e-Health

| November 2, 2008

Since 1990s we have been talking about an emerging new digital era which will see an integrated electronic health records system revolutionise patient care. It is already yesterday's news, the technology is available, yet we are still talking about it – so why isn't there a national e-Health database?

There has been much discussion, but the conversation is often confusing. It appears there are still gaps in the solutions, or the questions being asked are inadequate, incomplete or misdirected. We want to figure out what is the e-health debate really all about.

  • If the technology already exists, why aren't we using it?
  • What should the healthcare sector learn from other industries which are functioning successfully online?
  • Are the State and Federal governments capable of sufficient cooperation to coordinate a national e-health system?
  • Who will have to lead the e-health revolution – government or business?  
  • Which patients could benefit the most?

Let us begin by hearing some stories about how e-health works, or doesn't work, in practice. We want to learn about your experiences as providers and users across all aspects of the healthcare system.

Since 1990s we have been talking about an emerging new digital era which will see an integrated electronic health records system revolutionise patient care. It is already yesterday's news, the technology is available, yet we are still talking about it – so why isn't there a national e-Health database?

There has been much discussion, but the conversation is often confusing. It appears there are still gaps in the solutions, or the questions being asked are inadequate, incomplete or misdirected. We want to figure out what is the e-health debate really all about:  

  • If the technology already exists, why aren't we using it?
  • Fears persist that the introduction of electronic health records threatens privacy, why?
  • What should the healthcare sector learn from other industries which are functioning successfully online?
  • Would the collection and maintenance of an e-health system place an unnecessary burden upon healthcare workers?
  • Are the State and Federal governments capable of sufficient cooperation to coordinate a National e-health system?
  • Who will have to lead the e-health revolution – government or business?
  • Which patients could benefit the most?
  • If you were in a critical medical condition and unable to speak for yourself, would you want the hospital to be able to access to your health records before treating you?

Maybe the e-health revolution has failed to happen because the issue is so big and complicated that it becomes overwhelming.  So let's begin by discussing the small stuff and hearing some stories about how e-health works, or doesn't work, in practice. We want to hear about your experiences as providers and users across all aspects of the healthcare system.

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  1. Stan Goldstein

    November 5, 2008 at 5:13 am

    what is right versus what is acceptable

    "Start with what is right rather than what is acceptable." — Franz Kafka

    OK, taking inspiration from the quote of the day, and from Tony Abbott's very informed view from both extremes of the health policy continuum – patient/consumer and Minister – I remain confused. I'm not sure where eHealth is going.

    My medical colleagues ascribe to eHealth, it seems to me, because there is a belief that having information at hand and using technology effectively will lead to better health outcomes. Clearly there are other aspects of the interface between patients and healthcare, such as patient billing, that still cast a great shadow in the patient experience but which may not loom as large or as urgent for clinicians.

    So let me say that from my perspective Kafka is being taken out of context here. There is no "right". I don't even know if we all agree on the issues, the extent of the topic, or even the range of opportunities. But it seems to me that we use the term "e-health" as a catch-all that means too many things to too many people. I don't know if that doesn't cause enough confusion as to make it difficult for those that have a desire to actually address the right problems.

    Perhaps hardest of all, I'd have to agree with Tony Abbott that asking the bureaucracy to oversee the solutions may not be an optimal strategy.

    I know that there are issues about interoperabilty. I know that it would be better if we could find what's "right" and solve all the problems at the same time, avoiding cost and duplication, but maybe we have to accept that after 20 years of trying, small steps may represent an improvement over what we have experienced to date.

    Let's find solutions for e-transactions in the health space. Let's make e-diagnostic and pharmacy ordering and reporting available. We can already store a lot of health information, e-archiving, either by a patient or by an institution (Does it need to be one or the other?) Perhaps it should be one or the other, but it certainly needs to be affordable. And then let's see if we can take the record of information and data, of pharmacy and diagnostics, of imaging and discharge summaries, and add a little artificial intelligence towards a record that is not so costly that it would consume budget and resources that could otherwise go to patient care (or even prevention) but that helps patients travel upon care pathways, identifies existing problems, archives past inactive problems, makes information entry simple and information extraction simpler still, works at the bedside, and works in with our current workflows and ways of thinking through clinical assessment, evaluation and follow-up.

