We live in a world surrounded by technology – widgets, gadgets and apps. The impact this technology is having on our day-to-day business and social lives is considerable. The changes have occurred almost by stealth and have become an essential staple of daily life. We don’t think twice about how our communications devices, phones or banks interconnect – we just expect it to happen. So it begs the question, why hasn’t this same degree of interconnected functionality been achievable in the health sector?
Some 10 years ago I wrote an article entitled, “On the e-highway but where is the navigator?” I mounted a case at the time for the development of a strategy to drive the adoption of electronic medical records and connectivity across the broader healthcare sector. A decade later, it seems appropriate to review and reflect as to what has been delivered and what has really changed.
In 2005, that navigator, NEHTA, was established under the sponsorship and direction of COAG. A series of core foundation eHealth technology services were funded, developed and released under the overarching umbrella of the national eHealth strategy. Some of those foundation services are now in place to facilitate the delivery of a range of “e” requirements in both the hospital and community sectors.
These services were essentially focused upon providing the capability to facilitate seamless communications between healthcare organisations and to national repositories, in what is generally referred to as interconnectivity. It is analogous to standardising the rail gauge to allow for the movement of any train to any station on the rail network.
The national eHealth implementation strategy has been primarily focused on levering existing “e” activity in the hospital, community pharmacy and general practice sectors. In other words, it focused on those who had an existing level of capability in order to achieve early wins, the so-called early adopter and fast follower approach.
It was anticipated that the remainder of the sector, once having been made privy to and recognised the benefits of this new technology, would climb on board and abandon the paper record in favour of these “e” solutions. The unfortunate reality is that whilst some parts of the healthcare sector have implemented and embedded electronic capabilities for both administrative and clinical purposes, the majority of providers are yet to be convinced of the compelling business case and value proposition.
This is not the fault of the provider community; the fault lies in the failure to develop a whole of healthcare “e” local adoption strategy. The national strategy was developed by COAG and NEHTA and with its core focus being on reforming the public hospital sector and developing national document repositories. In the journey, the voice of the community sector was either drowned out or not adequately acknowledged.
Paper route still the norm
So if we were to re-prioritise the “national” eHealth strategy, where should we begin? If we commenced with the recognition that the overwhelming majority of clinical consultations and associated messaging transactions occur in the community sector, it would seem prudent to focus community sector efforts on the enabling of two essential deliverables, these being:
- A strategy for transitioning the specialist and allied healthcare sectors from paper based records to electronic records, and
- A strategy for implementing universally available, seamless interconnected secure message delivery (SMD).
The rationale behind this approach is relatively simple. It recognises that in the rollout of the eHealth product suite, an important and critical step was not addressed, this being the development and delivery of a compelling change and adoption strategy which addressed the needs of the community healthcare sector at the provider and practice level – call it the base requirement or priority use case. The national eHealth strategy failed to identify what community providers both wanted and required to support their existing clinical and business transactions.
Almost every referral from a primary care provider to a specialist or allied provider generates an outbound clinical message and a corresponding inbound message. Whilst in general practice the capability widely exists to create and send these messages electronically, the majority are still sent by the old-fashioned paper route (either snail mail or fax) because there is either no available or easily accessible or discoverable secure electronic endpoint.
In the specialist and allied health sectors the issue is both the lack of widespread adoption of electronic record systems combined with a broader inability to transmit electronically. So despite the massive investment to date in “e” technology, services and solutions, paper-based transmission and faxing remains the norm.
Implementation and adoption of community sector electronic medical records combined with an availability of interoperable SMD will achieve the dual outcome of supporting improved electronic communications between all healthcare providers – “point to point” communication – and promote the creation of useful and shareable clinical documents.
If we can deliver and support the priority use case, then as more clinical documents are created and transmitted electronically, it becomes a relatively small step to progress from the “point to point” to the “point to share” environment of national databases, allowing for some of the existing national strategy to be potentially realised. Some might call that a win-win scenario or perhaps you might say, “One small step for a clinician, one giant leap for the healthcare sector”.
Dr Nathan Pinskier
MB BS, FRAGCP, Dip Prac Man, FAAPM, FAAQHC
Chair RACGP NSC - Health Information Systems
Dr Nathan Pinskier is a Melbourne GP and the current chair of the RACGP National Standing Committee for Health Information Systems. He was the deputy head of the NEHTA clinical leads team until August 2013. These are his own opinions.
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