Organ Rejection: E-health and Doctors
Good morning.
Health information and the technology to store and transfer that information are huge topics for the medical profession.
But I have a confession to make. I am an eye doctor, not an e-doctor.
But I should be an e-doctor, and I will be an e-doctor one day…when I get more time away from people's eyes.
In the meantime I must watch my Ps and Qs about e-health and the benefits it offers to doctors and their patients.
There are AMA staff out there watching and listening so I'd better stick to the script.
Like many doctors, I recognise the importance of information technology and electronic initiatives to the modern medical practice.
I find it both exciting and scary.
Exciting because of the new frontiers it opens up.
And scary because I don't yet know how to use it. But then again, I can't even send text messages on my mobile.
But I'm getting there.
My kids are teaching me how to text, and the AMA has some very smart people driving our e-health agenda…and me with it.
I am one of the many doctors in this country who have to be given a lift on the information superhighway before I can safely and satisfactorily traverse it alone.
I suppose the e-health revolution can be likened to organ transplant, with IT being the life-enhancing element for modern medical practice and not-so-modern medical practitioners.
The problem, however, is that there is still too much organ rejection going on.
The challenge for the medical profession and the health system is to get more and more doctors to embrace and champion e-health systems.
They need to be educated about the benefits to their practice and the possible benefits to their patients.
It can be a medical tool as well as a business tool. But there is still some way to go - both with the technology and the acceptance of that technology.
Education and information - and trust - will minimise episodes of e-health organ rejection.
But, as you all know, progressing national priorities for information and communication technology in the health sector is a huge task and a huge ask.
As I said earlier, the key is winning acceptability - turning the sceptics into believers.
The 'gurus' tell us that the new electronic health age will improve the quality of care for patients and their health will be better.
They claim that access to better and more up to date information on previous and current patient clinical and medication history provided by electronic records will make people better.
This is a big claim but a noble aim.
To be honest, I am not yet completely sold on it.
But I am totally convinced that e-health will improve medical practice on several fronts:
- Billing
- Record keeping
- Prescribing
- Patient history
- Research, and
- Instant communication between doctors on patient care.
The clinical improvements will come later. They may not happen overnight, but they will happen.
One of the reasons for the delay is the way e-health is being aggressively sold.
There are lots of promises but some of the promises are not being met.
There are hitches and glitches that you would not want put to the test in a clinical situation.
If the machine that goes 'ping' doesn't go 'ping' when it's supposed to, there will be dire consequences.
There are problems because there is a lack of transparency about the proposed uses of some of the technologies and programs being developed.
Is patient care the priority? Or is it access to patient records?
Is something being developed because it benefits the patient?
Or is it really being developed because it would give the Government, say, more control over patient records and stats and the like?
The development of a quality electronic patient health record - combined with the capacity to securely transfer information to other health providers as appropriate - may certainly improve patient care.
I say may because the link between patient outcomes and e-health initiatives has not yet been adequately proven. It is still an unknown.
What is known, however, is that the development of a quality electronic patient health record will potentially provide certain parties with valuable health information.
Governments and the private sector could access the best possible source of individual health information that could be used for all sorts of purposes - bureaucratic, political and entrepreneurial.
The AMA has sat in numerous forums over the past few years on electronic health initiatives or policy discussions - but all too frequently the ideology behind the technology is clouded by the profit potential.
Both public and private sector entities realise how much money they could make or save by using for other purposes the data that has been collected to help people stay well.
I say we need to get everyone focussed on the primary care potential, not the stock exchange.
Secondary purposes must not be allowed to drive the design, direction or priorities in e-health.
There is a real danger that in designing and promoting electronic systems for the secondary purposes, the original purpose is lost.
An emphasis on the secondary will erode patient confidence in their doctor's capacity to protect their personal health information, even if it is de-identified.
The successful implementation of a national electronic health care record will depend on patients and providers finding it acceptable.
Trust and confidence between doctor and patient must always come first. That trust is the foundation upon which successful e-health primary care products and services can be built.
This is reinforced by the National Electronic Records Taskforce, which stated:
"The degree to which individual consumer's privacy is protected - and is seen to be protected - is critical to the success of initiatives aimed at greater sharing of personal health information by electronic means. Virtually unconditional trust placed by a consumer in his or her health care provider that information imparted to the profession will remain confidential is fundamental to the consumer's relationship with the provider, as well as the quality and appropriateness of the care received."
Australia must invest heavily in e-health and health informatics.
We need the investment to preserve the gains already made. We need the investment to go those next important steps into clinical territory.
Urgent investment is required to be made in the research and education sectors.
If not, Governments will not find the resources in Australia to deliver initiatives such as HealthConnect.
We lack capacity.
This lack of capacity continues to be reflected in the low number of organisations capable of tendering for aspects of the Commonwealth's e-health implementation.
