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.