health at the time. But in reality it's only been in the last five years in my position at Telstra Health that I've begun to fully understand how being able to inform policy and understand the impact of budgetary constraints actually is an important driver in taking us down paths that produce really good results for patients.

    The Centre will encourage collaboration by diverse institutions, and there are a number of others already in place in Australia that will absolutely merge, or will be able to mesh, with this new Centre. And together they will be stronger, more effective, and able to deliver great outcomes. So I'm really looking forward to another leap forward in the transformation of health into the digital arena. Thank you, Wendy.

  • Rinaldo Bellomo

    Wendy Chapman
    Thank you, Vincent. That was fabulous and amazing that you could pull that off with such short notice. Our next speaker is Rinaldo Bellomo. He directs the data analytics research and evaluation Centre at Austin Health and the University of Melbourne, and his Centre goes by the short name of DARE. And any of you who don't know Rinaldo, when you hear him talk you will think that that acronym fits him and his group perfectly.

    He's the Director of Intensive Care Research at the Austin Hospital, and Professor of Intensive Care Medicine at the University of Melbourne, and he's also the co-director of the Australian and New Zealand Intensive Care Research Centre, and an NHMRC Practitioner Fellow.

    He's on a lot of lists. Since 2006 he's been the most published intensive care investigator in the world. In 2014, Thompson Reuters recognised him as one of the most influential scientific minds in clinical medicine, and he's the most published biomedical investigator in the history of Australian medicine.

    So we're just so lucky to have him tonight and looking forward to his talk. He's going to be speaking on the evolution of our ability to use electronic medical records in acute care.

    Rinaldo Bellomo
    Thank you very much, Wendy. So we were lucky enough, about two years and a bit ago, to be supported by Shitij and the university to start exploring the ability to use electronic medical records in acute care to evolve our ability to understand disease and inform treatment. We were supported to form a small group of investigators, which were clinicians and data scientists, to see if we were able to evolve our ability to use the data that is produced in electronic medical records within a hospital system, such as the Austin Hospital, to inform future investigations in the field elsewhere.

    We got going and we tried to focus on at least three major areas of investigation, which related to sepsis, delirium, and the facilitation of randomised control trials. We focused first of all on trying to understand if there were better ways of identifying septic patients ,that were a particular risk when presented to the emergency department, using a tool called a qSOFA. Why will we do that? I was lucky enough to be part of the third international consensus for the definition of sepsis and septic shock, or sepsis three, which identify that in people presented to hospital with infection, the assessment of the respiratory rate, the blood pressure and the conscious state, so-called qSOFA, Quick Sequential Organ Failure Assessment, might be helpful in identifying those very patients that need to have advanced care or are at risk of doing badly.

    So we wanted to see if the EMR of our hospital would enable us to identify such patients. And you can see there that using the EMR you can identify all the adult ED presentations. 165,000. You can identify those suspected infection by linking the admissions to the ordering or microbiological tests as well as the administration of antibiotics, and you can identify that 20% of these patients were qSOFA positive. They can identify that these patients had almost a 13% mortality. That has to be put in the context that if you present to the hospital with an acute myocardial infarction with ST segment elevation, your mortality at the Austin is about 5 to 6%. So clearly a very high risk population.

    And this now has created the ability to develop alerts for clinicians in the emergency department that can tell them that there is a patient that fulfills this criteria in the emergency department and can hopefully change the rapidity, the context, and the efficacy of care. And the currently advanced process of delivering such alerts is holding out for COVID to finish so that we can actually move to a more normal world and we can implement such alerts.

    Identifying people with delirium is a very difficult thing to do, because there is no standard definition or gold standard that says if somebody is or is not delirious. We define somebody such, in language. We use words like confused, agitated, disorientated, aggressive, combative. And these words can give us a window on the presence or absence of delirium in ICU patients. We can use the EMR notes entered by nurses, residents, registrars, physiotherapists, to analyse whether patients with delirium are present and how many there are and what their characteristics might be if we can identify them by such means.

