STOP PRESS: HISA invites members to comment on NEHIPC strategy

If you are a HISA member you can request a copy of the presentation by clicking here

One way that members can help is to contribute to this forum, and through the various Special Interest Groups such as the Privacy SIG.

On the issue of privacy, I have been advocating for some time that there should be much more public discussion of the risks and benefits of e-health. Such discussion would include privacy as a major component. If Government or NeHTA is not going to take the lead, then I believe that HISA should do as much as possible within its limited resources.

HISA is well positioned to do this because many HISA members have put considerable thought into these issues and would be able to progress the discussion very rapidly if properly supported.

We have to remember, though, that HISA has relatively limited resources, and needs to focus on providing useful services to members if it is to survive as an organisation. This forum is a good example of the services HISA can provide, and I would encourage members to contribute as a way of keeping the strategy alive and relevant.

Unfortunately, the whole field of MEDICAL Informatics which is current thought of as a reasonably homogeneous area is actually a conglomeration of very very heterogeneous Informatics areas - time will demonstrate this to be the case when each specialty undertakes its own informatics research.

How do you reconcile GP informatics where there is established diagnosis in 70% of cases and the problem-oriented EMR seems to fit, with the informatics needs of tertiary specialists whose patients have an established diagnosis in ~100% of cases BEFORE referral and clearly need a diagnosis-oriented EMR?

So it no wonder that Public Health think they are different, because frankly they are different! Same data, but organised in different ways.

Can we develop a comprehensive eHealth strategy? - probably not with the level of use, disorganisation and lack of study in eMR systems in hospitals (not that this is the sole issue, but it is a significant part of any eHealth record initiative and the site of much disease related activity. Is any commercially available or FOSS medical system currently available built on good informatics research and accurate definitions of the specialty expertise?

A

I had a different (but still difficult) experience in Victoria.

In 1997, I was asked by a group of Home and Community Care providers led by a local government organisation to identify opportunities for using e-health (we didn't call it that then) to better coordinate their activities.

I developed a requirements document recommending the use of the then new fangled Web technology and existing standards for datasets and terminology (whatever happened to the Australian Community Based Health Services Codeset – I know it was the basis for CATCH – what happened to that?) to allow them to share referrals while retaining a copy on a central web accessible database so that others could see who was involved in the care team, and what they were trying to achieve. This was all based on an opt-in consent model.

Soon after that (in 1998 I believe) the Victorian DHS Service Coordination Strategy was developed, with Primary Care Partnerships funded and formed to progress issues relating to the coordination of health care services.
Because this was an initiative of the Primary and Community Health branch of the Department of Human Services, the acute health sector had limited engagement and involvement. The most enthusiastic and engaged members of the acute Health Services were the Aged Care Assessment Services.

It was at this time that the Victorian equivalent of the ONI was released - the dreaded SCTT. We were forced by DHS to use the SCTT (all 17 pages of it) for all referrals, and electronic referral became an arduous process involving many web forms. Still, for some users, this was better than their current processes, and in spite of some horrendous design decisions forced upon us, the system survived.

The introduction of the Victorian Health Records Act was actually a great help, because it focused attention on issues of privacy and security, and helped clarify issues such as informed consent and that sharing information electronically was not only possible, but often desirable and well supported by informed clients.

The office of the Health Services Commissioner in Victoria was a great help also. they were able to provide guidance and useful advice while encouraging the use of technology for the benefit of clients. They made it very clear that they believed that privacy issues need not get in the way of providing efficient and effective services, providing that the issues were properly addressed.

Several versions and more than ten years later, the Eastern Region Service Coordination System is still alive and apparently thriving, with about 500 providers involved, although I don't have a lot of involvement with it any more. Its future is uncertain, however, as DHS have recently announced a statewide referral gateway project, which will no doubt eat all the funding. One of the main benefits of the Service Coordination System is that it retained copies of referral documents and a history of referrals for clients. This information is very useful, for example, in reactivating services for someone who is discharged from hospital after a procedure. It is also considered helpful that members of the care team can see who else is involved in the care of the client. This is a rare luxury in health care in Australia!

Some standout learnings from this were: The GP population was very difficult to engage. The Divisions were very helpful, but at the end of the day it was difficult to get GPs to engage meaningfully with Service Coordination or with the systems to support it. The acute sector was not particularly interested either, even though the system would have been of great benefit, particularly for their transition and ambulatory care areas. Because the system was not “medical” it was difficult to get people who are medically focused  to see how it could be of any use to them.

The main lesson that I learned was that many of the problems in health care are not medical. They are due to poor communications and handover, complex funding mechanisms and eligibility criteria and a failure of the various disciplines and professions to see that their clients would benefit greatly if they could learn how to work together as a team and respect each others skills as well as understanding their limitations.

I haven’t really seen a great deal of progress in this area, but am hoping that the National Hospital and Healthcare Reform Commission will see things my way.