Experience wrangling Middle Eastern dictators wasn’t in the job ad for the head of Australia’s digital health agency, but the skills that saw Tim Kelsey outwit Colonel Gaddafi have no doubt stood him in good stead in his dealings with the disparate interests of the local healthcare sector.
Journalist, digital evangelist and health data innovator, the CEO responsible for the roll out of an online health record to every Australian by next year moved from the UK’s NHS to take on a job many thought of as a poisoned chalice.
Successive governments had spent years and over a billion dollars on what critics described as an expensive folly, but Kelsey’s background could be the key to delivering Australian healthcare’s most substantial digital infrastructure revolution.
“I wouldn't have predicted how my career would evolve but there is a common thread,” Kelsey tells Healthcare IT News Australia.
As a foreign correspondent in the Middle East covering the first Gulf War for The Independent, then an investigative reporter at The Sunday Times, the Cambridge-educated son of a British GP honed his skills as a communicator and transparency advocate.
“Certainly I remain very committed to the importance of citizens having access to information. That's a kind of conceptual thread that aligns some of the things I've subsequently done.”
Which is how Libyan despot Muammar Gaddafi can be said to have played a role in Kelsey’s pathway to custodian of the My Health Record. When Kelsey, the now head of the Australian Digital Health Agency, was presenting television documentaries for the BBC and UK’s Channel 4, he fronted a 1994 special investigation into the murder of police officer Yvonne Fletcher during a protest outside the Libyan embassy in London.
“I took her mother – a fantastic, delightful lady from Wiltshire, Queenie Fletcher – to Libya to confront and meet with Gaddafi and others in the Libyan government to try and get some answers as to who was responsible for her daughter's death.”
Describing the corrupt tyrant as a “very alarming individual to meet”, the bold endeavor led to Kelsey almost becoming entangled in some international political intrigue.
“He was extremely strange but very, very manipulative and very clever and his interest of course was to try and turn Queenie's presence in Libya into a propaganda coup. We absolutely stopped that happening.”
But it was a phone call from his mother in 1999 that prompted Kelsey to turn his investigative skills towards healthcare.
Working in southwest England, she had been referring patients with suspected breast cancer to a radiological consultant at the local hospital who didn’t appear to be following up.
“She rang me on one occasion at The Sunday Times and basically in floods of tears said that she was going to report this consultant to the regulator on suspicion of gross negligence.”
He says she took the “very brave, courageous step of becoming a whistleblower” and unmasked the specialist.
“So that's what she did and she exposed the fact this guy hadn't seen anybody for months, that he was an alcoholic. He had been sticking the mammograms from referring physicians quite literally down the back of his radiator, and the inquiry concluded that at least 11 women had had their lives foreshortened as a result of that and potentially as many as 50.”
These were life-changing revelations for this mother’s son.
“At this point, of course apart from the terrible tragedy for the women concerned, I was exposed for the first time to the plain and terrible truth that at that time the health service in England – and frankly in many other parts of the world – was flying pretty much completely blind on the degree to which it was actually doing a good job for its patients or not.”
Describing healthcare as the most dangerous industry mankind has developed, he says the idea the system didn’t know when it was harming people was a scandal.
Determined to create greater transparency, Kelsey left journalism and in 2000 set up Dr Foster. Named for a nursery rhyme, this early online business received support from a Labour government keen to move the focus from the volume of patient care to quality, and was prepared to allow a company to analyse and publish the results without restriction.
“So in 2001 Dr Foster published the first ever Good Hospital Guide which contained – for the first time, as it turned out, in the world – a risk-adjusted measure of mortality or death rates in hospitals which provided a fair comparison of the quality of care provided by those institutions,” Kelsey says.
“And what it revealed was a significant variation and that there were a large number of avoidable deaths taking place in hospitals for no other reason than just the geography of the hospital. So you were at more risk depending on where you lived than the severity of your illness, for example.”
That an independent organisation was driving transparency in public service and using digital technologies to share data was revolutionary. It also plunged Kelsey into liaising with clinicians who were resistant to change.
