How Could e-Health Help in the Northern Territory.

Unless readers have been hiding under a rock over the weekend they will be aware the Prime Minister has declared the situation with sexual abuse of children in the Aboriginal Community to the a “National Emergency”. All sorts of actions are planned to address the problem – among them being a compulsory “health check’ for the approximately 23,000 Aboriginal children under 16 in the Northern Territory (NT).

Estimates I have seen suggest that to undertake this task will require about four times the number of doctors who presently work in the NT. This will inevitably bring a range of informational and continuity of care issues into stark relief as many of the doctors who assess the children will be on a ‘fly-in / fly-out’ basis.

Just as the emergency of Hurricane Katrina provided an opportunity to show how e-health could make a difference – leading to the implementation of a now operational permanent emergency medication management system – it would be a valuable outcome if the same thing could happen out of this emergency.

The issues that seem to need to be addressed include:

1. Ensuring the consistency and quality of the clinical examinations provided by what will inevitably be a transient medical workforce – at least in the first instance.

2. Ensuring that there is ease in follow-up of any clinical problems identified by having a sharable standardised record which will be used by all clinical care-givers

3. Ensuring there is appropriate collection of information to guarantee the clinical outcomes of the children can be assessed and tracked to ensure the interventions are making a real difference to the health status of those being intervened upon.

4. Ensuring capture of relevant clinical information at the source of its creation to ensure observational accuracy and reliability.

To be successful any proposed solution will need at least to have the following attributes:

1. Be easy to use for the relevant clinicians

2. Be deployable ‘well of the beaten track’. (i.e. it will need to utilise satellite internet or some equivalent)

3. Be portable as far as the clinical user is concerned.

4. Provide structured information capture to ensure all relevant checks and assessments are made. (The information contents to be captured should be developed by experienced Paediatric Clinicians from the NT such as Dr Paul Bauert, who is spokesman for the Paediatrics and Child Health Division of the Royal Australasian College of Physicians and head of Paediatrics at Royal Darwin Hospital).

5. Be able to facilitate quality co-ordination of care when there is no stable local GP to play that role.

6. Address the issues associated with the identification of Aboriginal individuals who have a view of names and identity that is rather more fluid than while Australia.

While not wishing to be prescriptive I would see the use of something like the openMRS (http://openmrs.org/wiki/OpenMRS) which has proven itself to be a very viable approach to the management of a reasonably defined clinical domain in areas such as Africa.

(An example is reflected in the following news item from the site:

Happy Anniversary to the AMRS team! 14-Feb-2007 is the one year anniversary of the OpenMRS implementation in Eldoret, Kenya. To date, the system has stored close to 10 million patient-level measurements on 43,000 patients who have accumulated ~450,000 visits. Congratulations.).

Another possibility would be the use of the HL7 CDA or similar standard to define the information content to be captured. The openMRS approach may be preferred because of its dual layer data-model but this is extreme detail at this point.

I believe this or some similar approach could and would address the issues I identify, is practically achievable and would make a huge difference!

The advantages of a web-based system used in the field to collect, enable action upon and measure the outcomes of interventions are compelling to me and I suspect to anyone else who understands just how complex the clinical information logistics of this intervention would be if undertaken on paper.

There is a very short window to act..I would be interested to know what others think. This looks like an opportunity to make a difference to me!

Corrections, comments and other suggestions welcome. (This is a work in progress and may change depending on feedback)

David.