S10 EP7: Lily Liu, Innovation and Technology

With extensive experience in both Asian and Australian healthcare systems Lily is the Director of Digital Health at Western Health. 

If you would like to learn more about the AHDC, please connect with us on our website www.aushdc.org.au or on LinkedIn at linkedin.com/company/aushdc.

Transcript

[00:00:00] David Cummins: G'day and welcome to the Australian Health Design Cancel podcast series. Health Design on the Go. 

[00:00:23] I'm your host David Cummins and today we're speaking to Lily Liu, who is the Director of Digital Health at Western Health in Melbourne. Lily specialises in stakeholder management and is an advocate on the importance of communication and education through roles in the public sector. 

[00:00:38] Lily has extensive experience in both Asia and the Australian healthcare systems and is currently managing multi disciplinary teams within the healthcare sector at Western Health in Melbourne.

[00:00:49] We look forward today to speaking to Lily about Western Health and everything digital. Welcome Lily, thank you for your time to be here. 

[00:00:56] Lily Liu: Thank you, David. It's good to be here. 

[00:00:58] David Cummins: I've heard you speak at a few conferences now, and I'm always consistently amazed by not only your knowledge, but your passion in this industry.

[00:01:06] I would say it's probably actually a common theme amongst the ICT team when it does come to digital health. 

[00:01:13] What drew you into the world of digital health?

[00:01:16] Lily Liu: Thank you, David. I think you're very kind at your comment. I think for me, as we all know, healthcare is a very complex area. And there's a lot of room for improvement, a lot of things we can do to make things a lot better. So for me, I obviously picked digital as a way to support the healthcare industry.

[00:01:37] I also think that for the future digital health is just going to be health. Digital is part of healthcare. 

[00:01:43] And that is driven by a lot of the enhancements and improvement in technology space. So, obviously very passionate in this space and continue to be in this space moving forward as well.

[00:01:53] David Cummins: Yeah, I totally agree. I personally have been building for almost 15 plus years in health, but I've been part of the health sector for over 22 years. And I personally am a fierce defender of the ICT team. I think they're amazing. I think they can do absolute wonders if the correct planning and collaboration is there.

[00:02:16] What are your thoughts on people that just think your team or the digital health team just focus on wi-fi and mobile bars on their computers? 

[00:02:27] Lily Liu: That's a great question. I think I would probably look at the understanding interpretation of their understanding of what we do.

[00:02:35] If that's what they understand the digital health team does, that's probably a big gap that we need to spend more time to do stakeholder engagement. There's a lot of things that we do at Western for example, we look at clinical informatics work for redesign that doesn't have to be with technology or without technology.

[00:02:52] We also look at innovation, we look at change management and training, we look at comms and we look at architectural design. 

[00:02:59] So there's a lot of things that we do in the digital health space. But definitely there's going to be a lot of work to work with the stakeholders to engage them if obviously their perspective of digital is relation to wi-fi and connections.

[00:03:11] David Cummins: Yeah, it's certainly probably the most talked about one, especially when you're in a hospital where there is no wi-fi. 

[00:03:16] And I remember building a hospital once and literally at the end of the project, everyone had forgotten wi-fi and telemetry for whatever reason it was. 

[00:03:24] And so I've found that when we did have that lesson years ago, it was pretty much revealed that no one had actually consulted with the ICT team on that journey.

[00:03:35] So how important is it to get ICT involved early in the Planning and the construction process. 

[00:03:43] Lily Liu: It is absolutely crucial. Absolutely crucial. Oftentimes sadly, digital health and ICT gets left a little bit too late in the process and there is a misconception that we can just do it right away or do it tomorrow.

[00:03:57] There's always limitations and timeframes you need to consider, for example, if you're procuring the example that you have on the wi-fi and if you need to establish wi-fi connectivity for a new hospital site, you will need to think about the procurement of hardware, so procurement of hardware has period of time that is restricted by the vendor, for example, and you also need to think about procurement pathways as well.

[00:04:19] So a lot of things to consider. I always say to the stakeholder that I work very closely with, engage us as soon as you can, because we can sit down and work together with you, we can help you build the business case, we can help you do a market analysis. We can help you to set the right product.

[00:04:34] Oftentimes, and it's a lot better these days, but oftentimes we do get it quite last minute and it does make things quite challenging, particularly there will be a financial implication to the project itself and unfortunately not a great desired outcome for the clinicians who's using the product. 

[00:04:50] David Cummins: Yeah, in the world of construction, there's this amazing graph, which I can't show now, but basically, the more planning you have, the less money you spend.

