Service Improvements

This tiny corner of Cyberspace has now been operational for going on for three months. In that time we have added about thirty articles commenting on the various issues as they emerge in the e-health space in Australia.

While a .atom feed and I believe and RSS feed are available - I have now managed mastery of enough html to provide e-mail updates as well. You can subscribe on the site and it does its best to make sure your e-mail is secure and that you can opt-out again as required. Feel free to tell friends and enemies that they can now know quickly about the views I am putting.

While I have your attention let me make a few points about the experience of writing the blog. First it has been useful in clarifying my thoughts and positions and has acted an interesting exercise in exploration of a range of issues - prompting extra research etc which is all to the good.

I have to say that there are ominous portents for e-health in Australia brewing. First is the awareness that Medical Observer magazine has taken the e-health section it used to have off its website. Seems no one is interested.

Second we note that HealthConnect has been removed in all its guises from the recently announced Australian Budget.

Thirdly there seems to be a pervasive feeling of despondency regarding what is possible in Australia given the politics and Governments (of all shades) views. I see this most in the nihilism and frustration expressed in private e-mail and in correspondence in the GP_Talk forum, HL7-Info and OpenHealth.

The really annoying thing is that it is now clear Health IT, done right, works! It improves care, saves lives and in the hands of competent organisations saves money!

See below for the best facts currently available.

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Chaudhry B, Wang J, Wu S, et al.

Impact of health information technology on quality of medical care
Annals of Internal Medicine 16 May 2006; Volume 144 Issue 10 (early on-line publication)

http://www.annals.org/cgi/content/full/0000605-200605160-00125v1

Background: Experts consider health information technology key to improving efficiency and quality of health care.

Purpose: To systematically review evidence on the effect of health information technology on quality, efficiency, and costs of health care.

Data Sources: The authors systematically searched the English-language literature indexed in MEDLINE (1995 to January 2004), the Cochrane Central Register of Controlled Trials, the Cochrane Database of Abstracts of Reviews of Effects, and the Periodical Abstracts Database. We also added studies identified by experts up to April 2005.

Study Selection: Descriptive and comparative studies and systematic reviews of health information technology.

Data Extraction: Two reviewers independently extracted information on system capabilities, design, effects on quality, system acquisition, implementation context, and costs.

Data Synthesis: 257 studies met the inclusion criteria. Most studies addressed decision support systems or electronic health records. Approximately 25% of the studies were from 4 academic institutions that implemented internally developed systems; only 9 studies evaluated multifunctional, commercially developed systems. Three major benefits on quality were demonstrated: increased adherence to guideline-based care, enhanced surveillance and monitoring, and decreased medication errors. The primary domain of improvement was preventive health. The major efficiency benefit shown was decreased utilization of care. Data on another efficiency measure, time utilization, were mixed. Empirical cost data were limited.

Limitations: Available quantitative research was limited and was done by a small number of institutions. Systems were heterogeneous and sometimes incompletely described. Available financial and contextual data were limited.

Conclusions: Four benchmark institutions have demonstrated the efficacy of health information technologies in improving quality and efficiency. Whether and how other institutions can achieve similar benefits, and at what costs, are unclear.
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Just what has to be done to get NEHTA to develop and articulate a comprehensive e-health plan and to persuade Government to adopt it, is feeling as though it is beyond your simple scribe.

I will, however, press on!

David.