Tuesday, January 13, 2015
A Belated Welcome To 2015. I Wonder How It Will Play Out In E-Health? I Am Not All That Confident For Now.
Over the holiday break I was challenged to suggest what might be needed to make a positive difference in e-Health.
What I suggested then were that five actions were needed. These were:
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.
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.
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.
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.
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!”
Most who commented rather liked what I had suggested but still seemed rather pessimistic about the next decade or so. I think, on reflection, that what I missed in my post was that these five actions need to be seen as an integrated package. All five areas need to be properly, openly and transparently addressed. You, for instance, can’t develop a quality strategy and then not fund it - as happened in 2008 - and you can’t change management without making sure they have a clear strategy, commitment and real funding.
There is no doubt that 2015 will be a pretty interesting year with a new Federal Health Minister who has the PCEHR ‘hot potato’ placed right in the middle of her desk and who lacks any apparent expertise, right now, in the Health or E-Health sector. Deciding what to do with the PCEHR is going to be one of the most difficult parts of the portfolio, if we ignore the extreme difficulty of sorting out what to happen with the Plan B Medicare Co-payment - now that the AMA and the RACGP are now running public campaigns against the plan.
To me if the PCEHR is a ‘hot potato’, the co-payment is a grenade with the pin removed!
The old curse of ‘May You Live In Interesting Times’ is more that apposite and the times may indeed turn out to be more than challenging!
Posted by Dr David More MB PhD FACHI at Tuesday, January 13, 2015