[00:04:59] And as time goes on, those design and slash construction costs increase because of errors, and what have you, and then you go into the world of post occupancy defects and it just dramatically increases. I can only assume that would be the same in ICT as well. The earlier intervention you have, the less cost and the less risk, correct?

[00:05:19] Lily Liu: Absolutely. Absolutely. 

[00:05:20] There is a cost associated with late engagement because that means you've got to pay more to get things delivered and get things done quicker. There's also a misperception that we'll just throw more people at a technology project and it will be actioned a lot quicker.

[00:05:36] What you will find is, particularly if you're familiar in the coding space, in the ICT space, the more coders you have on a program or on a technology pace, the more messy it could get down the track. So it's not a case of, "Oh, we forgot to engage them. Let's throw more resources and money and it will be better".

[00:05:54] It actually, you have to go through a very strict governance process as well. 

[00:06:00] David Cummins: And it's a very interesting point that you just made there. So if I've had that experience of, ICT being missed like years ago, which it doesn't happen ever again on my projects. But if you've had that experience and I've interviewed someone the other day and they've had that experience, it seems to be a consistent and common Australian problem where ICT is not engaged early enough.

[00:06:22] I've got some ideas about why that happened. Do you have any thoughts about not only why that's happening, but what we can do to resolve it? 

[00:06:30] Lily Liu: I would always say that there is unfortunately a misperception that it's something that's easier to do. Oftentimes there's also a perception that we don't need to engage the right people to do the piece of work.

[00:06:44] Those two sometimes affect the early and the late engagement of the ICT department. Let's say you're doing a construction piece of work. My advice would be the construction project team need to have done it previously before. If you're doing a digital construction as well, you need to have right people in the role to provide that advisory.

[00:07:03] So I have worked on projects that eventually have people on there that know the ICT, know the digital side of things and provide accurate advice, but oftentimes they do get involved a little bit later in the process. I would say you need to involve them during the procurement and bidding and design process as well.

[00:07:20] David Cummins: Yeah, I even challenge that to say it should be part of the business case phase to actually make sure we've got the budget to make sure that they understand what Is happening and then, you know... it's always a good idea... Well, if you are working in section A and section A does have some form of ICT rooms or communication rooms or rack rooms that might need to be upgraded.

[00:07:41] Well, maybe that's not part of the budget, but we can certainly get efficiencies and an additional budget to try and enhance that section as well, because I do find that comms rooms in my experience in Australia might not have as much love as maybe a highly clinical area, but the sensitivity of if ICT goes down is dramatic, especially in this world where cybercrime is so huge as well.

[00:08:04] Lily Liu: Absolutely. I think a big portion of this is also the awareness. We talked about stakeholder engagement and early engagement before, but a big portion of this is knowing the importance of why do you need to have a secure space for a comms cabinet, for example.

[00:08:19] A big portion of this is why do we need to put in cyber security measures early on and why do we need to have a good wifi. There's a misconception that "Oh it would just work".

[00:08:28] And I think this is the bit where we need to really focus on what are you trying to achieve at the end of the day? Right. For example, in an EMR space, which is what I specialised in, you, will need clinical grade network. 

[00:08:40] There's a specific definition in Australia about what clinical grade network means, and there's specific criteria around how do you establish clinical grade network.

[00:08:47] But you can't, for example, put an EMR in without a clinical grade network. That took years to establish that standard. If you ask people 10, 15 years ago, people won't even know what that is. There is a maturity that's happening over the years, but it is a little bit slower and we need to probably catch up and get into the construction space as well.

[00:09:05] David Cummins: I must admit, I'm one of those people that does not know what that is. I've only done EMRs on two projects and that was a few years ago. 

[00:09:13] So what actually is that? 

[00:09:16] Lily Liu: So there's a multiple components of a clinical grade network. Obviously redundancy and making sure that you've got disaster recovery, you've got BCP.

[00:09:24] That's one of the key components of clinical grade network. Security is also another component and coverage. 

[00:09:30] So the idea of having a clinical grade network is that when you roll out an EMR, you would not have areas where you can't connect to the EMR. You will have enough redundancy so that if one fails, the other kicks up so that your clinical operation is not impacted by that.

[00:09:46] At the end of the day, you're trying to keep the EMR running as much as possible. So that's what the clinical grade network is for. 

[00:09:53] David Cummins: Yeah, very interesting. It totally makes sense. So On a global perspective, I know you've got a lot of Asian experience yourself. Where does Australia fit? 

[00:10:02] Are we behind the times in the world of sustainability, are we forward thinking like we are with some of our designs, which is fantastic.

