Friday, July 13, 2012
The NSW Health Minister Speaks Out On E-Health. She Is Not Impressed With Canberra So Far It Seems.
The NSW Health Minister spoke at a CEDA Conference last week and we have some interesting reports of the speech.
First we have
Summary: The Australian Government has been slammed by the NSW Government for failing to meet expectations with its e-health record system, launched last weekend.
New South Wales Health Minister Jillian Skinner has criticised the Federal Government for setting expectations too high on its 1 July e-health record launch.
Since Sunday, Australians have been able to register for a personally controlled e-health record (PCEHR), either via phone, in a Medicare office or by mailing in a form to Medicare. Much of the functionality for the system, including letting doctors put information in the records and connect their own systems to the PCEHR system, has yet to be implemented.
By contrast, NSW already boasts a substantial e-health record system in hospitals, with over 80 per cent of hospital beds covered with a system that keeps orders and results across the hospital, emergency departments and operating theatres. More than 75,000 clinicians have been trained to use the system, and it is utilised by 5000 unique users every day.
Speaking at a Committee for Economic Development of Australia (CEDA) lunch in Sydney yesterday, Skinner said that the NSW Government is working with the federal e-health system, but will not wait for it.
"We're continuing to move on, and we'll continue to move with them. We're not waiting for that, because I think it is so important," she said. "But I worry that the expectations that have been raised there, but people think they're going to have everything singing and dancing as of last Sunday. That is not the case. I think it was very slow to start, and it has gathered momentum now, but it was slow."
Much more here:
Second we have
New South Wales health minister Jillian Skinner has expressed disappointment at failed attempts to hit benchmarks set for the federally funded personally controlled electronic health record, which she claimed had held back plans for state-based e-health projects.
Skinner said that while the widespread uptake of the PCEHR "has the potential to revolutionise the medical practice", major issues still required resolution for the electronic health records project, which aims to provide individuals with a system that ties together information from GPs and hospitals.
The health minister pointed to data integrity as well management and access to records as key concerns she felt had not properly been resolved by the federal Department of Health and Ageing and lead agency the National E-Health Transition Authority.
The $628.3 million PCEHR project went live for the first time on July 1, enabling Australian citizens to register for an electronic record in a Medicare office or by phone.
However, key components of the system — such as online registration, a consumer portal and compatibility with GP computer systems — failed to meet the deadline, set two years after the initiative was first announced.
"The development of standards was very, very slow."
Lots more here:
It is interesting that the Minister was more restrained in her criticism of the Commonwealth Programs in here prepared speech
Here is the link and text to the full speech.
I acknowledge the traditional owners of the land
Chairperson Jane Treadwell, Editor FutureGov Magazine
Director-General, Department of Finance and Services: Michael Coutts-Trotter (Chair of NSW Government ICT Board)
Distinguished guests, ladies and gentlemen.
Back in April 2010, as Shadow Health Minister, I told a gathering of ICT specialists about my conviction that ICT would play a dramatic role in improving the health of the people of NSW.
ICT will play a role, whether in acute hospital care, preventative health, patient self-care, treatments provided in a range of health care settings – in a patient’s home, in the community, a private or not-for-profit facility or through the public health system. And it will be delivered by a range of health professionals.
I said I wanted to be not just Health Minister, but e-Health Minister.
So given the priority that we have given to enhancing e-Health, it will not surprise this audience to hear that the NSW health system boasts one of the largest ICT portfolios of any government agency or corporate organisation in this country.
NSW Health will spend more than $1.5 billion over the next 10 years on ICT.
Our ambitious ICT portfolio has placed NSW Health at the forefront of building and driving the nation’s eHealth agenda.
Evidence shows there are many clinical care safety risks that can be reduced or even eliminated by integrating patient diagnostic, medication and medical history into a single, accessible electronic record, for example.
And we have developed numerous innovative eHealth programs across the health system.
· We are employing Telehealth to link patients in rural and regional NSW with face-to-face specialist care in Sydney or anywhere else in the world for that matter, making services available anywhere, anytime.
