Talking HealthTech: 342 – Supporting vulnerable communities through technology; Nicole Nixon – Five Faces, Christina Igasto – Western Sydney LHD, and Richard Taggart – Sydney LHD

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When delivering healthcare, clinicians are dealing with people when they are probably not at their best. They are sick, injured and vulnerable. In healthcare, we talk about the importance of caring for vulnerable people, but what does that mean? How do we do that with purpose, and how can technology play a role in improving the care and engagement with vulnerable communities?

In this episode, Pete is joined by Richard Taggart, who at the time of the recording was CIO at Sydney Local Health District, as well as Christina Igasto, Chief Digital Health Officer and CIO at Western Sydney Local Health District, and Nicole Nixon, CEO of Five Faces. Pete, Richard, Nicole and Christina have an in-depth chat about who is actually a vulnerable person and how to go about identifying and supporting their needs. 

Who is a Vulnerable Person?

Though anyone entering a hospital can be described as vulnerable, vulnerable people include groups like the elderly population, which is typically affected by chronic diseases and disabilities. Also, just being an elderly person, there are certain needs that arise regarding the use of healthcare facilities, hospitals and services. Other people who can be defined as vulnerable include those:

• facing financial distress

• with low health literacy

• with mental health issues

• experiencing domestic violence

• affected by intellectual or physical disabilities

Those from the Aboriginal and Torres Strait Islander communities may also fall within the vulnerable category.

In addition, there needs to be a humanistic approach to responsiveness for every person that is vulnerable to support those with different needs. Therefore, listing the individual needs that they would potentially have will be quite challenging.

The Complexities of Vulnerability

Sometimes, even though one may fall within the vulnerable category, they may not want to be identified as such and refuse any special treatment. This is another added complexity that must be considered when designing health services. 

Vulnerability is completely contextual, and any single person from any background can be vulnerable depending on the context that they found themselves in. There is such a variety in the types of people that are seen in healthcare, both on the receiving and providing ends, and at any one particular moment, they or a family member could be very vulnerable. 

Being vulnerable could be for any number of reasons, such as ethnicity, sexuality, age, or a lack of knowledge of the system or language. A lot of times, people might not even realise that they are vulnerable, but sometimes things happen, and they find themselves in that position very unexpectedly and then need that support and advice. 

For example, relocating from a remote area to a city or from one country to another or having a disability might cause the complexity of the situation to increase. 

Designing Health Systems with Vulnerable in Mind

An important factor to consider when designing new things or refining the already existing services is to ensure that they are built for everybody rather than one specific population. The other thing that must be considered is kindness. In those vulnerable moments, that extra little bit of warmth in the language that you use and that extra little care and attention that you put in can make a huge difference. People can sense kindness in the way you’ve gone about building something. 

Also, validating and checking assumptions is one other thing developers need to do. You might design something in a beautiful setting, but when it gets used in the real world, you need to go back and check to determine if those vulnerable people are able to get the benefits intended for them. For this reason, it is important to co-design with the intended target market. 

Furthermore, these designs need to be simplistic and user-friendly. Another factor that is sometimes forgotten, especially if you’re a driven change agent, is that sustainability is also crucial. You might need to let the design sit for a while and not change that too quickly because that will cause vulnerability to someone that has trouble trusting, learning or adapting. When a product is being designed, one should always consider the needs of the different cohorts of people and different groups of people. For example, someone who needs to change an appointment might have a hearing impairment, or they might be choosing between taking income from a job or attending a health appointment. Therefore, how do you give them an easy way to reschedule their appointment?

There are so many different factors, but displaying empathy and understanding and keeping the language simple are key.

How can Technology Help the Vulnerable in WSLHD?

There are many variables that must be factored in when a solution is to be deployed in the WSLHD since the social determinants are quite broad. There are cultural differences, income issues, poverty, multilingual requirements and the whole Aboriginal Torres Strait Island community. 

The approach that the WSLHD has taken is to work very closely with its customer engagement manager and engagement team to tailor the district’s strategy depending on what community it is working with. But sometimes, even within the Aboriginal community, they might need to have a different tailored approach, and that all comes back to technology support. They must factor in the issue of connectivity, what if community members are transient? Plus, can you even have a digital solution in those places?

The WSLHD puts a lot of effort into understanding their communities and then translating those needs, issues and limitations into simple, co-designed, deployable solutions. In addition, the WSLHD is using the Sydney Health literary hub editor to assess the information that the district has on the websites and the documents to determine if they are readable for a general community. Then the next step is to create a digital solution app as we all are providing feedback, but also from a vulnerable context, and it is currently being worked on. 

How can Technology Help the Vulnerable in SLHD?

SLHD sees the same diversity that WSLHD does. Many people don’t speak English as their first language, and SLHD has the highest entity of social housing in the country, just in the little region around some of its major services. In essence, there is a lot of variety and a lot of people that will come with different types of vulnerable needs to consider. Consequently, when dealing with digital solutions, the health district tries to balance those standardised services with a hyper-local approach. 

SLHD has five million occasions of service where people go either for a face-to-face appointment or an online appointment in one of the district’s non-admitted services. Usually, a text message is sent to remind patients of their appointment. However, that text message is in English, despite the fact that more than fifty per cent of the SLHD population speak a language other than English at home.

As such, something that SLHD has done very recently in the last couple of weeks is to change that setting so that they can have it in simple Chinese, and it is being rolled out in other languages, and they can also seek help to book an interpreter in their native language.