[00:10:09] In the world of digital health, where do we fit. Is it on par with the world or we're just too behind or how does that work? 

[00:10:16] Lily Liu: It depends on where we're comparing to. 

[00:10:18] I think if you look at North America where, they've had EMRs a lot longer than we have had, so they're a lot more advanced than we are in terms of the adoption of the EMR, the informatics, getting the data out of it.

[00:10:30] They've now obviously moved to AI in that space as well. We do look up a lot to North America, you know, to the UK and some of the stuff they're doing. So we are still trying to learn from them and do that work. 

[00:10:42] From an Asia perspective, this concept of digital health and EMI is new to certain parts of Asia, but the benefit of Asia is obviously execution is a lot more straightforward there.

[00:10:52] There's a lot less governance and there's a lot more money thrown at it and there's a lot more technology acceptance in Asia country. 

[00:11:03] So if you look at in Asia, for areas like Japan, Korea and even parts of China... the consumer base is quite technology driven. So instead of the organisation putting technology downstream, it's actually the other way around. 

[00:11:16] To get more competitive, you need to have technology that people will love to use and people like to use.

[00:11:21] So it's a little bit different from an Australian perspective. 

[00:11:25] David Cummins: What an amazing utopia that sounds like because that's actually what we should all be doing. It should be what we'd be striving towards because we all understand the benefit of more technology and more AI actually increases clinical outcomes but also decreases risk.

[00:11:40] And although maybe a little bit more money to spend now, the rewards are great in the outcome. 

[00:11:47] That's correct, is it not? 

[00:11:50] Lily Liu: It depends on the product that you use and the use case that you apply it to. So we did have a lot of this conversation as well. The application of the emerging technology like AI, machine learning, you know, bots and everything.

[00:12:05] It's specific to a specific use case so you can't apply AI to fix everything. The use case is very specific. You have to find the right use case with the right tolerance level and with the right intervention. There are very good use cases around at the moment for the use of AI.

[00:12:22] You just have to look at how you apply it. 

[00:12:25] David Cummins: Yeah, interesting. 

[00:12:26] Just swinging back to the world of construction in reference to user groups, I'm lucky because I've got a clinical understanding. 

[00:12:34] So when I've spoken to nurses and doctors and the stakeholders I tend to have a bit more empathy and understand what their needs are and able to understand that not everyone might be be aware of the construction knowledge or even the clinical knowledge.

[00:12:47] So it's a really good opportunity to be that translator between the two worlds. 

[00:12:51] In the world of ICT, I very much put my hand up saying, I don't know what a heat map is and I don't know anything. 

[00:12:57] I think I've got good enough self awareness where I understand what I don't know and ask those questions.

[00:13:01] How does that work in your world when you do have a big construction project and they're talking about a build in a program and the restrictions of the methodology and how does that interact to your world? 

[00:13:13] Is it very much... you do what we say, or very much... can we take it on that journey, like the lingo and the understanding and the framework with which a project works has to be so integral and so collaborative, but I was wondering how it feels like to be on the other side of that?

[00:13:28] Lily Liu: Yeah, it's a great question. So when we do a digital health project or an EMR project per se, and we're going to what we call a design session with clinical stakeholders. What we tend to do is we split out the technical component and the lingo we try to explain to people from the clinical language that we understand.

[00:13:46] So for example, if I go through an ED workflow on how we triage patients and how we allocate beds and everything, we would have ED clinicians going through that workflow in the language the clinician understands. 

[00:13:57] What I found quite challenging from a construction space is I would go into a meeting about digital health and EMR for example or ICT and then I would have a lot of construction lingo thrown over and it is quite overwhelming to understand navigate through and then you've got a room of 20 people all talking at a specific pace and you feel quite of place. 

[00:14:18] So I do think that it would be hugely beneficial to have someone in there, similar to the way we would do for clinical engagement, to be able to translate language so that the digital and the clinicians and as well as the IT people understand. 

[00:14:31] And I do see that happening a little bit more these days than it was before, but they are still a big portion of those massive meetings and lots of construction talks that makes it quite hard. 

[00:14:42] And particularly when you're asking clinician who doesn't specialise in hospital building to sign off something that they've only seen probably once a month. 

[00:14:52] So that's something to think about as well. 

[00:14:55] David Cummins: Yeah, it is interesting because you are right. 

[00:14:56] That third element of design and construction is actually the sign off and the user sign off.

[00:15:01] What does one from a digital world A, understand the needs of the clinicians and B, make sure that it's delivered as required through all the checks and balances in?

