Sunday, July 14, 2013
What Is The Biggest Issue With E-Health At Present? I Don’t Think It Is What You Think.
This week we have the most recent Health Information Society of Australia (HISA) annual conference in Adelaide. (15-18th July, 2013)
You can download the program here:
I thought I would have a browse to see what was being featured.
Reading through there was lots of emphasis in Digital Health and following patient journeys in areas such as oncology and mental health.
What seemed to be missing was some sense of how the overall e-Health initiative was going and any serious retrospective review of what has gone on to date and what real outcomes have been achieved that make measurable differences to cost, quality and actual clinical outcomes for the health system.
I guess my point is that what is going on is not being strategically co-ordinated and more importantly we do not seem to be measuring the things that matter - i.e. the impact technology is having on the overall health system and what benefits are flowing overall - and not just at a particular institution with a particular narrow expertise.
Astonishingly it seems everyone speaking at the conference is so convinced everything is just fine and dandy that titles suggesting we have all the basics in place with e-Health and now need to elaborate, complexify and move forward. A search of the program reveals one hit for PCEHR and one for ‘record system’ do clearly that is seen and being done and dusted.
I would suggest that what we are seeing is a evidence based fantasy at the macro and outcome level. We have not measured and reported anything meaningful regarding the NEHRS / PCEHR for example other than the numbers enrolled - rather than the levels of actual use and actual clinical impact and even simple usage stats are unavailable.
This says it all:
9 July, 2013 Paul Smith
The number of shared health summaries created by GPs for the personally controlled electronic health records system is little more than 1100 — about 0.3% of nearly 400,000 patients who have been recruited to the billion-dollar scheme.
Health summaries are meant to be the backbone of the PCEHR and will list patients' current diagnoses, medications, allergies and immunisation histories.
However, there have been ongoing concerns about the workload the scheme will generate for GPs.
Doubts have also been raised over whether the profession will agree to take on the task of managing the summaries, which are designed to help streamline care with other health providers, such as hospitals and specialists.
The number of shared health summaries was obtained by Australian Doctor in May.
The Department of Health and Ageing did not respond when asked to provide an updated figure.
All this just goes back to a theme I have mentioned a few times on this blog - being that what we need is to do the absolute basics well, show those basics are actually working to deliver the benefits expected and then - in an incremental evidence based way - move forward measuring what we do for the population as a whole.
Reading as I do about what is going on overseas I am getting a distinct sense that the e-Health world is dividing into the excited spruikers who a technology focussed and sure all is well and the much more realistic and pragmatic who are realising that benefits delivery will be very hard and that issues of useability, complexity and safety in actual use in the hands of ordinary clinicians.
What is happening in the universities, research labs and the facilities lucky enough to have great leadership and motivation is fine - but diffusion into the real world is a much more challenging issue. We are a long way from that I believe.
I hope people have a great time in Adelaide and give a moment or twos thought to the bigger and much less clear picture.
Posted by Dr David More MB PhD FACHI at Sunday, July 14, 2013