Healthcare is one of the largest and most critical verticals within any geography, but aside from some specific technology exceptions, it’s historically been considered an ICT backwater in Australia.
However, recent government-led efforts to foster more efficient and integrated healthcare systems, as well as a common, Web-based log of patient and doctor information, are triggering a paradigm shift. The possibilities the impending National Broadband Network (NBN) opens for delivering health applications and services to remote and regional communities, are also expected to transform the market over the next few years.
According to IDC figures, the healthcare sector is expected to spend upwards of $2.3 billion on ICT by 2012, up from $2 billion in 2008. This year, 40.5 per cent of funds are predicted to be forked out on hardware, followed by telecommunications (33 per cent). The analyst group also expects services, including software-as-a-service, to be a major area of growth over three years.
One organisation working hard to modernise Australia’s healthcare system is the National Health and Hospitals Reform Commission (NHHRC). Established by the Federal Government in February 2008, the group is tasked with developing a longterm health reform plan, and has already released a series of interim reports and principles. The full blueprint is expected shortly.
In its most recent background paper, The Australian Health Care System: The Potential for Efficiency Gains, released in June, the NHHRC outlined key areas where improvements were needed. Those with ICT implications included improving hospital efficiency, implementing patientcontrolled individual electronic health records, making primary healthcare the health system hub through improved coordination and community orientation, and improving resources allocation across sectors by getting the balance right between prevention, primary health, sub-acute, hospital and aged care services.
“The Productivity Commission has estimated that the greatest gains in health system efficiency may be through reforms that impact on hospitals, largely due to the sheer size of the sector,” the group said in a statement. It went further to claim the introduction of health information technology, and in particular individual patient electronic health records (IEHR), would enhance labour productivity and technical efficiency within the health system.
Given government’s influential role on Australia’s healthcare practices, the NHHRC’s efforts and increased funding at both a state and Federal level, momentum is building in this sector and, along with it, opportunities for ICT providers.
Detailed in its recent report, Australia Healthcare Information and Communications Technology Market 2008-2012 Forecast and Analysis, IDC found the main drivers for ICT spending last year were: Providing better customer service; reducing costs and improving employee productivity. Top priorities include electronic procurement and prescribing, a healthcare portal, electronic reimbursement, computerised physician order entry systems, electronic patient records and electronic booking.
“Vendors need to understand the focus of care is shifting. E-health will change the way consumers interact with the healthcare system and health information,” the report stated. “Now people are looking for their own health information and starting health dialogues on the Internet. Soon, some patients will be the gatekeepers of their own health records. Providers should consider expanding their own online offerings on their websites or partnering with health 2.0 vendors to offer portals and functionality to their patients.”
IDC’s senior vertical market analyst, Melissa Martin, said the technologies and solutions in highest demand were HR and accounting systems, CRM, patient care applications such as adverse drug tracking and e-prescriptions, and applications providing capabilities around the electronic health record.
Martin said a significant percentage of investment was also in hardware and telecommunications infrastructure in 2009, with technologies like back-end WLAN and LAN networking equipment, storage capacity and IP telephony being procured to deal with increasing volumes of data.
Converged devices, such as Tablet and ruggedised PCs, were another product segment gaining traction in healthcare, she said. But while healthcare ICT was certainly improving, mainstream uptake of next-generation unified communications and video services was still a while away, Martin said.
“The healthcare industry has traditionally been seen as laggards for technology adoption, so change management has to happen. For providers, it’s not just about the technology, but also about the people,” she said.
In conjunction with state and Federal government efforts around electronic health record implementations, there’s also a push for more effective clinical management, as well as programs and applications around prevention and wellness, Fujitsu national industry director for healthcare, Jeff Smoot, said.
Fujitsu breaks healthcare into public hospitals, longterm community and residential care, and primary care (such as GPs and local radiology clinics). Within these, it concentrates on short-term and long-term acute disease management, aged and mobile care services. Its portfolio of services range from high-level strategic IT consulting, enterprise architectural design, program and project management services to systems integration and management.
“There is an emerging focus on keeping the consumer out of the acute sector for as long as possible, and in the home,” Smoot said. “That impacts community and aged residential care.
