Reforming Medicare needs all players at the table

4 minute read

Where were oncologists in the Strengthening Medicare Taskforce report?

The Strengthening Medicare Taskforce handed down its report this month promising $750 million funding to drive reform in health care.

Oncologists and other non-GP specialists are barely mentioned in the report despite one of the four key recommendations targeting the need for multidisciplinary care teams.

Dr Sanjeev Kumar, a breast medical oncologist at the Chris O’Brien Lifehouse and Westmead Hospital, said the report was not really publicised to oncologists.

“I didn’t really get any indication that there would be leaps and bounds in terms of changes that would modify the way that we provide care as specialists,” Dr Kumar said.

The report states the need for integration between specialists, hospital services and primary care providers under the focus area of Encouraging multidisciplinary team-based care.

Dr Kumar said that multidisciplinary team-based care is “absolutely fundamental”, especially in the provision of cancer care, but that current technology in hospitals doesn’t enable real-time data sharing with GPs.

“A difficulty in the provision of specialist care is when patients come to their first appointment but no one actually tells them, ‘Please bring all your medications in, please bring all your supplements in’. Most of my referrals … don’t necessarily [come with] the best history. But I need to know all the history and usually end up having to contact the GP,” Dr Kumar said.

Dr Kumar said perfunctory referrals and a lack of data sharing hinders his understanding of the depth of a patient’s comorbidities.

“If there was a portal that I could easily access, that was universally accessible to all specialists working for a New South Wales Health centre, it would make our life so much easier. I give patients really toxic drugs so it’s important to have a really good idea of what a patient’s underlying diseases are,” Dr Kumar said.

According to Dr Kumar, the national My Health Record is rarely used by oncologists in his circle. It was put in the “too hard basket”.

“I’ve always thought of My Health Record as an impenetrable wall. But if it was something that we could have opened in addition to our internal hospital system, if it was easily accessible online with a secure login, and provided a list of medications and comorbidities updated by a GP, then I think we would use it,” Dr Kumar said.

Digital health experts are divided on whether the ageing My Health Record (MHR) platform can actually be upgraded to become more user friendly and share data in the way required by multidisciplinary care teams.

MHR is a centralised model where, in theory, all health records are uploaded and then distributed as required. However, since MHR inception, cloud-based solutions and consumer demand for real-time data has opened possibilities for distributed models such as those in Denmark and the United States.

Distributed models don’t require one central database. Instead, technology securely connects patients and healthcare providers to a variety of databases containing current health records across all levels of care.

Dr John Halamka is President of Mayo Clinic Platform and has helped various governments plan their healthcare information strategies. He said that customers in the USA expect to easily access their real-time health records on their smartphone.

In considering the Taskforce report, Dr Halamka posed a few thought-provoking questions.  

“Has Australia put the data before the patient? Is this data centric or patient centric? Would making the strategy patient centred, rather than data centric, change the ambition to retain a centralised library of historical health data?” he asked. 

Tim Blake, Managing Director of Semantic Consulting, also has a lot of questions about the Taskforce recommendations. He said the report is “largely just hand waving” by a group of people who know change is needed but are unable to implement what is technically required. “Digital health experts have been advising the Government on this issue for nearly a decade. I can show you a report I wrote for the Commonwealth Department of Health from 2015 where I recommended similar changes,” he said. 

Mr Blake said that significant cultural change would be required to move on the Taskforce report. 

“Many clinicians today see documentation, and the sharing of that documentation, as far more of an administrative issue than a clinical one. Until we can change that mindset, it doesn’t matter how many FHIR (data sharing) interfaces we build,” he said. 

Despite limited consultation beyond primary care the Taskforce report presents multidisciplinary team-based care as central to reform. Whether MHR can be upgraded to enable this remains to be seen.

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