EPAS instability, lateness and cost blow-out to affect new RAH

The implementation delays, cost-blow outs and inadequate clinical usability being experienced with the roll-out of South Australia’s Electronic Patient Administration System (EPAS) is likely to have an effect on the design of the new Royal Adelaide Hospital (nRAH), which will now need to plan for paper record storage, the SA Auditor-General has warned.

In a critical report handed down last week, Auditor-General Simon O’Neill has revealed that the design and build phase of EPAS is 16 months behind the original completion date and is unlikely to be fully operational until well into 2017. The new RAH is due to open in 2016, with its physical design, proposed workflows and equipment selection influenced by the intended roll-out of EPAS.

Mr O’Neill also revealed that the Health Reform Cabinet Committee at one stage considered cancelling the whole project and removing EPAS from its activated sites, as well as stopping the implementation and only using EPAS at its current sites, including Port Augusta Hospital, Noarlunga Hospital and the Repatriation General.

The committee also considered continuing the implementation or taking SA Health’s preferred option of delaying the implementation until functional deficiencies could be resolved. It appears that the latter option has been selected, with the EPAS roll-out paused for the time being and a “stabilisation” phase entered into.

Along with the known problems with the system’s billing module – which has led to the SA government issuing a claim against the developer, US giant Allscripts – problems with clinical functionality are also emerging.

Pulse+IT understands that many clinicians at active sites are refusing to use the new system either because they consider it potentially dangerous or it does not suit their workflows. However, no clinicians have so far been willing to speak publicly about their concerns.

The InDaily news service reported in May that clinicians at Port Augusta Hospital had become so frustrated with the system that there had been emotional breakdowns and “rage attacks”.

The Auditor-General’s report says the recommended stabilisation phase aims to resolve key functional issues including:

“In addition to these six streams SA Health is planning contingency options for the nRAH in the event that EPAS is not ready to deliver its requirements,” the report states.

The implementation will also not fulfil its original scope, which included the replacement of iPharmacy and operating theatre management. EPAS was originally planned to replace over 70 legacy patient administration and clinician information systems, including the OACIS system used at many sites that was originally designed to become a statewide electronic health record.

It was planned as an integral part of SA Health’s IT upgrade, which includes the development of an Enterprise Master Patient Index and new statewide medical imaging and pathology systems. SA Health is currently preparing for the roll-out of Cerner’s pathology module.

However, in addition to the delays and clinical functionality problems, EPAS has also run over budget. The estimated total cost over 10 years was $408 million – $143m in capital costs, $220m in operating costs and a risk-based contingency of $45m.

The business case put to Cabinet stated that when efficiencies were included and the costs of maintaining legacy solutions was calculated into the cost-benefit ratio, EPAS would realise a benefit of $11 million over 10 years.

However, program funding was increased to $422 million in 2011-12. The current budget shows an underspend, but there has also been a “significant deterioration” in its budget position, the Auditor-General reports.

“In February 2014 the responsible Minister advised Cabinet that the program was several months behind the original schedule, with increased costs and a reduction of expected benefits, creating a net financial cost of over $50 million,” he said.

While SA Health has reported some benefits from the implementation, including continuity of patient information across active sites, drug dosing alerts that have potentially avoided medications misadventures and the provision of real time clinical information to assist in monitoring the progress and movement of patients, there have been some major issues.

These include the discovery of 4833 defects, not just in the billing or records modules but in clinical and patient flow systems as well. As of October this year, 338 of those defects are still unresolved.

And some clinicians simply do not like the system. As reported in one assessment from Noarlunga, “It is now clear that the PAS functionality is not sufficient to meet SA Health’s requirements and staff are experiencing considerable frustration in trying to use the new functionality”.

In addition to all of these fears, the Auditor-General has issued a warning about the potential effect on the new RAH.

“The EPAS solution has a critical inter-relationship with the current design of the nRAH, which has influenced its physical design, proposed workflows and equipment selection,” he reports.

“SA Health recognises that, from an operational perspective, if EPAS was not rolled out to the nRAH the current impact on the proposed model of care of not having an integrated electronic system is unknown. Any alternative solution is expected to require modified processes and manual workarounds.

“As the nRAH is physically designed to have minimal storage and use of paper records due to the proposed functionality of EPAS, a solution for central paper record storage at clinics and wards and daily transport of paper records will be required.”

