Brisbane’s Metro North Health is trialling Salesforce technology in a proof of concept for managing outpatient long waiting lists and improving patient engagement, but is also looking at the technology and other low-code/no-code platforms to help streamline manual processes.
Metro North, which includes Queensland’s largest teaching and research hospital in The Royal Brisbane and Women’s, has developed a digital health strategy that aims to establish it as Australia’s most integrated, efficient and effective digital health service by 2032.
It has a very busy schedule, including the restart of the statewide integrated electronic medical record (ieMR) program which will see the health service go live with the Oracle Cerner system at Redcliffe Hospital in the next few weeks, followed by Caboolture and then RBWH and The Prince Charles Hospital by 2026.
This follows the opening of its surgical treatment and rehabilitation service (STARS) using the full stack of the Cerner ieMR in 2021 at the height of the Covid pandemic, and the establishment of a virtual health service at the same time. Metro North now serves as the headquarters for Queensland’s statewide virtual emergency care telehealth service.
Now, after those massive projects, it is looking at how to use technologies such as Salesforce’s no-code, low-code platform to handle some of the lower hanging fruit that all health services are facing, particularly patient self service capabilities.
Metro North’s chief digital health officer, Jason Brown, who led the implementation of the ieMR at STARS and is also a burns surgeon and director of the Queensland Adult Burns Service, said Metro North was confronting the same challenges that all healthcare services are facing in delivering more for less.
“We are always being asked to deliver more outpatient care, more theatres, but with the same resources,” Dr Brown said. “The question is, how do we deliver care more efficiently with what we have? One of the main levers is obviously digital technology.”
The low hanging fruit that Dr Brown wants to initially confront with the proof of concept with Salesforce is in the self service and patient engagement area, particularly outpatients.
“In Metro North, we’ve got dozens of use cases potentially,” he said. “But the question is, how do we take a more agile approach to delivering bespoke, customised solutions without mortgaging the house?
“Solution A or B all do their things very well, but only do one thing. We’re working with Salesforce and other low code partners to look at that agile layer where we can deliver multiple solutions. Outpatients is a pressure point for us, like most other hospital and health services.
“Salesforce is one of the biggest players in the market and has lots of capabilities, so they’re obviously high up on our list of vendors to work with and to see if we can uplift our internal development skills.”
Integration and interoperability
Dr Brown said Metro North was lucky enough to have an apps development arm in its digital workforce as well as the resources to test out how well Salesforce and other products integrate with all of Queensland Health’s various legacy as well as new systems.
“You can have the prettiest patient portal with the fanciest AI built into it, but unless you can feed it with the outpatient appointment lists or get it past Queensland Health firewalls, it ain’t going to be useful to anyone,” he said.
“So we’re working with Salesforce on looking at what that proof of concept is and testing it out. One of the outcomes of working with companies like Salesforce and other low code platforms is whether it can integrate with things like Smart Referrals or the Enterprise Scheduling Module (ESM).
“But if it can’t work with things like HBCIS (Queensland’s legacy patient administration system) it’s not going to deliver the seamless patient and staff experiences needed to improve efficiency and outcomes.”
Dr Brown said Salesforce’s MuleSoft platform that allows organisations to integrate Salesforce with any cloud platform or enterprise systems is a powerful tool in its offerings.
However, the only way to deliver on the many different use cases and requests for solutions and applications that confronts his team is to use technology that is low code and cloud based.
“I think we’ve gone past the huge, enterprise level, on prem, very bespoke, complicated, difficult to customise, impossible to use systems,” he said. “I work in burns as a specialty, and that’s a very narrow sub-specialist area, and I have very specific requirements for our patients who get referred to me.
“If I can’t customise the solution to meet that demand while also meeting every other requirement in a large health organisation, then the solution is never going to represent value. It’s never going to meet everyone’s needs and when we have limited dollars to spend, the only way to do this is through a low-code platform that’s agile and customisable enough that we can customise it ourselves without paying a vendor large dollars for every change.”
Proof of concept
The proof of concept with Salesforce will initially be tried out in Dr Brown’s burns unit and will be used to build some elements of a digital front door, including a portal that will give patients the ability to get information on appointments and to exchange information if they have questions.
“At the moment the only way we can exchange information with patients is we phone them, usually with a blocked number, so they don’t answer the phone, or we text them and they can’t text us back.
“We need to have that ability to get that two-way communication, that sharing of information, whether it be related to their healthcare, related to their condition, related to their upcoming appointment, allow them to give us information back, for example, through a pre-admission clinic.
“All of these things are currently very manual and it currently involves a very highly trained clinician or an administrator to ring them and gather/share very basic information.”
“That’s where healthcare needs to be like in the banking sector or online retail. We’re just dragging the chain in that self service and engagement capability, having such capability available to patients can take away a lot of the labour overhead that currently exists in the system, because we don’t have these solutions that help engage patients and allow that two-way communication.
“So that’s the first one, that portal or front door. The second one is when they get here. How do you queue them? How do they check in? How do we make that seamless, so they aren’t sitting in a waiting room watching an Oprah episode from 10 years ago. How can they just go for a coffee and they’ll get alerted when they’ve been called for?
“We do have the Q-Flow solution, but how can you add value? Can you add to these solutions? Those are the elements of that we’re trying to achieve.”
Robotic process automation
Salesforce also has a robotic process automation capability that Metro North is looking at, “but they’re not the only players in town”, Dr Brown said.
“I think a lot of the focus over the next 12 months is to review/pilot the options out there to inform our future investment direction,” he said. “With the focus being on reducing manual processes and improving the patient experience.
“We are trying to get to the low hanging fruit and uplift our skill set internally. We’ll work out what is the best low-code platform for each specific problem. It could be Salesforce, it could be Microsoft, it could be ServiceNow, or one of the robotic process automation vendors out there. Our focus is to partner with Salesforce to achieve these goals.
“But we need to make sure it works and it’s fit for purpose. And then secondarily, we need to make sure it’s cost effective.”
Congratulations but I think we might have left out the paragraphs that explain how well it integrates with Primary Care. You know that section of the health system whose job it is to keep people well, to reduce hospital presentations and to reduce unplanned readmission after discharge…..and to keep healthcare affordable in the long term……