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.”
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.