National E-Health Strategy – Some Useful Resources.

Since it seems we are to have an E-Health Strategy developed for Australia (again) it seems to me it would be worthwhile to put together a few thoughts and to point to a few places that might be worth visiting.

As regular readers will know I have been on about this topic for a while. Looking back it seems I first raised the issue almost 2 years ago. See:

http://aushealthit.blogspot.com/2006/03/what-is-australias-national-e-health.html

This was followed up a little later by some thoughts that still seem pretty relevant.

Sunday, March 26, 2006

An Australian e-Health Strategy – Why, What and What Could It Achieve?

It seems your humble commentator has been ruffling the feathers of the great and powerful in the e-Health domain. I say this not because anything negative has happened but rather that some of my suggestions appear to be causing at least a minor response. It could be, however, that I am just an optimist and the improved information flows and so on were going to happen anyway. No matter, it is all to the good. Well done NEHTA.

The central issue in e-health as I see it is that Australia has not developed, articulated, discussed and agreed a National e-Health Strategy, which brings together all the work being undertaken around the country, assembles it into some sort of coherent whole and provides forward direction and leadership for all involved. In response to the apparent movement from NEHTA I want here to expand my arguments and suggest just what the National Strategy I am proposing may look like.

Before doing that I must answer the “why do we need one?” question. This is easy. Without a plan in virtually every walk of life there is a tendency to see a lack of progress, waste of resources and repeated false starts. The reason this sounds familiar is that this accurately describes the National progress in the e-Health domain. As a colleague so delightfully puts it – all we have seen is largely ‘Brownian Motion’ with no solid progress in any direction. In large projects, such as National e-Health, even with a plan progress can be difficult and slow, but without one failure is inevitable. The second reason we need a plan in my view is that we humans work best and contribute most if the goals and objectives are clear – hence the need not only for a plan, but for it to be publicly articulated and communicated.

On the basis that we need the plan, what should it contain and what factors and constraints should it consider.

Before anything is done the first step is to ensure it makes sense to proceed with planning. This is done by developing a generalised Business Case for National e-Health implementation. If overseas experience is any guide this will confirm the need for action and a plan.

What is involved in doing a plan? The first thing the National Strategy needs is a current view of just what is going on everywhere, and what is working well and needs to be preserved and encouraged. Next, once we have worked out where we are we need to work out where we need to be. This will involve a lot of consultation with all interested stakeholders to develop a vision of future Health Service delivery and then ensure we can put in place the technology to make it work. Fortunately there has been a lot of work done on the desired future state of the Health System and this can be utilised to guide the planning of the supporting technology initiatives.

Out of the requirements and consultative process there should emerge a number of options reflecting the use of different technical approaches, different priorities, different levels of preparedness to invest and so on. These will ideally be worked up into three or four roadmaps and then a second consultative process with stakeholders and the public will choose the most appropriate. This roadmap will then be worked up, in detail, and all the implications for consumers, professionals and others, risks, costs and so on thought through.

At this point there will exist both a clear reason for action and agreement at a high level as to what direction should be taken.

What might an overall strategy look like. The objectives and mission are easy. What we want from technology is better co-ordination of care (only answer questions once, don’t fall between the system’s cracks etc), greater safety with relevant knowledge provided to carers at the point of care, greater efficiency of service delivery at all levels and ideally our own little personal health record that has all our health information securely stored so that when needed it can be made available to those who need it – our doctor, nurse or who ever.

What technologies and systems do we need? Essentially there are five.

First all our hospitals need clinically rich and administratively effective internal systems that enhance patient safety and operational efficiency. These you can buy off the shelf from a range of Australian and overseas vendors – (IBA, Cerner, etc). These need to be advanced systems that provide excellent care documentation and physician order entry with advanced decision support.

Second our GPs and Specialists need similarly effective systems which manage all aspects of our care electronically and can receive and transmit information (referrals, prescriptions, test requests etc) securely and safely. These can be obtained reasonably cheaply but ideal ones are still a little way off.

Thirdly we need service providers (Specialists, Laboratories, Radiological Practices, Pharmacists etc) to provide their product (i.e. reports etc) electronically. Systems to do all of this are available off the shelf.

Fourthly we need in place a secure set of message standards to allow the information to flow where it needs to go safely and privately. These exist in simple form and are improving quite quickly.

Lastly we need some Standards to ensure all information that flows can be properly and reliably linked to the individual it relates to and contains information in a form that can be properly actioned by the receiving system. These largely exist today.

With some will, and a rational funding plan that pays those who create the information that is of benefit to those who get to use it, implementation need take no longer than three to four years. The Implementation Plan will need to adopt a simple, walk before you run, bottom up style but is eminently doable for reasonable cost given the potential benefits.

There will be some issues with integration with previous initiatives but there is nothing that is not doable in all this, other than the need to have a plan and the will and resources to execute it.

What could this achieve? The answer has not yet been fully worked out but if the experience overseas is any guide savings of 5-10% of the health budget and a considerable reduction in clinical errors of all sorts is well within our grasp. We should stop talking about it and get on with it!

