Ever since the Federal Government announced its plan to construct a National Broadband Network (NBN) much time and talk has been dedicated to the endless possibilities of the fibre network. In few sectors has this been more the case than healthcare.
Indeed, the potential for ultra-fast broadband to transform the health sector and make the electronic health, or e-health, a reality has often been touted as the raison d'être for the network.
However this excitement — spurred on by the promise of specialist consultations via video conferencing and GPs being able to access digital health records — has cast a shadow over the many layers and limitations of day-to-day technology already embedded in healthcare, whether it be hospitals, specialist clinics, nursing or medical schools.
The fact is, despite the government’s hype about the NBN, hospitals, medical schools, nurses and doctors are already achieving advances in health through the use of information technology.
Take Bill Vargas. As the IT Manager the Children’s Hospital Westmead (CHW) in Sydney Vargas has helped the organisation make the holy grail of e-health — electronic patient records — a reality.
While the National eHealth Transition Authority (NeHTA) has come under fire for repeatedly failing to deliver e-health projects on time — such as the implementation of a national Personally Controlled Electronic Health Record (PCEHR) — CHW has been working on its own decade-long electronic record journey based on Cerner.
“We’ve got a full electronic medical record integrated, which means we’ve got things such as, electronic ordering, electronic patient scheduling, results reporting including pathology,” he says.
“What we do as part of the electronic medical record is scan the paper afterwards as well so we’ve got document imaging. That’s integrated into the personal record of each patient so our transition from paper to data can be done over time… As paper is taken away and it becomes data, then we’ll no longer scan the paper.”
Vargas is quick to sympathise with the challenges NeHTA faces. He points to challenges with accessibility to an e-record system. “We’ve been at this for 10 years so it’s probably been a 15 year journey now; it was about changing work practices and processes and how the system can actually enhance services and assist clinicians in patient care,” he says.
“There are smart support decisions behind it and what we’re finding now is our clinicians are driving requirements to the extent that our resources do not allow us to keep pace with the requirements because there’s more demand for the new things to be done and our resources are limited.”
Other hospitals such as St Vincent’s and Mater Hospitals have been able to able to make the most of existing core competency — in its case, writing software. The hospitals’ CIO, David Roffe, says having these skills has allowed the utilisation of open source applications and tools — such as the J-box open source Web application server and content management system Joomla — to create its own electronic patient record.
“We’re an application and development house, which is unique in Australia,” he says. “There are four people in the development team and we have 32 IT staff to look after three hospitals: St Vincent’s Public and two private — St Vincent’s Private and the Mater Hospital in North Sydney. We’re a shared service; we provide those services across those three hospitals from a single IT department based in Darlinghurst.” Further suggesting how far hospitals are ahead of the curve, Roffe says St Vincent’s Private and the Mater Hospital have had an electronic medical record system for the past decade and a half.
“Everything a nurse has done in a private hospital has been electronic for 15 years and that same system is moving into the public as we speak,” he says. “We’ve been making that transition for about eight years.
Like CHW’s Vargas, Roffe stresses there are challenges, particularly around change management among senior medical staff — read: older doctors reluctant to change their ways — but younger staff are embracing change.
“The junior doctors just eat this stuff up and that’s what we provide for them, but the senior doctors don’t type, so if you put a clinical system in front of them that’s electronic, they don’t want to feel disenfranchised in front of the junior people,” he says.
“The junior people tend to do more of the work; it’s a generational thing. The junior doctors interact with the system; for the senior doctors we provide view access so they know what’s in it but they don’t like to type so the junior doctors do it all for them.”
Over the page: eHealth and mobility