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Australia Finally Heading in the Right Direction on e-Health

Robin McKenzie's picture

I read with great interest the words of National e-Health Transition Authority (NEHTA) chief executive Peter Flemming quoted in Australian IT on 13 October which indicated that the original vision of a single e-health record system had been abandoned in favour of "person-controlled" records that could be adopted more quickly.

The article quotes Flemming, "Five years ago, there was a strong view that there would be an e-health record for all Australians held on a massive database somewhere," he told the Medical Software Industry Association conference in Sydney last week. "That's no longer the view".

"When and if the e-health record is approved, we'll enter into detailed planning around the architecture, but undoubtedly people will have an option to choose health records from a range of sources and their medical information will be stored in a number of locations."

This resonated loudly with the conclusions that The Health Information Exchange sub-committee of the Australian National Consultative Committee on e-Health had reached in its work on e-health information exchange.
 
It became clear from our deliberations, which took into account best practice and thinking world wide, that a person-controlled record was not only the most speedy and cost effective solution, but that it was also the most likely to achieve consumer acceptance. 
 
Information Integrity Solutions (IIS - the company of which I am a principal) developed this thinking into a policy paper titled "Cutting Through: Using Health Information Technology for effective chronic care delivery", which has quietly been circulating through the back blocks for some time. 
 
Could it be that Australia is finally on a path that will lead us forward on the e-health agenda after all the false starts we have encountered over the last decade?

 

Robin McKenzie is Principal Consultant with Information Integrity Solutions Pty LtdBefore joining IIS in 2005 she held a senior position with the federal Office of the Privacy Commissioner. Between 1994 and 1999 Robin was a partner in a consulting company that conducted review, evaluation and research projects, including for the Family Court of Australia, the NSW Law Reform Commission, NSW Attorney General's Department, the federal department administering childcare funding programs, and Blake Dawson Waldron. Before that she worked with the Australian Law Reform Commission for five years. Robin has a law degree and an honours arts degree majoring in social anthropology and was admitted to practice as a Barrister and Solicitor in the Supreme Court of South Australia.

Comments

Can't tell what the direction is

 

I dunno Robin, I think Peter Flemming's comments can be interpreted along a spectrum of optimisim-pessimism.  You say his announcements resonate with conclusions of the Australian National Consultative Committee on e-Health.  Are those findings publicly available? 

It's almost trivial to observe that "undoubtedly people will have an option to choose health records from a range of sources and their medical information will be stored in a number of location".  What this actually says about the national e-health direction is ambiguous.  A cynic might say this is a retreat from the grand plan.  For years and years, the conventional wisdom has been that a health information superhighway could save 5% of the $60B+ annual health spend (not to mention the lives saved and outcomes improved).  Ever since the launch of the national health record vision in Adelaide c. 2000 there has been a hope that governments would find a way to fund the investment necessary to realise this multi-billion dollar saving. 

Whether a health records system is centralised or decentralised is an architectural decision, and not intrinsically a political or financial question.  Decentralised deployments are now favored, and that's fine, but this need not imply a free market driven e-health system.  I reckon the shape of the technological future is getting mixed up with what should be a different discussion over the form of management and financing.  And so, through indecision more than anything, we're trending towards a laissez faire e-health management model where patients and consumers will be shopping around for Personal Health Records (PHRs).

There's one crystal clear, a priori reason why we should be extremely cautious about, if not opposed to, the current PHR market trend.  The dominant offerings are still free.  Like Twitter they haven't worked out their sustainable business model as yet.  But one can bet that the commerciality of many PHRs will be based, like Google on advertising, or worse, like some of Facebook's experiments, on outright monetisation of personal information.  Is this the future we want for health records?  

What role will NEHTA play in the PHR bazaar, to protect the interests of patients and the national health system?  I hope it's going to be more than just setting or selecting standards.  Change management is the name of the game (this is actually why Obama OK'ed a US$25B e-health stimulus package; the IT aspect won't have a big economic effect but the labor force changes that go with serious nation-wide e-health sure will). 

We all know that standards and necessary but not sufficient to drive change.  But what some of us have come to realise - empirically- is that standards aren't even necessary.  Pardon the political incorrectness, but let's face it, industry is not enamoured with standards.  Look at the Apple iPhone: a category killer product with proprietary APIs.  The market is besotted with it, in complete defiance of its non-standard technology.  Personal Health Records on my iPhone will probably be fabulous, and popular.  But interoperable or even portable?  In a free market, why would they be? 

So if there is any "direction" in evidence at all, in an aggressive, Web 2.0-style marketplace of PHR services in the cloud, all vying to make money eventually out of health information and habitually pushing the privacy envelope, then I'm not sure what that direction is. 

Stephen Wilson

Lockstep Group

Lockstep Consulting provides independent specialist advice and analysis
on digital identity and privacy. Lockstep Technologies develops unique
new smart ID solutions that enhance privacy and prevent identity theft
.
 

