E-health projects sick without govt aid

Health professionals have slammed Australian governments for a lacklustre investment in e-health, claiming the nation has slipped behind many countries in the field because of weak funding and unresponsive departments.

Experts said a $218 million national fund allocation to the National E-Health Transition Authority (NEHTA) over three years to June 2012 should be increased to bolster what they say is an ailing e-health industry. The grants will be used for the SNOMED Clinical Terminology project, a national e-health identification system for individuals and providers, and to develop a user-authentication scheme for the health care sector.

Speaking at an e-health summit in Sydney last week, University of NSW Professor Branko Cellar said government health departments have ignored workable e-health technologies in favour of existing solutions to mitigate risk and accountability.

“A recent premier came to visit and was impressed by [telehealth] technology but even though [he] may want it, no one in the health department was incentivised to take it on because their seats are more carefully retained if they do more of the same — they see disruptive technology as too risky,” Cellar said.

“Australia was a world leader but now we need to start catching up with the rest of the world… There is no policy for [telehealth] in Australia and the government has never ran a clear trial of the technology.”

Cellar, a long term advocate of remote care and head of the Biomedical Systems Laboratory at the university, said the potential for telehealth to reduce time spent in areas like chronic disease management, which itself occupies more than 75 percent of clinicians time, is “manna from heaven”.

However, he said implementation of the technology has stalled because of what he dubbed ineffective policy and trials that lack “proper health-economic outcomes”.

E-health technologies are inherently “disruptive”, according to Intel digital health group industry development manger Dr George Margelis. He cited an example of a new telehealth deployment in Hawaii that allows patients to receive treatment over a video link for about $50 less than the fee for face-to-face consultancy.

“I'll be honest; vendors are sometimes as much to blame for [e-health] challenges as policy makers; there needs to be a shift to [coalitions of] healthcare providers,” Margelis said, speaking of the problems inherent to the rapid take-up of technology amid slow policy development.

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Ascribe Asia Pacific chief executive Bryn Evans took a different perspective and played down concerns over Australia’s e-health policy and direction.

He told Computerworld Australia has solid investments in e-health, found in NSW Health’s electronic Medical Record (eMR) and Victoria’s HealthSmart projects, but conceded the industry needs more government funding.

“The two largest states in Australia, NSW Health with its eMR Project and Victoria with its HealthSmart Program, are absolutely doing the right thing, and are developing and implementing a standard electronic medical record on a state-wide basis. It will mean that wherever a patient is treated in the state, their patient details, medical history, test results, treatment notes etc will be fully up to date and instantly available to any clinician attending to that patient,” Evans said.

“No more tedious and inefficient questions such as 'which hospital and doctor did you last see?, what did your last test results state?, what medication are you on?, or do you have your ultrasound scan with you?' that drive every patient to distraction. There will be an immense improvement to patient safety, as the electronic medical record becomes available everywhere.

“Of course there are legitimate questions over the pace at which this is being done, and the need to increase funding to expedite implementations, and there will always be different views on which software is being used... At the same time most people would agree that Australia is lagging behind the pace and funding of e-health programs in countries such as the UK and Canada.”

Evans said the South Eastern Sydney, Illawarra and Northern Coast Area Health Services in NSW, are part-way through “very successful” implementations across multiple hospitals, while implementations of less-comprehensive eMR projects in other state Area Health Services are scheduled depending on government funding.

Victorian Department of Human Services information management and technology health director Peter Williams said policy formation is the biggest challenge for governments implementing e-health.

“It is a policy problem not a technology problem. “If transmission of patient data is lost, who is responsible? The ISP? The sender?

“The big issue is how [e-health data] will be used and what the information means for business, rather than the technology itself.”

Cellar said telehealth services can reduce hospitalisation by 70 percent, the length of stay at hospitals by a further 70 percent, home visits by 7.5 percent and trips to the general practitioner by half.

New Zealand Health IT Cluster alliance chief executive Andrea Pettett said governments need to enforce strategic leadership and provide incentives for clinicians to use e-health technology.

She said governments could take a leaf from the ContinuaAlliance, a group of more than 170 members and some 30 governments that are leading many of Northern Island’s estimated £44 million e-health initiatives.

Panellists said development of Australia’s e-health policies have fallen behind the United Kingdom, Northern Ireland and New Zealand.