Monday, September 20, 2010

The Sydney Morning Herald Talks a Lot about E-Health for a Monday!

The venerable SMH seems to have taken both a shine and some caution to E-Health today.

First we have this:

Please take a number

September 20, 2010

An e-revolution is about to hit the health system. Doctors back it, but what will it mean for privacy? Karen Kissane reports.

Cath Ringwood has seen it all. As a former nurse and social worker, she has witnessed time and again delays, muddles and even dangers caused by a medical world in which communication relies on scraps of paper that too often are lost, or on patients' own foggy understanding of their history.

''The slippage is just so bad,'' she says. ''People aren't good historians. They don't realise the significance of some things - 'Oh, the doctor says I have a bit of fluid on my leg …' They forget important things, or they might not be able to tell you because of language problems, cognition problems, mental health or substance abuse.

''They might have a medical history at one hospital and something else going on at another hospital. You might be seeing someone for 12 months and suddenly realise they have a whole history of cardiac at St V's.'' Even when a comprehensive file is available, if it relates to a long-standing, complex condition it might be as thick as a brick. A new specialist in a large hospital will cast an impatient glance at it and turn to the patient for a verbal summary instead. Then there are the tests that have to be repeated because results have gone missing; pathology results mixed up because of a problem with labelling; and delays in passing information between specialists and GPs, who communicate via courtesy letters delivered by snail-mail.

Ringwood has experienced some of these frustrations on a personal level. She has been battling chronic lymphocytic leukaemia for several years. When a specialist told her the devastating news that she also had breast cancer, Ringwood waited four days to go to her GP for an urgent referral to a surgeon. That turned out not to be long enough. She had to tell the GP the news herself because the letter from the specialist had not arrived. ''It meant we had to start off from scratch,'' she says.

So Ringwood is pleased to hear the federal government will introduce shared electronic health records. If the roll-out goes to plan, by July 1, 2012, any patient will be able to ask their doctor to create one. They will be uploaded on the web to be accessed - with patient permission - by any of the nation's 700,000 registered medical and allied professionals. The first step is complete: a 16-digit number called a ''health identifier'' has been assigned to every Australian known to Medicare. It can be used in all health encounters from cradle to grave.

This number is one of the reasons privacy advocates do not share Ringwood's delight. They fear a stalking horse for another run at a national identity card. They also fear e-health records will mean Big Brother peeking through the keyhole of a very private place: the consulting room.

The e-records are a central plank of a massive IT revolution in the nation's health system. They are to be followed by a secure electronic messaging system - rather like encrypted emails - as well as shared e-systems for referrals, hospital discharges, pathology results and prescriptions. The idea is that computers in all the parts of our vast web of health services will finally be able to talk to each other.

Dr Mukesh Haikerwal, a former president of the Australian Medical Association, is lead clinician for the National E-Health Transition Authority and a true believer in what the technology will deliver for patients and doctors. He says ''the rubber hit the road'' for the project when federal Parliament - in the final hours of the last sitting before it rose for the election - passed a bill providing $466.7 million over two years to develop electronic health records.

The search for better care is not the only reason Western governments are backing e-health; they hope it will help contain ballooning costs. Eighty per cent of the health ''burden'' in Australia is now made up of chronic illness, which requires long-running care; the population is ageing; and shortages of health workers are expected to drive up their wages.

It has been estimated that e-health could save $8.7 billion over the first 10 years alone - not as instant cash savings but by flattening ''the exponential trajectory'' of demand and cost projections, according to a 2008 report by Booz & Company. Two-thirds of the expected savings would come from reduced errors and better medical practices. If health costs went unchecked, Booz argued, the system would struggle, patient safety would be compromised and universal healthcare might have to be rationed.

Vastly more here:

An interesting little summary is found at the end.



- Everyone will get a 16-digit individual health identifier.

- 700,000 professionals will get a healthcare provider's identifier.

- Up to 100,000 organisations such as hospitals get a group identifier.

- The patient and a care provider talk over what details should go into a shared electronic health summary.

- The e-health record is uploaded on to a secure website where it can be viewed and updated by authorised care providers.


- What health details are to be standard on the e-record.

- Who will store and manage records.

- How/whether patient consent will be enforced and recorded for each entry/access.

- How/whether patients will be notified of any privacy breaches.

Then we have this:

Britain ponders its sickly $20 billion e-health experience

Karen Kissane

September 20, 2010

Britain's push for e-health records won the ''most appalling project'' prize in the annual Big Brother awards of Privacy International in 2004. That, it turns out, was only the beginning of the project's troubles.

It is eight years and £12 billion ($19.9 billion) since Britain set out to establish a shared e-health record for 50 million citizens as a central plank of its overhaul of health and computers, in what was dubbed the world's largest civilian IT project. Now the rollout of e-health records is over time and over budget, dogged by savage criticism and languishing from lack of use.

Earlier this year, doctors called for a boycott of the system after it was found one in 10 records uploaded contained out-of-date information, including errors about patients' medication and drug allergies. This threatened patient safety, they said.

Earlier controversies erupted over patient consent. Britain has an opt-out system; patients must apply to be exempted from having a shared e-record and, if they don't, their consent is ''implied'' and the record uploaded. But research showed many people had not received notification of the system and did not know it existed. Some who tried to opt out were told they must first have a face-to-face session with an ''adviser'', and others were told they could no longer receive health care if they did not have an e-record.

More here:

Both the articles are worth a browse to see what is being said in the mainstream media as well to see how the issues in the UK are being reported down under.

As I have said often these is certainly a need to learn carefully from experiences all over the world, and not assume we can invent it all here!


1 comment:

Anonymous said...

On the medical registration renewal form, under the new national scheme, my personal data included a mobile number. It wasn't mine, because I'd never submitted one. I dialed it, and, sure enough, it belongs to another medico's data set. Do they have a procedure for investigating incorrect assignment of data?