    So this is reading 60 million words, thousands of EMR notes, and you can identify over a period of several years and 12,000 patients admitted to the Austin ICU that about 5,000 of them are characterized by notes written by nurses and doctors that identify that they are disorientated, confused, agitated and so on. The identification of these patients then opens the door not only to alerts, but also to important epidemiological assessment of what medications can or cannot do for these patients.

    Doing trials is a really expensive business. Randomising large groups of patients is a very costly undertaking. We wanted to see if doing EMR leveraged, randomised control trials would allow us to randomise thousands of patients, a large group of patients, and achieve high quality data capture at minimal cost. This is a paper we recently published in the Journal of the American Medical Association. It's one of the biggest randomised control trials in anaesthesia, and try to test whether the large tidal volume that is typically given to patients during anaesthesia is necessary, or it is actually potentially detrimental.

    The study was conducted at the Austin Hospital and it's a study that, in terms of numbers randomised, would typically cost three to four million dollars in Australia and New Zealand, and more than $10 million in the USA. But we did it and it cost $35 per patient randomised. And it's been published in one of the top journals in the world and it was able to identify that there is no advantage of using high tidal volumes, and in fact there's a trend in the other direction. Particularly for laparoscopic surgery, such large tidal volumes may be injurious.

    So let me conclude by saying that the DARE experiment has delivered multiple lessons, insights, and has opened the door to interventions. We're now incredibly busy dealing with multiple trials and multiple activities, and we've got more EMR-based trials coming along. We have contributed and are affiliated to the publication of more than 30 papers, about a paper a month, since we were created. And I would like to say that it's been a wonderful experience to work with data scientists and discover that if you've got a clinician alone, you don't produce anything like what you could with a data scientist. If you're a data scientist alone, you cannot have the domain knowledge to deliver clinical science. But in DARE, by putting them together, we've had new maths of zero plus zero delivering 30 papers over two years. Thank you very much.

    Wendy Chapman
    Thank you, Rinaldo. So now those of you who haven't met Rinaldo before know firsthand he's a force to be reckoned with. And we hope through the Centre that we're able to learn from what they've done with DARE and build a similar kind of environment so that other hospitals and services can have similar experiences.

  • Melissa Skilbeck

    Wendy Chapman

    Our next speaker is Melissa Skilbeck. She's the Deputy Secretary of the Victorian Department of Health and Human Services. Given she heads up the department's regulation, health protection and emergency management division, it's safe to say she's had a very busy year. There's a strong public health theme in her work, which includes identifying risks and social regulation to influence behaviours. Recent achievements in her division include the highest five-year-old immunisation schedule coverage in Australia and real time health emergency monitoring of numbers of patients arriving at the ED's across the state.

    We're very pleased to have Melissa speaking today about the development of SafeScript, a real time prescription monitoring system that has been a long time in the making but launched broadly in 2019. SafeScript provides prescribers and pharmacists with the clinical tool to make safer decisions about prescribing or dispensing high risk medicines, and facilitates early identification, treatment and support for patients who are developing signs of dependence. And the reason we are really interested in having her talk about this is it's a system that's connected across the whole nation of Australia. It was a lot of effort to get that into place and it's been fully embraced, and so we'd like to learn from her about how she did it and how that whole group did it.

    Melissa Skilbeck

    Thank you, Wendy. Thank you very much. And can I extend my congratulations to everyone involved in the establishment of the Centre. I couldn't agree more with the need for digital to join with health for better outcomes, and that was a key driver here. Hopefully, if Liz can put up the slides, we'll be showing you what drove us to SafeScript. Doctor McCauley noted a decade ago a number of people driving for a SafeScript system, and indeed the Council of Australian Governments had made a decision to do it a little bit less than 10 years ago. Yet it took quite a bit longer than that.