(Please note - for the expert readers - this commentary is very high level and lacks detail - but I am convinced it is basically sound - comments welcome!)

David.

Also here a little later

Sunday, June 11, 2006

An Australian e-Health Strategy - The Outline

As the sole reader (nod to Crikey.com) of this blog is aware I have been saying for a while now that Australia is being badly short changed by the lack of a coherent national e-health strategy and implementation plan to frame and put in context both NEHTA and the various State and Commonwealth initiatives.

While developing relatively more comprehensive documentation for publication initially in a different forum, it has occurred to me that what I feel is required can be very simply summarised. In summary what is needed is a two prong approach :

1. The NEHTA work plan to be supported and advanced and where possible and useful increased investment made. In saying this I am recognising that NEHTA will not deliver much of practical use until 2008/9 by its own estimation and that NEHTA will need to operate for a good deal longer (in perpetuity actually) and that reaching its apparent goals may take a good deal longer than a “transition” timeframe.

2. There should be a separate national initiative to get in place nationwide proven health information systems that are known, already to be both practical and to make a real difference to the quality and safety of health care delivery.

I see there are five areas such an initiative should cover.

a. General Practice and relevant office based Specialists should be encouraged and provided with incentives to obtain and use advanced ambulatory EHR systems with sophisticated Clinical Decision Support.

b. Secure Clinical Messaging should be established between Laboratories, Radiology Practices, Hospitals and GPs with documents to be exchanged to include discharge summaries, specialist letters and pathology and radiology reports (and maybe images)

c. Public and Private Hospitals should all implement appropriate clinical and patient management systems including Clinical Physician Order Entry, Nursing Documentation and Medication Management using “closed loop” drug administration control.

d. Health Insurers and Medicare should offer their clients Personal Electronic Health Records where individual can record important health information for use, by those they authorise, in their care.

e. There should be a concerted push by the Commonwealth to establish appropriate disease pattern incidence and monitoring systems for monitoring epidemic disease outbreaks and bioterrorism.

All this is totally feasible today using commercially available and in some cases ‘open source’ software. The only block to major progress in the short term and a better long term future is a strategic vision and the appropriate funds. The paralytic inactivity of the Commonwealth in not setting such an proven and doable agenda is a public scandal I believe.

This is all so obvious I am alarmed someone did not think of it ages ago!

David.

Other resources which also need careful review are:

1. The Health Informatics Society of Australia E-Health Strategy Survey.

This can be found by following this URL.

http://aushealthit.blogspot.com/2007/11/hisa-develops-plan-for-australian-e.html

This is a unique and valuable contribution to current thinking on the topic in Australia.

2. The BCG Review of NEHTA and the NEHTA response are useful for a report as to where things were as of October 2007 at the top level.

See here:

http://www.nehta.gov.au/index.php?option=com_docman&task=doc_details&gid=421&Itemid=139&catid=-1

and here:

http://www.nehta.gov.au/index.php?option=com_docman&task=doc_details&gid=423&Itemid=139&catid=-1

3. Dr Andrew McIntyre of Medical-Objects has produced a useful blog exposing his views on the topic as an important developer in the e-Health space.

See the following URL.

http://blog.medical-objects.com.au/?p=34

Additionally a search of my blog finds pointers to all sorts of plans being undertaken in other countries.

Examples include:

Scotland

http://aushealthit.blogspot.com/2007/12/scotland-updates-its-e-health-strategy.html

and

http://www.ehealth.scot.nhs.uk/

The USA

http://aushealthit.blogspot.com/2007/12/usa-plans-to-refine-its-national-e.html

and

http://www.dhhs.gov/healthit/

and

http://www.whitehouse.gov/news/releases/2004/04/20040427-4.html

The United Kingdom

http://aushealthit.blogspot.com/2007/10/shared-electronic-health-records-coming.html

Ireland

http://www.ehealtheurope.net/news/2935/ireland_to_invest_euros_500m_in_e-health

Europe

http://www.ehealth-era.org/publications/publications.htm

A Summary of a huge Europe wide E-Health Strategy research project

Switzerland

http://www.ehealtheurope.net/news/swiss_agree_compromise_e-health_strategy

Sweden

http://www.regeringen.se/sb/d/2950/nocache/true/a/65070/dictionary/true;jsessionid=anNzjDPaXjke

Canada

http://www.hc-sc.gc.ca/hcs-sss/pubs/ehealth-esante/index_e.html

and

http://www.infoway-inforoute.ca/en/home/home.aspx

Northern Ireland

http://www.ehiprimarycare.com/News/1103/northern_ireland_announces_new_health_it_strategy

New Zealand

http://hcro.enigma.co.nz/website/index.cfm?fuseaction=articledisplay&FeatureID=020306

This lot should get the consultants off to a running start. They will need it given the short time they have! There are a lot of lessons to be learnt from each of these countries that may indeed help.

It is of note that the amount of expert commentary on the ‘wrong headedness” of the current tender is building – this really is a serious opportunity wasted.

David.