WA News News & Reports IT Scramble in Health
IT Scramble in Health
Written by Dr Rob McEvoy
Friday, 26 August 2016

The RACGP has invested in www.Healthand.com in Melbourne, presumably to add value to its Oxygen IT product and thereby satisfy its 32,000 members, many of whom have CPD as the main drawcard of membership. Health& is evolving and taking on partners to provide health information, recalls for preventive health, appointment scheduling and anything that flows from an electronic health record. Services to health consumers will have to be free to encourage uptake.

201609-Pirakalathanan-Piraveen-Dr-July16Dr Piraveen PirakalathananWe spoke to Piraveen Pirakalathanan, Chief Medical Officer of the website, which already claims 500,000 visitors per month (40% return visits), and 64% of them on mobile devices. He said each visitor stayed about two minutes per visit and viewed 2½ pages, with 89% of visitors from Australia and 40% of these from outside metro areas (based upon postcode). Since its inception in 2014, Heath&’s aim has been to assist consumers better manage their health, and the rural reach has not gone unnoticed.

Personal health

Piraveen said the database of self-help information choosing commonly searched health conditions, about 400 in all. Pitched at a reading age of 14, videos and text are created in-house in Melbourne using a team including writers and animators.

“We created the information in a way that is engaging and easy to understand for consumers – each topic undergoes medical checks from when it is written up through to various stages of animation, for example, to ensure colours of inhalers are correct.”

He said the final check comes from their “medical advisory board of nine eminent professors”. Having taken care of credibility, Health& has turned its attention to other things. Top of its agenda is the evolving electronic health record. Health& clearly wants to enter that space.

“In April this year we launched a consumer health record, where consumers and their families can store health information, uploaded through users answering questions around lifestyle risk factors, allergies etc.”

Piraveen said a company would soon have them linked to about 300 of the most common wearable devices, outside the FitBit offering evident on their website. You don’t see Google ads as the policy is to avoid advertising. However, with such a big team to feed, Health& will need to generate income somehow.

“We don’t want it to be a medical website that is heavily into marketing. We want it to be a credible service for consumers to help them manage their health.”

Their latest is a free word search engine that uses “natural language”, IBM Watson. It’s still being worked out but it is part of the ‘ask questions’ functionality on the website.

Melbourne-based entrepreneur Bob Biddle is the financier of the website.

“Bob used to work for government, then set up Origin Health Care nursing agency in the 1980s and ’90s and sold it on to Skilled and went on to early retirement. He had this idea of adding value to consumers and started off doing a successful pilot in the US around providing fertility information before coming back to Melbourne.”

Bob’s developer partner and IVF expert Professor Gab Kovaks is on the Medical Advisory Board of Health&. During the writing of this article the website changed to give greater emphasis to RACGP involvement, credible health information, the personal health record and the one-stop nature of the website.

Nothing by accident

Piraveen said the personalised health record was no accident.201609-Healthand-Group-hero-2

“We are in discussions with the government and are a registered health organisation, which gives us the ability to tap into the MyHealth record. We have the same privileges and responsibilities as a medical centre or hospital to upload consumer health information. The government doesn’t have a good consumer facing website. It has set up the infrastructure to allow private companies to provide functionality to consumers and value-add around it.”

“We plan to integrate into the MyHealth record so the health information is effortlessly available to consumers when they come to set up in the later part of this year.”

“We want to provide some value to health consumers around storing their health information so we have taken the Red Book recommendations and MHMRC Guidelines and created those algorithms that run over the consumer data and provide them with personalised reminders around health prevention.”

Skin cancer and bowel cancer are currently on the website. The RACGP is backing their illness prevention screening, using information uploaded by consumers that assist with tailor-made recalls for their doctor. Of course, this relies on consumers uploading accurately and a compliant local GP who is an RACGP member.

“The RACGP is an equity owner in the company Health& through its private arm, RACGP Oxygen. Its sole focus is finding digital solutions they can present to their members to help them in their work. We sit nicely in terms of one of their solutions so they are investing in us and supporting us – we are helping them deliver one of their objectives of primary prevention.”

Stay out of politics

“They [the College] are held back by their old-school thinking and reservations about not compromising their reputation, which is all understandable, yet they want a company at arm’s length that is on the edge of those boundaries and being innovative and creative. That’s the whole point of setting up RACGP Oxygen”.

The RACGP is also based in Melbourne. Piraveen said they do not want to get “political” and like any startup, providing a service that satisfies most stakeholders will help them develop.

“Obviously the commercial reality will impact on that. We are yet to encounter the political,” Piraveen said.

“Most GPs – they quote 98% - are members of the college but, you are right if members do not believe in what the RACGP is doing and are purely there for CPD activities, I think they would still agree to the service we provide to health consumers. Regardless of whether you support the RACGP, at a core level as a doctor, I think you would be supportive of an initiative to support primary prevention in the community.”

“Our objective is to help consumer-driven care – we want the consumers to dictate what health professionals do in terms of their health. It still needs to be collaborative. We don’t want to move to a model where consumers order the tests but we want consumers to be better participants in their health. It is what we are advocating.”

“We are talking with another organisation [Health Engine, we determined] to build in appointment booking functionality, purely to help consumers.”

We queried who was calling the shots at Health Engine, acknowledging it was focused like them on health consumer convenience, but whether convenience would clash at some points with best medical practice.

“To be honest we are not quite sure if Telstra Health is a potential competitor or collaborator. We are yet to work out what is happening with that.”

Here’s hoping they get it right.

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While communication is one thing, investigation of notifications is another. We believe good doctors want the bad ones weeded out but they don’t want to be part of a witch hunt or get buried in lawyers, politics or paperwork.

The national Medical Board can respond to a complaint or act on the advice of the WA Medical Board to establish an assessment panel to either examine the health or performance and professional standards of a doctor. Health consumers are represented on panels along with medical practitioners.

The Medical Board and AHPRA have undisclosed lists of doctors who are approved by them as panellists and probably as expert witnesses. Many of these people, we believe, were ‘grandfathered’ across when National Law first came in (2010). Their impartiality is as unknown as they are. Then we have expected biases of the legal assessors, chosen by AHPRA, possibly thrown into the mix.

Is there a problem, Houston?

It is important this is sorted to everyone’s satisfaction as 42% of doctors in our survey thought panellists could lack impartiality to a serious extent.

In fact, only one quarter of doctors we surveyed (n=195) were happy with the impartiality shown by AHPRA or the Medical Board in processing a complaint (with 36% unhappy and 39% undecided). Nearly all of those who were unhappy said they were concerned that unfairness will be seriously damaging to someone. Investigation is a very confronting experience.

If someone is being investigated by a panel, either the panel or the person being investigated can opt for a more out-in-the-open State Administrative Tribunal (SAT) judicial hearing – the panel usually refers because it feels the evidence before it constitutes more serious professional misconduct.

What Fair Doctors Want

Talking to doctors, they appear to want an apolitical system of investigation that is fair and timely. They want to be treated reasonably. Unlike the legal profession, their work is mostly built around trust and honesty. They do not want a return to the ‘good old days’ where those with a political bent in the medical profession could influence what the Medical Board did.

While this is a very difficult area for us to investigate, with arguments and counter-arguments at every step, we cannot understand why the Medical Board would turn to arguably the most political organisation, the AMA, for its counsel (the national Board Chair met earlier this year with “senior leaders from AHPRA and representatives of the AMA” to workshop doctor complaints).

Why? Our e-Poll responses raise a question mark over the AMA’s involvement (and we don’t think AMA members have been polled on this issue.)

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