Health care reform: No gain without pain
 

A fundamental failing of our health system

November 24, 2022

Health care reform:
No gain without pain

A shift to value-based care in Australia may be inevitable but is unlikely to be painless. This post is the first in a series looking at healthcare industry issues.

Australia has a unique set of problems to overcome, said David Rowlands, a member of the Roster of Digital Health Experts at the World Health Organization (WHO).

He told the October Wild Health Summit: “What we are seeing are symptoms of a fundamental failing of our health system.”

“Our health system was designed 50 years ago for problems of 50 years ago. (It) was not designed to deliver integrated, value-based care. It was designed to deliver episodic care.”

Episodic care is provided to patients who need treatment for an “episode” of care with a foreseeable “endpoint”. Examples include cases treated in hospital Emergency Departments.

The focus in Australia’s health care system, Mr Rowlands said, is on outputs, not outcomes.

Value-based care uses a model where providers, including hospitals and physicians, are paid based on patient health outcomes. Under value-based care agreements, practitioners are rewarded for helping patients improve their health, reduce the effects and incidence of chronic disease, and live healthier lives.

The “value” in value-based healthcare is paid after measuring health outcomes against the cost of delivering them.

In contrast, episodic care is paid on an activity-based or fee-for-service model measuring the amount of healthcare services delivered.

Mr Rowlands said tinkering with the system will fail. “After 50 years, it’s time for a review.” He said the Australian system needed independent, external experts to determine the way forward. He cited Lumos, a new partnership between the NSW PHNs and the NSW Ministry of Health, as an example of doing things differently.

Lumos generates insights into patients’ journeys across the health system and shares de-identified data from general practices with other health services to provide a comprehensive view of patient pathways.

Elisabeth Koff, the managing director at Telstra Health and immediate past secretary at NSW Health, said she had helped negotiate health agreements and most came down to money rather than a strategic approach to healthcare.

She said reform agreements focusing on outcomes had been negotiated but, “then we forget about them, and they sit on the shelf”.

While there had been progress in New South Wales around collaborative communities, Ms Koff said change would be slow as governments are focused on the short term and, “health care reform is hard… no pain, no gain”.

Tracey Johnson, the CEO and company secretary at Inala Primary Care, said Australia’s health system is run by “mini-empires”, each seeking individual advancement.

“We don’t have a healthcare system,” she said. “We have a profile-for-profit system.”

Inala reinvests any practice profits into patient care, but it was becoming difficult to provide affordable care when reliant on a $39 bulk-billing item.

Ms Johnson said General Practice should be considered a specialist form of medical care, given the knowledge and training required. This could provide access to a wider range of Medicare-funded billing items.

Ms Johnson pointed to the role GPs play in taking pressure off overcrowded hospitals. “Data shows where patients visit their GPs more, there were fewer hospital admissions… Comprehensive care works.” 

MediRecords is used by general practitioners, specialists, multidisciplinary clinics and hospitals across Australia. The MediRecords electronic health records platform features embedded SNOMED CT-AU coding and is designed for interoperability using FHIR and APIs. MediRecords is currently developing additional functionality to support team case management and value-based care.

Article originally published by Wild Health and written by Dr Leon Gettler on behalf of MediRecords.

If you are interested in learning more about MediRecords’ functionality to support team case management and value-based care, book a demo below. 

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    Survey Results: What do Clinicians really look for in Practice Management Software?

    Survey Icon

    Survey Results: What do Clinicians really look for in Practice Management Software?

    Survey Icon

    COVID impact, working habits and rejection of Telehealth?

    Throughout July we ran a survey for users of Medical Practice Management Software, like MediRecords. The aim was to listen to, and learn from, both our own users and those who use alternatives.

    In this article we have summarised some of the more interesting insights around:

    • the impact of COVID on doctors
    • the working environments of clinicians
    • what users want from practice management software, and
    • How important Telehealth features are to clinicians.

    If any of this sounds interesting, then please read on! But before we get into it, we would like to say a big thank you to all who took part in the survey.

    As with all survey data, the stats can often be interpreted in many ways. If you have any insights or explanation for what we found in the survey, we would love to hear from you via marketing@medirecords.com.

    About the Survey & Audience

    Our survey was delivered to GP clinics via fax, email and through The Medical Republics e-newsletter. Whilst the survey was open to clinicians, practice managers, nurses and business owners, most respondents primarily identified as clinicians.

    We ran our survey throughout July, which ended up being an interesting time. The initial explosion of conversations around Telehealth had begun to quieten down (more on this later), whilst Victorians began seeing lockdown restrictions gradually being enforced as they experienced their ‘second wave’.

    One noticeable skew was that the audience had a significant amount of professional experience, with over 40% having over 20 years in General Practice, which is worth bearing in mind as you read this article:

     

     

    GP’s Working Environment

    We were keen to understand how GPs tend to work, as this allows us to better understand how MediRecords can be as useful to clinicians as possible.

    We found GP’s were split fairly evenly between those who work in one location, and those who work across multiple locations. What is not clear if this means they work across multiple practices, or often from home, something which could be influenced by the current pandemic.

