Implications of AI and big data for hospitals and consumers: Digital health leaders debate the way forward

MedTech News: Medical artificial intelligence (AI) applications span a spectrum, from diagnosis and disease screening to treatment selection and prognostication, and aim to optimise care, improve efficiency and enhance clinician and consumer experience.

A panel of leaders across healthcare came together at the Australian Private Hospitals Association (APHA) 40th National Congress this week to debate the implications of digital health, AI and big data for private hospitals and consumers.

Moderator Ben Thynne, Founder and Managing Director, Healthe Care Australia opened the debate by highlighting the rising costs in healthcare and the push to share data, while questioning whether the value proposition for sharing data relates to cost savings or something else.

Rhod McKensey, CEO of Honeysuckle Health (an agent for nib health insurance), said “Leaders are talking about value-based healthcare and using value as the principle by which to reward and measure success in the healthcare system. The big underlying theme is trust. It’s time to change the nature of the relationship between hospitals and health insurers to become more trust-based and collaborative. It’s easy to say and much harder to do because of the history of those relationships.

“We have to ensure that we can jointly use the data [from patients, hospitals and clinicians] for good. We need to ensure that any of the mechanisms that we develop are done transparently with enough time for people to get comfortable, and then ensure that the data is used to reward good behaviour rather than penalise bad behaviour.

“The system would be very comfortable to pay more for better value, but then how you readjust the allocation of capital within a hospital or within the industry is obviously quite complex.”

Privacy breaches and inability to understand or control AI applications concerns clinicians and consumers. In fact, a data breach at QIMR Berghofer came to light last week and revealed loss of personal details for patients involved in a research study. With no legislation to report consumer data breaches, the breach that occurred last year had not been reported by the research institution.

Tim Shaw, Professor of Digital Health and Director of the Research in Implementation Science and eHealth Group (RISe) in the Faculty of Medicine and Health at the University of Sydney, referred to his research on the experiences of consumers with practice analytics. The research explored the level of understanding consumers have in regard to how health professionals are using electronic health information to inform their practice. Additionally, it sought consumer perspectives on the use of electronic health data to support practice analytics including health professional’s training and lifelong learning activities.

Professor Shaw said “Consumers are somewhat shocked that we’re not actually using data much more effectively to provide feedback to clinical teams and individuals. What they don’t want from us is data phishing. They want to see clearly defined reasons why we’re going through their data, how we’re going to use the data and what the benefits are for the consumers in that process.”

Professor Enrico Coiera, Director of the Centre for Health Informatics, Australian Institute of Health Innovation, and Foundation Professor in Medical Informatics at Macquarie University, said “I don’t see consumers as a homogenous group. There are folks who are digital natives, expect to engage with healthcare digitally and are surprised when they are told they can’t. There are also folks like my elderly parents who need to see a human being at every level of healthcare. Ultimately, consumers don’t want to repeat the same thing about their health and condition to multiple people at different touch points during their health journey.

“People want a co-pilot to navigate their health journey. The health system is complex – even engaging in a simple procedure involves many touch points. So the idea of guiding consumers through the process and assuring them that they are on the optimal path is really important.”

In working with clinicians and incentivising them to provide their outcomes data to private health insurers, McKensey said “It’s not straightforward. Where we’ve had most success is in establishing a network of orthopaedic surgeons who are willing to never charge a nib or Honeysuckle Health member an out-of-pocket fee and only work with anaesthetists who don’t charge out-of-pocket costs. We pay these surgeon and anaesthetists more than the average that nib would pay for these procedures.

“In return, the surgeons have agreed to collect outcomes data that we facilitate, use (where clinically appropriate) an outpatients rehabilitation model that we have developed, and they agree to take quarterly reviews of performance and outcomes to measure value for members.”

Professor Shaw called attention to the role of digital health in health equity. In a survey conducted by University of Sydney during the pandemic showcased consumer willingness to engage with technology and data.

“I was really surprised that the level of education was the single highest determinant of consumer trust and willingness to engage with data and technology. It wasn’t age or where you lived. I think the piece on equity is going to be really big over the next few years,” he said.

AI has the potential to bring profound digital disruption of healthcare by creating a smarter, more adaptive health system – the key to the sustainability of quality healthcare in Australia. The priority for the use of AI and big data is patient safety, and the ethical and transparent use of AI by different stakeholders. Ensuring the privacy of consumer health data and the security of data from cybersecurity threats is an ongoing concern that is complex yet critical.

Lastly, to maximise the benefits and opportunities of an AI enabled healthcare system and overcome the current silos and fragmentation, we need a whole-of-government and whole-of-nation approach.

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