Dissecting Digital Health — with Clair Sullivan
Endocrinologist, health informatician and systems physician. Dr Clair Sullivan is an exceptional clinical informatician. She is a systems thinker and takes a holistic perspective to how she practices medicine — both as an endocrinologist and one of Australia’s most prominent clinical informaticians.
This is the full transcript of the podcast Dissecting Digital Health with Dr Louise Schaper, interview with Dr Clair Sullivan, Deputy Chair of Medicine, Medical Lead Digital Hospital Program, Endocrinologist at Princess Alexandra Hospital, Translational Research Institute, University of Queensland.
[01:07] Opening Remarks by host Dr Louise Schaper
[01:20] Today’s guest, Clair Sullivan introduces herself as an endocrinologist at Princess Alexandra Hospital in Brisbane — Australia’s first totally digital hospital. Louise asks Clair to share the process of going digital, but before delving into it, Clair expands on what led her to her career as an endocrinologist with an interest in digital health.
[03:04] Louise asks Clair how she prepared for her work with Queensland’s digital hospitals initiative and Clair expresses her belief in the need for clinicians to spearhead change. Clair talks about how team-oriented the transition to digital was, and stresses the need for collaboration between IT and clinicians.
[06:26] Louise and Clair discuss the advantages of the CHIA health informatics certification and having a hands-on background in health informatics field. Clair shares that her role involves a lot of communication and translation between IT and clinicians, and also to the public.
[07:39] Louise has Clair backtrack to the beginning of her interest in the medical field, and Clair talks about growing up on a farm working with baby animals, her love of the field of medicine, and particularly endocrinology, as a pursuit that combines both people and science. Louise brings up the concept of functional medicine, and Clair adds how endocrinology, OT and health informatics share parallels, through their systemic nature, requiring systems thinking.
[11:01] Louise turns the conversation towards asking Clair to reflect what career success looks like for her. Clair shares her big picture mentality about large scale change in care delivery efficiency and quality improvement. Clair believes solutions are there, but require reshaping the definition of good care.
[14:15] Louise asks Clair if she’s proud to be a data nerd, to which Clair expresses that she believes she is still learning. Clair shares that they have collaborated with the Australian Health Research Centre and made an impressive impact. She talks about this happening through moving away from an academic approach and towards an outcome-based approach.
[16:20] Louise raises the pressing need for reliable data in order for digital health to become sustainable. Clair shares her thoughts on bringing informatics into education as early as the undergraduate level.
[18:15] Louise and Clair talk about embedding informatics in healthcare curriculum and Louise shares that a majority of certified health informatics are clinically trained and know the challenge of looking for information first-hand.
Opening Remarks by host Dr Louise Schaper
[01:07] Louise: Welcome to Dissecting Digital Health. I’m your host, Louise Schaper, and I’m sitting here with a woman who is very impressive and you will be impressed — now she’s embarrassed! You will be impressed by her by the time we’ve finished our chat. Guest, who are you?
Today’s guest, Clair Sullivan introducers herself as an endocrinologist at Princess Alexandra Hospital in Brisbane — Australia’s first totally digital hospital. Louise asks Clair to share the process of going digital, but before delving into it, Clair expands on what led her to her career as an endocrinologist with an interest in digital health.
[01:20] Clair: My name is Clair Sullivan and I’m an endocrinologist at PA Hospital.
[01:27] Louise: Fantastic, and for those overseas listeners, PA Hospital is…?
[01:30] Clair: Princess Alexandra Hospital in Brisbane, Queensland. It’s a 1,000 bed hospital which has recently become Australia’s first tertiary digital hospital.
[01:39] Louise: Alright. So, was that an easy process?
[01:50] Clair: [Laughter] No, it was not, Louise. It was very hard, and it’s probably one of the hardest things that I have ever been a part of.
[01:49] Louise: Well, can you tell me a little bit about you first, and then we can go back to discussing PA. So, how did you get involved as an endocrinologist with a digital health interest?
[02:00] Clair: So, I feel really privileged to be an endocrinologist. It’s a fantastic job because I can look after some of those diseases that spread across the system. So, diseases such as diabetes and obesity really aren’t diseases you can treat in isolation in a room. You really have to think about the system, the number of people that have diabetes, the amount of money that we spend on it, how to give that vast number of patients equal access to care and monitor their outcomes.