    I don't know why this stuff has been so frustrating for me over the years, but it has. I hope that we can start to get the parts right, and at the same time we can work on Michael Georgeff's connectivity to bring the parts and the people together.

    Meantime, I have none of the answers at all. I hope that others will put up their thoughts and be prepared to have them shot down until the good ones are left to be acted upon.

    Good luck one and all.

    Stan

  2. vivazapata

    November 6, 2008 at 5:11 am

    Obama’s policy on e-Health

    From the Obama health Policy:

    (1) INVEST IN ELECTRONIC HEALTH INFORMATION TECHNOLOGY SYSTEMS.

    Most medical records are still stored on paper, which makes them difficult to use to coordinate care, measure quality, or reduce medical errors. Processing paper claims also costs twice as much as processing electronic claims.(13)

    Barack Obama and Joe Biden will invest $10 billion a year over the next five years to move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records. They will also phase in requirements for full implementation of health IT and commit the necessary federal resources to make it happen. Barack Obama and Joe Biden will ensure that these systems are developed in coordination
    with providers and frontline workers, including those in rural and underserved areas. Barack Obama and Joe Biden will ensure that patients' privacy is protected.

    A study by the Rand Corporation found that if most hospitals and doctors offices adopted electronic health records, up to $77 billion of savings would be realized each year through improvements such as reduced hospital stays, avoidance of duplicative and unnecessary testing, more appropriate drug utilization, and other efficiencies.(14)

    (13) Federico Girosi, Robin Meili, and Richard Scoville (2005), Extrapolating Evidence of Health Information Technology Savings and
    Costs. RAND, page 79.

    (14) Federico Girosi, Robin Meili, and Richard Scoville (2005), Extrapolating Evidence of Health Information Technology Savings and
    Costs. RAND, page 36.

    Original document: http://www.barackobama.com/pdf/issues/HealthCareFullPlan.pdf

  3. Stan Goldstein

    November 10, 2008 at 2:25 am

    If it sounds too good to be true …

    Glad to see the President Elect has taken this issue on board.

    He clearly doesn't have the cynical streak in him that I do. I am just trying to fathom what has been holding us up if it only takes $10 billion a year for five years to save $77 billion each year, presumably forever. I'm aware that our credibility as investors is somewhat shaken at present, but shouldn't we have been diving headlong into this opportunity before now if it was just a matter of money? How do we approach the problem of finding out whether there is good reason we haven't invested our $10 billion to date? I was hoping that even if the potential to be brave and open and to do the right thing did not, my cynicism would inspire some answers to be posted here as to the how we should be moving towards realising this potential.

    Mr Obama has recognised the 'why'. Isn't there someone out there to kick off the 'what'?

    (Conundrum: some of the very impressive people I meet from the IT world have been working on this for some years and yet it seems there is no pervasive solution [Hence, Mr Obama is forced to use the future tense]. Yes, we have all seen that banks have solved their problems and airlines theirs. But doesn't it seem too simplistic to assume that we in health are so profoundly blind to existing solutions or so stubborn as to be missing out on obvious opportunities?)

    I can only summise that there is a piece of the puzzle that is not nearly as obvious as we have been led to believe, and that either there is someone who knows the answer but is holding back to make a fortune, or we're not quite there yet. Is this an opportunity to discuss what the missing piece(s) might be? If not, why not? If so, please feel free to proceed.

  4. sashis2003

    November 12, 2008 at 9:15 am

    Records
    If we keep the record of blood groups of people along with their address so that in case of emergency we can search a blood group who stays near by the place of hospital

  5. foggy

    November 18, 2008 at 6:02 pm

    to “medical colleague” stan

    the missing piece is the secretary.all the non-paperless departments, firms,agencies, corporations, plants, so on, to date have secretaries working for them.many of the staff members, bosses themselves, and other officials do not know what and how the secretary works.yet the paperful offices' life goes on.what the e-health world needs is an IT secretary.not just a n overworked individual, but a whole team of expert secretaries.the team should have two sections, one for security and the other for getting the now paperless office onto the internet and the world of internat's multifarious connections into that same office.where lots of people who are not secretaries are also working.

    now would  each profession,give up a percentage of its members like doctors and lawyers and a host of others, who become IT experts and serve their professions as IT experts.OR proper secretaries should do their IT course and serve e-health depart just as most top clinicians have secretaries working on highly confidential matters.not everyone is cut out to be a tech or IT person someone has to fill a gap. everyone needs a job, and there are a billion of jobs, IT jobs are just one of the options.