    If I go to the slide, deaths in Victoria sadly drove us. So the classic comparison, to give a sense of proportion, is deaths from prescription medicine vis-à-vis road fatalities in the state of Victoria. Now that was the very significant increase in the mauve bar there of deaths due to prescription medicine. So the Victorian coroner was making a lot of commentary around that, directly to our department and ministers, as well as some more personal advocacy. The next slide shows you a picture of the Millington family.

    John and Margaret Millington is there with their son, Simon. He became addicted to prescription medication following a car accident, and very sadly he died in 2010. His parents have been extraordinary in their campaigning for a real time prescription monitoring system. They have assisted us enormously throughout the journey, and I was just talking to the team today about giving them an update on some happy news that had occurred from New South Wales yesterday, which I'll get to.

    They had a working example and the passion behind the impact of people seeking additional prescription medicine from multiple prescribers; in the particular case of their son, across state lines. The system was hopeful to give prescribers and pharmacists real time data about a patient's history of high risk medicines like benzodiazepines and oxycodone and others, so that they could better coordinate care and prevent multiple prescribers prescribing the same medicine unknowingly, and reducing that to reduce the risk of harm. As I said, many others in addition to the Millington’s have also been impacted to be clear about that.

    For us, we did a lot of pre work before we got an approval from the Victorian government in 2016, where we got a budget commitment of 29.5 million over four years and the four years to do the project. But if you look to the next slide, we could not do this alone and I just note there the extraordinary array of individual organisations who assisted us along the way in various ways, but in particular through expert advice all the way through.

    It was a co-designed system. We did not always agree entirely and there were different factors in some degree of detail of implementation. But very, very clear message from practitioners and from medical digital software providers, PHN's, et cetera, that the information needed to be genuinely real time; that importantly it shouldn't interrupt clinician workflows, and there was an array of different workplaces that clinicians were in and that meant different things, but it meant that we were in the space of engaging with the pre-existing practice software in a number of workplaces and professions; and that health practitioners needed support to interpret and act appropriately on the information they received; that foremost this needed to be a tool that supported better clinical advice and treatment.

    As Doctor McCauley noted, we partnered with Fred IT largely to design the technology on which this program is based. We also had support from Microsoft and from AHPRA, the Australian Health Practitioner Regulatory Agency, who gave us access to confirm registered practitioners for access to the system, and also supported our education and delivery around the system.

    I'm going to show you a slide that I suspect many of you have vastly more technical background to understand, but in effect this illustrates the platform is based on real time data, and that is it's based through the prescription exchange services, which Fred IT had a significant experience and expertise. This meant that our background information is continually updating. It also meant the prescribers didn't need to click in and out of systems. We integrated SafeScript with the multiple key platforms for prescribing and dispensing.

    We held a lot of test sessions with users, different sorts of practitioners in different environments, to get feedback on both design and usability. Because that interface was fundamental to the effectiveness of SafeScript as a tool supporting clinical treatment, and a great number of people assisted to do that.

    The other element of support was online training, which is the next slide. Both online and face to face, once we could do that. A significant amount of work that is ongoing to support clinicians on how to best respond to this new information that SafeScript provides. And it provides information on the screen, you'll see in the corner there, that gives a degree of warning or a green light to the intended additional prescription that a doctor might put forward or the dispensing event. But on the basis of a number of algorithms that go to combinations of drugs or sheer volume of morphine equivalent doses that might present risk as advised to us by a clinical group that we're regularly testing that listing of risky combinations of drugs with.

    We rolled out SafeScript initially in Victoria in October of 2018. Initially for a trial period and then on a voluntary basis for practitioners. On the 1st of April this year it became mandatory for prescribers and pharmacists to use the system under state law. The popups that you see have been responded to now for all of this year. We're starting to see some outcomes. It was, though, a point of some debate between the expert group I noted before and ourselves. Clinical experts were wanting more alerts rather than less. A lot of the advice we received from behavioural insights folk, those who do the nudging in policy world, were very clear about alert fatigue. So that's a balancing act we're still testing as we go and keep active maintenance of the system.