So, working at that scale across a very large disease burden obviously opens itself up to digitisation, so I think it was a natural link looking after diabetes and digitisation.
I was very fortunate to be given the opportunity, or perhaps I just didn’t step back quickly enough [Laughter] to be one of the medical leads for the digitisation of Princess Alexandra Hospital. So, that’s really how I ended up doing it. I’m not quite sure that I would ever choose to do it, it was sort of something that was maybe thrust upon me, but we’ve certainly grabbed it and run with it and done a lot of work in trying to improve the care of our patients with digital health.
Louise asks Clair how she prepared for her work with Queensland’s digital hospitals initiative and Clair expresses her belief in the need for clinicians to spearhead change. Clair talks about how team-oriented the transition to digital was, and stresses the need for collaboration between IT and clinicians.
[03:04] Louise: Alright, short straw, long straw, people can choose their perspective. That’s the thing we find with health informatics, so many of us it’s not actually a life plan. We don’t think at 12 years old that that’s what I want to do, and the number of people in health care that actually have no idea that we even exist as an industry is amazing. I need to try and fix that, but anyway, to actually get involved, how did that come about? In terms of you were given this opportunity, but what sort of preparation…I mean is this something that just any doctor or any endocrinologist can say, “Oh yeah, I’ll have a go,”?
[03:43] Clair: I want to say yes so that somebody else can come and help me. But, I actually think leading digital change in a big hospital is something that needs to come from the clinicians within the hospital.
We need the support of the IT and we need the support of the industry, and we need very, very strong executive leadership and I’ve had a great role model with Dr Richard Ashby, but it actually has to be the clinicians in the hospital who decide to take on digital health,
and I think we’ve all seen failed implementations where the doctors and nurses, allied health and the whole health team have decided not to take it. So, we had to decide to take it.
I think it’s difficult to say, “Could anybody do it?” I think what you need is a really, really good team of people. In isolation I would have failed and fumbled about and had no clue.
The reason we worked was the team we had, and we had a whole army of fantastic IT people, excellent advice from our executive, and the doctors, nurses and allied health at Princess Alexandra Hospital worked together.
So it wasn’t just one person, “I’m going to digitise.” It was a massive team effort. I just feel privileged to be part of the team, really. I don’t think I did anything. It was a team.
[04:52] Louise: And when did this journey start for you?
[04:54] Clair: Gosh, about two years ago when Dr. Ashby told us we were going digital, and that some of us needed to start helping. I guess I started trying to understand informatics on my very basic sort of level [Laughter] back then. I really had no clue, I’m still not sure I do.
[05:14] Louise: Well you’re a certified health informatician now.
[05:16] Clair: Well, I know it’s been part of the journey. So, I guess you asked me what else you need to do, and I actually saw you speak about CHIA. I had never heard of it before, and I thought if I’m going to be doing this, I really should go and try to learn from the experts. After hearing you speak I went and looked it up and decided that was at least some way to get myself some street cred [Laughter] rather than making it up. I must say, I was surprised. I actually had learned some of the curriculum in my day-to-day work, but I learned a lot that I had no clue about. It’s really given me more confidence, I think, to actually have a CHIA, because it makes me more confident than just being self-taught.
[06:00] Louise: Well, I mean, that was one of the reasons we did that too, because so many people in health informatics did fall into it and have their own journeys to get there, but then the idea behind that is that there’s 52 competencies across 6 different domains.
[06:15] Clair: Yeah, it wasn’t easy.
Louise and Clair discuss the advantages of the CHIA health informatics certification and having a hands-on background in health informatics field. Clair shares that her role involves a lot of communication and translation between IT and clinicians, and also to the public.
[06:16] Louise: No, it’s not easy, unfortunately, but it’s a good equaliser I find, because you being an endocrinologist, I trained as an occupational therapist and in research, so some of that health content, you and I, some of that’s a refresher, got that one down. I don’t know about you, but I’m not a technical, IT person.
[06:36] Clair: Project management was my weak area. I’ve got no clue. I had to read about Prince2, which for me is a foreign language, but I learned it and it’s given me more language to deal with the project people now because I can speak a little bit more of their language.
[06:52] Louise: And do you find that is some of your role, or a big chunk of it where you’re an interpreter?
[06:57] Clair: I’m a translator, absolutely.
