Robbie: Sure. So, I am a dietician and my background is in exercise science and nutrition from Southern Cross University. I then went on to do my master’s in nutrition and dietetics at the University of Canberra. And since then, my working career has expanded over community health, working with indigenous populations. I’ve done extensive work in corporate health but my main practising career has been in private practice. So, I’ve worked in a number of multidisciplinary clinics and through that time, I’ve worked with different practitioners in different modalities. And I’ve got a bit of an understanding as to what their frustrations were when it came to practice and clinic and also clinical workflows. And so, that is what basically led me to then go on and build my platform, Healthbank, which is a digital health solution and a practice management software for practitioners, which also includes telehealth as well.

Andrew: So let’s go through, you know, this post-COVID…I won’t say post-COVID, actually, it’s in-COVID, isn’t it? But during the time of COVID, this new era, this new epoch that we are going through, what are practitioners currently doing, and what are the transitions that are happening?

Robbie: Yeah, I think the best way to answer this question is to really look at what traditional healthcare models are versus what the modern healthcare models are. Because as you know, and many practitioners is that they were basically forced to pivot, which has been probably an overprescribed term as to what’s been going on during COVID, but it’s the best way to describe it. So, traditional healthcare models were basically the point of care was in the clinic setting and it didn’t move from those four walls. And the treatment was based on population health, statistics, and epidemiology. But probably more importantly, there has been more of an authoritative approach and a hierarchy where the patient has always been an afterthought and was not included in their healthcare journey. The treatment for patients has been more reactive and also the data that has been accumulated through the clinical process has been owned by clinics.

And also that information has predominantly been paper-based. Whereas now you compare that to more of a modern healthcare model. Think of all the things I just said and put it in the opposite, is that the point of care is now the patient and where they want to be treated. So it’s shifting to become more of a hybrid model of care, meaning that practitioners are still able to see their patients in the clinic, but also online and through telehealth and also through other digital health solutions. It’s based on the individual so it’s become more personalized and tailored to the patient’s needs, and it’s become more of a collaborative or a participatory approach, meaning that the patient is becoming more involved in the patient care journey. And finally, the data aspect of things is owned and shared by the patient. So that’s probably the biggest shift. And the treatment itself has become more proactive rather than reactive.

Andrew: Let me just ask you to repeat that because I think it’s an important point. The data is owned by the patient.

Robbie: Yes. So this is a very important point because traditionally, everyone, if you’re a patient, you go into a clinic, you provide your personal information and then, of course, they’re collecting all of your health information. And then that is owned by the clinic for legalities, which is also very important. They need to store your information. But if I was a patient, I need to either sign a consent form or a release form to access that information. Whereas where healthcare is going now is for patients to be able to have access to their information. So, that is through things like a patient portal or patient apps where they’re able to log in through secure portals, password-protective, and they’re able to access the information that their practitioner shares with them. But also potentially the information that they upload themselves to share with their practitioner. So all of a sudden, the patient has more control over what is being shared and also what is being accessed as well.

Andrew: How does that affect medical-legal issues with regards to the responsibility of the practitioner?

Robbie: Yes. So, obviously, depending on the platforms that are being used to store this information and to share this information, there needs to be secure pathways that meet very, very stringent and tight regulations and also compliance. So, in different countries and different areas, there are different regulations. So you’ve probably heard of things like HIPAA compliance in the United States, GDPR compliance in Europe and the UK. So, these platforms need to meet this compliance and regulations and that is what meets those medical legal aspects.

Andrew: Gotcha. Okay. And how does Healthbank approach the other issues that you sort of have to hurdle across, if you like, with regards to a different healthcare model where the patient is largely in control of what’s being shared if you like?

