Why not a national virtual care strategy?

8 minute read

NSW Health has put out a timely and important take on maintaining the covid momentum, but this shouldn’t be a state-by-state project.

Although dated for the years 2021-26, NSW Health’s Virtual Care Strategy only appeared for the public at the beginning of last month.

Presumably covid created the need for some rethinking of the original draft, creating some delay, and no one thought to tell the printer to replace the 21 on the front cover with a 22.

In her introduction to the strategy, outgoing NSW Secretary of Health, Elizabeth Koff (she officially left 4 March and is due to be CEO of Telstra Health come July) seemed to underline the likelihood of her department rethinking things as they went by saying that virtual care “has the potential to be something far more comprehensive than our experience with covid indicates”. 

“There’s a real collective call for us: if we are going to transform the system to a virtually enabled one we need to ensure we have strong engagement with the patients, carers and families, clinicians and our partners in primary health care,” she says.

The NSW Virtual Care Strategy is timely, and very important, because it underlines the importance of maintaining the huge momentum that virtual care has gathered as a result of covid, in the context of delivering significantly better quality care overall to patients as we move forward into a world dominated by chronic care management.

A  2020 survey of NSW hospital outpatients on virtual care, conducted by the state Bureau of Health Information, left little doubt that patients are now all in on the idea of virtual care. 

Ninety-four per cent said the care and treatment they received in their virtual care appointments “definitely” helped them, 73% said that it was convenient, 60% that it saved them time, 30% that it saved them money, 37% that they felt more at ease receiving care in their home surroundings, and 25% that they did not have to take as much time off work.

It’s probably important to note that the survey was taken very early in the covid pandemic, well before a lot of primary and tertiary care groups even got their virtual care mojo really going.

The effort by NSW Health is worth a quick read for its updated take on virtual care as we move into a possible post covid world. 

If you scan the rest of the state and federal health department sites, there is nothing that is contemplating how we should be viewing virtual care quite like this, as most references to virtual care strategy are still mid-covid takes on delivering services, or parts of broader digital health strategies written prior to covid. Apparently Queensland’s virtual care strategy is nearly ready and addresses similar questions.

The NSW Virtual Care Strategy sets out an argument for much better focus and co-ordination of virtual care in a few key points:

  • Healthcare providers need to be responding much faster to evolving consumer expectations: expectations that have been shaped by interactions with other industries well before they got a decent whiff of it in healthcare as result of covid. Services that are “convenient, seamless and personalised”. 
  • Virtual care can enable an enhanced and modernised consumer experience in healthcare. Technology advancements are providing viable complementary models of care: digital technologies, such as devices are creating new opportunities to expand virtual care services such as remote clinician video consultations and remote patient monitoring; improved diagnostic and predictive capabilities; and real-time patient data collection. 
  • Virtual care technology well delivered means timely and equitable access to better value care. Covid has underlined that virtual care technologies can address system challenges such as scaling infrastructure and building workforce capacity that we previously thought not possible. Virtual care has huge capacity for system wide savings and efficiency, both for the system and the patient. 
  • Demographic changes, in particular the march of an older population requiring far more longitudinal chronic care management, are demanding we change how we deliver care anyway. Again, covid has shown us what we previously thought might be too difficult for regulatory, safety, technology and patient acceptance reasons, is not any more. And we should embrace this new realisation with a vengeance.
  • Given how virtual care has evolved during covid so rapidly, there is a priority need to integrate virtual care into existing technology and achieve interoperability.  

At this point of the strategy commentary (we have changed their words a little in the above dot points), things go just a little off the rails. 

“The significant and consistent progression of technology will enable a highly streamlined, intelligent level of interoperability across the state. This will ensure consistent and comprehensive information is available to consumers and clincians alike. Along with integrating information, there will be a strong focus on the integration of existing models of care to ensure a seamless end to end journey for the consumer and clinician.”

There’s one word right out of place in the statement, although you can’t blame Health NSW for using it. It’s the word “state”.

The report goes on to say that the  “NSW Ministry of Health, together with key agencies and pillars, have collaborated through a series of workshops to agree on a system wide approach for actions to achieve the successful outcomes articulated in this strategy”.

Great, for NSW. Perhaps. 

But really, even for NSW a plan that does not engage some sort of national alignment on virtual care, even if it is a state-focused plan, is missing a big trick.

And it’s something every state and federal health minister should think about quick smart.

Seven individual state or territory-based virtual health care plans are a recipe for a lot more mess than we already find ourselves in as a result of the federal-state divide between tertiary and primary care management and funding.

By its nature, virtual care is cross boundary. 

Interoperability is a fundamental element of successful virtual care, and interoperability is a national digital health issue, not a state based one. There will be more synergy between the states and the federal system in alignment of virtual care strategy and funding, than perhaps any other thing in our healthcare system, potentially for the next few decades.

The NSW Health Virtual Care strategy touches on working with other “Specialist Health Networks” but only mentions working with “Primary Health Networks” once in the entire report. 

If you want an efficient virtual care program that manages chronic care across the state far more efficiently, you are going to need a tight beam (I think I got that term from sci-fi) into Primary Health Networks, and GPs in general, and that isn’t apparent in the NSW strategy. 

It is not that surprising. 

No matter how much certain NSW Health officials try (and some good ones do), the divide between state funded care (hospitals), and federally funded care (GPs), is a hard divide to cross because it’s a source of money divide. 

Healthcare and how it is delivered follows money.

In one very interesting virtual care trial run by RPA over the past couple of years, GPs have been a critical element of the success of the trial. But engaging GPs across the hospital system, when they are mostly all paid federally, based on volume of services they deliver, has not made things easy for the managers for the trial. They’ve needed to be innovative (and passionate, is my guess) in roping in their GPs and in how they’ve been funded to pay them.

NSW’s virtual care strategy effort is a good one. 

But it will need to put a lot of work into “tight beaming” interoperability with general practice if it really wants to break the key issues of chronic care management into the future properly open. From general practice, by the way, they should be able to reach into other allied health services. But that’s another technology story.

If you can network hospitals, GPs, allied health and specialists, then you are going to deliver to patients and the system efficiencies that will be revolutionary and generational.

There’s a tonne of complexity in such a strategy if you really add such a goal to it. But it feels hardly worth having a virtual care strategy if you don’t have this Big Hairy Ass Goal (BHAG).

As an example of complexity, the NSW strategy says everything must talk to the NSW Health EMR.

That’s going to be a complex problem when you have the Australian Digital Health Agency still pushing the My Health Record down the throats of most GPs and other states are also doing their own EMR thing.

Such complexity is why one state with a half decent virtual care strategy is seriously undercooking the potential of virtual care for the entire country.

And possibly even setting itself up for failure.

Going back to Koff’s important outline of the situation: “if we are going to transform the system to a virtually enabled one we need to ensure we have strong engagement with the patients, carers and families, clinicians and our partners in primary health care”.

We are also going to need national alignment of all or most of the states and the federal government if virtual care is going to deliver its true potential.

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