 

EHR coming soon to a hospital near you? Please tell me it is so

I was involved in the Health IT industry for a number of years and to me , it seemed clear that if some EHR was available to different clinicians treating a patient, then there would be less medical misadventure and less cost to the health system by reducing duplicated diagnostic tests. Over the 9 years of my industry involvement I saw lots of debate over platforms, standards, around who controls the EHR and who pays for all the clinician time and software development to make it all happen. However not much concrete progress was made. From the earlier postings in this thread, I hope that progress will not be far away---thats my optimistic side talking.

However I have been out of the health IT industry now for nearly 5 years and I do shrug my shoulders when every few months I see a newspaper article discussing the merits and challenges of the so far mythical, widely accessible EHR. I am confident that if I lined up all such articles over the last 10 years, the same issues would have been consistently discussed but over that 10 years, we have made little  concrete progress. I hope someone better placed than me, can, hand on heart assure me that I am wrong and considerable progress has been made resulting in less misadventures now caused by lack of patient information and that hospitals are not doing as many pathology tests and imaging that could be avoided if access to previous results was available. 

There are many more individual electronic patient records kept now on both doctor and hospital clinical software but as just another occasional health system user , I see very little evidence of information sharing electronically. I use a terrific family GP practice and they are very smart in the way they use technology. The GP's can generate a referral letter very quickly using their software and include any pertinent facts from my medical history but then the GP still, in 2009, hands me a referral letter to take to the specialist. Presumably the GP's receive some results back electronically and that was not happening 10 years ago. Little steps like that say we are making progress, but in the same period we have gone from submitting all  tax returns on paper to a sizeable percentage being submitted electronically via the internet. A large proportion of us trust the internet to do our banking. When i first joined the health industry, I was told that "health is different and unlike any other industry." Why is it different and such a laggard in the area of EHR and information sharing. A patient health record is after all, just another confidential file as is our tax file and our banking records. 

Regards

Mike Gregg

EHR is definitely coming but it still needs more time..

Hey Mike,

I would agree to whatever you said. I also believe that EHR will prove a milestone in saving those extra bucks being spent on the same repetitive tests again and again for medical checkup. Here, I would like to refer to a research document on the topic EMRs vs PHRs - The difference. The report/document was really interesting to read as it raised the curtain from some of the myths we have regarding EHR's future. The report summarizes as;

There are a total of 754 acute care hospitals that have not fully implemented a base of major clinical ancillary department applications (e.g., laboratory, pharmacy, radiology) to qualify for initial designation for implementation of EMR Adoption Model. This represents approximately 19 percent of the hospitals in the database. Most hospitals occupy the stage 1 and stage 2 levels of the EMR Adoption Model. The combined percentage of hospitals in these two stages is approximately 71 percent.

At this time, there are only 414 US hospitals that are at the middle stage of the EMR Adoption Model. This shows the tremendous amount of work and investment that must be done by US hospitals to implement clinical systems to enable their participation in EHR initiatives. More importantly, further implementation of higher stage EMR applications will enable the reduction or elimination of medical errors, while providing the digital environment . The higher stages of the model represent the facilitation of not only improved patient care, but also improvements in efficiency and effectiveness with which patient care services are delivered by clinicians.

Once the healthcare organizations are provided these capabilities, the focus can be shifted on sharing patient care information among all of the healthcare stakeholders. Currently, the hype surrounding healthcare IT has the 'cart before the horse.'  How can we discuss of EHRs, much less implement them, until we have implemented effective EMRs, no hospitals, but in all care delivery organizations including physician practices?

I myself am associated with Global Patient Record (GPR), a Personal Health Records provider. We at GPR have been providing solutions to improve patient care for over a decade now. The whole idea is to lower the medical liability and costs associated with patient follow-up and to increase the cooperation between patient and the provider. It offers the GlobalPatientRecord keep you (the patient) notified and informed as well as responsible for your health record.

The mission is to help the patient to play an active role in managing one's own patient record, Make better decisions when it comes time to have a health related checkup, be informed when the medical results are available, be notified when one's health provider is trying to reach one, identify areas of potential health risk and provide solutions to prevent missed patient follow-up, improve communication between the patient and the healthcare providers, has access to accurate patient information instantaneously whenever needed.

It is equally beneficial for patients and healthcare providers. Anyone can keep track of one's personal health record as well as one's patient record with Global Patient Record. And one has access to it anytime and  anywhere via medical records online.

The future seems far but it is for sure that it has to come and the way we saw the penetration of IT in our lives, healthcare has no exception to is.

Othman Latif
http://www.globalpatientrecord.com

Hi,

The health care organizations are provided these capabilities, the focus can be shifted on sharing patient care information among all of the health care stake holders. Free Collection of  Herbs | Aloe Vera | Lemon Verbena Currently, the hype surrounding health care IT has the cart before the horse.

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