St Stephen’s Hervey Bay to trial paperless prescribing

The federal government has given special authorisation to St Stephen’s Private Hospital in Queensland’s Hervey Bay to trial paperless medications prescribing, dispensing and claiming as a forerunner to the introduction of a national hospital electronic medication chart this financial year.

The special authorisation under section 100 of the National Health Act 1953 – which regulates the Pharmaceutical Benefits Scheme and requires a paper medications order to accompany a PBS claim – will mean St Stephen’s clinicians can prescribe, dispense, administer and send a claim to Medicare entirely electronically.

St Stephen’s Private, which officially opened today and is thought to be the first fully integrated digital hospital in Australia, is using a closed-loop medications management system from Cerner.

The hospital is the first in Australia to have been accredited with Stage 6 certification from HIMSS, an international measure of a hospital’s digitisation and integration.

Its systems also include Cerner’s electronic medical record, inpatient pharmacy, surgery and anaesthetics, critical care, clinical documentation, pathology specimen management, barcode scanning and real-time location systems for patients and equipment.

The closed-loop medications system involves electronic orders at the bedside which are transmitted to the integrated pharmacy system, where they are double-checked and the medications dispensed in single-dose blister packs.

These are barcoded and sent to electronic drug cabinets on the wards, where nurses scan the barcode on the pack as well as the patient when administering the drug. This is all recorded in the EMR.

In this trial, a claim for payment will then be sent electronically to Medicare without having to also send paper copies of the medication order.

According to the special authorisation, all stages of the closed-loop process are captured within the electronic medication management system, which records the identity of each user during each transaction. The Cerner system also incorporates an advanced IT security framework with robust PBS audit functions.

The trial is being used to inform the development of the PBS hospital medication chart, which the Department of Health is funding through the Australian Commission on Safety and Quality in Health Care (ACSQHC).

The chart will be a national standard chart for use in both inpatient and outpatient settings and will allow for prescribing, dispensing and claiming from the chart. It will also include non-PBS medicines.

It follows work on the national residential medication chart, used in residential aged care, which includes non-PBS fields.

At the official opening today, Health Minister Peter Dutton said DoH would work with St Stephen’s to monitor the effectiveness of the electronic system and pick up on the benefits to inform future changes.

The $96 million, 96-bed hospital, operated by UnitingCare Health (UCH), has been funded in part through a $25.9 million grant from the federal government for its construction as well as $21.2 million entirely for ICT and eHealth from the Commonwealth Health and Hospital Fund.

Mr Dutton said St Stephen’s would showcase the future of healthcare.

“St Stephen’s has raised the bar for all healthcare providers by embracing the technology literally before the foundations were laid,” Mr Dutton said.

“It will be a showcase for the improvements that eHealth information technology can make for healthcare and patient outcomes.

“Digital technology can make health care far more efficient and more effective for patients and providers.”

“We will use the lessons learned from St Stephen’s paperless prescribing, dispensing and claiming trial to refine the hospital electronic medication chart, which will soon be in widespread use in Australian hospitals.”

The hospital’s digital features also include patient, community and medical web portals, and information linkages with Hervey Bay Public Hospital, medical practitioners, other UnitingCare Health hospitals, universities and diagnostic providers.

Mr Dutton said electronic medication charts will start to be introduced in private and public hospitals this financial year.

DVA claiming for allied health professionals online

The Department of Veterans’ Affairs (DVA) has launched a new online claims system for allied health providers servicing the veteran community.

DVA Webclaim is now open to all allied, dental and optical health providers through the Department of Human Services’ (DHS) Health Professional Online Services (HPOS) portal.

It is aimed at allied health providers who only have a small number of DVA clients.

The system is currently only available through HPOS and is not integrated in practice management software. It is a ‘smart forms’-based system designed to reduce paper claims sent in by post, but still requires manual input of claiming data.

(Practitioners can also use plug-ins such as those offered by vendors such as Direct Control or Cutting Edge Software. Cutting Edge offers a free version of its product for low-volume DVA claims.)

Users will need a Medicare provider number and an individual public key infrastructure (PKI) certificate, available from DHS.

The new system will allow providers to receive an instant response to submitted claims, receive payment within two working days, access past DVA statements and download claiming histories. By using HPOS, which has a secure email facility, claimants can ask DHS questions about claims.