    Far more clinicians work on multiple devices rather than one, which us unsurprising given our consumer habits across phones, tablets and computers. It is particularly interesting for practice management software however, as ease of working across devices and locations is very difficult on server-based solutions such as Best Practice and Medical Director, compared with cloud solutions like MediRecords.

    It was interesting to see that almost as many people use Apple products as do Windows, again something that could make browser-based software more appealing to ensure consistency of experience and usability for GPs on whichever device they use.

    Preferences for practice management software

    We asked our GP respondents a lot of questions about their preferences are for practice management software. This information is best summarized in the two questions:

    • What do you like about your Practice Management Software ? And…
    • What do you not like about your Practice Management Software?

    Surprisingly, the same sort of answer was most popular for both questions – Usability!

    It can be easy to get lost in specifications and functionality lists when choosing Practice Management Software, but what this shows us all is that, fundamentally, it means little if the platform is not easy for clinicians to use. We suspect this will also be what drives most day to day frustrations users have with their current software.

    (By the way, we think this is great news given the positive feedback we have had on MediRecords from our users. If you are struggling with usability there is a solution!)

    So, are clinicians looking for something better?

    We then asked if clinicians were planning on reviewing or upgrading their software over the next five years. Only 40% of respondents said they would consider doing so.

    Many in the healthcare tech space may find this disappointing, but we believe it shows us the wider trend of reluctance to adopt and change with new technologies. Whilst many may be heralding a silver lining of COVID to be increased adoption of technology, the results suggest this mindset change will not happen overnight – even if pushed by a major event such as COVID.

    If clinicians are still reluctant to change, what does this mean for Telehealth adoption?

    We asked respondents to rank features in terms of the importance to them when choosing practice management software. Whilst we won’t be sharing the full results of this (hopefully you can understand, we want to keep some knowledge to ourselves!) what was surprising was that Telehealth was the second least important feature to the GPs we asked.

    The timing of the survey may have had something to do with this. Whilst in the earlier days of the pandemic many GPs were trying to figure out how to incorporate Telehealth into their daily workflow, by July Telehealth MBS items had been live for over a month, with GPs finding that using the telephone was an easier, more familiar solution in the short term.

    Again, this may reflect the reluctance of many to adopt new technologies, even if these technologies lead to better experiences for patients. We can see the benefits of telehealth via remote monitoring via projects such as Spritely’s recent trial in retirement villages in Christchurch, but clearly there is more work to be done to help clinicians see if there is a benefit for them.

    So, what do clinicians want from their PMS?

    Finally, we asked what GPs wished their PMS could do that it does not already.

    The results here were less clear, with 27% of people wanted a feature specific to their practice’s requirements, and a further 20% wanting an integration with a specific other service.

    This shows how personal and bespoke the needs of many practices are, and how software such as MediRecords must not only be flexible for different workflows, but also responsive to users when they need new feature.

    Again, usability came up, this time as something that respondents wish their PMS offered. Given the large share of the market enjoyed by traditional solutions such as Medical Director and Best Practice, perhaps this reflects the need for clinicians to look at some of the newer, easier to use options that are out there.

    Personally, we think MediRecords fits the bill perfectly! If you would like to find out more you can contact support@medirecords.com, book a demo, or enjoy a 30 day free trial now.

    About the Author

    Andrew Dyson is our Digital Marketing Lead here at MediRecords, and managed this latest survey. Prior to joining MediRecords he has worked on marketing projects, including in depth market research, for some of the largest employers in the UK.

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      Are the benefits of cloud solutions for healthcare more than we realise?

      Cloud solutions for healthcare

      The benefits of cloud solutions for healthcare: More than we realise?

      Cloud solutions for healthcare
      Michelle O'Brien

      Michelle O'Brien

      Could the shift to cloud solutions provide the healthcare industry more benefits than we previously realised?

      Cloud computing is finally changing healthcare.

      The consensus on the overall benefits of the cloud for our industry appears to have shifted, which was perhaps inevitable given the increased interoperability, maturity of security and the significant cost savings cloud services provide.

      However, I believe most organisations are barely scratching the surface when it comes to making the most of other benefits cloud solutions can offer. Some of the lesser known benefits, from small clinics right up to larger public health and enterprise organisations, include:

      • Improved health information exchange & interoperability
      • Predictable costs
      • Faster and more efficient scalability and fast system deployment
      • Improved backup and business continuity
      • Enhanced user experiences
      • More robust data security
      • Improvements in diagnosis and treatment through AI & Analytics
      • Easier compliance

      I am a firm believer that cloud-solutions will provide healthcare organisations with even more benefits than many currently realise.

      This is one of the key reasons I joined MediRecords, a leading cloud-based PMS, and why, over the next few months, I will be putting together a series of articles explaining each of the benefits listed above. Where it is relevant, I will be including examples of organisations who have achieved these benefits, and if possible, some tips on how your organisation may be able to follow these examples.

      You will be able to find these articles via the MediRecords blog, via our company LinkedIn page, and via my own LinkedIn page. Feel free to send me a connection request!

      In the meantime, if you are interested in finding out more about any of the above, you can always reach out to me directly, either via email (michelle.obrien@medirecords.com), or on LinkedIn.

      Michelle O’Brien, based in our Sydney office,  is Head of Strategy here at MediRecords.

      Michelle O'Brien

      Michelle O'Brien

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