good afternoon ladies and gentlemen and welcome to this session on disruptive technologies I'm Nick Buckmaster and I realized I probably need to give a couple of conflicts of interest in those I happened to sit on the quality and Safety Advisory Committee to the board of the Australian digital Health Authority and at the moment I'm also the senior responsible officer for the my health record implementation program within Queensland Health what that will tell you is that I'm a technology tragic and the reason I'm a technology tragic is that my father a general surgeon in Aubrey was a technology tragic and he taught me that it's good fun to play computer games but my father was a technology tragic because he also happened to buy the first sorry the second gastrous cope in Australia and as a general surgeon he went overseas to Japan to learn how to use flexible gastrous gastro scopes and brought that back with him and he started doing electronically formatted reports for gastroscopy and colonoscopy around about 30 years ago maybe not quite 25 so I think technology is in my blood but having said that we are on the verge of a absolute revolution in a very short period of time how we are communicating is already changing how hospitals work areas which have always been pretty technological our rapidly changing and what that means for all of us as physicians is that we are going to have to change how we work in order to provide good care for our patients we heard this morning from in Scott about the personal experiences of the implementation of an electronic medical record and the associated technology stack in his hospital but this afternoon we're going to look at a very big picture view of how technology is going to change the way that health works and we're going to see and hear about some examples about what is going to occur in our future in the next few years which will change dramatically what we do and what society will expect us to do I've got a few little housekeeping messages one is if you've got your personal technology device in your Hospital switched with the sound on please turn it off second one is if we hear the technology go beep beep beep be alert but not alarmed and if we hear the technology go Boop then we'll be guided to the appropriate exits I also remind you that there is the Congress hashtag on hashtag RAC P 18 and I have seen that there has been active discussions occurring on that site and a reminder that the Wi-Fi access is on the RAC P Congress Network and the password somewhat surprisingly is RAC P 20 18 and last but not least if you haven't already downloaded the app then please do so and the connection pass the connection is your email address that you use to register and the password is our ACP 18 and it only took me three goes to realize it was 18 and not 20 18 I would like to just tell you that unfortunately our last speaker today is unable to attend so we are going to hear today from John Lambert Leslie Burnett and Peter Corke and that will be followed by a panel discussion with questions from the audience during this session please go to the app and put in questions that you would like to ask we will have a microphone for questions but I also will be watching the questions coming through on the app and will ask those questions particularly those that are challenging and entertaining of our panel at the end so I'm just going to introduce to you now John Lambert John has been the recent chief clinical information officer for New South Wales health and in fact that was the first time that we've had a doctor be a a chief clinical information officer in Australia and that's not what's on the I did want him that I would ad-lib a little here's an intensivist he's been working in New South Wales health for 25 years he has recently commenced a new role as chief medical officer for the A&Z healthcare division of DXE which is a pretty large technology company and I welcomed on to our stage so thank you for coming John thank you very much Nick I'm just gonna try and make sure I keep the time so I'm just self servicing a bit of a timing here naturally doing it on the last flyer suddenly realized that I wasn't gonna be able to see my iPhone from where I was standing so I needed a bigger screen most technology Wizards like Nick and myself love bigger screens hello everybody I almost feel like I should give my talk from sort of where the sound desk is but that'll be a bit mean for the sound desk and especially the camera guys I am going to talk from up on the stage like you're supposed to much as I hate conforming I will start by acknowledging that we are speaking on Aboriginal land pay my respects to Aboriginal elders past present and future and also pay my respects to a number of people in the audience here who are my mentors and teachers from quite some time ago and you know who you are and thank you for helping create what I am today which is a bit of a mess as you can see I'm an anesthetist intensivists I'm sorry I wasn't one of those intensest that came out of the physician flock and I've actually been doing technology for longer than I've been a doctor I've been a technologist in one form or another for 30 years and when I took on the role of the inaugural chief clinical information officer poor fool then I I kind of valued it because I thought it was gonna be a great opportunity to bring together the knowledge that I'd acquired in both of those fields and make a bigger and better difference to the world at large so I don't know if I achieved that but I left that role at the end of last year and as Nicky said I'm about to start a new role on the dark side in the technology side of Industry and please feel free to keep me honest anytime you want my twitter handle appears on every slide so you can always hassle me so I'd like to start you've all just been at a break so you don't need to stand up I'm not gonna do one of those but I think we need some upper body exercise so if you could raise your right hand if you have computers working in your practice today in your private practices okay I'm getting really only half of you