Five minutes with Mitchell Burger

This month we spent five minutes with Mitchell Burger, Director Strategy, Architecture, Innovation and Research, ICT Services, in Sydney Local Health District.

Please tell us a little bit about yourself.
Hello everyone! I am Director Strategy, Architecture, Innovation and Research, ICT Services, in Sydney Local Health District. I find this an exciting and challenging role, spanning a broad set of priorities. I am also doing a PhD at the UNSW School of Population Health, focused on how to ensure the use of artificial intelligence promotes population health equity, rather than amplifying and entrenching inequalities. Before this I worked for the Australian Digital Health Agency, on the National Digital Health Strategy, and evaluation of the My Health Record system and Expansion (‘opt out’) program. I have a background in statistics and data analysis, and completed a Masters in Public Health, also at UNSW. On the weekends you’ll find me running around the Inner West chasing my rascal kids, who are two and four.

How do you define digital health?
It won’t be a surprise to anyone to hear that I find it very hard to define! I generally think about it as the use of digital technologies in the delivery of health services, but it’s a term that means lots of things; like ‘big data’ or ‘artificial intelligence’. That we talk about ‘digital health’ (and before this ‘eHealth’, and ‘Health IT’ – see here for discussion of timeline) underscores that we’ve got some way to go to where we need not draw a distinction. Certainly for digital-native companies, digital is just how they do business; it’s not remarkable. I think NSW’s new ‘Beyond Digital’ strategy is good step in this direction –  to where we are all in the business of providing health care together.

What do you think will enable digital health projects and innovations to succeed?
We are about to start consultation to develop our district’s new 5-year digital health strategy, and have done a little thinking on this, so here is a long (sorry!) list of bullet points. We’d really love suggestions.

• Genuine partnership with clinicians and the community in the codesign and implementation of new, digitally-enabled models of care – something akin to the Yolngu concept of Ganma
• Focusing on workforce development as a priority over technology – both building specialisations like informatics and data science and analytics, and also upskilling and promoting the slow and steady process of cultural change across the broader workforce
• Carving out protected time and spaces for clinicians to reimagine workflows and design and iterate new models of care in partnership with digital health disciplines
• Re-apportioning of government and health service budgets into digital infrastructure and transformation programs, commensurate with its emerging criticality and contribution to population health and growing business value (say, by benchmarking investment in digital as a proportion of CAPEX and OPEX to other sectors). And mimicking, say, long-term investment models like justice reinvestment and NZ’s welfare budget.
• Inclusion of sustainable funding mechanisms for new models of care by design, upfront
• Research operationalisation and streamlining innovation and procurement pathways, to accelerate research translation and give proofs of concept and pilot projects defined and well-trodden paths to production and scale
• Fostering and continuing to develop expertise in implementation science within regional health services
• Investment in foundational digital infrastructure (esp. data systems infrastructure) and institutional competencies that will enable a longer-term transition to value-based care and away from activity-based funding, and also enable us to leverage emerging AI and automation technologies
• Piloting regional commissioning partnerships between LHDs and PHNs using pooled, blended capitation and outcomes-based funding mechanisms (e.g. like the Prevention and Chronic Condition Management Funds (PCCMF) recommended by the Productivity Commission)
• My view (and I’m open to feedback!) is that we should reconsider interoperability as a microeconomic challenge, rather than a technical one, and that health services could accelerate interoperability through taking a much harder line in procurement and leveraging our near-monopoly market positions to instigate standards adoption and promote use of digital solutions like eRef, My Health Record, secure messaging, etc. within regional digital ecosystems

A final thought: I think that hospital districts, together with PHNs, are uniquely placed through their scale, community and cross-sectoral partnerships, public trust, and sovereignty over clinical and data governance to be at the forefront of digital transformation.

What do you think are the biggest challenges facing digital health at the moment?
Digital health is of course very hard, and there are many challenges, so it takes resilience and energy. Here is another long list of some immediate challenges – again, we’d be delighted to receive suggestions for how to address these, so please reach out.

• The sheer complexity of implementations, and the speed of technological development
• Poor, stagnant design and usability of clinical information systems, which don’t meet modern digital service standards
• Hype, and an overly future-oriented mindset beset with management jargon and technocrats (like me I have to admit!) chasing the next idea rather than seeing things through
• Disillusionment resulting from unfulfilled promise and overly optimistic digital and ICT business cases
• Eroding social licence for use of health data
• Legacy funding models which do not reward and foster innovation
• Data availability and data quality
• Institutional competence in data governance, privacy and cyber security
• Ambiguity in roles and responsibilities for digital initiatives between the different levels of government

Do you have any interesting resources or helpful networks people should know about?
For those interested in some of the issues surrounding the use of AI – I think the AI Now Institute is a fantastic resource. And I have a huge Endnote library full of reports and articles on AI, only a very tiny fraction of which I’ve actually read (optimistically I try to think of it as an antilibrary!), so I’d be happy to share this too.

Connect with Mitchell via LinkedIn

A very big thank you to Mitchell for taking the time to be the October member feature!