    The sorts of drug or dose combinations that trigger a red alert there have triggered, in the last six months, about 2.3 million alerts. So there is a significant amount of alerting going into practitioners. There is additional information and the question then becomes, has it been worthwhile? What's the worth of what we have done?

    We go onto the next slide. We've attempted to test this in a number of ways. We believe the SafeScript system has already proven its worth and did so in its first weeks of operation. It was not only rare that a system was delivered on time and to budget in the manner in which we did with such a genesis as it had, but importantly, on a policy basis, it certainly proved its worth. If you see the little map there, Victoria developed SafeScript separately from the national system that was previously being pursued, and we were previously pursuing, because the significant advances in technology meant that there was a much better option available through the exchanges.

    But of course from a policy position, one state having a system and not neighbouring states across the borders, to hark back to the Millington’s' experience, it was not going to be successful unless it was national. So it's with a great amount of pleasure and pride that we look at that map and see that almost all of our fellow sub national jurisdictions are now onboard. The additional bit of information we have from yesterday is the New South Wales state budget has provided our colleagues with some funding to implement the SafeScript national platform as well. So that's a very significant gain.

    Albeit the system is mandatory, nevertheless there's always a question as to how many practitioners are both registered and using the system. And we know that we have over 87% of GPs, 82% of pharmacists, and around 60% of nurse practitioners, of those who are registered and some of those are non-practicing, the total registrations, are on the system and using it.

    Then we go to trying to establish whether we've had an impact on harm to those taking prescription medicine. We've seen a downward trend on people seeing four or more prescribers, which is something of a leading indicator. We have also seen a reduction in the number of deaths from prescription medicine overdoses. This information in the bottom corner there has only just come out from the Victorian coroner's office. And while a small decrease from 2018 to 2019 of 424 deaths to 405 might seem relatively small, it's the first time we've seen any reduction in a decade.

    The coroner's court noted SafeScript along with some excellent clinical resources that the Australian College of General Practitioners had introduced as well, and I'm sure there are other influences. Attribution is awfully difficult. But we take those signs and our own interventions looking at the data ourselves to get in contact with practitioners when we see things, to be confident that this has had a very significant impact on public health already. We look forward to a much more significant impact across the nation as this becomes a genuinely national platform, and hopefully it's another example of why digital health is so important. Thank you.

  • Christine Kilpatrick

    Wendy Chapman

    Thank you so much, Melissa. Our final speaker is Christine Kilpatrick. She's been the Chief Executive of Melbourne Health since 2017, and before that she was at the Royal Children's Hospital and in various other roles. She is a neurologist specialising in epilepsy. Christine's a member of several boards, including Orygen, National Centre of Excellence Youth Mental Health, the Walter and Eliza Hall Institute, and the Florey Institute of Neural Science and Mental Health and Victorian Comprehensive Cancer Centre. So she's a very influential person in our state.

    Christine's led the introduction of the electronic medical records in two hospitals, starting with the Royal Children's and now Royal Melbourne. And they went live at Royal Melbourne during the pandemic. They were slated to go live at the very beginning of the pandemic and postponed it and ended up going live during the pandemic. So it'll be very interesting to hear from her about how that went. I'm sure there are some unanticipated consequences and local quirks, but we know from hearsay that it's been a success and that it's a crucial element in designing a more patient-centred journey. So to tell us about this journey and what's on the horizon, let's welcome Christine.

    Christine Kilpatrick

    Thank you very much, Wendy. Thank you. So what I'm going to talk about briefly is the introduction of EMR in Parkville, in particular across the Parkville or Melbourne Biomedical Precinct.

    So the Royal Melbourne Hospital, where I had the privilege of being the Chief Executive over the past three and a half years, we have a strategic purpose, which is about advancing health for everyone every day. And to deliver this, we've identified five strategic goals and in four of these the EMR, electronic medical record, is absolutely fundamental to achieve. Those being that we want our organisation to be a great place to work and a great place to receive care, we want to grow our home first, our home based program, we want to realise the potential of the Melbourne Biomedical Precinct and in particular the connectivity of the four hospitals in the precinct, and of course we want to become fundamentally a digital health service.