Oh three quarters two thirds someone like that okay did I say put them down I thought this is exercise we need to strengthen those shoulders now put up the other hand if you have a wireless network in your practice that you let your patients use interestingly almost no exercise of the left hand okay you can choose which hand you raise for the following questions how many of you use those user an organized system of a specialized solution to do the billing for your practice how about for appointment scheduling again what do you think quarter please help me with the numbers if you think you can see them better I've got all these lights in my face I can't see quite as clearly how many of you using it in the room when you're consulting with patients okay so that's sort of definitely less than a quarter and how about using it to actually do everything so documenting the patient notes writing letters prescribing looking up dynamic patient related information I think I can see four hands five six 10 15 maybe okay we've got some work to do because there's not a lot of point having digital disruption if nobody's digital in the first place and yet if I asked you to put up your left hand this time just to be different left whatever you're left if you have a smartphone or tablet somewhere near you right now how many would put up your hands here just about everybody fascinating I've got to find the clicker which is here so disruption what are we talking about the disruption that I have been involved in for the last four years especially is about disruption that solves big problems by any measure there's lots of people involved they're nasty gnarly problems that people haven't solved before but the interesting thing is they solve the problems of the people who are making the change when we I'll talk about the that comet in a second and they they generally solve problems this is the right time we didn't even realize we had how many people thought in 2006 that we had a problem because we didn't have a high-powered computer with a high-fidelity screen and constant internet connection in our pockets nobody would have dreamed about that being a problem they hang on there's one person who thought that was a problem okay good well you're obviously a futurist so but most people didn't even realize that that was a and yet everybody in this room ten years later of little over ten years later has one of these devices but the other thing about disruption is that so it solves problems it solves big problems it solves problems for lots of people but it totally changes the way we do things and there's heaps of examples of that ranging from uber Amazon Facebook Instagram think of life without all these things and you get the gist but the other interesting thing is that in most areas of digital technology disruption the disruption has come from outside the industry being disrupted Amazon did not run a bricks and mortar bookstore uber never ran a taxi company and the examples can go on so these are change processes disruption is all about change it's a really aggressive word isn't it disrupt we're you know rip it's it's a really nasty it actually has a lot of negative connotation disruption but let's talk about change or disruption by mandate as opposed to by choice I don't think this audience really needs a lot of explanation we've all experienced the early attempts at EMR rollouts yeah the big teams of consultants highly paid consultants telling us how we're supposed to do our businesses as clinicians interestingly these are different because generally they're trying to change us and we don't want to change why should I change I was working perfectly fine yesterday I don't see a problem with the way I'm practicing and more importantly the changes are not we we don't see the benefit of the change quite often it's a bean-counter it's some policy person who's supervising the improvement in outcomes we don't get to see the data of the improvement in patient care and safety and access to care and equity of care so we're making all the change but we don't see any other benefit whereas when you're talking about disruption nobody forced us to buy iPhones or Samsung Android devices or any other device like that we want to do it why do we do it because it's easy it's nice wow this is a cool way of doing things it just works it makes sense anybody ever said that about me you know not recently but some parts of the emails are great and lots of them art and they're working to improve that trust me I'm a doctor the but you got to get this app what you can still ring to get a taxi you can actually and I'll tell you the user interface is just as Tara always used to be so what's the secret what makes disruption work I believe from my in my opinion that and this is opinion there is some evidence behind this but not in the sort that you generally have a scientific meeting such as this it's about what's in it for me you know is a cheaper less effort quicker better quality am I going to be seen as trendy or fashionable is it safer interestingly you'll see all these sentences about for me is it cheaper for me not cheaper for the government is it less effort for me is it quicker I don't notice I've also put in there that sometimes things can be cheaper you don't actually save any money you spend the same amount of money and you get more product or you get a better quality product but safer for me I mean if we were really motivated as doctors by safety why on earth do we still not wash our hands every study shows that we're the worst offenders in washing our hands so really we're not motivated by the safety of our patients when they devote it by our safety or is there something else to play I might be being a bit simplistic there but generally the driver for disruptive change is that things are better for me having said that it's more than just the individual you've got to make it better for everybody involved in the thing you're disrupting so if you think of uber they made it better not just for the people catching transportation devices taxis in the old days they made it better for the drivers