Australia’s Northern Territory – An E-Health Leader?

The following press release appeared a week or two back from NT Health. At the same time it is announced HealthConnect is officially dead – or so it would seem – the name having been abandoned.

http://www.nt.gov.au/health/ehealthnt/documents/media2008jan18.pdf

Regional centres sign up to the Shared

Electronic Health Record

21 January 2008

Territorians are signing up to participate in an electronic system which is connecting health services under the eHealth NT program.

The eHealth NT Shared Electronic Health Record allows individuals to have their important health information stored in a secure repository, accessible from multiple health sites, with their consent. The Territory is a national leader in the implementation of the new system.

The new service is particularly valuable for individuals who change GPs, or who use multiple health services, as it helps health care providers, including hospitals, GPs and health centres, to securely access an up-to-date overview of an individual’s medical history.

Director of eHealth NT Shared Electronic Health Record, John Fletcher, said instant access to up-to-date health information can mean the difference between life and death for patients, particularly in an emergency situation.

“This service being implemented across the Territory means health consumers can be reassured that there is a secure system that allows doctors, and other health care providers, to access their health information. For a highly mobile population, as the Territory has, this system represents a major leap in patient care, especially for people who use different GPs, or a number of health services. Individuals no longer have to request copies of information from their patient records, remember medications, and other treatment information – it’s already there, and instantly accessible, if you’re signed up for the Shared Electronic Health Record.

“Electronic transfer of health information is a much quicker, more secure and streamlined process. It’s a giant leap forward in improving continuity of care, particularly for Indigenous Territorians. Implementation has only been possible because of the support of the Major Aboriginal Medical Services and their representative bodies, AMSANT and KRAHRS, Northern Territory Public Hospitals and Private GP Practices.” Mr Fletcher said.

Katherine Region registrations are largely completed and registration teams are currently targeting the areas of Batchelor, Adelaide River, Acacia, and Borroloola, Daly River, Nguiu, Darwin as well as residents living in the Tennant Creek / Barkly areas where a significant number of Territorians have registered and in Central Australia at communities including Ali Curung, Amatjere, Willora and Tara.

Opportunities for registration will also be available at the Imparja Cup in Alice Springs between February 11 and February 16.

To date more than 15,000 Territorians have registered to participate in the SEHR and over 900 professionals are registered participants.

The eHealth NT Shared Electronic Health Record is a joint Australian and NT Government initiative. It stores patients’ summaries electronically in a secure repository which provides rapid access for participating providers, and eliminates the need for paper records to be faxed or mailed, or for multiple telephone calls between providers.

The Shared Electronic Health Record was first trialled in Katherine after research had shown that communications barriers between different providers of health care for Indigenous Territorians were resulting in hospital re-admissions, service duplications, and self-discharges – all having a potential for adverse health outcomes.

Release Ends.

Obviously to discover more was irresistible – had nirvana arrived I wondered.

The initiative has a web site and this can be found here:

http://www.nt.gov.au/health/ehealthnt/index.html

A later press release also makes some pretty big claims

eHealth in first place at the Imparja Cup

Wednesday 30 January 2008

eHealthNT’s Shared Electronic Health Record is delighted to be a major sponsor of the 2008 Imparja Cup, the pinnacle of Indigenous cricket.

The Shared Electronic Health Record (SEHR) is a dramatic advance in health care delivery, allowing patients to have their health records stored in a secure repository, accessible from multiple health sites, with patient consent. The Territory is a national leader in the implementation of the new system.

John Fletcher, Director of the eHealthNT SEHR, said that instant access to accurate health information can be the difference between life and death, particularly in emergency situations.

“The new service means patients can be reassured that there is a safe system allowing doctors, and other health carers, to access their health information. For a highly mobile population, as the Territory has, this system represents a quantum leap in patient care, especially for people who use different GPs, or a number of health centres. Patients no longer have to request file material, or recall prescriptions, and other treatment information – it’s already there, and accessible, if you’re signed up for the SEHR.”

Read more at site

http://www.nt.gov.au/health/ehealthnt/documents/media2008jan30.pdf

What is really being done here is made clear when the following page is browsed:

http://www.nt.gov.au/health/ehealthnt/sehrs/technical.html

In summary what is happening here is that the secure messaging system Argus is being used to transfer discrete records, with patient consent, to a repository. The repository is arrange by patient record number. The server / repository has a record viewer that can display these records.

All this is, as NT claims, way ahead, in a conceptual sense of what is happening elsewhere in Australia – and for that it deserves the strongest commendation and encouragement but there are some issues.

On the positive side it is great that a rational and appropriate approach is being adopted to patient consent and patient control – although it would be good if in a later release the consumer could access and review their record with the doctor possibly explain what it all means.

The problems I see with the architecture approaches being deployed are:

1. A possible lack of scalability of this architecture beyond 2-3 times the present number of users without a range of issues emerging.

2. The rather lump like nature of the data being captured. A newer version might use some of the recognised data and information standards for health summaries.

3. The potential lack of robustness of the document identification numbers with some attendant risks for document mix up.

4.The possibility of a lack of granularity as to just what records a particular provider may access. The risk of abuse of such a system rises exponentially with the number of users who have access to the database.

It is worth noting that the Argus e-mail technology is also being used to enable secure doctor to doctor messaging and the e-prescribing pilots.

I look forward to some evaluation of all this work so the appropriate lessons can be learnt and adjustments made to make it all work more successfully and safely than now.

Well done to the team and I hope they can continue for forge ahead. Their site is well worth a browse to understand what is happening in the Top End. However, that this would be seen as progress really shows just how behind Australia is compared with places like NZ, Denmark, Holland the UK and so on.

In passing I note that the NT web site provides official confirmation of the death of the Australian HealthConnect program – even the name has now been abandoned! I wonder what will become of the SA, NSW, Qld and Tasmanian manifestations of this totally discredited and shockingly managed waste of public money – no wonder NT was keen to see the name go! The silence from all these has been informative. I note the Tasmanian program now says it is in its final stages and SA HealthConnect is changing project names and saying it is out of funds in August 2008 – unless renewed!

David.