E-health in a tangle

Excerpted from Australian Doctor, 20 March 2009:

With so much reform in the offing, does the Rudd Government have the political will to finally make e-health a reality? Ray Welling investigates.

Ordinary Australians can use their bank cards all over the world or seamlessly connect their laptop to a wireless net work from Broome to Berlin, yet their critical health data can’t be shared with their local hospital or even the pharma cist down the road.

This is despite extensive international and Australian research pointing to significant savings in lives as well as public health expense when health IT innovation is applied.

This year researchers in Texas reported in the Archives of Internal Medicine that increasing the automation of hospital notes and records led to a substantial decline in mor tality rates for all conditions studied. An author of the study said that by computeris ing health records, more than 100,000 lives a year could be saved in the US alone.

Closer to home, a 2002 Australian Institute of Health and Welfare study found that up to 18% of medical errors — many of them fatal — were due to inadequate availability of patient information.

According to the study, these adverse events account for as much as 3% of the gov ernment’s total cost of care — $3 billion a year in avoidable cost.

A business case for a national electronic health record program was published last year by the National E- Health Transition Authority (NEHTA), which suggested a net benefit to the Australian economy of between $7.5 billion and $8.7 billion over the first 10 years.

Australia is not the only late adopter of e-health. In the US, just 1.7% of hospitals sur veyed in 2008 had fully imple mented a comprehensive patient e-health records system across all units of their hospi tals and only 7.9% had imple mented a basic system.

However, the US is much closer to fully sharing health data. Electronic health initia tives were specifically men tioned in former US President Mr George W Bush’s last four State of the Union addresses, and USPresident Mr Barack Obama announced shortly before his inauguration that he was dedicated to making 100% of personal health records available electroni cally within five years. He backed that up by allocating $US20 billion in his initial economic stimulus bill to the task. Electronic health records were specifically mentioned in his maiden speech to the US Congress in February.

SO what’s happening in Australia? It’s not that we’ve been ignoring e- health. It is estimated that more than $5 billion has been spent by state and territory governments, GP divisions, and others on e-health devel opment activities in the past 10 years.

Those initiatives include a program by General Practice Network NT to have the entire NT population regis tered for shared electronic health records by 2010, bed side electronic records and clinical decision support tools being trialled in SA hospitals, a $250 million Enterprise Information Repository in Queensland, and a hospital- based electronic health record system deployed in the South Eastern Sydney and Illawarra Area Health Service in NSW, which is soon to be rolled out across the state.

But for e-health to make a real difference, national co- ordination is needed. On a national level, NEHTA was set up with Commonwealth funding in 2005 to develop core technical foundations for e-health in Australia, such as clinical terminologies, infor mation messaging standards and designing unique con sumer and care provider iden tifiers.

Other than this, however, none of the local or state groups developing e-health systems are talking to each other or working to create sys tems that can be integrated across borders. Some can’t even be integrated across hos pitals or surgeries in the same state. It’s a situation that brings to mind the 19th cen tury, when each colony built its railway systems using incompatible rail gauges.

Read the full story here (password required – let me know if you’d like a full copy).

Hip-pocket appeal could drive PHRs

It’s a fact of life: no organisation, not even governments, likes to spend money on something unless they can see that it will make or save money. Well, here’s some evidence about the money-saving aspects of personal health records (PHRs) that should make governments, even in Australia, sit up and take notice. The AusHealthIT blog has uncovered a story about a US study that claims the implementation of PHRs across the American healthcare system will save more than US$21 billion a year, through things such as more efficient monitoring and sharing medication lists.

As AusHealthIT blogger David More writes, “If PHRs can deliver even half of these benefits I will take two, thanks!”

One important caveat – the study was funded by ‘unrestricted grants’ from companies including Microsoft and Google, which of course have a vested interest in the success of electronic PHRs…

NEHTA and the budget, part II

In a follow-up to my earlier post about NEHTA’s budget spend, they’ve gone from being criticised for underspending their budget to criticised for over-spending on the wrong things. Australian IT reports that the authority has more than doubled its spend on administration – staff, consultants, etc. – over last year, 169 people costing nearly $30 million. My calculator tells me that works out at nearly $178,000 per head, so either they have the best-paid staff in the public service, or the consultants, who account for $13 million of the total, are raking it in. Hey, how do I get on the gravy train?