they allow people who previously weren't able to provide a service driving people around to do it for almost no effort of course the credit-card companies we're never going to be upset about a system that forced you to use a credit card to pay for the service they clip a ticket all the time anyway but even though for good disruption you need to make sure that all the players in the thing being disrupted get something back get to what geta what's in it for me get a with them not everybody always is better off and I this quote in The Handmaid's Taylor don't know how many watch that show really resonated with me better never means better for everyone it always means worse for some and maybe as clinicians we don't like that thought but I think it applies to most things that I can think of and with digital disruption and digital change programs it always seems to feel that we're the ones that get stuck with the worse the worst usability with some of the essentially change projects I thought this morning David pension did a fantastic job of giving us an example of disruption there John the food catering manager in um Cena in at the NHS he listed all these wonderful winners you know the politicians were happy the community was happy the local farmers were happy they got the unemployed off the unemployment ranks the executives got to talk about how wonderfully empowering they are of their staff the patients and staff could eat great food but there were still losers those old food outlets that were in the basement and reception area their hospital probably weren't singing the praise of this job of this disruptive event the company that was trucking all the food in from wherever it was else in Europe they've not only gone out of business potentially or their drivers the supply chain for them the farmers that supplied their food the energy suppliers there are always losers in these disruptions before I go on to about the leadership disruption my heading was who do we want to be in charge of our disruption as clinicians I did want to talk briefly about how do we increase the chance to success not all of these disruptive technologies work and there's a lot of people trying to be the next great unicorn the next great idea that makes billions of dollars for them but increasingly it's not just about good luck about having that whiz kid the Steve Jobs that can just see what people want and create solutions that we all love he's dead now so I hope it doesn't rely on people like that to produce all of the great ideas and there is a science behind good design the science of user or human centered design this is where we design things around the way Hughes humans operate understanding the cognitive science that drives all human beings it's an increasingly developed science it allows those of us who aren't gifted designers like Johnny eaves or Steve Jobs as examples to achieve great results and interestingly it gets around the issues mentioned by Henry Ford it gets around the issue of people asking for something because people generally don't know what they want and it sounds a bit patronizing or patriarchal whatever but it is interesting how people often can't describe the solution they have though sorry the solution they need what they can do is show you what they do every day and through the study of human behavior and human Center design you can work out where those pain points are and by by targeted questioning and other processes you can actually create solutions that actually solve the problem that people have without necessarily giving them what they asked for in the first place another factor in good human centered design is it actually trains you to ask better questions about what exactly is your problem you would not count the number of times I had vendors and doctors and clinicians coming to me saying I've got this great idea it's going to solve all these problems and you know like this is you just gotta get this rolled out across New South Wales I said well okay what problem are you trying to solve and they were unable to tell me what problem it was actually solving so spending more time this is gonna be a theme I bring back in the later slides spending more time on being clear about what problem you're trying to solve is absolutely vital if you want one of these successful disruptions the worst cause of failed system is work as imagined you take a bunch of well-meaning clinicians who work every day as a doctor or a nurse or whatever part they play in the hospital system put him in a room and ask them what are the requirements for your system what are the functional specifications well it's the minimum data set and and like even better you get an expert committee you get all these hand-picked people that the politicians love and put them in a room and you know we're gonna have a great solution but the best people in the world all in this room it's going to be just sublime and what they forget is that if I sat down and told you what I did even as a si CIO as an intensive care specialist every day and you then followed me around and watch me do it you'd think I was a lunatic we are incredibly bad at describing what we do every day at the detail level required to design user interfaces and software so it's absolutely key that human Center design removes that completely if you're doing good human Center design nobody is sitting in a room designing these pieces of equipment or tools or software package whatever so but in the end doesn't matter how you do it if it's going to be a success if it's going to be a disruptive success it's got to be usable it's got to be useful I've seen great usable device you know apps that do nothing useful oh great love the user interface she looks beautiful doesn't do anything abuse to me it's got useful and in our situations can be safe and of high quality and then of course it has to be used there is no point having this awesome tool that is really functional and really useful that nobody is using for whatever reason and preferably by choice rather than by mandate so look I get a lot of in my role as the C CIO there are a lot