E-health – The need for unity of purpose - AMA President, Dr Andrew Pesce, Closing Remarks, HEALTH-E NATION, Canberra, 19 August 2009

CLOSING REMARKS, HEALTH-E NATION, NATIONAL CONVENTION CENTRE, CANBERRA, 19 AUGUST 2009
AMA PRESIDENT, DR ANDREW PESCE

E-health – The need for unity of purpose

Ladies and gentlemen, speakers and presenters, supporters of e-Health …

It is a great pleasure to provide closing remarks for such an important and timely Conference.

E-health – the term and all its connotations – has been around for as long as I have been involved with the AMA.

It has always been considered important to health.

It has always had great support.

But it has always been something that has been ‘out there’ somewhere in the future.

Well, I think that future has finally arrived.

This Conference is evidence of that.

The work of the National Electronic Health Transition Authority – NEHTA – is evidence of that.

The Final Report of the National Health and Hospitals Reform Commission is evidence of that.

The positive statements from the Prime Minister and Minister Roxon are evidence of that.

Bipartisan support for the introduction of far-reaching e-Health programs and innovations into our health system is indisputable proof that e-Health is here in Australia – and it will change the way we think about the use and exchange of health information.

The AMA has a proud record of supporting the march towards a world-class e-Health framework in this country.

The AMA is committed to achieving better health outcomes for all Australians through the implementation and uptake of e-Health.

Our Federal Budget Submission this year sought funding for e-Health infrastructure in hospitals, medical practices, aged care, pharmacy and other allied health practices.

Our submission was based on the significant investment already made in the development of specifications and requirements for a national approach to e- Health.

It is now up to the Government – in collaboration with the private sector - to take the running and make all our e-Health dreams a reality.

Faster and improved capacity for broadband technology is essential to improve health services and capacity to rural and remote communities.

I note that work in this area is happening.

Increasing the use of telemedicine generally has the capability to provide greater efficiencies for both doctors and patients - and improve health outcomes in the community.

The AMA has encouraged Government to progress the inclusion of telemedicine into the Medicare Benefits Schedule.

And we actively support the work plan of NEHTA.

We participate on a number of NEHTA committees and working groups to provide future directions.

Many individual doctors give up their time to provide clinical advice and expertise to NEHTA projects.

The medical profession strongly supports the moves towards making electronic health records a reality.

We know the benefits that e-Health will bring to safety and quality of patient care, and this is where our primary interests lie. 

For that reason, we believe summary electronic health records are fundamentally a clinical tool to aid doctors and other health professionals in sharing accurate information about an individual at the right place and the right time.

The summary electronic health record will be an adjunct to the comprehensive patient record kept by the doctor.

The current debate is very much about who should control the electronic health record.

NEHTA and the NHHRC are pushing a patient-controlled model.

The AMA is open to patients controlling access to their summary e-record, with some exceptions such as access by emergency physicians.

But for e-records to be truly effective in improving safety and quality of care and reducing adverse outcomes in health, the focus should be on provider-controlled input into the record.

An electronic health record must find the balance between efficiency and privacy.

Protection of patient privacy will be the critical factor in gaining acceptance from consumers and the medical profession in the implementation of an electronic health record.

With the increased amount of data being collected from various sources, a robust data governance framework will be needed to ensure appropriate use of data while protecting patient privacy.

We also support the development and implementation of Healthcare Identifiers to identify each individual, healthcare provider ,and organisation.

These are an essential building block towards the shared electronic health record. 

Legislation to make identifiers a reality is expected early next year, and it is likely to set the building blocks for protecting privacy in an e?health environment.

However, there are still many practical issues to be resolved in making e?Health a reality.

Is a national database (or series of databases)  the most appropriate storage of an electronic health record?

Does the use of portable devices held by the consumer - such as a memory stick - pose a range of practical usage barriers for the clinician and undermine the integrity of the record?

The AMA is very keen to be part of a broader debate about these details.

We believe the implementation of e-Health should be handled carefully and progressed in a positive way.

Government incentives have been instrumental in computerising general practice and supporting their e-Health capabilities.

Some specialists are not as ‘e-Health ready’ and will need support.

With additional assistance, guidance and support for doctors and other health professionals - coupled with a clear framework and investment by governments for e-Health infrastructure, including access to appropriate broadband bandwidth – the e-Health era is upon us.

There should be no negative implications for patients, such as linking the payment of rebates or benefits to patients if their health provider is not e-Health ready.

This is one of the recommendations of the NHHRC.

We think all doctors want to be part of the e-Health journey.

However, the diversity of medical practice means that doctors will have numerous times and places when it will be most appropriate and rewarding to get on board the e-Health train.

More carrots, fewer sticks – that is the way for e-Health to reach its desired destination.

We would support the Government in providing assistance and guidance through a range of education and marketing tools to roll out e-Health to the medical profession.

We are looking eagerly at the roll-out of an electronic prescribing system as a fundamental building block of an electronic health record.

In the absence of clear Government direction - and also a lag in development of standards and specifications - the marketplace now features two major players pressing forward with electronic prescription transfer systems

The AMA does not endorse one product over another.

But we are looking for e-prescribing products to streamline and integrate with existing work practices and clinical practice software.

Most doctors are already e-prescribing.

Gone are the days of illegible handwriting.  Most doctors use computers to generate scripts.

Beyond that, there’s not much in it for doctors to e-prescribe.  For that reason, new systems must be cost neutral for the doctor and be practical and adaptive to use.

Patients must be able to fill their script from a pharmacy of their choosing and we are looking to see how this plays out with the current e-prescribing products.

Despite the broader benefits of e-prescribing, the AMA is mindful of the inadvertent medico-legal implications that might arise from the functionality that e-prescribing systems offer, particularly for general practice.

For example, if e-prescribing software has a function to notify that a script has not been dispensed, then what are the legal obligations on the doctor to follow that up with the patient?

Currently, the doctor usually only finds out a patient hasn’t filled their script at their next appointment.

You can see how e-prescribing might impact on the way doctors practise.

But there is no denying it will improve medication management.  It's about making sure all boxes are ticked before systems are rolled out.

The AMA would prefer all available software systems be interoperable and seamless to the doctor, so that they may choose any system and know that it will talk to any other system.

I urge the software industry to work together on this front, for the good of the Australian health care system.

Still, I believe all our concerns can be addressed as the e-Health juggernaut moves on.

E-health needs doctors.

And doctors need e-Health.  It’s just that a lot of us don’t know it yet.

Doctors and other health professionals lead very busy lives.

Many of our number know the term ‘e-Health’, but a lot of them are yet to be made aware of the benefits that will flow to the way they practise medicine and care for their patients.

Thank you to CHIK Services and all the other groups who organised and supported this Conference.

The AMA and the medical profession stand ready to get behind e-Health and make it the reality that the Australian health system needs.

Thank you.