Robbie: Yeah. So what we are trying to do and essentially are achieving successfully, which no other health platform has really done before, is create a digital health solution for both practitioners and patients to allow for a more connected patient-centric care ecosystem, which is something that I guess hasn’t been really focused on previously because, as I mentioned, the patient has usually become an afterthought. And so, what does this mean? Essentially, I believe a successful digital solution should put the patient is at the heart of every decision that is being made. So, involving them in the care process rather than just dictating to them and telling them how it’s going to occur. So, it’s the patient portals that provide a solid foundation for what we call that digital front door strategy. And the digital front door is not just an app, but instead, it’s a connected ecosystem of features that create a cohesive patient experience across touchpoints. And it makes for a more seamless and engaging experience, and for patients to be able to access information and service tools to better manage their health every step of their healthcare journey.

Andrew: Gotcha. Okay. Okay. So, I guess when we are looking at health care, we have to think about the endpoint, the bang for the buck, if you like, and that is improved patient outcomes. But before we get to that, what about business efficacy? Does having digitized processes, does that translate into, you know, like improved repeat business, improved workflow, improved patient engagement? Are all of these sorts of aspects of practice, are they showing improvements with a digital and online platform where the patient has this interactiveness?

Robbie: Yeah. So I believe the patient experience and engagement is more than just the patient portal. It’s about how the practitioner is providing a front door to their business. And their expertise through the integration of these seamless and relevant digital tools that mutually benefit the practitioner and patient resulting in empowerment, adherence, and sustainable health outcomes. So, a big part of that is the automation of processes and workflows. And it’s absolutely clear that technology is fundamentally changing healthcare. As a result, workload and workflow automation has emerged as the core component to reduce patient data error and ensure internal health systems remain secure and responsive. And as a result, a company like Healthbank really has focused on building healthcare processes that are automated to help practitioners embrace value-driven transformation and deliver an even better quality of service, not to mention, to help streamline their administrative and operational tasks as well.

Andrew: You know, I think it’s interesting that COVID has forced us into moving somewhere that was attempted previously, even the Australian government attempted it with real issues and concerns. And then as soon as COVID came along and it had the necessity to shut down, to do telecons, it was like, “Yeah. Okay. We have to, I don’t want to, but they’re… Oh, actually, this is good.” So it’s really funny how you talk about pivoting that it’s an overused term, let’s say pirouette. But it’s just really interesting how this acceptance has just been, “Ah, yeah. Okay. No worries.” But let’s get onto patient outcomes because this is really what we need to show, right? So how does telehealth and this new digitized platform, how does it affect patient outcomes? How can we measure it?

Robbie: Yeah. So, firstly, patients have rising expectations when it comes to their healthcare experiences and every patient is unique and has individual needs and pracs really need to cater to those needs. And, you know, as an educator, I always love asking practitioners how many actually ask for feedback in their clinic or their practice. And how many practitioners actually ask their patients, how they would like to participate in their own care journey. And I think the word connected is what is so crucial in the success of these outcomes. And it’s really essential for a successful patient-practitioner relationship and patient-centric care, if you will, it’s the term that practitioners need to become more familiar with because it’s about seeing the patient as a partner and as an individual, placing them at the centre of that care. And when you do that, you’re able to… Well, it enables the practitioner to make more informed clinical decisions and provide better care, which in turn empowers the patient increasing adherence to treatment. And most importantly, enhancing the patient experience.

Now, this is all achieved through digital connectivity. So, you are asking about how we measure these actual successful outcomes, well, with data, and this is also very important because patients need to become more comfortable and familiar with being able to utilize data, interpret data, and analyze data that they’re receiving from their patients. So, thankfully, through the use of more smart devices, wearables, non-wearables, things that can help input data and analyze and interpret in real-time, sending it to the practitioner, enables them to take a very proactive approach in the treatment protocols that they set for their patients. Now in doing so, they’re able to then implement a treatment protocol and then continue to track that data and then measure it throughout the process. Let’s say it’s a three-month protocol, and then at the end of that three months, see how that data has changed, and therefore, they’re able to measure successfully the outcomes it has provided.