    And so, it's fair to say that the health sector has been rather slow to use technology to support and to deliver healthcare, and really to implement an enterprise wide electronic medical record. Now, I think there are a number of reasons why that's so in this country. I think our sector is somewhat risk averse. Health has traditionally been risk averse, and probably government, for some good reasons, has been risk averse. We've seen plenty of technology implementations fail, and early attempts, in particular in Victoria to introduce digital health systems, were not particularly successful. Overall weren't successful. So this added to, I guess, the negativity and reluctance to go down this pathway. And then the final point is that obviously it's an expensive endeavour to implement, and costs meant we needed government support to achieve this.

    So it became obvious to us that healthcare is really, I think, far too complex these days to be managed on a paper-based system. It's just far too complicated. And the benefits of an EMR are very clear to us all now. They support safe care, reduce variation in care, reduce duplication of care, assist in doing the right thing, in delivering evidence-based medicine. They improve connectivity of care across the precinct, particularly when the four hospitals are on the one system, and they improve the patient experience, as well as of course the fundamental ability for the patients to have access to their own medical record. And of course, very, very importantly to us and to the university and to our medical research usages, is they enhance research across the Melbourne Biomedical Precinct.

    So we knew very clearly in our minds that what we needed was an electronic medical record. And in 2018 we were fortunate, we were able to convince the Victorian government and they were committed to funding the implementation of what turned out to be our choice – the Epic system across Royal Melbourne Hospital, Royal Women's Hospital, Peter MacCallum Cancer Centre, using the Royal Children's Hospital EMR, which we had implemented there and went live in 2016.

    It was a big program. It started in 2018 and as you heard we went live in August this year. We called it Connecting Care, because that's what it's all about, and these are logos of the four hospitals. So it was a big undertaking and a big cultural change for all four organisations working closely together, but we did successfully do this. Next slide.

    And so, I think there are a number of factors which are critical to the success. I mean, I have the experience of doing only two, I must admit, but nonetheless. There are probably not that many CO's who've put in two electronic medical records, or been involved in it I should say. So, critical to success are these factors, I think. You need to get a project director who's done it before, at least once. Preferably a few more times than once. So on the precinct here we recruited Jackie McLeod from the Children's, so putting in at the Children's, and she'd also put in Cerner at Austin. So had a vast experience with both Cerner and Epic, so that was a great success factor for us.

    The other is the choice of the product. When we were at the Children's we went out to tender and Epic was our choice, and they had certainly been a good company to work with. You work hand in hand with them and they're as keen to have success as we were keen to have success. So we both needed to succeed to be a successful outcome.

    The other is, I think, fundamental is to see the EMR as not an IT project. Although IT is critical of course and IT staff are critical to support it, it must be seen as a clinical change management project. And I learnt that very clearly at the Children's.

    The other is of course engagement of clinicians. Not only in the implementation and building it and working with it, but also in the choice of the product. And at the Children's we had them on the procurement team and choosing which product they wanted to implement. I think it's key to focus on change management, because that's what it's all about. And so, significant resources for change management are critical. The governance of the project is really, really important. We had all sorts of layers of governance. Something I think maybe we overdid it, but it worked well at the Children's so we used the same model for the precinct and I think it has served us very well.

    And the other point is we had a team of 120 and at one stage 150 people working to build EMR, and 64% of those people came from the health services, including the Royal Children's Hospital. So there's a lot of people who understood what they wanted to achieve, understood the health services. And now when many of those go back to their roles, original roles, then they take with them extraordinary amount of knowledge. And similarly for super users, which are critical to a successful go live. These are the people that are trained up and know everything imaginable about the EMR system. We used in house people. So we looked for our own clinicians to become super users, we didn't bring super users from outside. So that certainly worked very well. We also used medical students who worked out to be wonderful super users as well, and I think they very much enjoyed it.