Australians want e-health records

Australians support the introduction of an Individual Electronic Health Record (IEHR) and would agree to their medical records being included in the service.

This is according to a poll conducted on behalf of the National E-Health Transition Authority (NEHTA), which showed that 82% of respondents believe an IEHR would save lives and improve health services by having important medical information immediately assessable. 77% of the 2,700 people surveyed across Australia indicated they would want their records added to the service.

“This research confirms Australians endorse the use of electronic health records if they are introduced with all the necessary levels of privacy and security,” said NEHTA chief executive Peter Fleming.

The news was welcomed by AMA president Rosanna Capolingua, who reiterated the organisation’s long-time support of electronic health records, but also highlighted issues such as patient confidentiality and system access, as the issues delaying implementation. “Maybe not next year, but hopefully soon after we may see some movement,” she suggested.

Security and safety around the electronic storage of medical information was a key consideration, with 79% of those polled indicating it was important any future IEHR offers patients the ability to quarantine sensitive or very personal medical information. The poll also showed that Australians feel strongly about choice in relation to the IEHR. 78% of respondents said the IEHR service should be voluntary.

– From 6 minutes

From Medical Director to Microsoft – another Australian e-health delay drama

From today’s edition of 6 minutes:

“A pharmacy-driven electronic prescribing project announced with much fanfare earlier this year has hit a setback with one partner, prescribing software company Medical Director, going cold on the project.

“In March the Pharmacy Guild announced a ScriptX project to start in October which would allow GPs to create electronic prescriptions on a central encrypted hub that any participating pharmacy could access and dispense.

“But the project’s creators, pharmacy software company Fred Health, now says it is looking to work with new partners such as Microsoft to develop a similar system, known as eRx Script Exchange, to start next year.

A spokesman for the company, Mr Paul Naismith, told 6minutes that their original partners HCN, the vendors of Medical Director, had decided not to go ahead with the SciptX project as planned.”

Is this the precursor to Microsoft launching its HealthVault product in Australia? Meanwhile, no great surprises that HCN/Medical Director have backed out on the project; if a teacher was to give a report card on HCN, it would no doubt include the comment, “Does not play well with other children”…

Google, Microsoft, now Amazon?

Call it the commercialization of healthcare online. First it was Microsoft Health Vault and Google Health offering personal health record (PHR) solutions for consumers. Now Internet pundits are saying the healthcare industry should look to Internet giants Amazon for ideas on how to bring healthcare into the 21st century. Anna Maria Virzi, writing on the ClickZ network, says that patients should have access to information about their health records in the same way UPS or Amazon tracks package deliveries.

“A doctor’s follow up communications with a patient – though not exactly marketing – are all part of a customer feedback loop that can help keep a patient and her family informed to make better choices about continuing care,” she writes.

She cites the example of Group Health Co-operative, a Seattle-based managed care organisation. Patients there were first given the opportunity to contact physicians by e-mail about eight years ago and by 2008, “nearly all of the organization’s 850 physicians communicate with patients online; physicians respond to 97 percent of the queries by or before the next day.

“First and foremost, this is to take better care of patients,” associate medical director Matt Handley said. “It saves a patient in-person visits. It leaves a record for patients to access, and it indirectly improves access [to a physician].” He said it was “much safer than paper records.” 

“Once patients realized the benefits of e-visits, Group Health Cooperative promoted the initiative in advertisements.

“But, Group Health patients won’t find any ads popping up in the clinical messages they receive from physicians. ‘There is no spamming, no promotional messages to patients through our electronic medical records,’ Dr. Handley said.

“Group Health professionals say the retention rate was 6.5 percent higher for enrollees who used the digital health record system than those who didn’t. ‘Two-thirds of the patients say this is a very important thing to them when they think about where to get their healthcare,’ Dr. Handley said. ‘It’s hard to give this up.’