Scrapping the fax machines for blanket-delivering robots: An interview with eHealth Queensland’s CTO

Warren Prentice is responsible for evolving a largely analogue health system into a highly connected, interactive digital information systems which support precise, informed treatment of healthcare consumers across the state of Queensland.

Sitting down with our Partner and Strategy Director Jason Donnelly at ADAPT’s Connected Cloud & DC Edge, Prentice shares how to deliver a resilient digital infrastructure for over 100,000 employees at eHealth Queensland. From getting rid of faxes to experimenting with robots to deliver patient goods, he tells us how integration has been ever critical.

Jason Donnelly:

Digital hospitals give you this blank canvas to design infrastructure and data services, so how do you manage the integration into the existing hospital landscape?

Warren Prentice:

Preferably before, they do the architecture for the building. We like to plan for what that digital hospital will look like and when I say, “we’re involved” not just the ICT organisation but also the clinicians and everybody supports how that hospital will run. So, BIMS, building management, right the way down to the wardens that are going around and obviously working the wards through to the security folks and get everybody on the same page around what are the requirements? What are the existing requirements of those hospitals? What are the coming initiatives that we see in the pipeline and also where is the opportunity for innovation?
If we don’t really start that right at the beginning where we do that architecture and design work, we’re already trying to shoehorn in potentially a square peg into a round hole.

Jason Donnelly:

You’re obviously looking to build a number more of these digital hospitals across the state. So, over time, you’ve built this very standard blueprint in how to take that framework in order to build up or is it on an individual basis?

Warren Prentice:

It really is on an individual basis. You might be building a brand new hospital for children. You might be building a brand new hospital for women’s health issues, so before we’re calling Queensland a split between the women’s and children’s hospital now, has become Royal Brisbane Women’s and we’ve obviously got Children’s Health Queensland from former Lady Cilento. So, each of those particular environments will have very different needs and aesthetics and that’s really important as part of that discussion as well. Let alone the discrete value that technology can bring to the different models of care and those different craft groups of supporting those different patient types.

Jason Donnelly:

Absolutely. So patient data is within the press with multiple different opinions, whether it be from the MR2 rollouts or whether it be from My Health Records and uptown pieces, right? So, it’s a very complex landscape, but from your point of view, what do you see as the main use case for utilising that patient data effectively.

Warren Prentice:

We must obviously acknowledge the privacy and the confidentiality needs with anything we consider around patient data. So, if we acknowledge that and if we very respectively put that to the side as to what the true value of patient data could be, I say that probably the most impressive area that it could be applied to is around precision medicine, but also predictive medicine based upon what you might learn from somebody’s genome for example. And then applying for that precision medicine, and I’ll give you a really good example. I saw a presentation by a particular researcher. A very senior medical person, that was doing some development work around robotics, but also I think around some of the more micro-sized technologies if I can put it that way. Nanotechnologies. In the sense of how they were developing that type of nanotechnology, which is something that I was completely surprised about. When you think nanotechnology, you kind of think of the Hollywood version of that, something being very tiny and microscopic, like a machine. But actually they were using DNA to craft this nanotechnology and through the use of obviously the analysis of the data, we can now target certain types of chronic conditions to then go ahead and start to preemptively respond to potential issues that the patients may have, using things like nanotechnologies in conjunction with the data that we’re getting.

So, from a precision medicine perspective, there’s some research out there at the moment that’s talking about some amazing numbers around prolonging life. This then brings us obviously, yes, to our problem that I was talking to earlier in my presentation about the growing population numbers and then how we then manage that, which of course is becoming even more of a challenge. But what wonderful opportunity though, for patients and for the human race more generally.

Jason Donnelly:

Absolutely, it’s an incredible opportunity. At the moment, that needs communication and integration of that communication coverage and from primary up through to tertiary physicians, right? So, at the moment that’s quite a big step, even though the technology is there, the processes are probably not as mature as the technology is.

Warren Prentice:

No, and I think if you then equate that to how we as consumers expect to access certain types of information, because the nature of healthcare being so much more cautious, we are, I would say quite a way behind in terms of how we would then manage and share that information. And rightly so, given also some of the challenges that other industries that embraced the technologies sooner have faced.
I mean things like My Health Record. I don’t think anyone disagrees that we do want to be able to access our patient information wherever we go. I guess this is a first bold step that somebody had to take and non-politically, we look forward to seeing that technology grow, in its use, and obviously, its maturity as well. Then we can start to share end-to-end. And we talk about patients being more informed as well, so I mean as a person that’s getting into that more senior age group as well, I want to be more informed about my healthcare and I would like to have access to my healthcare information end-to-end, to help me make the decisions that I need to make in partnership with a clinician not in reliance totally on a clinician to make those decisions for me.

Jason Donnelly:

Absolutely and maybe one day we can get rid of faxing totally.

Warren Prentice:

There are so many health services that still rely on faxes today. You’ve seen obviously in the history of the healthcare industry, government initiatives that have tried to crack the nut so to speak on patient referrals and things like that. Many failed types of projects, because I guess the need to get the buy-in from that broader community end-to-end. But we still remain optimistic there’s a future there, though.

