A Message from the CEO

Leading Digital Health

Mark Nevin, CEO

With continued advancements in clinical care, data storage, sharing and interoperability there remain major challenges. I’ve previously lauded how advanced and sophisticated our two specialties are relative to most industries. Notwithstanding this, timely sharing of information across clinical boundaries remains haphazard and frustrating for most specialists, referrers and others involved in multi-disciplinary care.

As this is my last Inside News article as CEO, I hope you will indulge me in focusing on a particular passion. Digital health has been an area of interest of mine since the early years of my career in eye care, helping to design and pilot electronic healthcare records for use in domiciliary optometry.

My passion for the area grew while working in policy and strategy in the UK and in Brussels, particularly once I comprehended the value of the data itself and stewardship of the information flow. This has continued in my time at the College and last year, my policy and standards work in this area was recognised with a Fellowship from the Australasian Institute of Digital Health.

Both clinical radiology and radiation oncology went digital some decades ago. The radiology sector developed the Digital Imaging and Communications in Medicine (DICOM) standard. The College was instrumental in bringing it to our two countries via Integrating the Health Enterprise (IHE), and we integrated DICOM to our practice standards and training curriculum. DICOM has expanded considerably since then to include domains for other clinical fields including radiation oncology.

“The College’s policy work in digital health commenced about a decade ago. Our first major policy publication was a joint “roadmap” paper with the Australian Diagnostic Imaging Association (ADIA) and Medical Software Industry Alliance.”

The paper, titled Securing Quality Outcomes: Systemised Access to Diagnostic Images articulated the logistical problems for radiologists and referrers in accessing prior images, and associated challenges for clinical decision-making. It proposed a national solution to resolve these. Regrettably, at the time, this was not seen as a priority for governments and no funding was made available.

The following years saw enduring competing priorities: the Australian government focused on My Health Record; while the radiology sector sought to advance electronic referral and information sharing relating to diagnostic images. The College advocated strongly for our digital health priorities for radiology via the Medicare Benefits Schedule Review and the government’s work to develop interoperable digital health.

The College regularly pointed out the lack of a critical foundational piece: standardised terminology, where we notably lagged the pathology sector.

In order to corral alignment between key decision-makers in government, notably the Department of Health and Australian Digital Health Agency, and the radiology sector, the College produced a white paper in 2020 outlining the College’s vision for a fully electronic flow of medical communications between referrers and radiologists, including eReferral, imaging guidelines and access to historic images.

This would also involve integration with My Health Record, and in time facilitate the adoption of artificial intelligence. The white paper made abundantly clear that this would not progress without standardised terminology for radiology tests and procedures.

I was delighted eventually to land grant funding in March 2021 for the radiology sector to develop a recommendation for standardised terminology. The downside was a horrendously short timeline of three months to complete the work. Some amazing teamwork between clinical leads, College staff, ADIA and other stakeholders made it happen and a recommendation was delivered to the government on time!

While the Australian environment is ahead in this respect, there are principles and learnings which will benefit interoperability with radiology in New Zealand, and radiation oncology in both countries, not least in accessing historic images.

The College’s submissions to the Health and Disability Review had a major focus on data, information technology and artificial intelligence. I anticipate that the changes to amalgamate district health boards in New Zealand will bring opportunities for national digital health infrastructure. Conversations on this have commenced within FCR’s Digital Health Working Group. A key next step will be advocating for radiology and radiation oncology to be central to that.

The College is uniquely well placed to lead the next phase of digital health in both countries. As a medical college, we have a broad remit including oversight of professional skills, practice standards, a focus on quality care, and have established ourselves to lead policy and advocacy. We have therefore the mix of ideas, credibility and a strong track record of delivering.

This is sadly my last CEO piece for Inside News. It has been a pleasure to have worked with members and our valued staff on so many initiatives that have bettered the lives of New Zealanders and Australians. I hope to stay in health care and to see you around the traps. In the meantime, take care and stay safe.