· We are collaborating with clinicians by activating voice recognition software in emergency departments to free-up precious time for patient care.
· We have established real-time emergency department waiting time data for the community, published online and updated every 15 minutes.
· We are ensuring that patients are the focus of the health system with technology now providing instant digital images, which can be reviewed and reported by specialist doctors even before the patient is back in the ward – slashing waiting times for results and delivering treatments earlier than ever before.
· We are developing and introducing Apps and tablet technology to provide instant access to clinical research and digital medical libraries for better information sharing between clinicians.
· We are supporting trials where Electronic health records have revolutionised the speed and accuracy of medical information between hospital wards and between patients and their GPs.
· We are using Technology to better track financial and performance management, not only in clinical incident monitoring, but in preparations for an Activity Based Funding model and to ensure value for money for every tax-payer dollar spent.
These are not future ambitions – this is what happens today in many of our State’s hospitals, as we take advantage of the Information Age’s technological revolution.
Last year, I said that I wanted the NSW health system to lead the nation in e-health.
We are now delivering on that promise, with NSW Government commitments worth nearly $400 million in new ICT spending over the next four years.
NSW Health’s major ICT projects currently underway include:
· *$170 million for a new electronic medications management system to prevent errors and reduce adverse drug events;
· *$85 million on electronic medical records systems to improve patient tracking, clinical documentation, scheduling and reporting across a range of clinical specialties;
· *$43 million on new clinical information systems to provide a single point that collates all relevant data to assist clinicians in our intensive care units. This system will also integrate with the electronic patient record and the medications management system.
We are also investing over $90 million to upgrade our corporate systems and to build new networks, data centres and messaging solutions, which will allow us to implement Telehealth on a wider scale. It will also allow for a common access email system that will connect all staff in all areas of NSW Health.
Our commitment to Health ICT is also evidenced by NSW Health becoming one of the three anchor tenants in the State’s new data centre - a vital component in the NSW Government’s ICT Strategy 2012.
At the hospital and Local Health District level, we need to continue to build new ICT systems and skill sets to address the equally important task of monitoring, collating and analysing the data we collect so that we can provide timely information to management.
As our tech-savvy workforce increases, we will get smarter and more innovative.
I want a resilient system, but one that is flexible and able to innovate to become more efficient. But above all, I want a health system that can deliver the highest quality care to patients.
In meeting these goals, Health has delivered a clinical ICT foundation across NSW, providing greater support to the patient journey through the health system.
Two important components of this clinical foundation are our electronic medical record and medical imaging capabilities.
The Electronic Medical Record, or EMR, allows clinicians to access a patient’s records from any location, at any time, to make rapid assessments and coordinate care.
NSW has now achieved a record level of electronic medical record maturity within our hospitals, with electronic orders, results, operating theatre and emergency department electronic records rolled out to more than 80 per cent of beds across the state.
Nowhere in the world can this level of coverage and interaction be found. With 75,000 clinicians using this patient record system, NSW leads the way with Australia’s largest e-health program, and the most comprehensive electronic health medical record system in use internationally.
This has not been without its failures and criticisms in relation to the initial implementations of EMR in hospital emergency departments – but site by site plans are now in place to maximise its efficiencies.
Voice recognition software is an example of maximising the benefits of EMR. In the recent trial at Manly Hospital, clinicians have the power to use their voice to navigate clinical systems and dictate medical decisions and treatment plans into a patient’s electronic medical record.
Doctors say they completed clinical documentation up to three times faster than they did previously and medical records were more complete and accurate.
Our Medical Imaging capability promotes radiologist productivity and gives electronic access to images across all public hospitals in NSW. Previously, medical images and reports were only available in hard-copy.
It saves money, it saves time and most importantly it speeds up patient treatment.
In the words of the clinical director of radiology at Westmead Hospital, “the new system has sped up the diagnosis and treatment of patients and replaced an out-dated system that was a clerical nightmare for radiologists.”
Or a junior doctor at Liverpool Hospital who reports, “I spent at least two hours trying to locate films for case meetings. With the new system, all the hospital’s images are available at the click of a button”.
