Indigenous health should be a very promising proving ground for e-health applications. Indigenous people have much higher rates of chronic disease and typically use wholly government-funded or government-run health facilities. Therefore, e-health has more than the usual potential to improve treatment. As well, the predominance of government health provision should mean fewer than the usual problems of coordination and interoperability of systems.

Although the federal and Northern Territory governments have both promoted e-health initiatives and, on paper, much progress seems to have been made, I suspect that the usual caveats concerning the gulf between what's supposed to be and what's actually happening remain in order.

Katherine was the site of one of the first and most extensive Health Connect trials. As part of this trial, all the indigenous health clinics in the area computerized all their patient records and made them available to the other clinics in the trial.

According to the NT health department, a shared electronic health record is now "progressively" being implemented. This could mean that significant health facilities in the Territory mostly have electronic records and that at least some of them are able to access the records of others. I hope that's the case. It certainly should be, several years down the track from the Katherine trial.

As part of its roll call of initiatives, though, the health department also states that the shared electronic health record is being extended to "three major GP practices" in Darwin. It also says that the Medchart medicine management system is to be implemented and that the Primary Care Information System is to be rolled out across remote area health facilities. Call me cynical, but I suspect this means that GP practices are not yet part of the shared record, neither is information about the drugs particular patients are taking, nor are such records as currently exist yet generating follow up treatment.

If I'm right (and I'll try to explore this on my next trip to the Territory) e-health there is pretty much as elsewhere: a jigsaw that's missing several pieces and has yet to be put together.

In general, many health service providers still think that record keeping is less important than actual treatment and still think of their records as being for their own exclusive use. Overcoming this culture remains extremely difficult because it's rarely an urgent priority for any particular key decision-maker.

The creation of shared electronic records is a test that the Australian health system has yet to pass.

Here are some questions for this forum:

1) Who has had a personal experience of an e-health application and did it make the health service more convenient and/or more effective?

2) Why are health service providers lukewarm about e-health?

3) Where is government going wrong in its attempts to promote e-health?

Hi Tony

Thanks for joining us for this conversation.

A few months ago I'd never even heard the word eHealth, so this month (eHealth has been our topic of the month heare at Open Forum during November), I've had a bit of a crash course in what the term means.

What I've concluded is that it's a redundant concept.

In 2008, we should expect that the best way of doing things might incorporate some high-tech tools, that's just a reality. It creates an unneccessary psychological divide to seperate eHealth from Health.

We need to stop focusing on the "e" for electronic and start understanding that technology merely a means to the end of those other "e" words: effectiveness and efficency, or even excellence.

The administrative systems of the Australian public health system are not excellent, or even as effective or efficient as they could be. That's not a complaint against the health system in particular though, for instance the same could equally be said of our legal and criminal justice systems.

Canny use of technologies which are already available on the market cheaply or freely would probably achieve much more, much more quickly, for public systems than spending millions on developing new peak bodies, websites or software.

Best practice government procedures and proccurement policies are central to making any public sector function better.

For a start, how much money could be saved if all federal and state governments cut back spending on traditional telecommunications and got some Skype and gmail accounts? Those saving spent on old fashioned health needs (like extra nurses) could bring a real ehealth/health benefit.

A tech-savvy health system does have a lot to offer residents of remote communities by minimising the some of the disadvantages of geographical isolation. But when it comes to the basics like extra doctors, nurses and beds, nothing helps like cold hard cash.

If implementing an idealised ehealth system is not working out, and it appears it's not, then perhaps we should shift our thinking to a broader picture of how governements can make the most of technology to make all public systems more efficient then spend some of the savings on delivering better healthcare services.

I'm looking forward to hearing more ideas from you and our readers over the course of the week.

Wishing you all the best of health

Sally Rose

Blogger-in-Chief

srose@openforum.com.au

I'm an RN. I'm a mad gamer and love my boy toys so I'm not lukewarm on technology. But poxy applications just mean double entry and double the chance for mistakes. It makes me insane how often I have to spend more of my shift updating patient recordsthan I should. It's also really hard for locoms and agency staff when they are can't do basic stuff because they are not familiar with the in house sytem.

Cheers Johnno

I just want to add that if we can develop something as complex and well functioning as ATO's e-tax, then surely technology cannot be an issue. Perhaps what we actually lack is a real champion of e-Health in Government to make it happen. The benefits for patients and doctors are so obvious.

As for the use of new technologies - well, we are living in the 21st century, aren't we? Things are only going to get 'techier' so we have no choice but to stay technology literate, in order to survive.

2) Why are health service providers lukewarm about e-health?

Having worked in IT in several industries, the health industry is notable for the lack of cohesion and consensus in its user base. I think it is this that prevents traction on e-health. The individualistic, competitive nature of the industry is evident not only when trying to provide IT solutions. It is also evident as a patient. For example, if you have a sore back you have to self-diagnose and choose between a list of practitioners that includes chiropractor, physio, neurosurgeon and acupuncturist. Each, to varying degrees, think their solution is the only one. While most practitioners genuinely care for their patients, or at least the illness, there is a lack of trust between practitioners that prevents progress on a number of issues, including IT and e-health.

3) Where is government going wrong in its attempts to promote e-health?

Perhaps overly simplistic, but incent practitioners to work together rather than compete with each other.