Wednesday, September 29, 2010

The View From The E-Health Front Line. One Man’s View.

This is what I found to be a wonderful note from someone on the ground. Posted with his permission. (It is in note form - but the intent is clear!)

---- Begin E-Mail.

David,

Thanks for your article in the AUSTRALIAN this weekend.

Have visited http://www.aushealthit.blogspot.com/

Could not see where/how to add to the blog discussion.

As a medico about to retire [at 65] and having spent some 36 years in anaesthetics, may I comment:

Commenced a Health Informatics course with UTAS ... which disappointed me as the curriculum ran out of steam.

Prof did not even answer my letter.

The core prescribed reading texts for that course informed us of the billions of dollars euros and pounds wasted on ehealth.

Why don't we all learn?

Why don't "stakeholders" and "significant persons" building ehealth read the established facts/history?

I support ehealth ...

Some thoughts:

I vehemently and steadfastly support the:

"Girl in the short black skirt" interfacing ...

It is inappropriate and an ergonomic interruption to the work habits and practices of health carers/professionals to assume that they sit at a desk and use a keyboard.

The "Girl in the short black skirt" at a restaurant whips out her card on a slip string, swipes, hits the touch screen and goes.

That fast.

I witnessed Epworth Hospital Box Hill attempt to introduce a paperless system, driven essentially by pharmacy, in Melbourne.

Try as we did, and we did speak to the CEO, the Medical Director, the medico from ACT who contributed to the [hopeless] software, the full time trouble shooter from pharmacy, and others at the coal faces.

Having witnessed the CEO wishing to personally rip the wires from the walls, and the medical staff planning to jump [private] ship, I did give the IT guys a loan of my Health Informatics course texts, and suggested they read the basics.

Now, as an imminent retiree I assist the Tasmanian Medical Retrieval Service, and RFDS with medical retrievals:

Having offered my services in public as a rural locum since Oct 07 I found a Mac Air + Telstra dongle ergonomically "perfect".

Now, I have an iPad ...

{And iMac and Mac Book Pro},

Ergonomically convenient pad which does not interrupt my work flow and is a window to the net world.

On my ICU rounds I can access any net and wifi data within seconds bedside.

{And offer to ventilated patients to tap out their messages to us}

When called out on an urgent retrieval I can record the case details, communicate, look up medical conditions, refresh details of procedures such as inserting an intercostal drain, check out details of medications etc etc all on my lap in the King Air 200 RFDS aircraft, or in the back of an ambulance, en route to the patient.

All I need is my databases and a Telstra signal.

Any person involved in setting up "work stations" with keyboards in hospitals just does not understand work habits/ergonomics of healthcare workers .... especially proceduralists in theatres ...

I recall comments by midwives at Griffith Hospital in NSW in 2008:

"It takes only x time to deliver the baby and clean up and then we spend an hour and a half at the [ping] computer entering the details"

The NSWHEALTH system I witnessed being introduced at Broken Hill GWAHS in 2009 will not fly in an operating theatre suite.

Admittedly my GP does use her terminal well.

In fact, in the Western District of Victoria I set up a Peri Operative Unit and in my office we had a blisteringly fast connection courtesy of a smart CEO.

Utilising that in pre and post anaesthetic consultations, in an office actually did work very well.

{I had a duplicate screen for the patient to watch, and deleted any hospital email}

The privacy hurdle is real.

However, I do assume that the world knows who I am, where I am and what I am about to buy, already.

So .... ???

My concepts of ehealth include:

Blisteringly fast convenient "at the bedside" access to:

Patient's known clinical "Problems" list {"History"}

Significant other "History" data ... such as ...

· Trend data of past numbers

· True "allergies"

· Prescribed Rx Hx.

· and non time critical access to details of Hx events PRN

Inpatient current-admission numbers imaging and other data.

Carers' instant access to academic/journals/other quality data, in the office, at coffee, on the tram, at home, at bedside, and during a boring Keynote.

In the hospital setting ... ALL DATA AVAILABLE, STANDING ON WARD ROUND, AT THE BEDSIDE "ON THE FLY", FOR ALL MEMBERS OF THAT WARD ROUND, on their own iPad.

SCREEN TAP DATA ENTRY/RETRIEVAL AS A FIRST PRIORITY INTERFACE MECHANISM .

One patient One system ....

Same data retrievable at GP, in DEM, in private, in public ...

Dr George Waters

----- E-Mail Ends.

Thanks George. I especially like your emphasis on speed, ease of use and ubiquity of information access.

David.

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