    So the project, just at a high level, went across 25 sites of Royal Melbourne Hospital. So it's huge. Five sites for the Women's Royal Hospital and five sites Peter MacCallum Cancer Centre. And 11,900 odd staff needed to be trained across our organizations. And as you heard, we were planning to go live and we're on track to go live, the date was chosen some time ago for the 2nd of May this year, and we are on time, on budget and in scope. But COVID wave one arrived and the end of March we were hearing stories that there'll be a big and serious wave, wave one, and no doubt it that was similar to what we'd seen overseas then 40% of staff would either have COVID and not be at work, they'd be too afraid to be at work, or they'd be furloughed. So we made a terrible, and when I say terrible, a very tough decision, but there was enormous pressure on us to defer and say, "No, we will not go live because of COVID wave one."

    Well, by the end of April, COVID wave one was disappearing and we thought we'd dodged a bullet and we would be fine, and so we made a further decision. Yes, we would go live, and we chose the date of the 8th of August 2020. And the reason why it had to be quite a few months ahead is because of all the social distancing we had to change our model of training. We couldn't have lots of people in a room, which we normally would do. We had to have very few people socially distance in a room, and we needed to do online training as well.

    So that was our date we chose, the 8th of August. in the next slide you'll see that that was absolutely spot on our peak of COVID patients, in patients, at Royal Melbourne hospital. In fact, it was four days earlier, 99 we had. But it was about 94 patients we had on our go live date. So it was a very difficult July and early August coming up, wondering whether we should keep going. Of course there were a number of staff who thought we should definitely stop, but there's an enormous amount to lose if we stopped and an enormous amount to gain by going live. And so, very nervously, very anxiously, we decided that we'd keep going and we would go live.

    In the next slide I think it talks about... I'm highlighting here the benefits of going live. Not going live in a pandemic, but having an electronic medical record in a COVID pandemic and then beyond. The first point to make is that the go live was remarkably, surprisingly successful. And I think staff saw it as a distraction, sounds odd, but a real distraction from what they were going through with looking after COVID patients and managing the situation. So that was a positive.

    But the other positives once we had the EMR, we could manage the screening clinics, which we had here at the hospital for patients who came to be screened and swabbed, and screening of visitors who came into the hospital. And the questions, as you may all recall, kept changing all the time. And so, this could be quickly and automatically updated into the EMR, and that happened very frequently and was so much easier. And guidance for PPE could be quickly and frequently uploaded into the EMR and we could keep up to date.

    We could understand the COVID status of our patients. We had automatic reports on the number of patients in hospital who were COVID positive, who were suspected COVID, and who had become cleared of COVID and their location. And that was just automatic whereas before that we had bits of paper trying to work out where everybody was.

    The other very important issue that I never thought about as being a positive of an electronic medical record was that staff were able to access the medical record either from their home, if they were at home, or from another site or away from the patient, and this was of course an enormous benefit with social distancing during these times.

    The other is that we could use telehealth and staff could be at home and use the EMR to do telehealth and enter into the medical record. They could be at home and look at their patient's record when they're an in patient in the hospital and see what was happening.

    We also realised now, we never thought of this as a potential benefit of EMR, is that we can support our home based care. And so, we're now starting to use EMR for supporting patients at home, and this is a great asset for our staff. And then finally, of course, virtual care. There are a number of ways of supporting patients out in the community, and EMR is a huge benefit for that.

    So I guess we've always seen the benefits of the safety of care and understanding the patients and understanding the flow of patients and having everything at your fingertips and the benefits for research, and they are of course profound. But we had never thought through or thought about these benefits such as telehealth and home based care and virtual care, which has clearly come from the EMR.

    So that's been our journey. I make it sound like it was absolute roses. There, of course, was the challenges with the go live. But overall it's been remarkably and surprisingly successful, and I think in a funny, strange way the COVID pandemic probably helped us along the way. So thank you, Wendy.

  • 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.