The department says medical claims will be able to be lodged through DVA Webclaim in the near future.

Online course in active health and fitness technologies

The University of Tasmania is offering a free online course covering how new fitness technologies can enhance health and lifestyles.

The Foundations of Technology for Healthy Living course, thought to be the first of its kind in Australia, will cover technologies such as smartphones, activity monitors and video games that are increasingly being used to measure and understand daily activities.

Devised by Stu Smith, director of UTAS’s Centre for Research and Education in Active Living, the 10-week course is free and is being offered by the Faculty of Health.

In addition to understanding how new technologies can be used to live a healthier lifestyle, the course will also cover the concept of gamification and how it can be used to elicit behavioural change.

Associate Professor Smith has been involved in developing video games for both rehabilitation and improving health outcomes.

“The use of games in health is a huge area of growth; they are now widely accessible, as well as portable via tablets and smartphones,” he said.

“We want students to understand the benefits of physical activity, the strengths and limitations of the devices that are coming on to the market, and how they can be used to change behaviours for a healthier lifestyle and reduced risk of disease.”

The course includes a free Fitbit to participate in certain aspects of the coursework.

The part-time course begins on October 20, with applications due by October 13. All HECS fees for the course have been waived. Online enrolments are open now.

eHealth standards up in the air as IT-014 program ends

Standards Australia is restructuring the technical committee that coordinates the development of eHealth standards following the end of its 2012-2014 work program, with no forward work program agreed for the new financial year.

Technical committee IT-014 covers both health informatics and telehealth, and is charged with overseeing the development of standards and technical specifications in the areas of eHealth information security, messaging and communications, electronic health record interoperability and clinical decision support.

Following the restructure, all unfinished projects will be required to be resubmitted for assessment through Standards Australia’s proposed projects process, and the committee will serve only as a ‘mirror’ committee for the International Standards Organisation’s technical committee 215 (ISO TC/215).

In early June, Standards Australia held a forum to discuss the future plan in relation to health informatics standards development. At that forum, the organisation advised that it planned to make operational and administrative changes when the 2012-2014 work program ended on June 30.

At the time, it said that there was no forward work program agreed beyond that date, and that it would take the opportunity to review its committee structure.

It said that any unfinished projects would be deferred, but that it remained “ready to facilitate health informatics standards development”.

In a hint that there is much disagreement over eHealth standards development in light of the unprecedented changes to the eHealth sector over the last few years, Standards Australia said there had been a number of challenges in the work program but that despite this, a record number of documents had been published in the period.

A Standards Australia spokesperson said the restructure was not due to funding issues.

”Standards Australia took the opportunity to review its committee structures when the previous work program came to an end in June 2014,” the spokesperson said.

“Funding is not a factor in the review although we did take the opportunity to review our committee structure at a time when the forward work program has yet to be settled.

“Standards Australia is reviewing its committee structures for health informatics standards development to ensure that the contributions made by all lead to outcomes in the national interest. This is business as usual for us. It is also business as usual for us to align national committees with international committees.”

The spokesperson said that aside from the international mirror work, all projects which did not complete through the previous work program will be required to be resubmitted for assessment.

This does not mean that Australian standards development would not continue, the spokesperson said. “We welcome project proposals for international as well as national project development work. We are in discussions with stakeholders in relation to a forward work program which includes national and international standards development work.

“All projects for the adoption and development of Australian standards follow the same process. We require a project proposal setting out the scope of work, evidencing broad stakeholder support from industry, government and consumer interests and a net benefit assessment indicating that the project work would lead to a net benefit to the Australian community.

“We are accepting proposals in the current round of Standards Australia resourced projects.”

In terms of the development of technical specifications for the PCEHR, which is one of the roles of the National E-Health Transition Authority (NEHTA), the spokesperson said Standards Australia was “working with a range of stakeholders interested in continuing this work program through Standards Australia”.

Mention was made at the June forum of the potential role for the Australian Commission for Electronic Health (ACeH), which the Royle review panel into the PCEHR recommended be established in place of NEHTA.

Recommendation 10 of the review encouraged the establishment of a regulatory body that would monitor and ensure compliance against eHealth standards that are set and maintained by ACeH.