“There were, of course, at that time, people who were skeptical, more actually opposed to the idea of transparency of healthcare and also to the emergent digital technologies too. They weren't opposed for unthoughtful reasons, these were considered positions which were, I think, incredibly valid.”
Concerns about the digital disruption included that it could add to workloads and detract from patient care.
“I learned during the 10 years I was with Dr Foster of the vital importance of really listening very hard to ways in which technology can support improvements in clinical practice and benefits to patients rather than imposing IT solutions on clinicians,” he says.
“That's why in the end Dr Foster became quite a ubiquitous tool in the management of quality in hospitals. By the end we were running a very significant online analytics service for hospitals all over the world, and that’s still what Dr Foster does.”
Kelsey sold his shares in Dr Foster in 2012. The company was bought by Telstra Health in 2015 for what is believed to be up to $50 million.
His skills are now being dispensed in an Australian healthcare system undergoing rapid transformation. Heading out on the road, the digital health agency’s consultations included hundreds of meetings with about 3000 people, and the agency’s new CEO spent a lot of time – once again – listening. Hundreds of submissions were also received from organisations and individuals.
With that came relationships with the AMA, RACGP, Pharmacy Guild of Australia, public and private health providers, start-ups, patient advocates, and others in the industry, all of which were bought together on the journey by a sort of Pied Piper of digital healthcare.
For Kelsey, an electric and double bass player who most recently contributed to the band Betting on Trains (“funky party music with soulful horns”), the National Digital Health Strategy approved by COAG last month was the culmination.
“I'm actually feeling very positive at the moment about the degree to which all the people who can really make this change happen are around the table working with us, and the strategy is frankly an outstanding example of that.”
Now the ADHA will continue its roll out of a My Health Record that people can opt-out of. A draft interoperability implementation plan will be produced by the end of next year following further consultations with the community, and technical and other standards will be established for all public and private healthcare providers.
“Who is it that needs to share data, what are the rules going to be around what is a clinician, do we include the vast and vital workforce of carers in the information revolution in healthcare, for example? And obviously my view would be yes.”
He has also taken on the task of providing clinicians with secure messaging by 2022 as an alternative to the fax machines so oddly ubiquitous in the sector.
Within all of these technical innovations is the question of how cybersecurity can be assured? Kelsey says industry best practice and vigilance have ensured the My Health Record has never been breached.
“The system itself is specifically constructed so that it's not accessible as you'd expect from the internet, so things like [worldwide ransomware attack] WannaCry was never going to be an issue for My Health Record. We have a cybersecurity centre that is genuinely at the cutting edge of keeping the system safe internationally speaking.”
The only concern – ideally minimised by training – is user error.
“Sometimes a doctor might accidentally put the wrong bit of information in the wrong record and when that happens – and that’s nothing to do with My Health Record. That’s just a general issue of clinical record keeping in every health system. But when we see that we have a set of protocols, which is to immediately suspend the record and correct it.”
More than 5 million people currently have a My Health Record, with each able to control whether, say, their physiotherapist has access to the mental health treatment plan contributed by their GP. The privacy provisions also allow access to be tracked.
“You are able to see who has accessed your record and which organisations accessed your record in real time, and subscribe to SMS or email alerts that will tell you that as well. So you have complete transparency of every occasion on which your record is being viewed and that is a huge reassurance. People keep on telling me just how valuable they find that particular reassurance.”
The nation’s greatest champion of what he describes as “the world's first genuinely person controlled health record”, received a reassurance of his own when it comes to the lifesaving benefits of the platform when he was recently admitted to the emergency department of a Sydney hospital.
The attending specialist, it transpired, didn’t know about My Health Record or that he could have very rapid access to patient details.
“When I explained to him what it was, he just could not get over the fact. And he was very engaged with the way in which just having access to a view of somebody’s medications, for example, could massively transform the way he does his business, he provides care in the emergency department,” Kelsey says.
“I've been tasked by him with going back to make sure that he and all his colleagues are aware of how they can get access to My Health Record. It was actually quite an inspirational moment in the sense that by the time we get to opt out everybody, of course, will know about My Health Record.”