[00:15:11] Lily Liu: What we do from a digital perspective, is we do what we call a current state analysis. So one part of the current state analysis is we also have a project team who understands who previously would have been clinicians working on the floor. 

[00:15:25] So in the ED example I've given you, we would have an ED doctor, and ED nurse, potentially the clerk. 

[00:15:31] So every role that we can replicate that we know what's needed, we would have something similar on the digital health team. We would go down to a day, sit with them and understand how they do their jobs and then we'll come back and document and map the workflow out.

[00:15:44] And then that gets translated with the vendor, whoever we pick, into a future state. That's something that you need to go through to understand specifically how they do and what they do. 

[00:15:55] David Cummins: That's amazing. 

[00:15:57] I've actually not really even heard of that before, that's amazing. 

[00:16:01] And that's pretty much what you've done a few lectures on as well.

[00:16:03] I know Western Health are doing quite a bit of work at the moment but that level of detail is, is phenomenal. So one can only imagine the outcomes have been phenomenal as well, correct? 

[00:16:12] Lily Liu: Well, that's the thing, right? 

[00:16:14] We need to know every single variation, every single workflow in order to design something.

[00:16:19] If we miss that out, it needs to be captured during testing otherwise it will happen during go-live. So the more we spend time to understand what the current state and what he could do, the more benefit it is when we build the solution and when we go live with it.

[00:16:34] It's one of the things you just have to invest a lot of time and effort to with the right people in the room.

[00:16:39] David Cummins: Yeah, and I know we're about to run out of time, but my last question is actually about the old and the new. 

[00:16:45] So, as you know, most of hospitals in Australia, you know, are in their 60s and 70s, if not 50s and a lot of that technology, A, didn't really exist or B, it's just so old and redundant, especially the hardware.

[00:16:57] Again, I would say something that does get missed, especially on newer projects again, one of the years ago, we just had this big tower and we just, didn't work out the integration of ICT from one side to another and it does seem to be something that does get missed as well. 

[00:17:13] How hard is it to do that integration?

[00:17:15] It sounds quite challenging where you've got old software, old nurse school, old whatever... and then you actually have two software and then all these clinical risks arise as well. 

[00:17:26] So again, it just seems like a risk that could have been avoided if we had the right technology and the right communication at the start.

[00:17:34] Lily Liu: Absolutely. 

[00:17:35] So one of the things I mentioned before, what we do is architectural design and review. One of the hardest thing to do, from a software perspective, is to bring all the systems together via interfaces. You can do it, but it is very hard. 

[00:17:49] We call it patching, but the definition of patching is it will break at some point. So you will always need to start from the top and look at what is the best design. 

[00:17:58] You don't want to replicate workflows, you don't want to create redundant. 

[00:18:02] So if you have multiple systems to do the same thing, that's not ideal from a clinical workflow and operational efficiency perspective.

[00:18:09] So that's something to consider as well is anything that you can reuse, we should always expand that. 

[00:18:15] Anything that you can design from the beginning to make sure you've got a comprehensive design workflow. So similarly, you don't want to design a room differently from level two to level four, you don't want to have a system that works differently for the same area.

[00:18:28] That's very much similar to that, but I think there's lots of investment that we need to make in order to look at the ICT architecture design and the digital side as well. 

[00:18:39] David Cummins: Yeah, fantastic. 

[00:18:40] Lily, I know you're super busy. I just want to thank you so much for your time. I found that fascinating.

[00:18:44] There was some good tidbits there that I hadn't even considered or thought of. So for me, I've learned a lot and I'm sure that will help with my projects in the future. I'm sure other people will find that beneficial. 

[00:18:54] Thank you for your dedication to this industry. I think it's fantastic to actually have people like you literally standing up and saying, this is what we do, we're not perfect, but these are some of the lessons. 

[00:19:03] And really creating a roadmap for other people because I do feel that the world of ICT is sometimes neglected in the world of construction and I do think there is no reason why it can't be enhanced.

[00:19:14] And I do think that it comes from education as well and I do think that ICT is just a phenomenal industry where we literally can achieve anything that always will stand up and they'll always make sure. 

[00:19:26] They rise to the occasion, and I think with people like you, it just gives a lot more people that energy and enthusiasm as well, so thank you for your help with that.

[00:19:34] Speaker 3: Thank you, David and thank you for the opportunity to share my experience with your listeners as well. 

[00:19:39] David Cummins: You have been listening to the Australian Health Design Council podcast series, Health Design on the Go. 

[00:19:44] If you'd like to learn more about the AHDC, please connect with us on our LinkedIn or website.

[00:19:49] Thank you for listening.