And a senior surgeon at Nepean Hospital, “the system is invaluable for patients. For patients from Dubbo who want to be operated in Nepean, the surgeon can look at images and advise a time when the theatre is available and the surgeon is available. It could save up to three days waiting.”
While a number of new clinical programs are now being initiated, one of the most important will be Electronic Medication Management, which will prevent errors in prescribing by managing medications electronically - not having to decipher a doctor’s handwritten notes.
Medication errors remain the second most common type of medical incident reported in hospitals and, of all medication errors, omission or overdose of medicines occurs most frequently. Independent research has shown public hospital costs arising from adverse drug events and medication errors causing harm may be as high as $380 million per annum.
Reducing all errors will significantly improve patient safety and the quality use of medicines.
The NSW Government is spending $170 million on a new electronic medications management system to prevent errors and reduce adverse drug events, with pilot sites at Concord and St Vincent’s Hospitals.
Automating the system to provide standardised, legible, complete orders combined with clinical decision support systems, will not only reduce medication errors but has the potential to be one of the most important changes we make to patient care this decade.
Good communication about a patient’s clinical management is important in providing continuity of care across hospital and community healthcare settings.
NSW has three health sites implementing foundation work for the national Personally Controlled Electronic Health Records: Greater Western Sydney, Hunter Urban Division of General Practice; and St Vincents’ Mater Hospital.
At the core of enabling this work is a range of clinical information sharing for GPs including shared health summaries, medical images and discharge summaries from hospitals.
This allows information generated by a hospital visit, including treatment plans, images and test results to be viewed directly by GPs in their rooms, with their patients.
We are at the forefront of breaking down the often artificial barriers that can exist between hospitals, community healthcare and at home.
An excellent example of this work is the development of an electronic Blue Book and smartphone app, providing parents with mobile access to their child’s health records.
Every family currently receives a hard-copy of “My First Health Record” - a blue-covered book that collects important information on a baby’s milestones and immunisations, and other critical information for parents.
By creating the electronic Blue Book, we are firmly putting health care back in the hands of the consumer.
Parents will be able to update their records and, if they choose to do so, share that material with their health providers.
The smartphone app, now in its final stages of development, means a parent can have this material with them wherever they are, and whenever they need it.
Very soon, we look forward to rolling out the e-Blue Book to all parents who use the public health system in NSW.
Our success will be achieved through more than just technology and funding – it is achieved through good governance too.
Last year the Director General released her review into future governance arrangements for NSW.
A cornerstone of this review found that the statewide rollout of major eHealth systems needs to be supplemented with pervasive clinical engagement at the local level involving multiple testing and iterations of new systems before they are implemented.
To affirm NSW’s commitment to lead Australia in the development of eHealth, the NSW Government will establish eHealth NSW to embed leading practice and oversight of key ICT investments.
eHealth NSW will provide:
· Greater collaboration between the central bodies and Local Health Districts
· Genuine clinician involvement and leadership in decision-making at the Local Health District level
· A more collaborative approach to planning and delivery
· System-wide visibility to facilitate monitoring and sharing of best practice
· More opportunity for local innovation, configuration to support local workflow and front line support
Advances in information technology offer important improvements in health care delivery.
Technology does not substitute for the high quality care provided by clinicians, rather it enhances it. By providing those same clinicians with the modern tools and information they need, when they need it, it will enable them to achieve so much more for their patients.
This is just a brief outline of some of the advances we are making in NSW Health so that we can put the patient first and improve the productivity of our vital health system.
I have great pleasure in officially opening the 2012 FutureGov Forum NSW and look forward to working with you to transform our health system through better use of technology.
----- End Speech.
It is useful to have the NSW perspective on e-Health put and to see that, at least for the present Ms Skinner is a supporter while being a little concerned about just how things are evolving.
One certainly gets the feeling she is starting to appreciate that e-Health might not be quite as easy as it first appears to deliver successfully - but being in the early phases of government the full difficulty and complexity may not yet have dawned.
Well worth a read - for understanding of what it hoped for. What happens the next few years will tell.
Posted by Dr David G More MB PhD at Friday, July 13, 2012