Prescribing better health care – the digital way

Digital Health 29 November 2018

Dr Steve Hambleton … ‘We need to guide our patients to the appropriate resources’
David Myton talks to leading e-health advocate and Digital Health CRC board member, Dr Steve Hambleton
For more than 30 years Dr Steve Hambleton has worked as a GP at the Kedron Park Medical Centre in Brisbane. Today his patients include the grandchildren of his first clients. On the face of it, not much has changed – he treats more or less the same kinds of ailments that require similar treatments to those presented to him in 1988.
The familiarity, however, is deceptive. A revolution in healthcare is even now unfolding: one in which Hambleton himself has been a key player.
The former president and vice-president of the Australian Medical Association is an energetic proponent of the move to bring about a connected, data-driven digital health system that would put the patient, not the doctor, at the centre.
“There is so much information that a patient and their trusted carers can get access to these days that can benefit the patient and benefit the doctor-patient interaction,” he says. 
“We need to guide our patients to the appropriate resources.”
Complex primary healthcare interactions, he argues, should result in up-to-date shareable health information about the patient “that can be rapidly accessed by the other healthcare practitioners to help the next provider make much more informed decisions to maximise benefits and minimise misadventure”.
Hambleton, who has a distinguished career in Australian health care at federal and state level, is talking about My Health Record – a digital platform in which “a patient’s health information can be viewed securely online, from anywhere, at any time”.
Its genesis goes back to 2003 when federal, state and territory health ministers established the National eHealth Transition Authority (NEHTA) to develop the specifications, standards and infrastructure necessary for an interconnected health sector.
In 2012 NEHTA – which has handed its oversight to the Australian Digital Health Agency - launched the PCEHR (personally controlled electronic health record) as ‘opt-in’ to share summary health information with all registered providers.
Then followed a name change to My Health Record and a change to ‘opt-out’ status – and so “by the end of 2018 it will support a critical mass of participants”. 
“Together with a critical mass of relevant health information it is likely to substantially shorten the time to the realisation of the benefits.”
Hambleton, also an adjunct professor at the University of Queensland and a board member of CMCRC-SIRCA Group’s Digital Health CRC, is an ardent evangelist of this move to e-health.
Its benefits, he says, will include reduced duplication of tests, better coordination of care for people with chronic and complex conditions, less medication misadventure, and better-informed treatment decisions through improved sharing of information.
‘An increasing body of research is showing that improving patient activation has great potential to improve health outcomes’
He points out that to assist patients with their care decisions MyHR “is available on home computers using the secure MyGov portal and mobile devices through trusted third-party providers”.
“An increasing body of research is showing that improving patient activation has great potential to improve health outcomes.  One way of doing that is to provide access to the data about them,” he says.

Treating patients more effectively

Hambleton’s view of his role in recording patients’ medical records has changed.
“At university I was told my medical notes were an aide-memoire to help me treat my patients. And then when I joined a group practice, I realised my notes helped my colleagues and me to treat our patients.
“Since computerisation, my notes and health summaries have helped me to write better referrals so that colleagues outside my practice can assist me in treating patients more effectively.”
And now that he can share a patient’s up-to-date health summary on MyHR “it can help my patients to achieve better outcomes from the health system, even when I am not directly involved”.
Aside from his role as a GP, Hambleton has had a distinguished career in Australian health care. As well as being a former president and vice-president of the Australian Medical Association, he has also served as chair of NEHTA, President of AMA Queensland, and on the AMA Council of General Practice at a State and Federal level for more than 15 years.
He was awarded the AMA Gold Medal, the Association's highest honour, in recognition “of his outstanding and tireless service to the medical profession and the community”.
Since leaving the AMA Presidency in 2014 Hambleton - also a passionate advocate for Indigenous health - has continued to be an influential figure, regularly sought out by the government of the day to provide advice and leadership in key areas, including e-health and rural health.
Among other roles, he is also the Co-Chair of the My Health Record Expansion Program Steering Committee, Clinical Programs and Clinical Reference Group Australian Digital Health Agency, and a member of the Medicare Benefits Schedule review.

Digital Health CRC ‘the place to watch’

Hambleton recently took up a role as a board member and independent director of the Digital Health CRC, which he says is “going to be the place to watch”.
“It’s so exciting. You walk in there and you see the sparkle in everyone’s eyes. It’s going to be vital as we move into the new era. Our intention is to accelerate the benefits of digital health by proving scientifically that our interventions are working.”
The Australian Digital Health Agency, he says, is good at collecting and aggregating data - but it doesn’t have the capacity to reflect on the data.
“If you like, it’s creating a data lake and that isn’t going to deliver rapid transition. The Agency is absolutely essential, but it can’t be as agile and it can’t be as rapidly moving as the DHCRC can.
“It can’t afford to go up a ‘dry gully’ but the DHCRC can – if you don’t go up a few dry gullies you haven’t gone up enough gullies.”
‘You walk in there and you see the sparkle in everyone’s eyes ... Our intention is to accelerate the benefits of digital health by proving scientifically that our interventions are working’
The DHCRC comes in with “enormously powerful partners such as state governments and big universities that can help to rapidly drive the change in nimble ways”.

Collect, reflect and share 

At the DHCRC, he says, highly competent researchers can “collect, reflect and share” and turn “data into information” to support digital health.
He reflects that one of the best ways of taking the medical profession on this digital journey is the data – “we’re not going to be able to convince people to change what they do unless we can show the new way is better and more efficient”.
The move to digital health, he says, is a “huge opportunity” for new commercial enterprises to move into the space.
“There are probably companies that don’t exist right now but will exist tomorrow who will be patient-facing and who will collect and analyse their information and present it back to them assist with their health care journey.”
The DHCRC will be of vital importance in the new health ecosystem.
“We want ideas, and we want to aggregate the smart ideas – we’ve got a significant investment from government and our partners, and we’ve got a really energetic and enthusiastic team that has seen a glimpse of the future and they want to bring it to fruition.”

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