Elizabeth Koff is today Managing Director of Telstra Health, but she has spent a career focused on solving public health challenges at scale. The self-defined ‘health tragic’, shares her passion on driving system level change and why she feels the digital health sector is reaching a tipping point.
You’ve focused on public health challenges at scale throughout your career. What has driven that passion?
I’m what many would describe as a health tragic, because I believe in work that has purpose.
My first taste of population health was as a freshly minted dietitian, working on a project with Westmead Hospital Community Medicine. That opened my eyes to the impact population health can have at scale.
You can make a difference one-on-one with individuals, but you can have greater impact by improving outcomes for whole populations. Running the NSW health system, for example, was a large enterprise, and the potential to drive significant health outcomes was extraordinary. Now, at Telstra Health, initiatives such as bowel, cervical and lung cancer screening can similarly make a tangible difference.
What are the biggest challenges, and opportunities, in digital health?
Health is complex. There are many providers, payers and interactions, so creating a system that can share information, data and intelligence around the patient is challenging – but it is also what will transform the system.
The technology capability is largely there. COVID showed that rapid pivots to virtual healthcare, electronic prescribing and home monitoring were possible.
A lack of standards and consistency has been a major impediment. The introduction of FHIR standards and a move towards sharing by default will help providers develop interoperable software and improve information sharing across care settings.
The challenge is the appetite across the system to invest in digitisation at the level needed to transform care.
What opportunities do you see AI delivering for digital health?
Digital health is reaching a tipping point. COVID gave the system a nudge, and AI is now taking it to another level, by enhancing workflows and processes.
The care economy has major productivity and workforce challenges. If digital and AI solutions can reduce unproductive time, that will be an extraordinary benefit to the system and to care delivery.
AI is inextricably linked with how we digitise healthcare, and this will raise important questions around AI-delivered care. Trust will be central. In healthcare, you cannot take a “go fast and break things” approach, because mistakes can have catastrophic consequences for patients.
What is the value of working through the Digital Health CRC?
Telstra Health worked with the Digital Health CRC and RMIT on a deteriorating patient index for aged care. The AI-enabled initiative identifies residents whose condition may be worsening, then connects aged-care records with hospital emergency departments to support faster clinical assessment and intervention. The aim is to help facilities manage residents in place where appropriate, while improving the handover of information if hospital care is needed.
This tripartite model – industry, academia and health – is invaluable and the Digital Health CRC is a real catalyst and matchmaker.
Technology companies may think they know what the health system needs, but sometimes they do not. Academic partners bring independent validation, while health services can articulate what they need and value.
Too often, people develop a product and then ask health services what problem it can solve. The better approach is to identify a friction point in the health system first, then build a solution around it.
How does Australia’s digital health ecosystem compare on a global scale?
Health systems around the world are grappling with similar issues: connecting care, understanding patient journeys across settings and sharing intelligence about patients.
Patients being in control of their health information is critical. There is also clear opportunity for companies that respond to genuine system needs. Ambient listening documentation tools, for example, have attracted strong interest because they address the administrative burden on clinicians and can free up more time for direct patient care.
Australia faces challenges around scale, risk appetite and investment. Large systems may need solutions that can operate across hundreds of hospitals, which can be difficult for smaller startups to provide. Health services also operate with finite budgets, where immediate clinical equipment needs can take precedence over digital, even where those investments could save time and money in the longer term.
Finally, what advice would you give people driving digital health innovation in Australia?
First, understand what the health system needs. Many people have a good technology idea that they think will change the world, but if the system does not need it, there is no point. Find the friction points in healthcare delivery and focus on those.
Second, perseverance is essential. Healthcare is complex: there are many providers, funders, payers and market participants. It can be difficult for technology providers to get a foot in the door of large hospital systems.
Finally, it is important to remember that most care occurs outside hospitals. Digital health should support connectivity across the whole ecosystem.
