E-Health System Finally in Sight?

We had another breathlessly optimistic article from the Australian Financial Review today. This is clearly designed to build on the enthusiastic article on the need for e-Health in the SMH, Age and Brisbane Times on the weekend (Not that is to disagree with that general thrust!).

Health's black hole

July 18, 2009

Billions of dollars are spent on technology to keep people alive but still the left hand does not know what the right hand has done. Mark Metherell looks to the future.

An unexpected legacy has emerged from the near-fatal bashing of Dr Mukesh Haikerwal by thugs with a baseball bat. The former Australian Medical Association president was walking in a park near his Williamstown home in Melbourne late one night in September when the gang set upon him, fracturing his skull.

Haikerwal, 48, was rushed to nearby Western Hospital and spent six days in intensive care before he was transferred to Epworth private hospital. His medical colleagues, he says, "saved my life and put me back into good fettle" but a deep reservation persists. "Whatever has happened is because of their individual efforts, not because of the medical records system."

The GP was startled to learn just how much the inaccessibility of updated medical records affected his care. After high-level treatment at both hospitals, he returned home only to be hit by persistent fatigue. His GP discovered the cause was anaemia. Despite the batteries of blood tests he had in both hospitals, the condition was missed because the lack of continuing record-keeping meant the severity of the declining trend in his red blood cells went unnoticed.

Later, when he had a scan at another hospital to review his condition, it was not possible to compare it with the original scan taken just after the attack because the two systems did not communicate - a "potentially dangerous" disconnection, Haikerwal says.

An eerily similar episode occurred when his mother was admitted to hospital with a suspected heart attack, then transferred to another. She was treated and discharged but failed to mend. Only later was it realised her heart was leaking, a problem missed because unmatchable blood tests performed by different laboratories obscured diagnosis.

The lack of instantly accessible, up-to-the-minute electronic patient records contrasts oddly with the sophisticated lifesaving medical technology routinely available in hospitals. "This is a 19th-century system imposed on a 21st-century system," says Haikerwal, who is a clinical adviser to the National E-Health Transition Authority, a federal-state body.

Lots more here:

http://www.brisbanetimes.com.au/national/healths-black-hole-20090717-do8p.html

The AFR article is here:

http://www.afr.com/home/upgrade.aspx?EDP://20090721000031363488

E-health system finally in sight

Tuesday, 21 July 2009 | The Australian Financial Review | Julian Bajkowski

By the end of the year we should know what the prognosis is for the electronic health program, writes Julian Bajkowski.

It’s taken a decade of wrangling, false starts and controversy but doctors across Australia could finally be exchanging vital clinical details of patients over state borders in less than a year.

At least that’s the strategy National E-Health Transition Authority chief executive Peter Fleming plans to pursue.

We are then told.

1. It’s going to be a big sales job.

2. The NHHRC has a part of its agenda a National Electronic Health Record.

3. The Business Case for this was submitted to COAG several months ago and no response so far.

4. That he NHHRC believes 2012 is an achievable time table for the National EHR.

5. Handling privacy will be important and that laws might be in place by mid 2010 to cover this issue.

6. Andrew Howard has been brought back – having been acting CEO – to head strategy.

7. Current identifiers are riddled with ‘literally millions of duplicates, false and non-functioning identities such as those of dead people’

Not a word of this is news as far as I can tell – and essentially funding, privacy and legislative support are still to be sorted out.

I really wonder just what is being spruiked here. I suspect a rear guard action to get some leverage from the NHHRC report release to ask for a whole lot more money? Or am I too cynical?

1000’s of GPs are already happily exchanging results from pathology and radiology using services provided by HealthLink, Argus, Medical Objects, eClinic, proMedicus and the like. Hospitals and specialists that have their acts together can also provide reports and discharge summaries.

e-Prescribing seems to be stumbling forward – in much less than ideal ways in my view – but at least there is some learning going on about what works, what doesn’t etc. NEHTA is, of course, quite un-involved in setting any directions here as well as in the messaging mentioned above.

Read more about how messily this is all happening here:

Battle for e-scrip funds

Karen Dearne | July 21, 2009

THE Pharmacy Guild has a swag of new technology programs in its kitbag as the latest round of pharmacy program funding negotiations kicks off in Canberra.

Electronic prescribing is the big-ticket item, with the guild's half-owned eRx Script Exchange busy signing up pharmacies to the hub while eyeing a potential $60million new market with some 240 million scripts issued annually at a fee of 25c each.

It seems the door may be open to transaction fees, with a federal Health Department spokeswoman saying such payment arrangements may be considered, "taking into account the business efficiencies e-prescribing and dispensing provide".

General practitioners are not so willing to cede control to pharmacy interests.

Instead, doctors are lining up behind a rival system, MediSecure, originally built for a federal government trial in the Northern Territory, and endorsed by the Royal Australian College of General Practitioners.

Essentially, the present scenario boils down to a battle of the software interfaces.

Much more here:

http://www.australianit.news.com.au/story/0,24897,25810119-15306,00.html

Why we are not getting the coherence and value from all this work is because those who are meant to be creating the strategic framework for all the various actors in the e-Health domain are essentially out to lunch and have not done their job at all well over the last 5 and a half years. It is just possible we might be seeing some improvements in the last few months with some aspects of this, but right now anything that could be called a national direction is simply absent.

We have the bizarreness of there being a National E-Health Strategy that is secret and unfunded and NEHTA wanting to spend billions when it can’t even make what we presently have conform to some basic rules of interoperation and information exchange.

The message to NEHTA should be very clear – show you can really deliver with the funds you have already been given before daring to ask for more! The time for saying ‘trust us’ is well and truly gone.

If it were not so serious it would be hilarious!

David.