of people fearful of disruption you know everybody heard the stories Polaroid went out of business the taxi companies are upset bla bla bla how do we stop ourselves being disrupted now doctors do pretty well you a lot of control who else can be a physician the RAC P keeps a pretty tight grip on who's allowed to be a physician can't see that changing that quickly but then Trump got voted in there's a fair degree of unhappiness with the current service there's not enough positions people say they're in the wrong places they never keep to their appointment schedule product yeah most people are happy but then they don't know all the dark secrets that we know about all the things that go wrong and that might change soon there's a lot of really clever people who are looking very closely at what you do for their opportunities to disrupt you the incentives are even changing the governments are increasingly looking at paying you not for doing something but for being successful for having a successful patient outcome and if you don't have a successful patient outcome you don't get any money there are people who are interested in paying you for a better patient experience more satisfied patients regardless of whether their treatment actually worked or not there are people prepared to pay for healthy behavior and you could argue well that's the worst of all because with all these people healthy who's going to come and see doctors I think we're a fair way off there but the barriers are dropping in terms of incentive financial incentive the barriers are also dropping technically then my health record fire if you don't know these terms we can talk about them in the question and answer session but these are technologies that are making it easier for interoperability easier for systems to work together easier for disruption and the general public is increasingly saying hey I've got this device in my pocket all the time they should really help me with healthcare so there's a lot of drivers for you to be disrupted so I wouldn't be too complacent I think healthcare is reasonably safe but then about a year ago I really didn't think I was going to see walking robots that could climb a hill covered with stones and you don't have to look very far on the internet for a video of exactly that just this week they have this amazing looks like a torso legs walking up a hill in the bush covered in rocks and stones and sticks and not tripping over that is pretty impressive knowing the technology behind that so if we're going to get disrupted who do we want to disrupt us the patient the government pays lawyers Jen Morris had a great quote there I'm not gonna have somebody tell me whether I'm allowed to know your outcome data I want to know whether you're safe practitioner and I don't care what you think about that the Nerds or us the people actually do health care us and and when I say us I mean clinicians of all types doctors allied health practitioners alternative practitioners nurses as well as the practice managers and the people that keep the engine running but actually I'm much more worried about the people we wouldn't even think of because that's when most disruption has come from people that you would never have thought of if we leave it to the Nerds I went to lots of conversations and conferences where this has talked about you know we're going to replace the doctors with AI doctors are hopeless at making decisions they're hopeless at looking at all the data computers are going to be much better at this maybe I'd rather the IR worked on how we could make appointments more effectively so that people didn't spend as much time in waiting rooms robots replacing surgeons well nobody cares about surgeons but increasingly physicians or procedural clinicians too and the robots will probably replace you as well I personally believe there's a lot of value in laying on of hands and the personal touch and the human contact but you know everybody feels the video is going to replace face-to-face consultations that will be interesting haven't seen it happen despite video conferencing being available for well over a decade they're replacing chat BOTS with automated systems genomics will answer everything and protein omics if genomics doesn't fix it personalized medicine Wow customized medicine titrated to the needs of the individual patient and their particular disease constellation and the medications they're on I would never thought of that we need digital disruption to do that I thought that's what we were taught to do in med school but anyway that the IT nerds are saying well this is what we can do with big data and data analytics and and customized experiences through the computers patient reported experience and outcome measures this one's an interesting one because I feel that colleges have a particular role in defining appropriate outcome method measures and maybe it's the society is not the colleges in intensive care world antics came up with the we didn't come up with your party score but we had the Australian modification of that and we have reasonably good risk of death prediction algorithms which we could use to write units against each other and and potentially individuals against each other better than nothing most of the other specialties are not that advanced and don't have subspecialty level granular method methods of measuring what is a good outcome how do you adjust for the fact that this practitioner sees 90 year olds with five chronic into current conditions whereas that practitioner only ever sees people under the age of 30 but trust me on this one if you don't start doing it other people will do it for you and I don't suspect that that outcome is going to be as pleasant for us the Nerds are very good at making things smaller making it Karia ball making the battery life longer converting your glucometer machine into something that's embedded inside you or you wear on you that gives continuous readings connecting to Wi-Fi I'm pretty happy leaving that with them and it's generally done in partnership with clinicians so I'm not too worried about being disrupted