Ageing at home: ICT and seniors’ living

This story first appeared in the May 2014 issue of Pulse+IT Magazine.

The 7th annual Information Technology in Aged Care (ITAC) conference is being held in Hobart later this month. As the role of technology in helping people to stay at home longer continues to grow in importance, this year’s conference theme of the ‘digital revolution in seniors’ living’ is a fitting one. Emphasis will be placed not just on gadgets and the potential of telehealth, but on developing sustainable models of service provision in community and residential aged care.

The use of technology in aged care is no longer restricted simply to the use of clinical management systems in residential aged care, or of monitoring systems or telehealth in home care. It now runs the full gamut of technologies that can support the care of elderly people in their homes, their communities, the primary care sector, the hospital sector and the residential aged care sector.

It is not so much the use of technology that poses a challenge in aged care, or the development of new technologies geared towards elderly people. These days, the challenge is very much about how to develop sustainable business models to encourage initial investment in technology and ongoing funding for the provision of care to the elderly in what will remain a predominantly publicly funded sector for the foreseeable future.

As assistive technologies continue to develop – and to come down in price – more of the nitty gritty of service provision through these technologies is coming to the fore. The ITAC 2014 theme of “assistive technologies: disruptor or enhancer of services?” is therefore a pertinent one.

The afternoon session of day one of the conference will hear from the Aged Care Industry IT Council (ACIITC), which earlier this year released a report calling on the government to invest $10 million as seed money to assist the industry to begin to catch up with the public investment made in the primary care sector, particularly to GPs and pharmacists. While $10m is a drop in the ocean, ACIITC chair Suri Ramanathan argues that it is a start on the road to more integrated care for the elderly in all settings, not just the ad hoc approach seen in the past.

What the council’s Aged Care ICT Vision calls for is an emphasis not on proven technologies like telehealth or emerging technologies like the PCEHR, but on the more mundane but very much critical areas of integration of care planning, management information and reporting, and staff productivity.

Technology conferences are used to seeing IT vendors spruik their wares, but at ITAC this year, the Aged Care Industry Vendors Association (ACIVA) will discuss the role of vendors as critical partners in delivering care.

ACIVA president David Loiterton, who took over the role from long-term president Caroline Lee last December, will discuss the view of vendors that it is imperative they play a connected role with providers, the government and other regulatory bodies.

“We need to be proactive in contributing to and helping shape technology policy, as well as interacting with the various departments to stay ahead of the changing landscape in the aged care sector,” Mr Loiterton says. “We all understand the complexity of attempting much of this individually and with disparate goals.”

Mr Loiterton says ACIVA members continue to face a number of challenges to serve their clients well, not the least of which is navigating the new government’s departmental structure, and trying to manage continual changes to regulations and the effect that has on their product development, including from policies such as consumer-directed care and Living Long, Living Better.

“There continues to be poor communication and interaction with vendors in a timely manner, to allow for changes to be made and ‘appropriately’ tested,” he says. “ACIVA will seek to work with the peak bodies and government to ensure these changes are more transparent to vendors at an earlier stage.”

In addition to a number of speakers covering the importance of technology to the nursing workforce, the topic of mobile technology in the home and in residential aged care facilities is on the agenda, as is IT governance and risk management, medications management and telehealth.

Preliminary results from some of the NBN-enabled pilot projects will be revealed, including from the CSIRO’s multi-site national trial of telehealth for the management of chronic disease in the home; a presentation by Stelvio Vido from RDNS on its integrated telehealth project which includes remote monitoring and GP connectivity; and from Alan Taylor from Flinders University, who will discuss the South Australian telehealth pilot project which is trialling the remote provision of palliative care, aged care and rehabilitation therapies.

There will also be a PCEHR session, with Feros Care’s Kate Swanton discussing the justification for and journey with the PCEHR at Feros Care’s facilities. Social media will make an appearance with Stuart Couchman of Azzurri Communications discussing how social media can be used to improve client and guest experience in aged care using technologies such as Azzurri’s Wi-Fi.

Former Victorian minister for aged care, Bronwyn Pike, who is now working with Telstra as a community care lead, will discuss Telstra Health’s ambitious plans in the aged and community care sectors.

To read the full story, click here for the May 2014 issue of Pulse+IT Magazine.

