Prescription for e-health

If there is one area where the benefits of technology reach their utmost potential in society, it is hard to argue against e-health. It has long been an area of exciting innovation and promise. It has also been chronically underfunded. But with healthcare reform at the forefront of the national agenda, the possibilities for an integrated approach to e-health makes the area rife with challenge and opportunity.

And, with the release of the final report form National Health and Hospitals Reform Commission (NHRC) in July, the clamour around e-health has reached a crescendo. So how are healthcare providers adopting IT solutions and what technologies are central to their strategies?

“There is a significant upturn in the amount of investment in e-health,” says Microsoft health spokesperson, Dr David Dembo. “And that’s for the all the reasons that have put the healthcare’s sector back up against the wall as an industry in crisis — it’s had to innovate.

“The tipping point around the debate is the role that IT can play in healthcare’s transformation is really happening. The debate at the moment is around whether companies will achieve what they promise rather than the role of IT.”

The elephant in the room

Without doubt, the person-controlled electronic health record, perhaps the key e-health recommendation from the NHRC report, holds both the greatest challenge and opportunity. For one thing, the mere mention of standards, or lack thereof, is enough to strike fear into the hearts of anybody working in the sector, IT-related or otherwise.

“Take an individual hospital unit,” says Siemens’ chief technology architect, Mark Anderson. “If I am transferred to a hospital on a different system, it gets interesting. The trick is getting that information in the appropriate format.”

Most of the states are already some way into electronic health record programs. In New South Wales, for example, the Electronic Medical Record (eMR), which aims to replace paper medical records with an online version that tracks and details hospital care, is already well underway. About 84,000 clinicians and scientific staff in up to 188 public hospitals will begin using the eMR over the next three years.

However, it is widely acknowledged that though a much-needed step in the right direction, healthcare extends far beyond the reach of hospitals.

“You have a number of initiatives going on that have been very public-health focused, very hospital focused and it’s only recently people have realised we can’t have a true health record if we’re not including long-term care,” says Industry Director of Health Solutions at Fujitsu Australia and New Zealand, Jeff Smoot. “You must have community care and residential care involved, GPs have to participate — it’s not just about the hospital.”

And that’s where it gets tricky. Each time another level of the industry comes on board, complexity around standards grows.

“Standards are a challenge everywhere, particularly in healthcare because there is so much of it” says Microsoft’s Dembo. “Decision-making is a lot more complex. It is a fragmented system and standards involve multiple committees with somewhat overlapping interests. The creation of standards is critical to getting general interoperability but the pace of their formation is standing in the way of progress.”

In the absence of standards, health professionals have innovated on their own terms with whatever funding they can procure. The result is pockets of brilliant healthcare technology that doesn’t scale, creating an interesting dilemma for the realisation of national e-health reform.

“Many innovative doctors have gone out and invested in their own systems and the issue is, for them, no state-wide or countrywide system will do as perfect a job,” says CSC director of health services, Lisa Pettigrew.

That ‘cottaged’ industry, as Dembo terms it, can create significant risk for IT professionals working in e-health.

“When you have a cottaged industry servicing an underfunded IT shop, it adds a significant amount of risk and cost onto IT projects and increases the likelihood of failure,” he says. “That’s created a huge chasm between the IT professionals, IT managers and the doctors and nurses.”

Microsoft’s take is to embrace standards where they exist and create its own set where they do not.

“Those might become the default standards and they might not. It doesn’t really matter to us as long as we get going. And we will backward integrate any default standard that comes along down the track.”

Overseas success

The silver lining to the standards cloud is that it’s hardly a new phenomenon, albeit a complex one. These days, health providers are far more open to collaboration and the consideration of overseas models. Commoditisation is no longer a dirty word. Denbo claims Microsoft’s US experience shows that the Nirvana of an electronic health record can not only be achieved, but at a fraction of the expected cost, with a working model up and running in less than a year.

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In Europe, CSC worked with the Dutch Ministry of Health to create a secure system that lets doctors share medical records without compromising the privacy of patients. The system pulls together records from multiple healthcare providers, but it doesn’t store patient histories and the doctor’s system can’t store the records.

“They haven’t tried to create a central database,” says Pettigrew. “The data is pulled in and rendered, stored temporarily, then removed. It’s an opt-out model with transparent audit trails, so you can see who has accessed your records. I think that is critical of any e-health system regardless of privacy legislation.”

The focus these days is to understand what has worked in a country and what hasn’t, says Fujitsu’s Smoot.

“I don’t think you can copy one model, drop it into another country and expect it to work. It’s around questions like — What are the policy issues? What will it take to get all the key stakeholders on board? What are the procurement processes? What would they do differently? How did they get people involved in implementation? What can we learn from the positives and negatives that have come out of some of the other countries?”

Opportunity knocks

The good news is IT people with skills in the fundamentals are not only well positioned, but will become highly sought after, particularly in areas such as collaboration, dashboards and mobility. Customer relationship management also has an important role to play, as health organisations begin to add CRM overlays to their record information to gain a case management view.

The key, says Denbo, is not to put e-health in the too hard basket. The “low hanging fruit”, such as making it easier to find information through patient and clinician portals and looking at efficiency through collaboration models, is where the opportunities lie, particularly as government strategies begin to focus on citizen-centric delivery.

“There is a dire shortage of people with skills in healthcare because most of the other industries have tended to pay more for those skills than health,” says Denbo. “It’s a brilliant time to be working in health. It is an industry undergoing transformation, with e-health a fundamental component of that transformation. And at the end of the day we are all consumers of a broken system — I would rather be working on fixing the system for ourselves.”

This article originally appeared in Computerworld Australia's August/September print edition. To subscribe please email Computerworld or go to our subscription page. You can also follow @computerworldau on Twitter and let us know.


Copyright © 2009 IDG Communications, Inc.

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