Presentations from:
Dr Peter Garcia-Webb - Introduction
Dr Mukesh Haikerwal - Official Welcome

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Dr. Peter Garcia-Webb,Chair, AMA Expert Committee on Information Technology

The idea of bringing us all together to review the state of progress on E-Health grew from a long standing concern that progress in this area of health system development was slower than expected. The catalyst was the address by the Health Minister, Tony Abbott, to the Health Information Conference in August where it seemed clear that the Commonwealth was going to spend less on E-Health and at the same time blame doctors for being reticent about adopting this new technology.

David Moore, a long standing health IT commentator wrote recently in the IT Australian:

"It seems the national E-Health strategy is in disarray, having no credible strategy or framework. This needs urgent fixing. Worse, it seems national consensus over direction is fracturing. It is likely that large sums of money will be wasted and to something not even remotely like the hoped-for national shared record system. Even if the approach is strategically correct, (which is debatable), skilled intervention is needed at the highest level. We need a thorough, transparent review of outcomes and a renewed commitment to a credible plan.

While not wanting to debate whether David has it right the purpose of this AMA E-Health Forum is to bring together the substantial intellectual horsepower and experience of the assembled group in the expectation that all will not only be participants but also speakers.

Does the "E" in E-Health really exist? We believe the technology is there and ready to be applied.

The focus of this meeting is on E-Health systems that occur in general practice, specialist and related sectors. It is not that the jurisdictions are not important, but more one of scope for this meeting. We will of course consider the communication between hospitals and GPs/Specialists.

Finally an acknowledgement of the sponsors of this meeting: the Commonwealth Bank, Cisco Systems, IBM and Ocean Informatics.

Dr. Mukesh Haikerwal: E-Health - the Way Forward

The following is an edited version of introductory remarks from the AMA President, Dr. Mukesh Haikerwal.

Welcome to the AMA E-Health Forum
The electronic collection, storage and transfer of health information offer incredible opportunities for both patients and the profession. The capacity for health professionals to have access to the right information to the right patient at the right time and in the right place in order to deliver the best quality health care is at the core of our commitment to E-Health. The benefits to patients as they work and travel in ever increasing circles are only too clear.

We do, however, need to be cautious with our language and understand that while the focus is on the technology and communication, it is the health care professionals and patients who contribute to improved health care outcomes - the IT is an enabler. Yet there is convincing evidence that electronic systems can support access to reliable, robust, current, comprehensive, timely information needed to deliver the highest quality care.

Technology does, however, bring with it real concerns around impact on privacy. Issues around 'function creep' directly related to data linkage in particular have caused the AMA some concern and heartache. The costs of new hardware, software and the personnel and change management are additional imposts on an already stretched workforce facing increasing patient demand.

These issues must be the subject of constant consultation and negotiation as we continue to develop electronic systems in Australia. Acceptance by the profession is the key to success and in turn a significant key to consumer acceptance as numerous trials have demonstrated.

The AMA has expressed its concerns at what it perceives to be a diminution of systematic consultation with the medical profession over the past 2 years, particularly with the establishment of the governance structure that includes the Australian Health Information Council and the National Health Information Group. Indeed the National Electronic Health Transition Authority has also come under scrutiny in regard to consultation and has not escaped criticism from a range of quarters.

In that context, the AMA's links with industry have grown and continue to do so, and this forum is a case in point. The AMA knows that the e-health industry recognises that consultation with the profession is the key to the development of appropriate health sector technical systems. We are very pleased to have seen a real enthusiasm from industry to get it right through understanding how doctors work in different settings, what their needs are and where current inefficiencies exist.

Importantly, as with doctors, industry is also putting the patient at the centre and seeking to identify how electronic systems can relatively seamlessly ensure that the right health information follows the patient on their journey through different parts of the health system.

This Forum aims to consolidate these links with industry, demonstrate that health professionals can contribute to the development and implementation of E-Health systems and collaborate with industry. While industry and the profession do have very different perspectives on key themes on the E-Health agenda, these do not reflect irreconcilable differences but different sets of skills that, combined, create a powerful mix for success. It is clear that the objective of delivering improved patient outcomes through the application of appropriate technology is a shared aim.

Importantly the AMA wants to demonstrate its commitment to progressing E-Health and take a leadership role in a consultative and collaborative manner with all the key partners who have the power to make our visions for E-Health a reality. For nearly 10 years the AMA has been involved in the issue of E-Health as it developed in Australia. Consensus on many of the contentious issues is close to being achieved.

A feature of the past years has been the proliferation of localised trials of E-Health systems, and while these have made a contribution, the AMA has had some concern that the outcomes have been given undue emphasis in the national discussion and debate. As a consequence we have somewhat lost sight of the very critical big picture issues, including the lack of progress on some of the building blocks that were such a key feature of the landmark report by National Electronic Health Records Taskforce in 2002. In particular these relate to connectivity. Localised trials and projects will fade away without a process to link them and add to the components of a system that can deliver a national approach to health information management.

Technology is not the only barrier to progressing E-Health in Australia and other issues contribute to professional resistance involving electronic systems. Online electronic Medicare claiming is a timely example where AMA and Ministers are working well together to make an effective system a reality, yet the process of achieving agreement is not complete. The AMA appreciates the Government's careful approach to significant change, however it also needs to heed well-informed advice on the significant efficiencies and reduced administrative costs that such a system could provide, resulting in increased patient convenience and substantial savings to Government via Medicare administration.

In conclusion I would like to make a plea to industry and all those others out there developing the future of electronic health care. Firstly new systems must not simply mimic and duplicate the inefficiencies of current practices and processes. The change resulting from electronic health information management systems can provide the opportunity to drive us all towards different and more efficient ways of doing what we do, while of course maintaining the quality of care to patients. Secondly there has to be a focus on the business case for clinicians. Doctors own and have to run businesses, have to make good business decisions that contribute to their ongoing viability.

This is a key issue that is frequently forgotten or ignored. The business structures of the medical profession are not homogenous and "one size does not fit all". The business case that might be attractive to GPs will not work for specialists, who have different practice and business models. In particular specialists need systems that are flexible to cope with their varied working locations.

The AMA is well placed to work with both the health information industry and with Government to progress E-Health. We have the clinical and medical industry expertise to work to help both groups achieve their objectives while keeping a focus on the needs of patients and the community.