  6. foggy

    November 19, 2008 at 7:14 pm

    e-Health the world over.

    As e-health is yet an especial domain. the world over and till it is capable of providing powerful integrated servis to the medical needs of all and sundry.i feel we will have to divide it into two avenues; CONFIDENTIAL and NON-CONFIDENTIAL..we will leave confidential matters with those accessing very hi-tech servis which they can afford. we should go after the non-confidential arena and fully exploit it.

    The Non-confidential E-health i should think caters to patients,general folk and medical(medical technicians and doctors-specialists and non-specialists)persons.

    here the e-health will be mainly for providing INFORMATION and INSTRUCTION of a Non confidential and general type.

    -for Patients.general awareness of health matters.FAQs.patient related questions requiring precise answers and instructions(regarding treatment, equipment, medicine compatibility(food, other drugs, allergenic material)).solid reference to the ideal doctor or department for a particular complaint.a Virtual admission to hospital, rehearsal with actual seeming "dud" forms and all the hospital procedures(tour) required one by one for the only, first time nervous attendant of a serious case.

    – for Medical; medical tech groups.instructions from medical experts to primary health care givers.life saving technics.opening first time specialised equipment, assembling and applying.expeditious advice.making the best of what you have got.

    -for medical v olunteers instructions; for hands-on training.providing solutions for those getting stuck during simple procedures.poison/antidotes.correct handling of patients.

    -for medical students;any medical topic, surgical operation, any sub -specialty dvd films they want to see.what to tell the patients?FAQs by medical students.virtual tours to any hospital and medicine academy.

    -for underserved areas;-diagnostic advice to medicos.stress on clinical s/s only.to have differential diagnosis.to pin point a clinching diagnosis.to find out a syndrome picture, without any invasive tests, or proper sufficient equipment.if equipment available-how to collect samples for diagnosis and send them proper, to available LABS. the list is super ad infinitum. and e-health is responsible for it.

  7. MikeM

    January 15, 2009 at 11:01 am

     I’m mystified by some of

     I'm mystified by some of the comments here. I have conditions that require me to visit my medical practice four times a year. Usually I see the same doctor but if she is not available the one I see has access to most of my medical records through the online practice management system. Nowadays most lab and specialist reports arrive by email. The stand-out is images from X-ray and the like, although they are digitally created nowadays and transmissible over ADSL2+ networks.

    But there is no database that contains all my stuff. There are email summaries from the respiratory clinic that checked out my asthma and from the surgeon who did my colonoscopy, but there is nothing that resembles a central collection of these records and my GP's system is not accessible to anyone outside the practice.

    This illustrates several different problems. 

    There is the technology one of how to create integrated, accessible databases. However since Google, Microsoft and Yahoo! have demonstrated with their gigabyte (terabyte?) databases, integration and access to data that was never designed to be integrated and accessed this way, is this a problem that is only perceived by IT managers over the age of 50?

    Second is the problem of patient sensitivity about their own medical histories. Does a teenage girl in Mississippi really want her parents to find out that she went to New York to have an abortion? Does a girl want her former classmates in Iowa, where she used to be a boy, to find her in San Francisco if a former classmate has become a doctor?

    But these are unusual cases. Can we find a way to deal sensitively with them, while providing access on a needs basis to most people's medical records for most health care workers who could benefit from seeing them?

    The third problem is with the medical profession itself. In Australia it takes around ten years study, training and apprenticeship to become a general practitioner.

    That is far more training than necessary to renew my six months prescription for asthma medication or authorise a colonoscopy that the surgeon recommends that I have – or even to slice the small wart off my leg, sending it to the lab to see what it is.

    Opening up medical records will expose the profound triviality of what many highly trained GPs actually do. Yet there is a severe shortage of GPs.

    More open information has the potential to break down one of the most entrenched trade union make-work positions in the nation.

     No wonder they don't want to do it.

    MikeM is roadkill in the wake of the capitalist juggernaut but his voice continues to protest that he is not an individual.

  8. MikeM

    January 21, 2009 at 11:09 am

    Conversation stopper?

     My previous post seems to have been a conversation-stopper in what initially seemed to be a passionate discussion.

    Why?

    MikeM is roadkill in the wake of the capitalist juggernaut but his voice continues to protest that he is not an individual.

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