Health Information Exchange becoming a reality in Canada. When in Australia?

Done right, an approach based on Health Information Exchange would be vastly CHEAPER AND BETTER if government established a well regulated,  competitive market place for the supply of services instead of building a monopoly that will inevitably fall behind the 8-ball.

Canada is getting on with the job that matters with eHealth information:  Health Information Exchange (I call it HIX…).  In Australia, are we running the risk of building last century’s equivalent: a large, monolithic Health Information Record (eHR) system?

Hopefully not.

The budget announcements by the Minister for Health and Ageing show some encouraging signs:  for example, in "Support for e-records cautiously welcomed" in The Australian on 15 May 2010, she was very careful in her choice of words not to exclude (nor confirm) an option based on HIX.

What do I mean by Health Information Exchange?  It is real time exchange and aggregation of relevant health information about an individual, regardless of where it is held.  This exchange remains within the control of the individual except where delegated (eg to a health professional or a family carer) or consistent with agreed ‘break the glass’ emergencies.  The concept is similar to today’s web page which is constructed in real time from many sources.

IIS has described this as the ‘way of the future’ for some time, even before the National Hospitals & Health Reform Commission came to the same conclusion.  See “‘Cutting Through’: Using Health Information Technology for Effective Chronic Care Delivery” which we prepared for The Health Information Exchange Project.

Done right, an approach based on Health Information Exchange would be vastly CHEAPER AND BETTER if government established a well regulated, competitive market place for the supply of services instead of building a monopoly that will inevitably fall behind the 8-ball.  The argument that Health Information Exchange would inherently increase privacy risk compared with a government built system is ridiculous: it is the attention to privacy & the way any system is built & governanced that matters, not the question of ownership.

One interpretation of HIX based thinking that I particularly like is Microsoft HealthVault.  It has just been instantiated into Canada with Telus Health as the local partner.  There is an excellent demo video available at their website.  And it addresses the privacy question.

0 Comments

1. 

   foggy

   June 8, 2010 at 6:39 pm

   health information X

    

                                                                                                                                                      Your article brings us to a junction of health information.of course the patient is central to the theme of all things medical.this fact has gotten more accentuated with the existence of the patient information database.

   A patient may want to communicate with the full range of medical personnel.from proximal care givers(both family members or professionals).the specialist to the assistant pathologist who has got the patient’ s specimen all meticulously lined up beneath the window.and as expected all of the above medical personnel might want to communicate with the patient at one time or the other.and of course at all levels of communication privacy is required.

   The question arises how much information ought  the patient hold?i like to visualize this on his e reader.at least as much as he held in the “paperful” days(analogy) in his file or box.now we come to a major difference,the document papers and prescriptions were all focal.that is to the patient and to those whom he wished to show them to.with pride just like a dear old album full of snapshots.now the patient’ s electronic data card or e reader are like a key, which can connect to his entire electronic health database at clinics, hospitals(private &public), onto the  rest of the health concerns ‘ connections especially thr research angle! So really how much information about his health status should be there for the patient himself?
   • 

     Malcolm Crompton

     June 14, 2010 at 8:30 am

     The question of how much

     The question of how much information a patient should be able to access and how much they should hold or be primary custodian are good questions. 

      

     But they differ. 

      

     With few exceptions, a patient should be able to access any information about them and indeed this is a right under the Privacy Act.  That said, a lot of medical information can be difficult for non-professionals to understand, so often an explanation is essential!  And many patients may not want to see it all: but they do have the entitlement when they ask.

      

     The separate question of the extent to which the patient be responsible for storage etc will require us to work it out in the best interests of public policy development.  Even if we don’t ask the patient to be primary custodian, they should be in a position to control who sees it.  As the Federal Minister has said, the focus needs to be on ‘personally controlled’ electronic health information exchange.  Working this through won’t always be easy – what about the ‘break glass’ emergency; what about dementia or when a patient is not in full control of the faculties etc.?  But again, this needs to be worked through with the dignity of the patient front and centre.
2. 

   foggy

   June 16, 2010 at 8:22 am

   patient permission

   Dear Malcolm Thanks for the differing two points-the access to information and what records(elektronic)the patient can actually hold.

    

   I remember when i was working at an hospital (in pre-electronic times),getting hospital statisics for Clinical/academic/research purport did involve a little tedious official protocol;but especially in the old and discharged cases records, the patient was nowhere in the scenario for asking any permit, no not in my knowledge!

   I would really like to know of those countries(Canada who have taken the plunge in the e-health on record availability matters;how are they progressing?is it been trial and error?or well planned out efforts burgeoning fruition!
   • 

     Malcolm Crompton

     June 16, 2010 at 11:40 am

     How are countries including Canada are going implementing eHRs..

     Which countries have made real progress with eHRs?  Seriously good question.  Canada is getting on with the job, but anybody at Canada’s Health Infoway will tell you how hard it has been.  See for example http://www.infoway-inforoute.ca/about-infoway/news/open-letter-to-canadians/canadas-ehr-progress.  The example I was giving illustrated the way of the future!  US, UK & many other English speaking countries have found it really hard.  Just start an online search & you will see that national level, broad based schemes have often struggled.  This is one of the reasons why the way ahead is likely to be in the connection and exchange of health information about the patient from relevant but disparate sources, within the control of the patient, rather than a massive, integrated system.

      

      
     • 

       foggy

       June 17, 2010 at 4:38 pm

       Canada for example

       the infoway site was excellent!Thank you.stupendous work.i liked a few points for myself.

       radiologists’ productivity has increased by 23 percent.

       last year 2.5million potential cases of drug interaction were avoided.

       significant breakthrough in post surgical cases.

       telemedicine now delivering care to over 660 rurals…

       patients waiting time drastically cut.

       if hix is developed with the dignity of the patient foremost in mind then i am sure everything will fall in place proper,and will gather Speed as problems get solved hands on.