The Children of HealthConnect – How are They Going – Part 2?

This is the second article on the children of the now defunct Federal HealthConnect program. It covers initiatives that are branded as HealthConnect in Tasmania and the Northern Territory (NT).

Northern Territory.

There are essentially two projects under development in the NT, with the initial Shared Electronic Record being in abeyance either permanently or until NEHTA develops and publishes implementable standards some time in 2008 (on the current plans).

HealthConnect NT does not appear to have its own project web site.

The Northern Territory Department of Health and Community Services (DHCS) is responsible for implementing HealthConnect and other leading e-Health initiatives in the Territory.

Project 1 is the Point to Point (P2P) service, a secure electronic communication network between health professionals across approximately 200 potential sites in the Top End commencing in Darwin and Katherine.

The HealthConnect funded Point to Point (P2P) Service is based at the Top End Division of General Practice in the Northern Territory started in September 2005. The technology used is secure e-mail using Argus as the e-mail client

As of June 2006 approximately 50 practices have been connected to a range of specialists. It is planned to gradually extend the network to also cover ancillary services, pathology and radiology etc as well.

Further extension to more remote areas is planned for 2007.

Project 2, which will involve electronic prescription transfer, is being planned to start in mid 2007 according to the ArgusConnect CEO in a recent e-mail.

As far as this all goes it is a distinctly good thing to improve communications between practitioners in the NT.

There are however a range of practical and strategic issues with all this.

First Argus is a software product that, while having the GP client being ‘open source’ has only a limited guarantee of long term supported commercial viability. That is not to say failure is guaranteed but rather that it is possible and this needs to be factored into decisions to adopt Argus. (As the user base grows this risk will hopefully drop).

Second the utility of the product is very much dependent on the network effect (i.e. it becomes more useful the more users there are – much like the telephone). The competition in this market segment makes reaching critical mass by no means certain.

Third the choice by Argus to make their client software free continues a trend that at least some would suggest has had a severely distorting effect on the growth of the clinical software market in Australia.

Fourth the need for a centralised directory for e-mail addresses etc to contact other Argus users introduces the ‘single point of failure’ issue that Argus competitors are said to have, albeit in a less acute form.

Fifth the choice of communication standards adopted by Argus – while practical at present – may prove to be somewhat limiting in the future.

With this said, this seems to me to be a worthwhile initiative that should be watched closely as it evolves and at some point evaluated to see just what level of value is being received for the costs involved and how the total costs of ownership and operation compare with the alternatives.

It does also need to be said that, although branded HealthConnect, this project bears scant resemblance to the 2004/5 Business Architecture (Version 1.9) envisaged for HealthConnect originally.

Tasmania.

For some reason, seemingly associated with a certain Tasmanian Senator, there have always seemed to funds available for speculative technology ventures – especially of the electronic kind. Tasmania’s long path to success was chronicled in the Launceston Examiner last year.

“LGH Launches New System

By Alison Andrews, Tuesday, 4 October 2005, Courtesy of the Launceston Examiner.

The days of doctors' notes are numbered with the launch of HealthConnect at the Launceston General Hospital yesterday.

The national health information network has been three years in the making and will mean that LGH doctors will be able to send a note about patients to their local general practitioners electronically rather than in traditional paper form.

The system was trialled in Southern Tasmania three years ago, concentrating on people with chronic diabetes, while the LGH was a test site for an associated initiative, MediConnect.

This offered secure electronic information between hospitals, doctors and pharmacies to help improve quality and safety in the handling of medicines.

The new system, to electronically link hospitals and GPs, will start in Tasmania at the LGH, and next month will include the launch of HealthConnect's admissions and discharge notification project, said the services' director Mary Blackwood.

"That will allow immediate notice of a patient's admission and discharge," Mrs Blackwood said.

HealthConnect is a national initiative supported by the Federal Government. Tasmania and South Australia are the first two states to introduce the new communication system.

Launceston GP Jennifer Barker welcomed its launch.

"GPs are always busy and it is good to know that we are moving beyond the trials to the implementation stage," she said.”

This exciting innovation is the so called Electronic Notification of Hospital Events (ENHE) project, where a fax or e-mail is sent to a GP, with the patient’s permission, to let them know their patient has been admitted or discharged from Hospital. No clinical information is sent – just an administrative notification.

Flush with the success of this awesomely complex project a new project has been commenced. This time the discharge notification will also have the discharge medications listed. The scale of the advance has meant the project is now termed the Patient Discharge Medication Record pilot (PDMR).

To quote the project site “The PDMR that is sent to the GP will contain comprehensive medication details, and will have a multi-disciplinary focus, allowing notes from doctors, allied health, and nursing staff to be added.” This project is at present just a future and no time line or additional information has been made available as yet. We will wait and see!

HealthConnect Tasmania is also involved in projects that have nurses communicate warfarin test results to GPs so they can adjust dosage, a GP Assist Call Centre to divert calls from the public to the right information source, and the use of laptops for the ambulance staff to record their transport details (a copy of an already operational Melbourne system).

The recently published 2006/07 Health Connect Tasmania work plan (dated 22/11/2006) bring tears to the eyes in terms of vagueness and obfuscation – as virtually all HealthConnect documentation has done since the end of 2004.

HealthConnect Tasmania Work Program 2006-07

In 2006-07 the HealthConnect Tasmania work program is progressing in three key areas:

• HealthConnect Tasmania Core Activities, including: eHealth promotion and communications, eHealth governance and evaluation, eHealth policy, planning and support, and eHealth core systems and services;

• HealthConnect Tasmania Partnerships which is largely the management and expansion of the HealthConnect Tasmania Outposted Officers program within key stakeholder organisations; and

• HealthConnect Tasmania Sponsored Projects, a program of projects which are collectively progressing the national outcome, “enabling health care providers to have access to a broader range of information through standardised secure electronic communication”.

It is hard to know just why this was published when the period affected is already half over. Typically plans are finalised and published before they commence. It is even harder to know just what all this actually means!

Again we find the HealthConnect banner being used to fund and sponsor conducting trivial, non-standardised, repetitive and utterly non-innovative projects. The lack of strategic direction and national value is really appalling and very sad.

As a final note, it is clear the HealthConnect web site, while updated regularly, has not been reviewed for content currency in a while. It is still – as of early December 2006 - extolling the virtues of the Medicare Smartcard – oblivious to the fact this has apparently been abandoned in favour of Joe Hockey’s Access Card months ago.

Overall these two posts have described a dramatic fall back and withdrawal of the Federal Government from old HealthConnect the vision and a sad collection of trivially simple, non-standardised, non-scalable projects which seem to have little intrinsic value and which lead essentially no-where. The $128 Million of funding supposedly spent on all this could surely have been much better spent than this.

The NT Point to Point Project (using Argus) is the only slightly bright light, despite its possible flaws, on a very dark landscape.

David.