“The long-term care sector is already under pressure and this will just increase exponentially in the next two or three years. At the same time, the cost of IT procurement is very expensive. It’s a fragmented industry that’s starting to corporatise.”
In the short-term, Fujitsu is looking at opportunities around applications acquisition and infrastructure implementation, along with change management. Longer term, Smoot spied ongoing opportunities to deliver ICT solutions for community, aged care and primary care providers.
“What we’re trying to do is offer services that have a low cost of procurement, but also provide ongoing maintenance and support,” he said. “Telemedicine has been topical in the acute sector and in mobile treatments. In the home, people are taking more responsibility for their own health by monitoring vital signs – that’s where you get into more technology innovation.”
An integrated e-health platform is a long-term utopia, and there are a plenty of hurdles to jump before Australia’s healthcare providers unite their records into one overarching system. In the meantime, Microsoft is focusing on building blocks that allow ICT providers to help healthcare organisations step onto the path in a low-risk fashion.
Its e-script initiative with the Pharmacy Guild of Australia for example, uses Microsoft’s open source, standards-based Health Connection Engine running off its Exchange platform and BizTalk Server. Customised applications are then provided by other software vendors including Simple Retail, Fred Health and minfos.
“It’s great to see Government considering an e-health strategy, and there will be benefits from that infrastructure investment. But there’s enough data now to start sharing so that healthcare providers can benefit today and tomorrow,” Microsoft leader of health and social services, Dr David Dembo, said. He pointed to “business as usual” products and services, such as SOE, virtualisation, applications integration, improving communications and improvement overall ICT infrastructure as major areas of investment.
“There is a focus on getting the fundamentals right,” Dembo said. “The larger, IT companies are more genuinely engaged in healthcare now and at a more practical level, not a futuristic one.” Microsoft has 850 partners specifically in the healthcare space, as well as a range of systems integrators providing more traditional IT products and services.
“We always think the opportunity for sales are around care delivery, but these are businesses as well – they have back office, ERP systems and so on. You don’t have to be a health partner to after that business,” Dembo said. “One thing we are seeing is the emergence of CRM systems with these [healthcare] customers. There is a legacy in health of taking a linear patient view. What we’re now seeing is some are taking CRM and overlaying that on systems to give them a patient-centric view.”
And unlike IDC’s Martin, Dembo said there was plenty of scope for UC and collaboration despite the broad lack of sophisticated networks in the health sector.
“If you do want to improve efficiency and drive out adverse events, you have to have your data achieving that for you,” he said. “You have ageing telco infrastructure but at the same time, there is an opportunity for hardware and software providers to go in and deliver a unified communications strategy.”
While there are opportunities in all segments of healthcare, the biggest challenges, particularly with public healthcare organisations, are lengthy procurement processes and dealing with multiple stakeholders.
“Historically, ICT spending has only been about two-and-a-half per cent of total operational spend, whereas other industries are two or three times that,” Fujitsu’s Smoot said. “But the cost of doing healthcare is unsustainable in the market the way it’s being delivered now – there’s wide recognition of that. This is forcing change and a productivity shift – we’re moving away from the silo-to-silo approach to a more coordinated care model. It’s about the individual from start to finish, rather than the care delivery cycle.
“That’s where ICT spend will increase. The issue is keeping people away from IT for IT’s sake. I’m amazed by the number of pilots out there for monitoring dementia patients or hospital wards. The problem with them is they’re not scalable. It’s like running any other business – you have to set realistic expectations to have IT supporting that business model.”
IDC’s Martin agreed a major inhibitor was lack of standardisation and interoperability across e-health records. Each hospital or GP will run its own system for patient records and information, which will be difficult to bring together when the NBN is implemented.
“Healthcare has been underinvested, so getting the right funding in the right areas is important,” she said. “With the economic downturn, everyone is putting the breaks on projects and people are also relying more on Web information rather than going to hospital or the doctor.
“There is an opportunity there for health 2.0 producers who provide portals and information services online.”
Industry representatives ARN spoke to agreed skilling up staff to take advantage of ICT systems was key to successful adoption long-term. But whichever part of the ICT spectrum you herald from, it’s clear healthcare sector opportunities are there for the taking.
“It’s a beautiful time in health informatics. I say carpe diem and seize the day,” Microsoft’s Dr Dembo said.