Health Care in Australia is in an Age of Digital Reform: Is Interoperability, Primary Care and Consumer Driven Care a Real Consideration?

The Federal government has rolled out initiatives around e-health that have not really delivered value for money to any of the parties if we are to be frank and honest. They are spending a lot of money to achieve their desired goals but they are creating new problems as a result of interoperability. You would think that with the introduction of e-health, everyone would be excited and rush to use it. But that is not the case. Australia has more than 28,000 GP clinics (according to the 2010 figures from the Bureau of Statistics) yet only 300 clinics are using the electronic health record system.

The Personally Controlled Electronic Health Record, now called My Health Record, was first introduced in 2012. The government at that time saw e-health as a natural extension of Medical services and PCEHR (My Health Record) as a key enabler of that policy. Both advocates and critics of the system agreed on the potential usefulness of electronic health records to improve patient outcomes and increase the potential efficiency of health services. They agreed on this one thing though there was almost no evidence that electronic health records, in and of themselves, improve the quality of care. The adoption of e-health initiatives was generally expected to bring a paradigm shift in traditional healthcare system by:

·        Reducing medical errors.

·        Enhancing healthcare quality.

·        Minimising healthcare costs.

·        Empowering consumers to understand their healthcare needs and make informed decisions on their healthcare.

Now the nation has spent a lot of money on the e-health initiatives and yet uptake is very low. Few patients have entered their records on My Health Records and few doctors use the system. One wonders why.

There are several reasons why adoption of e-health has been slow. There is still great fear concerning privacy which is why most patients have not uploaded their records. Then there is fragmented funding and governance of healthcare services, a problem that exists at policy level. There may also be concerns about the costs and complexities associated with e health implementation and there might be need to resolve issues about how it will affect practitioners and consumers alike. After all there is no rigorous research evidence on the benefits of e-health that might drive the requisite change and politicians are reluctant to be seen to be tampering with a politically-sensitive service. Not to be forgotten is resistance of professionals to changes in existing models of care, which is why a small percentage of Australian GPs have adopted the system.

Another problem may be the way implementation is effected. It is a common problem in many organisations that a new technology is introduced and then the people who must use it simply cannot adopt it because they were ignored at design stage. In other words, no one asked them what they need and why, and most likely the solution they are presented with does not address the need. This may be one of the problems facing the adoption of e-health in Australia today. Australian doctors and patients are struggling to buy into the idea of e-health at implementation stage. It can even be argued that GPs who see the same patients over and over again do not see any value in the electronic systems. In other words there is nothing to be learned from the system.

Having spent a lot of money on creating and promoting the system, the federal government is now embarking on a new $485 million drive to encourage consumers to enter their health records. Maybe at last the government will explain the benefits to the consumers of creating an electronic health record. This plan is based on the assumption that doctors are likely to use the system if their patients’ records are on it. Read more here. I think this marketing effort, which should have started at design stage, should include all health professionals and the people. These groups are the users and/or beneficiaries of the system so they must understand the benefits before they make the effort to enter their health records online.

Will health practitioners derive benefits from e-health? That remains to be seen. This does not mean that I am anti technology. I like all the benefits that technology provides. I believe that technology is going to make delivery of health care easier and cost effective for rural and remote areas, and also for the aged who are confined at home. I believe that those who suffer from chronic illnesses can wear devices that keep track of vital signs and can make it easier to alert health professionals when there is a problem.

In fact I have written on the need for better use of telehealth and the advantages of using telehealth for patients and service providers in the article The Basics of Telehealth. I have also written extensively on the need for a universal digital health record system for the Australian health care system, instead of the various discrete systems that various groups currently use. I have emphasised that the universal digital system(s) that the Federal government should one day come up with must have interoperability which I believe is the key to integrated care and to overall success of digitalization. Unfortunately no peak body seems to be using all the available information to make this possible. At the present moment the use of current and future technology is lacking and where it is used it is fragmented.

That we are facing shortages of doctors in rural and remote areas is not news to many. It is common knowledge that although Australia has increased the number of doctors graduating every year, the doctors are reluctant to work in remote and rural areas. In the article called Introducing Physician Assistants recently, I proposed that physician assistants are faster and cheaper to train than doctors, and yet can do most of the work that doctors do except surgery. They are therefore an alternative to be considered as the solution to the doctor shortage in the rural and remote areas of Australia as the NDIS and Aged Care become open markets for practitioners.

Technology can be used to reach patients in remote areas and those who have mobility problems, like the aged and the disabled. With the right technology in place, one doctor can monitor a long list of patients, and intervene when particular vital signs signal a problem. What we need now is technology in each GP clinic that is linked to wearables. Why are wearable manufacturers not designing the technology that links their products to doctor’s office?

Wearables are becoming smarter much like a mini computer. Look at a smart wearable like the Helo. The Helo can measure heart beat, blood pressure, respiration rate, energy levels, step count and much more. If it could be linked to a doctor’s office for remote monitoring, doctors can monitor every patient who needs monitoring. This could be possible if we had more interoperability and smarter analytical based software in GP practices.

Linking doctors’ offices to patients must be considered because Health Care in Australia is a Shifting Paradigm and patients are urged to take better control of their own health. With better information, patients are willing to take control of their health but they need remote monitoring so that they can receive timely help when there is a problem. Telemedicine, predictive diagnostics, wearable sensors and many other new apps will transform how patients receive care and enable them to take more care of themselves with the help of remote monitoring. Read more here.

The need for health care navigators cannot be ignored, considering that patients find it difficult to navigate the complex health system. If we are going to deliver the right care at the right time, Australia must use care navigators in conjunction with e-health to achieve this goal. With technology similar to Patientory, the patient, the doctor and other health practitioners should be able to see the whole medical record of a patient securely no matter where they are being treated. And moving across the state or across the nation will not affect access to the health records.

We live in the digital age and it is time for Australia to up its game. The health care system must make e-health available to all citizens in remote/rural areas, and those who have mobility problems. More use must be made of wearable devices that are monitored by doctors’ offices, so that patients can look after themselves while being monitored. This requires that centralised digital health records are created and kept safe, and are made accessible to the right health care practitioners at the right time. If this is carefully planned, Australia will be able to provide the right care at the right time.