NEHTA’s future in the hands of COAG: Hambleton

Former AMA president Steve Hambleton intends to play an active role in improving clinical input into eHealth and in influencing the direction of the National E-Health Transition Authority (NEHTA) despite the recommendation of the Royle review, of which he was a member, that the organisation be dissolved.

Dr Hambleton, who was appointed chairman of NEHTA late last month, said he stood by the recommendations of the review but that the final decision on NEHTA was in the hands of the federal and state health ministers. NEHTA is owned and funded through the Council of Australian Governments (COAG).

“COAG together with the federal health minister need to decide about future directions, the strategic direction of eHealth in this country,” Dr Hambleton said. “I think there is an enormous opportunity for us to do something. How and what body that is done in is the governments’ decision.”

He said he took on the role of chairman to be in a position to help implement future plans for eHealth.

“I think there’s a huge amount of investment that has gone into IT in this country, and I think there is a real opportunity to make sure we leverage off the investment we’ve made so far and get outcomes that are meaningful,” he said. “There is an opportunity for structural reform in the health system supported by good communications.”

While former chairman David Gonski played a low-key role at NEHTA, Dr Hambleton said the chairman’s position and the board itself, which is made up of the state directors-general of health or their appointees, had a great deal of influence over the direction of the company.

“Obviously the governance body is the one that interprets the direction that the company should go in and the management needs to deliver on that, but you do have an enormous amount of influence together with the other board members, and that’s the exciting part,” Dr Hambleton said.

“We have very intelligent, motivated and engaged people but as we said at the AMA, as we said in the review, we need to make sure that we engage and deliver what the profession needs.”

It is no secret that NEHTA has come in for a great deal of criticism, particularly from the medical software industry over its management and technical capabilities. Clinicians have also been critical of its lack of engagement with healthcare professionals in the implementation of the PCEHR, starkly illustrated last year when the entire clinical leads team resigned, including another former AMA president, Mukesh Haikerwal.

Dr Hambleton said he accepted there had been criticism of NEHTA’s past performance but that he was confident it could be changed.

“The answer is absolutely we can change it,” he said. “There is no doubt that there has been criticism levelled, governments have been concerned, software groups have been concerned, the profession has been concerned, but if you don’t get in and do something you can’t change it.

“If you get in there and do something, and recognise there are issues, you can. I’m very confident that we can take up the challenge.”

He also said he was confident that he could improve clinical input and governance and that NEHTA was already moving to engage clinicians more in product development.

“My role early on is to find out where the clinical engagement in that sits and to make sure that we have sufficient to progress what NEHTA’s tasks are,” he said.

He clarified a statement quoted in another publication last week that “NEHTA would continue indefinitely”, stating that he actually meant “eHealth would continue indefinitely”. He said a number of foundational products had been delivered, such as Individual Health Identifiers, secure messaging, the Australian Medicines Terminology and SNOMED-CT AU, which in effect had created a national rail gauge on which to build.

“We’ve got that, we’ve just got to start using it,” he said. “Having been to places like Canada where there is no standard rail gauge, at least NEHTA has decided what the gauge is.

“Part of the challenge is how NEHTA participates in the future, but much of the rest of the challenge is how we engage with what we’ve already got. There are some really good things about the PCEHR, the basics are there, and we’ve just got to start using them. It is not all because of NEHTA, but NEHTA has played a significant role in setting up the frameworks.”

Interoperable EHRs: it’s all about the data

This story first appeared in the April 2014 issue of Pulse+IT Magazine.

Interoperable EHRs are the holy grail of eHealth, but most remain a closed shop. The development of archetypes – discretely defined clinical concepts – and the sharing of them through a Clinical Knowledge Manager (CKM) such as that hosted by NEHTA and used to inform the PCEHR, means real interoperability is possible.

Electronic health records (EHRs) have been around for over 30 years now, but it is still hard to share information between health software programs. Traditionally, we have had vendors develop electronic health record software applications created entirely from scratch ‘in house’. Each one has been proprietary and the result has been a data structure that is unique for each software application.

The data within each vendor EHR are effectively silos of health information, with clinical content as simple as blood pressure represented differently in each system. Interoperability – the ability to unambiguously share health information between different EHR systems – has been elusive.

As a means to bridge the gap between each EHR, for more than a decade there has been a gradual growth in the development of agreed, standardised messages, documents and/or profiles.

