Draft Submission to the NHHRC in Response to their recent Interim Report – February, 2009.

In this response to the NHHRC Interim Report I wish to point out that the approach adopted by the Commission has been fundamentally flawed in the way it has assessed the possibilities and potential value of Health IT (e-Health) as a key enabler of Health System Reform.

The Commission states quite clearly in the Interim Report that they have yet to address just how Health IT is to be approached and developed.

“Finally, in our Interim Report we argue that creating a robust and integrated primary health care service will require the implementation of a person-controlled electronic personal health record.

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An electronic health record that can be accessed – with the person’s agreement – by all health professionals and across all settings is arguably the single most important enabler of truly person centred care. It is one of the most important systemic opportunities to improve the quality and safety of health care in Australia. We will explore the prerequisites and incentives to allow us to reach this goal in our final report.” (p8)

What is more worrying is that I do not find in the report a clear understanding that, while the Electronic Health Record is important, it is by no means the only part of the system that can be enhanced with appropriate deployment of information technology.

Obvious examples include supply chain automation, tele-medicine and tele-health, performance monitoring as well as basic office automation and advanced messaging and communication (VIOP and the like). All these can also improve health system performance and efficiency and all these are presently underinvested in, in my view.

My key issue is that appropriate deployments of a range of information technology needs to underlie any significant system transformation.

Attempts to design a reformed system in the absence of a careful assessment of what is possible is simply ‘wrong headed’ and highlights the need to make sure the final proposals are developed with a strong understanding of the possibilities.

If one considers the four themes that the commission has identified one can quickly point out areas where information technology can usefully contribute.

Taking each in turn

• Taking responsibility: individual and collective action to build good health and wellbeing – by people, families, communities, health professionals, employers and governments;

This could be improved with personally managed health records, automated collection of physiological parameters to assist in treatment of diabetes, heart failure and so on

• Connecting care: comprehensive care for people over their lifetime;

This can be addressed by electronic health records but also by secure clinical messaging, evolving relevant standards for representing health information and so on

• Facing inequities: recognise and tackle the causes and impacts of health inequities; and

Remote and regional communities need to be connected to the cities for assessment, referral, treatment monitoring etc. All this needs a mix of messaging and communication technologies put together to optimise patient access, outcomes and convenience.

• Driving quality performance: better use of people, resources, and evolving knowledge.

There are a range of technologies designed to improve the measurement, interpretation and management of all levels of organisational performance which are widely used in commerce – and which need consideration to assist reform and to measure the success of the implementation of that reform.

In a nutshell the Australian Health System needs a technology strategy and plan that is designed to facilitate and enable the transformation of the health system to meet the goals articulated above.

Presently the Government (Federal and States) have a significant issue with the co-ordination, planning and delivery of the information technology support for the health system and the NHHRC has a unique opportunity to make recommendations that would establish appropriate goals and an appropriate governance framework under which these goals could be addressed.

I am aware of the planning efforts from Deloittes, Booz and Co and NEHTA and it is crucial these initiatives be unified and clarified into a single accepted way forward if any progress is to be made.

While I fear there is not now enough time to do much, in the direction I am suggesting, if at least the need for further work to unify and clarify the role of information technology in Health System could be clearly articulated that would be a major forward step. At present I believe we are in a state of considerable disarray in this crucial domain that we now see such aggressive investments being made by the new Obama Administration in the USA.

Dr David G More – MB, PhD, FANZCA, FACHI

Comments or suggestions welcome.

David.