Clinics and GPs the first step to e-health: Academic

E-health systems should focus on General Practitioners first, before widening to hospitals and specialists, according to the Professor of Surgery at the University of Sydney

University of Sydney Professor of Surgery, Professor Mohamed Khadra

University of Sydney Professor of Surgery, Professor Mohamed Khadra

Updated: Federal Treasurer, Wayne Swan, has announced an additional $2.2 billion in funding for the Australian health system, bringing the Government's total investment to $7.3 billion over five years, and $23 billion over the next decade. Of the new funding, $467 million will go to voluntary electronic health records.

General practitioners are the first step in implementing an effective e-health system, according to the founder of the Institute of E-Health interest group at Nepean Hospital, Professor Mohamed Khadra.

Khadra, who is also Professor of Surgery at the University of Sydney and a urological specialist, told Computerworld Australia that the majority of healthcare took place in the community, and not in hospitals or specialist care.

"It's crazy that so much of what is talked about in e-health is about hospital records and hospital planning when 999 out of 1000 health episodes occur out in the community," Khadra said.

According to general statistics provided by Khadra, around half of the Australian population would see a GP or some form of community healthcare when ill, whereas ten per cent of would see more than one doctor in a given month. Of 1000 people, only 10 would see a specialist, while only one person from that community actually ends up in hospital.

"I think it needs to start at the GP and community health level, and then go upwards from there," he said. "The GP is the person coordinating patient care; they're the ones that need to have access to hospital records and data. While what happens in a hospital is critical in the process, it's actually pre-care and post-care from the hospital that's vital, and if the GP doesn't know what's going on, it's a real shamozzle."

The electronic health industry is currently plagued by a severe lack of interoperability between healthcare providers, leaving hospitals, GPs, specialists and pharmacists unable to share information between each other about patients. While Khadra noted that debate about patient privacy continued among bureaucrats, patient advocacy groups and the community itself, it was almost non-existent within the health community itself. Instead, it was the technological challenges brought up from a lack of coherency between healthcare providers that impeded the implementation of a nation-wide electronic health system.

"Even at the individual clinician level, and that's where it's really important, there's probably about 30 different patient records systems like Medical Director," he said. "Even the level of engaging the community with the hospital is impossible.

"There needs to be a united approached to e-health, and that can only come from a government creating the opportunity for people to start to converse."

Khadra's Sydney-based Institute of E-Health has discarded the more popular topics of unique health identifiers and patient records in favour of relatively more straightforward solutions like telemedicine. The Nepean Hospital in the western Sydney suburb of Penrith boasts the "world's first virtual intensive care unit," where specialists remotely care for patients in the Blue Mountains areas of Katoomba and Lithgow.

The system, which boasts similarities to the solutions touted by established e-health providers like Intel, is effectively cobbled together from existing technology, rather than offered as a coherent solution. Khadra hopes to utilise the combined effort of IT professionals, specialists and designers to make the solution easy to use and available on a wider scope. However, despite requests for funding from the Federal Government, the institute is yet to hear back, and Khadra doesn't believe telemedicine will get much of a mention from this week's Federal Budget amongst other health-related priorities.

Those priorities largely revolve around e-health patient records and healthcare identifiers, both expected to play a large role in coming weeks.

Released in June last year, the National Health and Hospitals Reform Commission's (NHHRC) study, titled A Healthier Future For All Australians: Final Report, laid out eight recommendations for the implementation of a national electronic health system. These included a mandate for every Australian to have an e-health record with a chosen record provider by 2012, with the ability for hospitals and other healthcare providers to transmit key data to each other by 2013. It also recommended the introduction of unique personal identifiers, which would not in themselves carry any patient record data, by 1 July 2010. The latter recommendation was further cemented by the Healthcare Identifiers Bill 2010, which was introduced in the Senate in March 2010.

According to the Medical Software Industry Association (MSIA) - a conglomerate of over 60 e-health provider executives - the unique health identifier program remains on track for the 1 July deadline.

However, in the recent National Health and Hospitals Network report, e-health failed to get a mention beyond a commitment to take "further steps towards the introduction of a personally controlled electronic health record for all Australians", leaving the future of other healthcare programs like Khadra's telemedicine solution up in the air.

The transition of control from individual state-run health authorities to a federally funded system means the $2.2 billion additional funding to the health system in this week's Federal Budget has a potentially greater effect on a unified e-health system, as well as the ability for smaller hospitals to gain access to funding to implement such systems without relying on larger hospitals in the nearby area. But whether that funding eventuates - and if its reinforced by respective legislation and industry action - is yet to be ascertained.

“International experience has shown that if we are to effectively deliver improved safety and quality of health management in Australia it must be adequately funded,” MSIA president, Dr Geoffrey Sayer, said in a statement. “We are therefore urging Minister Roxon to include sufficient capital investment in eHealth within 2010-11 budget allocations.”

Khrada said the billion-dollar funding would only be effective if it was concentrated in a singular, cohesive effort, rather than led by competing industry players.

"I would love to see a unified platform with a unified set of repositories whereby each of us can see it from our directions," he said.

A recent report released by consulting firm Booz & Company found that a comprehensive e-health system would save healthcare providers and the Government up to $7.6 billion per year by 2020.

Notably, GP clinics that invest $3000 each year in e-health systems could yield savings of $668,000, according to the report.

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