Jason Donnelly:

So, moving away from faxes and to your point earlier around robotics. You’re doing some very innovative projects with robotics. And how much of a focus does innovation get versus your business as usual? Percentage breakdown would be lovely.

Warren Prentice:

Well, I think the numbers going around today were reasonably accurate. There’s also different classes of innovation. There’s innovation that we would do potentially as a maturing journey in operations in the day-to-day. But if we were to just look at raw innovation within ICT, not necessarily been in research, which is different again. In a healthcare sense, but in ICT, it probably is around that 17% mark. So, the rest of it is probably more related to run. Obviously the plan build run model and break-fix, and where we can also use that maturity journey to be able to deliver some of that OpEx, not necessarily capital, but OpEx to do innovative work, which is what we do whenever we find that we’re tuning our budgets based upon the ebbs and flows of the workforce and actual things that occur within the environment.

Jason Donnelly:

Of course, and when you’ve got the time that you are spending on innovation, let’s say it’s in ICT, do you have a program in place that allows you to highlight the successful innovations that take place in order to scale them through the rest of the industry?

Warren Prentice:

Yes, we do. We partner in a number of ways. So, you might be aware of some of the incubation type activities that most governments are doing. We do partner in that space, and we do expose some of those innovations projects to those programs. Which then allows startups and all those types of elements to get involved, and there’s some great work being done out there in the community. We also then allocate through the different committees and the different programs that we’re involved with internally, certain amounts of those funds to initiatives that have been decided by the clinicians in partnership with health to run. And then I think external too in terms of the health system more broadly is we get involved in part with some of the initiatives that might be done in the regions with health services for example as well.

So, it’s really based upon how does it align with our strategic planning? What are those new opportunities that are emerging that we would take advantage of? Fail fast, learn fast but not obviously fail fast in a patient sense, but in terms of embracing the technology in a safe environment in the first hands. So those are the ones that we explore. And then finally, what can we do within the operational space? We’re always a large force for the size that we have in Queensland health, especially in the technology space. We’re always trying to find ways to improve how we do our business, through the maturity model approach, so the more of the standard ICT maturity model approach which would also bring them in part to that the use of innovations.

And then I think finally as well, how do we also provide new opportunities for our workforce to get their hands on new technology that is out there as part of our training programs and investments in our people? So there are lots of levers that we use I guess is the one way to put it.

Jason Donnelly:

Absolutely. Okay, wonderful, so, you’re in a fairly unique position where you are continually delivering the services that you do throughout the state. When natural disasters may hit, and those have a direct impact on your budgets for business as usual in innovation. With an increased number of natural disasters taking place, how is that affecting the way that you are having to plan and having to budget this?

Warren Prentice:

Yeah, so there’s two parts to it. There’s obviously the capital component and there’s the operational component. Operationally, it will impact our budget in terms of how we might choose to spend that operational funding. But generally, our OpEx is our OpEx.

We are locked into a certain type of growth model which is very modest. This impacts capital space. While we would like to for example manage our assets using a more mature model because of the pressures that are put on us through natural disasters. The number of natural disasters has increased incredibly since when I first started in just two and a half years to where it is now.
Which is quite surprising. And as a result of that, it’s not just one office anymore, it’s multiples. Ask yourself, even if you’re managing your household budget. From a household budget perspective, at what point does that pressure become onto where you’ll be spending money on a new TV or a new fridge or something versus having to repair the damage done.

On a large scale, it’s the same concept for governments. If we’ve got big bills to pay, the money has to come from somewhere. The revenue is not infinite. There are different federal related activities that you can certainly look at, but again, that’s not infinite, and we are now seeing a looming issue around ongoing capital investments to committed funds that we saw in our pipeline as a result.
We have yet to see that be realised, because obviously, that’s a decision that us, as public servants we can only guide the government on our positions, but ultimately it comes down to the political element to make those decisions based on all the information that they have.

Jason Donnelly:

Wow, and so linking all of that, piece back to why we’re actually here. How do you deliver a resilient digital infrastructure, especially for an organisation as large as yours? 90,000 full-time employees. 107,000 total employees.

Warren Prentice:

Total staff.

Jason Donnelly:

How?

Warren Prentice:

The most important theory I think to apply here is, never rest on your laurels. What is good enough today is not going to be good enough for tomorrow. We’re seeing that now with the increased number of natural disasters. We’re seeing that with the increased numbers in terms of volume in digital uptake and dependence on services. So, I don’t think you can now sit back on days of old where you can say that we’re good for ten years. Those days are changing rapidly. Our technology is also moving faster, but we certainly need to keep continuing to evaluate. And we’re also getting to the position through these natural disasters where we’re constantly having to review what we do anyway because it’s real-time for us. Mother nature is testing us every day. The volumes are testing us every day. There seems to something new come up every quarter in this game right now, which is a lot different from the way it used to be.