Delia Scales

Hi, I'm Delia, an ex-nurse and founder of the Wikihospitals blog. I'd like to tell you why I believe Australians needs information about the best quality and most affordable hospitals, clinics and nursing homes. 

Australian healthcare has been rapidly privatised. 30% of hospital beds are now private. The majority of all cancer treatments are now private. Out of pocket medical costs are now second only to Switzerland and the United States. 18.2% of the health budget now comes from out of pocket costs. Patients feedback has not been saught about theses changes.

Many patients go into private treatment with no idea how much their overall bills will be. Bills can be fragmented. One surgical procedure alone can triggering up to six different bills. Every major media outlet in the country has printed stories of patients ending up with thousands of dollars in unexpected out of pocket costs. Greens senator Richard di Natal successfully lobbied for a senate enquiry into out of pocket costs, the results of which has now been published. 

The political mantra is that 'privatisation improves quality' by allowing the market to drive improvements. But that only happens if there is transparency, and the 'customers' can freely choose. Clinical standards in healthcare are as hidden from patients, as prices are. Information about doctors under review for drug problems is difficult to access. Information about nursing homes that trigger repeat complaints is difficult for relatives to find.  Australian patients are going into the health system blind to both cost and quality. Some are coming out broke, and damaged from substandard care.

Few people realise that there are extensive lists of good and bad hospitals and good and bad doctors, compiled by private insurance companies and the health bureaucracy. These lists have kept out of public view under 'privacy' and 'commercial in confidence' laws. This secrecy blocks any drivers for reform. It also blocked patients from making informed choices.

The Wikihospitals app project aims to assess all healthcare providers in Australia. The actual quality of services provided to patients, including whole of treatment care, multi disciplinary teams, coordination and discharge planning will be looked at. The out of pocket costs that patients are likely be left with, will be assessed. Based on this information, suggestions will then be made to the app users, on healthcare providers in their area than may offer a better service. Information will also be given on the latest apps, smart devices and cloud-based software, that can help patients best manage their disease. Health care providers who offer excellent quality services will be be invited to advertise their services. App users will have a chance to give feedback about their experiences. Best Practice Clinical Guidelines will be set out in clear, easy to understand format, so patients can gain an understanding of the way their treatments should progress.

Wikihospitals app is an ambitious project. But unless something serious is done, medical treatment may become the largest source of personal bankruptcy, as it is in the United States. Not all health professionals support secrecy of health errors and out of pocket costs. Many are campaigning to lift the veil of secrecy, and help bring healthcare into the twenty first century. 

I have already tried out overseas contracted developers and found them to be useless. No one is responsible for the work; nothing is coordinated. Web technology is broken down into different computer languages. Different people normally specialise in different aspects of web design. If you don't have a coordinated team of developers, you don't have a functional product. With computer work, what you get is what you pay for (unlike healthcare).

I discussed my project with a wide range of developers. It all came down to a custom build relational database, run through a desktop web browser or mobile app. Expensive, complex, unusual.

I did pitches at the Sydney startup group. 'Great idea' they all said. 'But how would it work?'.

I decided that I needed to have the project professionally assessed, to see if it was viable, from a business, technology and customer point of view. Here are some sobering stats on startups and apps:

Only 4% of Australian startups go on to become successful businesses.
95% of apps on the apple and android stores are abandoned within a month.
Less than 5% of users are still using free apps a month after downloading them.
Although most apps are free, companies spend $20,000 to $150,000 developing them. 

Sobering, but essential information.

I looked for an Australian company that is coordinated, professional, able and willing to take on an unusual and challenging project. I came up with Appster. They run a two day Rapid Concept Workshop, before they even commence design and development. The workshop brings together developers, a coordinator, a marketer and a business analyst. The whole project is assessed to see if it is viable. This workshop costs $7,000.

I believe this is the most professional and responsible way to go about developing the Wikihospitals app. I'm not going to ask people to support a project that will fail in a couple of months, and waste every one's time and hard earned money. Have a look at this video of the producer of BlueDot, discussing his opinion of Appster and their help building his innovative location-based mobile business system. For more information check out their uTube channel. I'm very impressed.

This is an unusual and unique project. There are major obstacles. 

Information on out of pocket costs, and variations in the actual quality of different health providers, is obscured from public view.
Information on Best Practice Clinical Guidelines is very difficult for patients to find, is written in academic language and often available only in commercial databases.
The health workforces comprises of extremely powerful and well connected unions and professional associations
Health and social assistance is the largest workforce in Australia.
A large proportion of political lobbyists are from the health industry.
Funding for health care is fragmented across state, federal, not for profit and commercial boundaries. There is no coordination of data to assess cost and quality that could be used to drive reform.
Health funding is based on a episodic 'fee for service' basis, despite suggestions that 'whole of treatment' funding could bring better quality and lower costs.
Health funding is not tied to quality of services or patients satisfaction ratings, removing any incentives to improve.
There appears to be no political will for health care reform among the two major parties. 

This list is long! Nobody has been able to make the health system accountable to consumers. But it WILL eventually happen. The health IT space is booming in America. Silicone Vally is continuously looking at this ineffective, overpriced and error prone industry, and seeking ways to challenge old fashion power structures. Look at Pokitdok, USA best hospitals list, 23 and me.
Australian doctors have set up a range of innovative projects to share information.

And think of the prize that awaits the person who invents the uber or airbnb for health care.