People like you: Towards equitable, personalised healthcare

FEATURE - Industry Innovation Article – Kevin Ross, chief executive Precision Driven Health

The success of the New Zealand health reforms will depend heavily on how well we leverage digital technology, data and data science. Having spent the last five years building collaborations between our clinical, data science and technology partners, I see huge untapped potential to improve the quality and efficiency of our system.

Where we are and where we are going
Firstly, let’s agree on where we are starting from. Our current system produces inequitable outcomes, is inefficient, vulnerable and paternalistic. Our workforce is tired. Yes, we are riding high from a world-class COVID-19 response, and that demonstrates the amazing potential available when we all, including the citizens, clinicians, managers and partners, get behind a strategy and a plan.

Second, let’s agree where we are going. I hear a little too much “don’t worry, your job/care won’t change” and not enough “the time for change is now - how can you help?”. Change feels threatening, but if we focus on protecting our own interests we’re going to spend a lot of money and energy to get nowhere.

The target beneficiaries of the health reforms are not doctors, nurses, politicians, planners, researchers, vendors, or change management consultants - they are citizens. Citizens are empowered by good health, and citizens pay for care through their taxes. How about we frame up what we are trying to achieve from the perspective of those we serve, and design the system around that.

As a citizen, I care a lot about my health and the health of those around me - especially when it is declining. I’m happy to play a much more active role keeping well, and be nudged toward better decisions. When I do need help, I want to know where to go and that my advice and care will be based on the best available information about me and about my condition. Technology has a huge role to play in this.

People like you
Healthcare advice is about people like you. “At your age, with your history people like you should be screened for this condition”; “people like you with this diagnosis tend to take this medication”. At its core this is a data matching problem - your data understood and translated into action. In future, we might deliver advice in person, or we might use technology to bring the conversation closer to home, but this should be available to all and personalised.

If various social media platforms can be scarily accurate at predicting what I might watch or purchase with a bit of encouragement, surely our healthcare system can enable personalised healthcare at scale, and help us understand people like you. The building blocks for this include shareable data, interoperable systems, and well-governed practices for algorithms and care. 

A reformed healthcare system must achieve meaningful inequity reduction. Let’s set a national goal that your ethnicity at birth ceases to be a predictor of your health outcomes or life expectancy, and let’s measure how we are tracking toward that goal. This means measuring the right things - improving an average is not good enough if it also widens the gap. It also means empowering Iwi and other communities to lead the changes we need to make.

You cannot build personalised healthcare and achieve population-level improvement with siloed, poor-quality data. Equally, we cannot achieve these goals with one behemoth of an IT system. The temptation in health is to adopt one single system that finally solves all the problems of the past, but any system of that magnitude will be out of date before it goes live. If properly resourced, the vision of Hira is much more likely to produce the results we are after, and the recent NZHIT report highlighting innovation at the core is essential to our success.

Setting clear expectations
As a citizen, I should be able to see, understand, and correct the data about me. I should be able to track who is doing what with my data. I should be confident that anyone who manages my data is doing so under clear ethical principles. In general, I expect that the data about my health will be safely used to improve the care of others. 

As a clinician, I should have access to all the information about my patient, and the latest knowledge about their condition. This includes relevant medical and non-medical data, recent research findings, and links to wider population trends that might support any treatment decisions. We cannot expect clinicians to keep up with expanding information, manage multiple technologies and still maintain a personal, patient relationship without appropriate tools, access and training.

As a researcher, planner or policy maker I should be able to access and explore what is happening in a population. There should be clear rules and tools to enable and protect personal information, and those protections should enable rather than inhibit analysis and progress.

Setting goals
As a community, we need to believe in the goal of equitable, personalised care. If we can see measurable progress toward our goals, then the first setback needn’t be fatal. 

Let’s create a truly world-class health system. Not just one that runs efficiently, not just one that keeps providers happy, but a system that enables people and their whānau to live their fullest lives. People like you deserve that.

Listen to an eHealth Talk podcast with Kevin Ross on Empowering Data Driven Healthcare.

If you would like to provide feedback on the above feature article please contact the editor Rebecca McBeth.

Read more FEATURES

Return to   eHealthNews.nz home page