I do feel like a translator, translating from the clinicians to the IT and then translating from the IT to the clinicians, and then from all groups to executive and also to the public. So, it’s a multi-faceted communication issue.
[07:17] Louise: I like to say that…if I’m in a room full of geeks, I’ll say that health informaticians are the babel fish of healthcare.
[07:25] Clair: Yes, that’s exactly right. We speak both languages, and hopefully no one notices that we’re translating furiously in our minds.
[07:32] Clair: No, we make it look really easy and that’s part of it [Laughter]. That’s part of the CHIA training. [laughter] Thank you Louise.
Louise has Clair backtrack to the beginning of her interest in the medical field, and Clair talks about growing up on a farm working with baby animals, her love of the field of medicine, and particularly endocrinology, as a pursuit that combines both people and science. Louise brings up the concept of functional medicine, and Clair adds how endocrinology, OT and health informatics share parallels, through their systemic nature, requiring systems thinking.
[07:39] Louise: In terms of your interest in medicine, do you mind me asking, how did that start? Was it a childhood dream?
[07:52] Clair: Yeah, it was, actually. Yes. I always think…so my family has farms, so I’ve seen the little animals born at a very, very young age, and helping with that.
[08:04] Louise: In Queensland?
[08:05] Clair: Yeah, in Queensland. I got a feel for biology, I think, and then going to school and university, and I always liked people.
People and science together, and it’s also a really humbling profession. I feel really privileged to be able to help people in a time when they’re really vulnerable,
so it also fulfills that want to help people, at that time when they need help, so I feel really privileged to be able to do medicine and then sort of have that ability through digital health to translate it across a broader scale is awesome.
[08:42] Louise: The Exponential Medicine conference is on right now, do you know about that?
[08:50] Clair: I saw your Twitter feed, yeah.
[08:52] Louise: Yes, so I was Tweeting out about it. It’s a term that was new to me, but apparently it’s not new, called functional medicine, where the presenter, I think he was from Cleveland Clinic, was talking about seeing the whole person in a holistic manner.
[09:05] Clair: Absolutely.
[09:06] Louise: Which is actually, as an occupational therapist, is how we’re trained. So, it’s really quite unusual for us to get that medical model restricted to looking at a body part, but I thought this guy was really interesting, he was a proponent of the need to reshape medicine just in terms of its classification. So,
instead of specialising in the pancreas or the brain that we should actually be specialists in the system, so it’s the nervous system or endocrinology.
I think that really made sense for me. I’m sure that’s quite controversial.
[09:43] Clair: I don’t think so. Certainly endocrinology that systems thinking is something I have to deploy every time I see a patient because unlike orthopaedics where you just fix the bone, when you’re looking at fixing someone’s blood sugar or their weight, you have to look at the systems. You have to look at their biology and how their body works. You also have to look at their psychology, so how they’re thinking, and if they’re able to change their diet and their social circumstances, so if they have restricted social circumstances, they might not really be able to afford to go to the gym or to buy fresh food. So, it’s a system, and that systems thinking that you develop in
a job like an endocrinologist or an OT is the same sort of systems thinking as when you’re looking at digital health, because it’s not just fixing your computer, it’s the person on the computer, it’s the way that person’s thinking, it’s their behaviors, it’s psychology, it’s social determinants.
So, I think there’s really strong parallels between clinical training and systems such as OT or endocrinology, and the systems thinking required to succeed in digital transformation. So, I think there’s really close parallels between the two.
[10:44] Louise: Yeah, absolutely. So there you go, they picked well when they picked you.
[10:49] Clair: [Laughter] Oh, I don’t know.
Louise turns the conversation towards asking Clair to reflect what career success looks like for her. Clair shares her big picture mentality about large scale change in care delivery efficiency and quality improvement. Clair believes solutions are there, but require reshaping the definition of good care.
[10:50] Louise: So, in terms of your professional goals, looking back at your career at some stage in the future, what does success look like for you?
Success for me would be to make things better for patients on a large scale.
So, not just within my consulting room, I do that every Wednesday, but to do it on a large scale because I think that model of really sharp, focused bespoke care is unsustainable, and I think we need to look at a way of translating that really nice care across the system on a large scale. So,
I would love to think that by translating and digitising that care, we’ve been able to standardise care for many diseases across the state,
reduced unwanted variation, cut out waste, and improve the quality and efficiency of care that we deliver. So, I think if we can do that, that to me is success.
