The National E-Health Transition Authority, formed in 2005 by the Council of Australian Governments to bring unity to e-health development, can be likened to the 20th-century push to standardise Australia's rail gauges. Doing things in a standard way unlocks the potential of the developments taking place across the nation and ends the current situation of multiple technologies that cannot talk to each other.
Why the need for electronic records? They were recommended by the National Health and Hospitals Reform Commission, which recognised that to keep costs contained and the system sustainable the health system must work in a better way. Costs and demand may be rising, but technology is the health system's get-out-of-jail card.
Investment in e-health will provide accurate, timely information, improving service planning. Current, accessible information can be used to monitor patterns of disease, including epidemics and trends. It will also improve service delivery, particularly when patients move from one part of the health system to another.
In Australia, almost all GPs and pharmacists already use computers for clinical management. Yet there is a very poor uptake of computers in other sectors outside the hospital. Variable connectivity exists within the hospital systems and there is precious little sharing of information between sectors.
Because of this lack of connectivity, those of us who use technology in healthcare have been on a superhighway to nowhere. This is about to change.
The electronic systems that have evolved in the hospital sector cannot share information in a coherent way. GPs and other community providers cannot share the information they have with others, especially the hospital system. Information is often lost in translation and does not follow the patient (or carer), who is left to try to explain their own history and treatment, often when distressed and not thinking clearly.
Because some investigations may not be to hand, they may be repeated or, worse still, care decisions are made with incomplete results.
The passing of the Health Identifiers Act on June 24 last year paves the way for Australians to be assigned a single identifying number, which can be attached to each piece of health information about them, replacing the 20 to 30 such identifiers used today.
Together with a robust system to identify health providers and the organisations where they work, the health identifiers allow for secure access to information, and confidence that the right information is available about the right patient, at the right place, at the right time, and written to and read by a known health provider.
Important work has already occurred towards the introduction of e-health systems, both overseas and in Australia where the system is due to launch next July 1.
Barwon Health in Victoria and the Northern Territory has working systems that have been welcomed in their communities. Their success in delivering better, joined-up healthcare has come from the fact these projects have been led by doctors and nurses, address a clinical need and support those using the system.
It's true that the usefulness of the system will be in question if not enough people enrol, or the information on their record is of poor quality, is too scanty or has other problems that make looking it up a nuisance instead of a bonus.
This has led to calls for the onus of enrolment to be changed, so everyone is automatically enrolled yet has the ability to opt out, rather than the present opt-in design. If key information is not available, such as pathology and radiology reports, its usefulness is diminished. If it makes the jobs of doctors and nurses more difficult, or it exposes them to extra legal risk, it will fail.
The lesson from Britain, where an pound stg. 11bn ($16bn) investment is in disarray, is not that the goal was flawed but that clinicians were marginalised. Australia, having avoided that trap, is set to deliver a secure, useful system for all.
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Autor(en)/Author(s): Mukesh Haikerwal
Quelle/Source: National Affairs, 10.09.2011
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