The health informatics community in Australia is underfunded by international standards.
Before going on, I want to put on the record a definition of health informatics for the benefit of people who may go to this speech on the AMA website.
It's all about education, after all.
I found a definition, courtesy of the University of Missouri, which I will share with you.
Health Informatics is:
- The rapidly developing scientific field that deals with the storage, retrieval, and optimal use of biomedical information, data and knowledge for problem solving and decision making. It accordingly touches on all basic and applied fields in biomedical science and is closely tied to modern information technologies.
- The study of the interrelationship between (a) information (including computers and communications); (b) science (including engineering and technology); and (c) medical research, education and practice.
- The analysis and dissemination of medical data through the application of computers to various aspects of health care and medicine.
- The science of collecting, storing, packaging and using health information. A major component of the research conducted by this theme involves the development of standardised classification and coding schemes to enable data collection and connectivity within large, integrated information systems. This work is fundamental to the successful implementation of system-level structures, such as community health information networks, through which the linking of health records, critical to continuity of care across multiple providers, can be established.
- Health Informatics (HI) focuses on the application of computer information systems to health care and public health. Informatics extends beyond simply using the computer as a tool for computation into the process of knowledge acquisition, storage, retrieval, representation, and manipulation. A major focus of Informatics is the support of information systems for reasoning, decision-making, and learning. Health Informatics encompasses the fields of information science, computer information systems, and educational technology in support of health care delivery, education, and management.
- Health Informatics is a body of knowledge and a set of techniques to organise and manage information in support of research, education and patient care.
- Health Informatics includes projects such as the following:
- Design of electronic patient records both locally and nationally
- Development and delivery of public health information
- Construction of clinical information support systems
- Design and maintenance of protocols based on evidence
- Development of terminology, coding, and classification systems
- Evaluation of the impact of information technology on the clinical process, clinical outcome, organisations, and resources
- Clinical audit
- Telemedicine
- Database construction
- Design of clinical workstations
- Data management
- Use of internet technology in medicine.
So, there you go. It's all ahead of us.
While there are centres of health informatics research and training in most States, they are relatively small - and few, if any, are economically sustainable as they are.
While some clinical health informatics programs exist, there are no large-scale professional training programs in health informatics.
Several tertiary institutions have commenced some form of health informatics training from postgraduate certificates through to Masters and PhD programs.
However, the pool of graduates remains small and there is no defined career path or for health informatics professionals…not yet, anyway.
Consequently there is a variable skill level and project failure is often related to poor implementation. AHMAC was advised that only two of 35 projects have made the grade.
The bulk of the Australian health investment in information communication technology remains un-evaluated and it is not possible to make clear statements about costs and benefits.
Australian research, however, is critically undervalued and underfunded by international standards.
For change to happen and projects to succeed, health professionals must develop skills in health informatics.
Our current health informatics capacity in Australia is not sufficient to meet our current or projected demands.
The issue cuts across education and communication infrastructure…not just health.
Governments can't allow portfolio ownership issues to delay the march of health informatics.
The solutions include both short and long term strategies that address education, research and practical implementation of measures within existing e-health policies and strategies.
The professional community has now established its own College of Health Informatics, which is small and receives no formal funding.
It has no resources to formally develop any national professional training framework despite the will to do so.
This lack of resources is compounded by the loss of human resources - the brain drain of our best informatics people being lured overseas to work in a more energetic environment with adequate funding.
So the whole lot - e-health and health informatics - is stuck mid-stream.
We've come part of the way but do we have the commitment to do the hard work to get the job done.
Successfully progressing the national priorities for electronic health records in Australia means bringing everyone along with you - the providers, the profession and the patients.
The fact is that there is a continual failure in Government initiatives to deliver a business case for providers.
HealthConnect, and previously MediConnect, have not delivered a business case for general practitioners.
One also wonders how or when a business case will be developed for non-GP specialists.
It would need to be a completely different business case than for GPs.
The absence of a business case is most telling in the processes for trial projects already implemented.
Doctors have participated in trials where the complexities and time resources that were required to be devoted to non-clinical elements drove doctors away or prevented them from participation.
General practice and non GP specialists own and run businesses.
These businesses support workers and their families.
They impact positively on other local businesses in the community.
Their viability as a business is crucial and must be foremost in the minds of Government and the private sector.
The main game is now in the National Electronic Health Transition Authority, and AMA is highly supportive of it.
NEHTA is at last a chance to ensure a coordinated national approach to the establishment of a national electronic health record.
The AMA is committed to working with Governments to progress the national priorities in e-health.
We are equally committed to protecting the fundamentals of the doctor patient relationship. This is a relationship that must be protected. The trust must not be exploited.
I may not know how to text but I do know when I have been talking too long.
Thank you. I'm happy to take questions…easy ones please.