The National Health and Hospital Reform Commission Hears about the Need for e-Health.

Over the silly season a few reports we are almost certainly missed. The following is one I had not caught up until now.

December 8, 2008

NHHRC Consultation Reports Now Available On Website

The reports of forums conducted by the National Health and Hospitals Reform Commission (NHHRC) with community members and frontline health workers in thirteen venues around the country are now available on the NHHRC website.

The reports cover both the frontline and community forums at the following locations:

• Adelaide
• Alice Springs
• Brisbane
• Cairns
• Canberra
• Darwin
• Dubbo
• Geraldton
• Hobart
• Melbourne
• Perth
• Shepparton
• Sydney

There are also two consolidated reports – one bringing together all the frontline health worker consultations, and the second bringing together the community consultations.

All the reports can be viewed at www.nhhrc.org.au under the heading ‘Consultation Reports’.

The views expressed in these reports are those of the consultation session participants and should not be taken to be the views of the National Health and Hospitals Reform Commission or the Australian Government.

See release here:

http://www.nhhrc.org.au/internet/nhhrc/publishing.nsf/Content/mediaRelease081208

In the report gathering the views of a huge range of health professionals we have a heap of interesting ideas.

However, what is most interesting to me is the following section, under the first section heading Overarching Solutions, we find as one of the three the EHR. The first two were to create a single national health system and to adopt a multi-disciplinary approach to care delivery. Here is the third.

---- Begin Extract

1.3 Electronic health records

A national system of electronic health records for every individual in Australia was suggested as a solution to a broad range of issues and challenges within health service delivery. Different alternatives to implement the system include a central mega-Medicare database linked to people’s Medicare numbers, or a transferable patient record, based on an electronic swipe card or equivalent computer chip type system, to access health records.

The issues and challenges that a national system of electronic health records could address include:

· Many different parties have different pieces of information about each patient, but there is no ability to connect this information together, to track patients or identify those who need health services but are not accessing them (lost to follow-up).

· Patients lack medical knowledge and are often unable to inform practitioners of their medical history accurately.

· When people move interstate – for example, for work, holidays, or as ‘grey nomads’, their medical information is left behind and is difficult or impossible to access by future doctors. This problem is contributed to by the fact that confidentiality requirements across each State are different.

· Patients are sometimes transferred between health service districts for treatment, but their patient information does not follow them.

· There is often no follow-up with GPs once a patient leaves an acute setting – for example, discharge summaries are not received.

A system of electronic health records could work to:

· Improve health information to ensure accurate patient information.

· Improve communication between private and public sectors.

· Improve communication and access to shared clinical information between hospital and community-based providers

· Improve clinical decision making, planning and benchmarking by recording clinical outcome measures and quality of life measures, to support whole population trend planning, longer term planning, prospective analysis of health data from birth, and benchmarking of trends.

· Enable faster referrals to allied health, secondary, and tertiary care.

· Reduce incidences of lost referrals.

· Enable faster exchange of discharge summaries and faster patient transfers to and from hospital.

· Improve communication between different health workers treating the same patient, by allowing health workers to know what other treatments a patient is receiving.

· Help free up clinical staff from basic administrative tasks and support better measurement and monitoring of patient outcomes.

· Support prevention and early intervention by flagging risk factors early. For example, a patient’s records could be flagged to monitor falls and if a second or third fall is reported, appropriate staff could visit the patient to assess hazards at home or review medication use.

A national system of electronic health records should include the following features:

· A useful interface that allows records to be available across sectors so that information about a patient’s condition and treatment in hospital is accessible by the patient’s hospitals, private and public sectors, State and Federal governments, allied health workers and community health practitioners. However, some health workers raised the issue of privacy, pointing out that patients may not want every health practitioner to see their complete health and treatment history – for example, people may not want information on mental health, sexual health or drug and alcohol treatment to be available to other providers.

· A wireless, digital, system that reduces reliance on paper-based systems and improves communication flows.

· The ability for practitioners to update the record at the point of care.

· An alert function to care providers, such as GPs and community nurses – for example, when a patient is admitted or discharged from hospital.

· Shared, distributed, and centralised databases of pathology, imaging, and cardiology. This would

· lead to a massive reduction in the duplication of testing, and prevent disparate databases which do not integrate.

Challenges to the delivery of a national electronic health record include privacy issues and the question of ownership over the records. This poses doubt over what e-records should contain and who should have access to them. Addressing public concerns about privacy through secure systems and education of health workers and patients in their use, and legislative change, particularly of the Privacy Act, to enable shared records while protecting patients and workers, will be necessary. A further challenge will also be the transfer of paper records to the electronic system, especially in rural and remote areas where adequate internet provision cannot be guaranteed.

---- End Abstract.

The full report is here:

http://www.nhhrc.org.au/internet/nhhrc/publishing.nsf/Content/29DAB5DDAD170183CA257519000B533B/$File/Consolidated%20frontline%20workers%20consultation%20report.pdf

Well, we now have the NHHRC saying e-Health is pretty important and a Deloittes strategy which shows how it should be done.

Must be close to time to get on with it!

David.