Cybersecurity for the Vulnerable Community 

Protecting patient data is always the priority, particularly for the vulnerable community and with the recent flare-up in cybersecurity issues, the safety of patient data has intensified. Therefore, things are no longer being sent via email; instead, the use of digital forms is encouraged. 

Using digital forms, communicating with people in a web-based environment and always keeping security at the top of mind is very important. Five Faces works with the local health districts when designing to ensure that they are taking every possible consideration in that design process.

Is Simpler Less Secure?

Developers like Five Faces are getting better at making solutions more consumer-centric for both staff and patients. They are trying to reduce the burden on the people and the people doing the administration and everything as well. So, on the one hand, it’s quite the opposite; simpler means more secure and less difficult. These solutions automate workflows and make processes more streamlined. 

On the other hand, the reality is that health systems are incredibly messy, complex places. There are a lot of paper processes, a lot of things that are being collected just because. There is a need to change the way information is collected, shared and used. The current cybersecurity issues in Australia have highlighted the fact that large service providers keeping information unnecessarily because of an arbitrary process or a regulation that really doesn’t make sense in 2023 need to start asking themselves why they are collecting this data. 

It’s a clinical governance issue in a number of respects for digital health people because health is only truly provided when the clinician and the patient have a trusting relationship. If patients are not confident in sharing the information, then how can they have that trust? Similarly, if the system goes down, then clinicians can’t provide that care because everything is electronic, and this can cause patient harm.

Accordingly, the other area of cybersecurity to consider is the need to have deep technology specialists who understand design but also understand the health context. Many more of them are needed to help at the design, maintenance and also decommissioning stage of all of these digital systems being deployed.

The information and technical security are both vital and pertinent questions like, “is it safe? Why is it captured? How do we get information security and accountability?” must be asked. As it relates to technical security, there needs to be collaboration to mitigate and solve these issues. 

Moreover, there are still so many antiquated paper systems, such as fax machines and mailing information through the post office. It will be interesting over the next few years how these are modernised and see how the industry progresses in the way we handle information.

Examples of Tech that can Help Vulnerable Communities 

There is so much that can be done, like creating apps for:

Another way technology can help is by installing light strings in the floor showing the way to the toilet and heat cameras in the toilet for fall risk. More advanced solutions could look at visual and auditory impairment, such as using AI to recognise colours, persons etc. 

One of the good things coming out of the pandemic is that consumers are using their smartphones a lot more. Even people who maybe didn’t have a smartphone before now are very familiar with opening up the camera and using a QR code, among other things. So, now there is this baseline foundational level of digital literacy in the community that can be leveraged to engage them in their health. 

The SLHD has also made some behind-the-scenes improvements to improve communication and identify vulnerable children. Additionally, the health district has been working with the aged care sector to enable all of those important workers and more easily connect them to a clinician reducing the need to take them to a healthcare facility using simple things like a video conferencing call or a text message.

Building Sustainable Solutions

It is essential to have a solution that is flexible and agile in the workflows. It should be something that can quickly be modified. Ideally, it should be designed so that the user doesn’t always have to go back to the vendors when changes are needed. Developers should always think about the next step because technology is ever-changing, and in the next five years, technology will have changed dramatically. 

A sustainable solution must be customisable, able to integrate with other systems and demonstrate a return on investment. 

Justifying the Spend

There is a large number of vulnerable people in the healthcare setting. Inevitably, it becomes a matter of prioritising lined up with the quality, benefits and safety, which is another part that might not be aligned to the tangible cost but has other benefits in the safety quality perspective, which is important in the healthcare setting. 

It’s also good to think about the other uses for a particular solution during the procurement process. Another thing to consider is how to use an already interoperable system to build apps on an already existing platform. There is a lot of inertia in the health system and a lot of tech that has not been adopted because either we haven’t got the scale or the momentum or we haven’t built a culture that is required for us to adopt it.

There needs to be less focus on the return on investment to try something because just trying something gives us a return in that we’ve learnt something, shared something etc. Then there are those that can get tied back to the core platform strategy or invested in to make it more sustainable and that’s when the return on investment should come into play. 

Collaborating to Serve Vulnerable Communities 

Five Faces keeps patients and consumers at the centre of digital solutions. They share how each district, hospital and clinic has a different need, workflow, or group of people they’re serving.

As the vendor, Five Faces can share these learnings among other hospitals and other health districts to generate real benefits. 

Health districts or facilities looking to implement technology to service the vulnerable should really tailor the solution and think about the vulnerable community that is going to use the solutions and co-design with them. Also, there needs to be more use of multidisciplinary teams around the tech. Vendors and healthcare providers need to be responsive and humble and help the vulnerable community to, in turn, help them lead the way. 

Creativity is really good for the health business to foster a culture of solving problems and sharing ideas. If the sector can get to the point where designers and clinicians and clinician designers can work together to solve problems for patients and their families, act with kindness and then continue to validate what they are doing in a creative way, then they will create a momentum and an innovation for change.

We are all here to serve the patient. So if we can continue to keep that top of mind, and if that means sharing experiences etc., that is what we need to be focused on.

Questions from the THT+ Community 

At the end of discussion, the panel answered questions that were raised by the Talking HealthTech THT+ Community:

1. What are examples of emerging technologies you’re seeing or would like to see more of to support vulnerable communities?

“Bots will definitely grow, and I think it’s already happening in our health space as well.”

2. How does service design play a key role when putting together solutions?

“We design in a four tier explanation. We look at the experience, we design the digital tool, put that into the hands of the user and then we look at the experience. But when it actually goes to service design is when we put that into context on how everything operates from corporate to clinical.”

_{Source talkinghealthtech.com}