[11:57] Louise: But don’t you think that’s completely doable?
[11:59] Clair: It is, and we’re nearly there. We are about to deploy a whole lot of power plans… so, for example, for someone coming in a diabetic coma, we can digitally deploy nursing instructions, we can order IV fluids, we can order IV insulin, we can order the blood tests digitally, and we can order an x-ray every day for the stay of the patient. So,
we can actually package up that care, which does a number of things. It improves reliability, so it means the resident doesn’t have to think every day, it reduces variation, so it makes the right thing to do the easy thing to do,
and it gives us reporting capability and looking at variations, so we can then look at how those power plans are being used, is someone varying off that power plan? If so, are they actually doing better? You know, maybe the variation is a good variation, in which case we should change the plan. I can see that we could just continuously iterate and perfect our standard of care so everybody across the state is getting good care and you can then be free in your own mind to think, “Why is this patient different? Why shouldn’t they attend to this plan? Is there something about this patient that means I need to change it?”
It’ll just change the way we work and change the way we think, and it’s really exciting to have visibility of that care as well, and I think that’s what we sometimes forget, is the ability to look at how our patients are doing. Instead of just delivering care, we need to better understand is it the right care? Is it the most efficient care?
I think that’s the exciting thing about what we’re about to do. It’s not just delivering the care, but monitoring those outcomes.
[13:36] Louise: So when do you see this happening?
[13:39] Clair: We’re looking to start with medications in March. The power plan should be coming in in March. So, it’s not far away, and it’s just building that capability of reporting and I’m not sure how much time that’s going to take us. Then, of course, there’s also all of the change management and transformation, so that’s quite challenging for some people to think about. So, we have to do that piece as well. But, I’m pretty confident. Queensland is a good place to innovate, and
our hospital is not the sort of place that would be resistant to change. It’s the sort of place that will embrace it,
I think they’re ready to do it.
Being a proud data nerd and adopting an academically rigorous approach to drive changes to practice is a driving force for Clair.
[14:15] Louise: That’s fantastic. And I should mention as well, if anyone can hear any background music, Clair and I are at a restaurant in a hotel. We tried to find somewhere quiet to chat, but where we are actually is at the Health Data Analytics conference in Brisbane, and you’re a speaker as well. So, what about your passion for data? Are you a proud data nerd?
[14:39] Clair: Oh, I’m a very proud data nerd. I’m not sure I’m smart enough to qualify as a nerd, — is there like a ‘data pre-nerd’ or something, I don’t know. Like a try-hard nerd…maybe a try-hard nerd [laughter]. But yes, I do love data, and so I’ve been privileged to be involved in some big data analyses already, not using data from a digital hospital but from some other sources. I’ve had a little bit of experience in data linkage and big data analyses. One of the other drivers for digital transformation is getting a taste for that as well. So, we’ve got some experience now and in collaboration with the Australian eHealth Research Centre, we’ve crunched 20 million episodes of emergency care.
[15:19] Louise: Wow, 20 million episodes!
[15:20] Clair: Yeah.
[15:21] Louise: And what timespan were those 20 million episodes?
[15:22] Clair: That was over four years, 59 hospitals, so that was published in MJA in May. So, it gave us a taste and allowed us to develop some expertise, some runs on the board.
That ability to look at data and to crunch it not for the purposes of a research paper, not for our own glory or anything, but to improve patient outcomes, and I think that’s what I’m passionate about, is sort of moving it away from that academic realm and into actually translating it into care in the hospital.
[15:47] Louise: So, it’s got the academic rigor behind it?
[15:49] Clair: Absolutely, because you need that. You need that, otherwise it’s not right. So we have to have that academic rigor and we have to publish it, but then it can’t stop there. And then we need to actually, before we do the analysis, have that translational machinery in place. So, we’re going to use this data to do something valuable for patients. So, it’s a slightly different, new way of thinking, but I think that’s the way those analyses will gather momentum and gather funding, because everyone can see it actually being used to improve the care that we give, the outcomes and the efficiency.
Louise raises the pressing need for reliable data in order for digital health to become sustainable. Clair shares her thoughts on bringing informatics into education as early as the undergraduate level.