in that particular space but it's certainly an area that all of the technology companies are looking at how can we harness this massive volume of data we're going to be gaining of every individual in the planet so what can you do to stay in charge as I've said before be really clear about what your problems are don't worry about the solution somebody else will design them make sure you think about the rest of your team it's not all about the doctor there's other people in your office in the hospital that have to interact with the patient and play part in this and if you don't create a solution that works with all of them nobody will use that solution make sure everybody knows what these high priority areas are I noticed that the AICP has an eHealth reference group starting up if you want to get involved in that that's a great way of getting it on the agenda and the RSC P will be an organization people listen to shaping materials to the audience I noticed on your website you've got the scene called evolve which looks like a sort of a an evolution perhaps of choosing wisely I love I'm an intensivist I tried to find some best practice do not dues for various areas so I'm interested in stroke diabetes here's a real bad guy trying to find out what exactly I was supposed to do you know search for a stroke and three different articles came up one for pediatric contract why don't why couldn't I just see a list of all the things you're telling us to do or not do in a nice curated form for a professional let alone public you might want to see this as well really important when you're having things on the public internet to curate the message to the audience and sure who's gonna go looking for evolve if they aren't a physician already aware of the program but it's just something to be aware of when you are trying to influence the executives and the government and other players who are not physicians to remember to use their language not yours and to structure things in their mindset not yours and be involved just coming to this session thank you your being involved I wanted to play a recording of something that bugs me am I allowed a couple more minutes or you haven't seen your sign so I don't know where I'm at oh I've got to finish gentleman stop oh yeah we've it's really cheating because we lost a speaker so I can't I'm sure I can take a couple of minutes you know if you could just play recording number one hi I'd like to reserve a table for Wednesday the 7th it's for four people at 6 p.m. oh absolutely APRA like a five people for you four before you can come how long is the way usually to be seated tomorrow for next Wednesday the 7th oh no it's not too easy you can count okay oh I got you Thanks okay now I'm sorry it's not a clinical example but you can easily see that relating to somebody trying to make a booking for one of your practices how many people in this room have heard that exact recording okay there's enough of you but just don't be involved in the next bit then because I think that minute is wasted thousands and thousands and thousands of times in practices all over the world and I really think we should be focusing on doing something to improve the patient experience of getting appointments made with us getting our of deferral documents here and ensuring that clinicians are actually available when their appointment time comes up and we don't have to wait an hour and their practice waiting room etc but that particular recording is interesting because how many people in this room think that that was a conversation between two human beings that's a bit of a treat I'm on a talk about disruption and technology so it's probably a load of question but it's good to see a few hands up there that was actually in between a computer and a machine sorry a computer and a human the asian lady with the very difficult to understand accent was actually the human that's probably not hard to understand if we had more time and maybe later I can play your recording number three where they're two adult Americans speaking English native English speakers and I played it to my family members and half the family members picked the wrong person as the human that's how good our voice recognition and speech technologies are today and they're not even trying to do anything really exciting so it fascinated me because in the space I mean in in digital technology companies and health New South Wales we're trying to work out all these ways of standardizing the the format of the message so that you can go from your app in the iPhone and it goes into your EMR and then it comes out to your practice management system and back to the my health record and everybody's got agree on the format Google are just saying we don't care just put us on the phone with a person we'll make the appointment that the example there was triggered by somebody with their Android device to saying to the Android device please book me a table on the 7th of March for four people at this particular restaurant then the computer goes away and rings the restaurant and hazard hi conversation without the human involved at all now you think how that could be applied to your practice in the next few months or years I'll wrap up on that there's sorry there we go the the the other slide was there as a backup if I took too little time which never happens thank you for taking the time to listen I hope I've stimulated a few questions remember the app the front page of the app once you download it bottom row middle button is an ask a question button so you can type in any question you'd like and we'll try and answer it if nickel let us see the exciting questions and look I can't help remind you that I mean David Penton I'll quote him again use your collective voice the physician community is a very powerful community but I'd like you to be the disruptors or at least on the winning side of disruption not the losers and in the four years that I was in any health New South Wales I saw a lot of technology companies trying to cut you out of the equation completely so let's try not to let that happen thank you you [Music]