Monday, October 04, 2010

Some Serious Experts Wonder Just What the Government is Up To With the PC-EHR. So Do I!

The following editorial appeared in the Medical Journal of Australia today.

Will information and communication technology disrupt the health system and deliver on its promise?

Johanna I Westbrook and Jeffrey Braithwaite

MJA 2010; 193 (7): 399-400


  • Investment in information and communication technology (ICT) in the health sector can bring important benefits. To date, the focus has been on automating clinical work practices such as ordering tests and prescriptions, which significantly improves efficiency and safety.
  • Uptake of ICT has been slow and the results less favourable than anticipated for various reasons, including poor integration of systems into complex clinical work processes, limited training, and the intermittent nature of ICT funding. As a result, many health care organisations have been operating hybrid paper and computer systems that introduce new patient risks, staff frustration, and outcomes below expectation.
  • The focus must shift from automation of clinical work to innovation; from evolutionary application of ICT to revolutionary uses. Health professionals must embrace ICT as a “disruptive technology” that will produce significant changes in their roles and responsibilities and lead to real health reform with new, innovative models of health care delivery. As other industries have shown, substitution and role changes are areas in which ICT can lead to the greatest gains.

Author details: Johanna I Westbrook, PhD, FACMI, FACHI, Director, Centre for Health Systems and Safety Research Jeffrey Braithwaite, MBA, PhD, FCHSM, Director, Centre for Clinical Governance Research.

Australian Institute of Health Innovation, Faculty of Medicine, University of New South Wales, Sydney, NSW.

The full paper is here with those who have access.

This I found to be the most interesting paragraph.

“Given that $462 million was allocated to individual e-health records alone in the 2010–11 federal Budget, clarity about what is desired and expected from e-health is becoming an urgent problem. The key lies in how ICT in health care is viewed and what people want it to do. At present, the focus is on creating efficiency and safety gains by using computers to automate existing manual processes. For example, computerised ordering systems largely substitute paper orders with electronic orders. This has produced demonstrable and sustained improvements in the speed with which test results are available to clinicians. Substantially reduced rates of medication errors following automation of the prescribing process are further promising evidence of the benefits of ICT.”

What is being said here, with me paraphrasing is that these experts are really not sure just what the Federal Government is proposing with the Personally Controlled Electronic Health Record (PCEHR).

To put it colloquially, if these smart people are wondering just where does that leave the rest of us?

The other key theme of suggesting we need to move from automating ‘what is’ to working out what is possible with better technology will also get no fight at all from me!

We really deserve better from government than the present ‘mushroom treatment’.


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