Tuesday, December 23, 2014

A Challenge: What Are the Five Things Australia Needs To Do To Develop A Transformative, Cost-Effective e-Health System?

In welcoming the appointment of the new Federal Health Minister the Consumer Health Forum raised 5 key points it wanted to see actioned.
The second point was as follows:
“2. Commit to eHealth: The revolutionary changes (and cost savings) possible in health care through the introduction of a robust, consumer-centred eHealth system cannot be underestimated.  Funding commitments must be made beyond 2014-15 to realise the potential of this system.”
In a brief response to this point I suggested that I was keen to have some of what the authors were inhaling on the basis that I believed to imagine that such was possible, if the present directions and approaches were continued and funded, was rather unrealistic.
Here is the full link:
Hardly surprisingly I was challenged to say what I would do in five points - so here goes.
Action One:
Recognise that there are two distinct clients for e-Health systems and services and that their needs are not by any means the same - meaning that different systems are required for each. The professional clients (doctors, nurses, allied health etc.) need systems that enhance their clinical capabilities, improve record keeping and facilitate their secure sharing of clinical information to improve patient care and safety.
The consumers need systems to allow them to record their own information while at the same time having access  to, ideally, the live clinical systems so they can better engage with and understand and contribute to their care.
It is obvious the present PCEHR does neither of these things well.
Action Two:
We need to recognise we don’t need a single monolithic System but that we need an e-Health ecosystem where health information flows efficiently, accurately, securely and privately between appropriately credentialed actors within the health system and to and from consumers.
Action Three:
We need an updated National E-Health Strategy that consults all stakeholders properly and provides the  governance, leadership, strategic technical, standards and managerial pathways to actually achieve the goals cited by the CHF for this domain. We then need the Strategy properly funded and led - as did not happen with the 2008 version.
Action Four:
Before anything more is done or spent actually undertake a proper in depth peer-reviewed evaluation of what e-Health in all its guises has achieved in Australia and what has been achieved in the rest of the world that might be applicable to Australia. This research should inform what comes next.
Action Five:
We need to understand that no-where in the world has a transition to e-Health been easy, uncomplicated, pain free or without missteps. As we increasingly realise, getting this right is a very considerable and some might suggest near impossible challenge that takes lots of time, lots of money and dedication - as well as quality leadership and governance for success. E-Health is not something for generalist bureaucrats and technicians to have repeated goes at and repeatedly fail at!
I could ramble on for ever on this - but it what is said above is taken seriously, actioned and funded there is hope. If not then the next 20 years will be the same as the past 20!


Bernard Robertson-Dunn said...

re: “2. Commit to eHealth: The revolutionary changes (and cost savings) possible in health care through the introduction of a robust, consumer-centred eHealth system cannot be underestimated. Funding commitments must be made beyond 2014-15 to realise the potential of this system.”

Note the qualifiers in this and other claims for eHealth. Words like "possible" and "potential" are frequently used, however the reality has never been demonstrated. It should also be noted that most of the claims for eKHealth come from people who want to see money spent in their direction - a classic case of vested interest.

And to be clear, I draw a distinction between Health IT (sensors, monitors, prosthesis, etc) and health record systems which are used for health decision making (eHealth).

IMHO, so far eHealth is a worthwhile goal, but, it's like Gandhi's reply, when asked what he thought of Western Civilisation - “I think it would be a good idea.”

eHealth hasn't happened yet and nobody knows how to do it. Any approach needs to recognise this and proceed in a manner that takes small steps and learns and relearns from the mistakes inevitably made. Unfortunately, the PCEHR was a big step, a big mistake and it is very difficult to learn lessons, because so many big mistakes were made.

I suggest that the only really useful lesson to be learned is that the way it has been done so far is the wrong way. What it hasn't shown is a better way.

Anonymous said...

Can we have change for the future while those responsible for current are still holding the design authority strings, I doubt they would want the lessons to be learned to be exposed. All the while the debt increases and the hole gets deeper, consultantion get shallower. I am sure the CHF will be warmly embraced, they are filling a void. Lets see if this health minister has what it takes. Cut the crap Minister

Terry Hannan said...

Bernard, I cannot fully agree with your statements re non-established effectiveness. Here are some readings you may be interested in.
(1-3) For Reference 1. The COMPLETE issue of the IJMI covering 25 years of effective clinical computing.
OpenMRS: www.openmrs.org and (4, 5)

1. Safran C. Editorial. Int J Med Inform. 1999;54:155-6.
2. Safran C, Porter D, Lightfoot J, Rury CD, Underhill LH, Bleich HL, et al. ClinQuery: a system for online searching of data in a teaching hospital. Ann Intern Med. 1989;111(9):751-6. Epub 1989/11/01.
3. Safran C, Sands DZ, Rind DM. Online medical records: a decade of experience. Methods Inf Med. 1999;38(4-5):308-12. Epub 2000/05/11.
4. Braitstein P, Einterz RM, Sidle JE, Kimaiyo S, Tierney W. "Talkin' about a revolution": How electronic health records can facilitate the scale-up of HIV care and treatment and catalyze primary care in resource-constrained settings. J Acquir Immune Defic Syndr. 2009;52 Suppl 1:S54-7. Epub 2009/11/05.
5. Tierney WM, Achieng M, Baker E, Bell A, Biondich P, Braitstein P, et al. Experience implementing electronic health records in three East African countries. Stud Health Technol Inform.160(Pt 1):371-5. Epub 2010/09/16.
A Quiet Revolution
Strengthening the Routine Health Information System
in Bangladesh-full pdf available on request.

Oliver Frank said...

Well said, David. I like your five steps.

Anonymous said...

Anon Dec 23 11:39. I cannot see any real change happening under the current umbrella. My guess is there will be a push for revised specifications, at a minimum NeHTA will need to refresh those that have gone through standards. I Think we may start seeing just how badly NEHTA has undertaken product management. I hope I am wrong and the proof will be in the fullness and richness of the revised specifications. 2-4 years is Quite a long time and we can't live on clinically validated data alone

Bernard Robertson-Dunn said...


Thanks for the references, but three of them are last century, one is very specific (HIV in resource constrained setting) and the last is in the context of African countries.

Can you point to any studies a) in the Australia/America/UK context and/or b) a bit more recent?

I have read many studies on large scale (read national) eHealth record systems not working and very few (approaching zero) on where they have been a major success.

What would be really interesting is a review of the use and benefits of the Singapore system (on which ours is based), although their social context is very different from ours.