Andrew: Yeah. Yeah. I love what you’re talking about change because that’s really…I’ll always remember, a doctor, a functional doctor telling me, “If something is…if I get a bad result, I’ve got enough ego to know, okay, change. And that’s right. If I get a great result, wonderful. I’ll pat myself on the back,” he said, “But the worst thing that happens ever is no change.” He said, “I don’t where I am. Like, you’ve really got to assess and start over and reanalyze.” You said something very interesting earlier and that was about the wearables and sending information in real-time. When we are talking about things like, you know, let’s say the new watches that are around, some of them are able to track things like atrial fib, when we are talking about that sort of thing, and forgive me for harping on about this medical-legal issue, but obviously, the wearer has the primary ability to do anything about that, but can it alert the practitioner to an event so that the practitioner might be able to contact that patient or indeed, you know, get in touch with the relevant emergency services, for instance. Is that something that’s available?

Robbie: It’s definitely possible. And anything is possible when it comes to coding, I’ll just let you know.

Andrew: Wow. Yeah, true.

Robbie: Yeah. And essentially, it’s what platforms like Healthbank are trying to achieve and what certain digital health platforms are wanting to achieve in that regard. So, for example, let’s take whether it be Fitbit information, whether it be any other medical device that is measuring, as you say, AFib, heart rate, blood pressure, all of these are designed by a manufacturer and a company. And therefore, you might have specific log-in information to that company. So, therefore, you’re already giving away your information to a third-party service. Now all of these services or companies have what we call an API, which is essentially something like what Healthbank can then draw upon and integrate that with our platform. So, therefore, if we integrate a device into our platform, patients just need to sign into their Fitbit account as per normal and then upload that information, and then we can then attach that securely to a patient profile. And then if we wish, we can then set alerts at specific points if we want to or need to alert the practitioner and vice versa. We can also send push notifications to the patient to potentially prompt them to set up an appointment with their practitioner.

Andrew: Right. Okay. So, you know, I was thinking about a double-edged sword here, and I was thinking about interruptions to, you know, a current interview with a patient if an alarm goes off from another patient who’s having an AFib attack or episode. But I guess, and I was wondering about how that’s different in practice, but I guess any, for instance, GP will have an emergency situation where they’ll, you know, have a patient coming in with a heart attack and they’ll have to assess them quickly and then get the ambulance there and shunt them off to the hospital, or they’ll have to do some emergency into intervention with something that’s happening that interrupts their current interview, their current consultation. So, I guess, you know, in the end, it’s no real difference. I was trying to get my head around it, but, yeah, no real difference.

Robbie: No, not really. And I think also what I should make clear is that, obviously, there’s a difference between emergency medicine in acute events versus what, I guess, Healthbank caters more to the preventative side of health. So we are dealing with allied health professionals, complementary medicine practitioners, and therefore, these types of practitioners are using these types of services as more as remote patient monitoring. So, therefore, if I have a patient with Type 2 diabetes, they might have a glucometer, which they can then upload in real-time all their blood glucose levels and the measurements to their profile. So then it allows me to just log in and look up their profile and find out how their blood sugars are tracking without me even needing to see the patient. And so, therefore, again, I can set specific parameters or ranges where if they’re elevated for a set period of time, it might alert me and also the patient to then follow up and say, “Hey, let’s book in. And let’s check-up with how things are going with your blood sugars.”

Andrew: Yes. Actually, yours is a perfect example of tracking BSLs, low and high. Low is obviously gonna be more emergent than high, but, you know, if you’ve got somebody whose BSLs are just on an upward trend, it’s not uncommon that they don’t notice it until they’re extremely high. How high have you seen BSLs go before people are presented to a practice and gone, “Oh, whoops.” So what you’re saying is Healthbank can set a notification so that if it goes say above 12, that’s millimoles per litre for those U.S. listeners, if it goes above 12 millimoles per litre, that you can get a notification to go warning, is that correct?

