23 March 2016
Throughout March, the Ideas Boom has been touring Australia in a series of oversubscribed "stakeholder workshops". I imagine the discussions ricochet with words such as innovation, ecosystem, incubator and accelerator. This is the lexicon of the innovation agenda.
Conspicuously missing from this vocabulary are words such as waste, inefficiency and duplication. In the rush to turn new ideas into successful products and services, we seem to have conferred newness with mystical powers.
That’s not to say new innovations such as drugs and devices do not have a place in the innovation agenda. As a cardiologist and researcher, it is a challenge to think of major medical advances that did not start as new ideas in a laboratory and progress through an innovation cycle into fully formed products and procedures with genuine benefit to patients.
However, the problem with the innovation agenda focus is that we seem to be obsessed with putting our energy into newness at the expense of improving existing products and services.
We need to shake off the idea that the innovation agenda is solely about sunrise industries and start looking at ways we can reform underperforming industries by dealing with inefficiencies and waste — especially those that transfer costs to the taxpayer.
More than any other sector, health would benefit from a reform of existing systems. With a burgeoning deficit and little appetite among the electorate for new taxes, I believe it is time we rolled up our sleeves and tackled the inconvenient truth that the health system is riddled with inefficiencies and profiteering by entrenched interests.
The scourge of waste is seen across the board in health. One prevalent situation is the use of marginally beneficial and duplicate imaging. Let me provide an example from my experience as a cardiologist involving reordering of echocardiograms that attract a Medicare rebate of about $250.
Imagine you are a patient who has had an echo test ordered by a general practitioner in one location and you are referred to a specialist or hospital in another location. The report will go with you, but the chances are the images will not. Say the new specialist finds your presentation is inconsistent with the report. They can’t get easy access to the images because we don’t have a means of uploading echos on to a common server for downloading on demand. So what does the specialist do? Order another echocardiogram, of course.
Solving this problem isn’t rocket science, but I fear problems such as these may not be sexy enough for the innovation agenda. For years, we’ve had a common file format standard for viewing medical images — it’s called DICOM. In theory, DICOM enables the integration of network hardware to facilitate image archiving and retrieval from a central repository. This should enable your specialist across town to retrieve and view the echocardiogram, ordered by his colleague — and subsidised by the taxpayer — with just a few mouse clicks.
The reasons conspiring against wider implementation of this standard are simple. They include lack of imagination and, critically, the absence of a profitable business model. At the moment, the system doesn’t reward people for implementing more efficient practices and eliminating waste. If anything, they are rewarded for doing the exact opposite.
Quality of care and appropriate use of diagnostics is another issue that could be addressed as part of the innovation agenda. Our recently published research showed a 17-fold variation in cardiac imaging per 1000 people across Australia. The highest concentration of use is in urban centres such as Melbourne or Sydney, reflecting the referral practice of major medical centres. How then do we interpret the number of echocardiograms performed in Wide Bay, Queensland? With a population of 270,000, this region has more echocardiograms performed per 1000 people than Tasmania or the ACT. These variations do not appear to be related to the relative burden of disease and this finding highlights the fact we lack research to be able to measure overuse. Maybe that should be part of the innovation agenda.
Medical research has an important role to play in the innovation agenda by tackling waste and inefficiency and, in doing so, delivering better value for our collective health dollar. We could start by finding a better balance between research that develops new tests, drugs and devices and collecting evidence to show that a procedure or diagnostic we have been doing for years may not actually deliver much value.
As we embrace the innovation boom, it’s important to acknowledge that jobs and prosperity for all don’t just arise from new companies; they also arise from being smarter at what we do.
We will have squandered the innovation agenda if we fail to use it as an opportunity to address the serious issue of waste in the health sector.
Tom Marwick is director of the Baker IDI Heart and Diabetes Institute.
—Read this article on The Australian website.