Disrupting the health sector
NZHIT guest column by Dr Will Reedy, Spark digital health director
If the New Zealand health sector fails to deliver digital access to health records, it is at risk of being disrupted by companies that provide a digital experience via a consumer-held record.
As I travel the sector and engage with providers and consumers in a number of forums, it is clear that nearly all consumers want a digital experience, including access to their own health record.
When you ask these forums whether they have a digital experience and access to their own record, it drops to less than five per cent of attendees. If you then ask those who have a digital experience whether it meets their expectations or not, all of them say no.
With this in mind, I believe the New Zealand health sector is at risk of being disrupted by companies that provide a digital experience to consumers via a consumer-held record.
Consumer-held records – the future is here
I was recently on call in the Middlemore Hospital emergency department where I was seeing a 60-year-old American woman with a suspected broken ankle.
As I was taking her history on a paper ED assessment record, she opened up Apple Health Kit to show me her medical record, uploaded from her hospital doctor and family physician systems in the US.
She asked me if she could send her record into our ED system or to a local printer for me to print out. Unfortunately, the answer to both questions was no, and I proceeded to write down her relevant clinical details while scrolling through her medical record on her phone.
We treated her and discharged her from the ED and I printed and handed her the discharge summary. Again, she requested that I send it to her phone or make it available to upload for her doctors in the US and sadly the answer again was no. At this point she politely took photos of the discharge summary and threw the paper copies in the ED bin.
There are an emerging number of vendors – Babylon, Sharecare, The Diary – who provide consumer-held records that offer many of the capabilities consumers crave.
These vendors can help manage wellness, but also have tools that allow consumer-held records to integrate and share information with provider systems that support modern interoperability standards.
These vendors also support a variety of methods to deliver virtual healthcare, and a number have made significant whole-of-system investments in countries such as England, Korea, the US and Canada, in partnerships with significant companies to provide a consumer digital-health experience.
What do Kiwis want?
The Ministry of Health recently completed a piece of human-centred design work with a wide range of consumers and providers across the country which concluded that “consumers expect to engage with and control their health information in the same way they do with other digital services – seamlessly and transparently across multiple channels – to help them Live Well, Stay Well, and Get Well”.
Consumers engaged in this process wanted digital tools to manage health and wellness and wanted a multi-channel digital experience.
Recent population health studies have shown that data collected from healthcare providers only represented about 20 per cent of the data related to social determinants of health, and participants in this project wanted to be able to access or enter their own data related to these determinants.
They also wanted to participate in digital health innovation projects and were keen to work with providers on how to support better customer journeys for health and wellness services.
The human-centred design work used a number of health and wellness scenarios to gain an understanding of what happens today in the delivery of health and wellness services. Consumers were then asked to describe what could happen tomorrow and to identify areas for digital health innovation.
The potential use of digital tools by consumers and their whānau or carers was seen as a key enabler in managing their health and wellness, and participants were able to give specific examples of digital technologies they would like to see support the delivery of future health and wellness services.
The importance of information
As a final step in the human design-centred process, consumers were asked to identify what information was important to them.
Consumer-entered information and shared-care plans were ranked as the most important sources of information, followed by medical history, medications and social/environmental information.
Consumer-entered information is any clinical or non-clinical information that is contributed by the consumer and/or their carers and that the consumer finds important. This may include family history, social history, beliefs, preferences and data from wearables.
This information was seen as useful for consumers to feel they have control over their own record and the ability to capture relevant information and stories from their perspective.
Consumers across New Zealand have a fairly good understanding of the opportunities for digital technologies to provide a digital experience in managing their health and wellness.
If New Zealand health providers do not meet their needs, New Zealand is indeed at risk of being disrupted by international providers of consumer-held records. Watch this space.
Dr Will Reedy is the director of digital health at Spark.