Robbie: Yeah. So we’re currently in the process of working with a vendor, which allows for the integration of every single wearable, whether it be medical, fitness, or lifestyle-related on the market. And that’s currently in the build process. So we’re not there yet, but it just means that there’s a lot of flexibility because we cannot dictate to the patient as to which wearable they should be using. At the end of the day, they’re going to make their own decisions. And therefore, we just want to be able to cater to the patient’s needs and make sure they’re being looked after by incorporating the particular wearable that they might be using on a daily basis.

Andrew: Gotcha, sure. So with regards to different practitioners and their different requirements, does Healthbank cater for that?

Robbie: Yeah. Well, as I mentioned, the reason I started Healthbank is because through my practice and I just realized that the features that I was subjected to for a practice management software, they just weren’t catered to me and my needs. So I then wanted to build something that caters to a range of practitioners but is more specific. So, therefore, it can be tailored rather than saying, let’s say a 100 features, whereas I might only use 20 of them. It’s like we want these features with Healthbank to be meaningful and to be able to capsulate data, but then make that data useful to the practitioner. And that’s what’s not being done to date, and that’s where we’re trying to make a difference.

Andrew: Right. Okay. So today. What about the future? Where to now?

Robbie: Well, how long’s a piece of string? This could be a whole nother podcast in itself, but I truly believe that the future of healthcare will strongly be influenced and driven by digital transformation enabled by radically interoperable data and open secure platforms. And it’s obvious that there is likely to be more of an emphasis on sustaining health, being proactive rather than simply responding to illness, which is being reactive, which is what I said before. And that connected or an increasing number of connected smart devices means that healthcare is rapidly moving towards a decentralized system allowing for a more patient-centric care model and a shift from healthcare in the clinic to more homecare. And the vastly expanding virtual environment associated with the healthcare sector means that it will drastically benefit from technology-enabled care services, including advancements in telehealth, mobile health, digital health, and eHealth, and the increasing dependence on wearable and remote diagnostics and treatments makes technology-enabled care services essential for reliable and security service provision.

So, therefore, that’s going to lead to more hybrid models of care into the future. So it’s going to be a mix of in-person care because, please don’t get me wrong, even though I’m an advocate for digital health, there are still things that we cannot do as practitioners in a digital environment than what we can do face-to-face. So I’m completely aware of that and I still promote face-to-face interaction. But there’s going to be more of a hybrid care model now of in-person and also digital health as well.

Andrew: But I take your point because, you know, with the rising cost of healthcare, with increased patient empowerment that they demand, and this is something that has been missing from certainly orthodox healthcare and this is one of the big reasons why people have sought out let’s say alternative healthcare, the more functional model because they’re dissatisfied with the orthodox care. And forgive me, just going back to that rising cost and this patient empowerment, people want to be in control. There are those people though who just wanna be told what to do, but I guess from what you are telling me, it sort of suits both personality types, doesn’t it?

Robbie: Absolutely. And I think the major message that I’m trying to get across in educating practitioners around clinical practice or digitizing practice is that it’s all about the delivery of care. That’s what’s really important and that’s what’s being forgotten. And I think practitioners need to take a really good, hard look at the way that they’re delivering care to their patients. So a lot of practitioners are stuck in the traditional care model. They refuse to budge or pivot, and they might be quite stubborn in their ways. And then there are those who are very open to the idea of moving forward. And I guess the key here is if they do not move with the times, sadly, they will get left behind and it’ll be all these other practitioners who are implementing new ways of patients being able to access care, interact with their care. They’re the ones who will grow and thrive and grow successful businesses and clinics as well.