[16:20] Louise: Back to what you were saying is your life goal around improving the sustainability of the healthcare system while improving patient outcomes.
[16:23] Clair: Yes, which is what I’m going to talk about at the conference, how we change our thinking from pure academic research, which is obviously incredible, but to apply academic rigor to be directed back towards improving care without the 17-year lag (it has been proven it can take for research outcomes to change clinical practice).
[16:44] Louise: Okay, well, one other challenge. For digital health and all this data stuff to improve patient outcomes and healthcare sustainability, we need not just the data,
We need highly reliable data. But when we train clinicians, either on the job or in undergraduate training, we learn how to take notes but no one actually instructs us about the importance of the integrity of the notes, whether they’re on paper or in electronic form. It’s a huge barrier to healthcare improvement.
Have you got some words of wisdom for how to do that?
[17:34] Clair: I think someone like you needs to be with us, because I think that health informatics needs to be taught at an undergraduate level. I had no clue about any of this until I got to this ‘elderly age’ and did my CHIA. Wouldn’t it be great if we were all taught about this in our formative years? So then it’s not actually a new concept once you start working, it’s just part of your training and inculcation into your clinical life, whether it’s allied health, etcetera — it’s part of the toolbox.
Knowing how to treat diabetes is important, knowing how to deal with stress is important, and also knowing how to manage information and technology is really important.
So, it’s unclear to me why we still don’t have that, and I guess there’s just not enough of us around to teach it yet.
Louise and Clair talk about embedding informatics in healthcare curriculum and Louise shares that a majority of certified health informatics are clinically trained and know the challenge of looking for information first-hand.
[18:15] Louise: Yeah, and it’s also I guess really quite competitive to get content into curriculum. But what I’ve always found and even when I taught OT (occupational therapy) all those years ago, I would do what I could to embed and integrate these concepts in my teaching and in the assignments.
[18:42] Clair: Yeah, that’s right.
[18:43] Louise: Like, how do we capture and use information properly and what are the important skills to know?
[18:48] Clair: And I think that as we develop a data analytics facility, the clinicians will see the import of good data, because they’re going to want to use that data to improve their care, so that light-bulb moment will happen.
[18:58] Louise: Yes, and to save money so they can get their pet project funded.
[19:01] Clair: You’re right. It will be a light-bulb moment where we realise “Oh, unless we don’t put this data in, the data we get out is not going to be reliable to improve patient care.” Now, we’re not going to start that dialogue until we’ve got the data analytics facility up and running and that’s not quite yet. But, once that happens, and they can see that the data coming out is directly feeding back into the care, I think there will be a light bulb moment, and so I am excited to think of it. I know how our clinicians will do it, because they’re dedicated to improving the work that they do.
[19:32] Louise: Absolutely, no one becomes a clinician for paperwork or for fame and fortune. It’s because of the same reasons you do, and I find that the amount of people that do health informatics and are clinically trained, the majority of them are actually clinicians. The majority of people who are doing the CHIA exam are clinically trained and they all have the same story. They’re sick to death of spending 30% of their shift running around looking for information, and knowing that the information they have probably has holes in it, it’s not accurate.
[20:12] Clair: Yeah. So, we can do better.
[20:15] Louise: We can do better.
[20:16] Clair: So, I think there’s layers.
There’s teaching it, but then also modelling it, so when you see your bosses doing it properly, and then the third layer, I think, is the value.
Why am I bothering to do this? The value that’s going to come out of it later. So, it’s systems thinking again, which is new for some clinicians perhaps where they’re thinking ‘ by putting in the data now, I’m taking an extra five seconds out of my day to improve the system. So, it’s kind of getting that systems thinking trickling through.
[20:40] Louise: Yeah, I agree. Well, thank you so much for chatting with me!
[20:43] Clair: That’s alright.
[20:44] Louise: It’s been a really nice time and enjoy the rest of the Health Analytics Conference.
[20:47] Clair: Thank you. Thank you for inspiring me to do CHIA!
[20:50] Louise: Oh, no problem! [Laughter] And I’m sure now everyone listening at home is now logging onto www.CHIA.org.au
[21:00] Clair: Do it! You should.
[21:02] Louise: [Laughter] Thanks again for your time, Clair. It’s been a pleasure. I’ll talk to you in 12 months’ time and you’ll have more news to share. Thanks.