Sunday, 14 October 2012

NBN: The Smart Internet Revolution comes to Healthcare

A letter to Paul Budde on this topic.

Unexpectedly, I think I've identified how Coles and Woolworth's are going to fulfil a long-time ambition: enter the Pharmacy prescription market.

They can take a lead from Australia Post and setup either dedicated self-serve collection lockers near each site, and/or piggy-back on their existing Home Delivery service. They have the logistics operations and expertise to execute on this right now.

Subject: A surprising healthcare Structural Industry Reform due to NBN and "The Internet"

Paul et al,

This thought arose in the last couple of days:
Australia Post's "parcel lockers" will unleash significant change in on-line buying from Australian e-tailers, because it addresses the same old-technology "last mile" problem addressed by the NBN.

With the NBN/PCEHR driven Electronic Prescriptions, I think it will drive a Structural Reform of Community Pharmacies - most dispensing will take place in automatic facilities and be direct-delivered. Local pharmacies won't be able to compete on price, just as corner-stores, small fruiterers, bakeries and butchers were displaced by Woolies and Coles in the last 30 years. They'll enter a vicious-spiral of lower-turnover forcing higher mark-ups which will reduce turnover more, etc etc.

BUT, some Pharmacies will survive, just as some small stores still survive with Coles and Woolies, often in the same shopping malls like my local mall. Because they provide "value-add" services, understand customer-service and don't focus on commodity products where they can't win.

Which will have implications for Healthcare:
Pharmacists play an important community role in the use, not prescription, of drugs.
[On-going Operations vs single-shot Project work.]
The important thing for the NBN I slipped in my letter to my local MHR:
  • video "in-home" consultations
Medicare and the Dept of Health (esp. their funding for Medicare Locals) needs to address and develop Policy and payments/service schedules for the many ancillary healthcare services that will be needed to support Healthcare-in-the-Home, part of which will be in-home visits (for medication and dispensing-aid reviews), on-line video-calls and, when needed, practice-rooms visits.

There are probably 10-20 ancillary healthcare specialities needed for good in-home care, Pharmacy being just one. We know from successful Community Support programs for increasingly common conditions like Diabetes, that a) they are cost-savers by preventing expensive hospital admissions and b) require the close coordination and cooperation of teams of ancillary healthcare professionals.

Every Government needs to be actively seeking Healthcare savings through technology and simple procedural steps like In-home care. Reducing Hospital expenses and Nursing Home demand is critical for budgets surviving the economic impact of the Ageing population over the next 40 years.

If there is to be successful "Coordinated Multi-Disciplinary Care, Monitoring and Exception Reporting" program delivered by In-Home and In-community care via Best Practice Treatment Guidelines for even the top 22 conditions examined by the Caretrack study, then there will have to be reliable, centralised IT systems supporting it, including wireless mobile devices and Apps.

Just like in a hospital, a doctor (GP), will be able to order a per-patient customised, standard Treatment regime for any patient and know that it will be competently, diligently and consistently delivered by other healthcare staff. When the doctor needs to review the patients' progress, or gets called in to deal with complications or poor progress, they can rely on full, accurate and pertinent patient records.

None of which will happen by accident: it has to be designed, delivered and co-ordinated.

But especially, it has to be controlled and monitored: there needs to an explicitly assigned person responsible for the monitoring, care and follow-up of every individual in a programme.

Perhaps in the Community, as in Hospitals, this supervision, administration and coordination role belongs to Masters-level Nurse Practitioners.


Letter to my local (ALP) member on this.

Piece on the changes...

Piece on Caretrack Best Practice and the need for Coordinated Multi-Disciplinary Care, Monitoring and Exception Reporting:

The 22 medical conditions examined by Caretrack, in order of percentage appropriate care:

  • Coronary artery disease
  • Dyspepsia
  • Chronic heart failure
  • Hypertension
  • Low back pain
  • Panic disorder
  • Chronic obstructive pulmonary disease
  • Diabetes
  • Venous thromboembolism
  • Osteoporosis
  • Depression
  • Atrial fibrillation
  • Cerebrovascular accident
  • Community-acquired pneumonia
  • Osteoarthritis
  • Preventive care
  • Surgical site infection
  • Asthma
  • Hyperlipidaemia
  • Obesity
  • Antibiotic use
  • Alcohol dependence

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