Andrew: You know, it’s so true what you say with regards to patient empowerment. I’ve spoken to quite a few practitioners now who prior to COVID for various reasons, some moved state, some just decided as a life choice for just enjoying time with their family and things like that, some had necessities with a young family. But whatever the reason, these practitioners moved onto a hybrid model or a digital model in some cases ahead of COVID. And so when COVID hit, it was just like, “Huh.” But I get your point that I really can’t see us going back to a totally face-to-face model anymore because it suits so many patients, with busy lifestyles, with distal locations, practitioners moving, all these sorts of issues. So I can see that Healthbank or something similar would really take that and be a seamless sort of move into, as you say, this hybrid model. It’s fantastic.

Robbie: Yeah, absolutely. And also you’re talking about the future. The future’s definitely data-centric and data-driven healthcare. And you mentioned that with growing technologies like AI, machine learning, data analytics, it’s really going to allow for virtual care and database technologies that are essentially going to become the bridge to build smarter health systems. And virtual care and telehealth offer a permanent way to change clinical and operational processes leading to greater efficiency, better management, and improved experiences for both the practitioner and also the patient. So that’s what we’re trying to build here is to enable proficiencies and efficiencies in practice for both parties.

Andrew: I love what you’re saying there. There’s one sort of thing…as a final question that I have to ask you, and that is something probably one of the most confronting things that any practitioner will do, whether they’re orthodox or complementary. And that is a clinic order. So will this capture of data of the patient experience, and indeed their feedback, I can only see it actually improving a clinic order because you are actually asking willingly for patient feedback, which if they’re dissatisfied, they’re happy to go, “Yep. No worries.”

Robbie: Absolutely. And, you know, I think that’s really important because when you are being able to obtain information securely and store that information securely in one place, rather than having to rely on different softwares for maybe your accounting, for your bookkeeping, for your appointments, for your practice management, if you have multiple softwares that you are having to export and get data from when you have an audit, that’s not just only stressful, but it’s also time-consuming. So the one thing I mentioned is that workload automation, and Healthbank is also, if you will, a healthcare automation software and solution. And it’s really being able to transform the way that practitioners, clinics even, and staff operate. And it’s that automation that then also allows practitioners to spend more time focusing on patient and patient care. They can actually rely on more accurate information because when you automate processes, there’s less human error involved and you reduce the risk of that human error, especially if you have a heavy workload and you’re back to back.

I’ll use a very practical example because this is, again, what I did in the clinic and realized how much time I used to waste by doing manual processes. So you have your appointment, you then finish that appointment. If you don’t have a receptionist, which let’s face it, a lot of pracs during COVID got rid of to save money, they would then have to take the payment from a patient, manually raise an invoice. They would then if their patient wants to claim either through Medicare or through private health, they’d have to swipe their card through the terminal and do that claim. And then they might book them in again through their practice management system manually. So that in itself could be an extra five to seven minutes on the back of that appointment. So a lot of practitioners are then running behind time, or they’re cutting into the time of the next appointment. With all of these automations, automation of raising invoices, being able to claim online, and also being able to allow the patients to book their own appointment online, this cuts down on all of that time. And then practitioners can see additional patients through the day, earn more money, and also not be stressed around those processes at the end of the day.

Andrew: Yeah. Yeah. I can just see it having so many benefits, as well as work-life commitments as well, you know, practitioners with young kids and things like that. Practitioners that might need to…let’s say they choose to practice from a clinic, even if they travel a large distance from home if they commute. I can just see it cutting down on these interferences in time management. So it’s just a brilliant idea. Robbie, there are so many avenues that we can go down today because there is so much that we can talk about with regards to healthcare and how digitized healthcare can help practitioners. But thanks for taking us through what Healthbank can do for pracs and indeed how digital health is helping us to pirouette in a proactively streamlined fashion today on “Wellness by Designs.”

Robbie: No problem.

Andrew: And remember, you can find all of the other podcasts and the show notes on the Designs for Health website. This is “Wellness by Designs.” I’m your host, Andrew Whitfield-Cook.