Each of these have been mapped or transformed from the EHR’s proprietary data patterns to the agreed data pattern, so that they can be sent to other healthcare providers or exchanged with other EHR systems. This solution has enabled some success in simple health information sharing, mostly documents or reports such as discharge summaries or pathology results.

The downside to this approach is that each document or message can take years to reach consensus, so the process is effectively glacial and the amount of information available for sharing is limited to the sole purpose of these documents or messages. The unresolved question is whether this is a scalable approach as we want to share greater amounts of health information in finer granularity, and whether this is sustainable.

In order to try to change this paradigm, there has been a slowly emerging international approach to provide clinical leadership for defining the clinical data patterns, rather than leaving it to each vendor to ‘reinvent the wheel’. This has originated from over 20 years of research and development into electronic health records, and has been championed by the openEHR Foundation.

To read the full story, click here for the April 2014 issue of Pulse+IT Magazine.

Image app for the pathologically inclined

The University of NSW’s Department of Pathology and Museum of Human Disease have come together to design an interactive educational app for medical students and practitioners that catalogues thousands of images of diseased tissue stored by the museum.

The Images of Disease app is intended to promote learning about disease processes and their effects on human tissues and organs. It includes views of gross pathology and histopathology, with selected images appended by diagnostic imaging investigations and clinical and autopsy images.

Images can be searched by disease name, organ system or pathological process, with hundreds of diseases covered. A number of interactive ‘hotspotted’ images are available to enable in-depth exploration of the features of common diseases.

When a specimen name is highlighted in red, this indicates that there are hotspots on the specimen which will display a text description and red outline.

The app also includes a ruler icon to measure the actual size of the specimen or features within the specimen.

Head of the Department of Pathology Gary Velan said students can look up a particular disease, see what it looks like, read about its typical clinical features and see other diagnostic imaging investigations such as an MRI scan or X-ray that would normally accompany the condition.

The app is optimised for iPhone 5 and is only available for iOS-based devices for the time being. It costs $17.99 through iTunes but is free to UNSW medical students.

“We are hoping that through app sales we will be able to fund the development of the app for Android and Windows devices so all students will be able to access it,” Associate Professor Velan said.

Silver surfers seeking digital options for healthcare information

Accenture has released the results of a global survey of older people and their attitudes towards digital healthcare technology, finding that while older Australians would like to use technology such as electronic reminders and online prescription refill requests, they rate the importance of such online services lower than consumers in other surveyed countries.

The survey is part of ongoing analysis of research that has also recently surveyed doctors’ attitudes towards allowing patients access to electronic medical records and consumer attitudes to the same.

The consumer research involved over 9000 people in nine countries, including Australia, Brazil, Canada, England, France, Germany, Singapore, Spain and the US, of which 1000 were aged over 65, 175 of them Australian.

Of those older people, 63 per cent are seeking digital options for managing their health, the survey found. Although roughly three-quarters (77 per cent) of seniors surveyed say that online access to their health records is important, only 17 per cent say they can currently access them.

The survey found that Australian seniors predominantly wanted access to healthcare technology such as electronic reminders (68 per cent) and online prescription refill requests (55 per cent), but that only 18 per cent of healthcare providers currently offer such capabilities.

Similarly, half of respondents want to be able to email healthcare providers, but only six per cent say they currently have that capability.

Leigh Donoghue, managing director of Accenture’s health business in Australia, said that older Australians are increasingly online and digital tools were giving them more options to remain connected and manage many areas of their lives from home, including virtual healthcare services.

“Healthcare providers must expand their digital options if they want to help their senior patients more actively participate in their own care,” Mr Donoghue said. “As the sector moves into an era of consumer-directed care, digital tools can enable service providers to better meet the needs and requirements of senior citizens.”

While the Accenture survey found that the majority of Australian seniors (62 per cent) do not actively track aspects of their health, such as health indicators, health history and physical activity, he expected the general market for connected and standalone health devices, applications and services to continue to grow rapidly.

“Seniors are already a part of this, being notable users of health devices such as blood pressure and heart-rate monitors,” he said.

“Given the health needs and motivation of this group and the accumulated wealth of the baby boomer generation, it’s likely to be a priority growth segment for many product and service providers. This will accelerate as more seniors move online.”

The survey found that Australian seniors rated the level of importance of such online services much lower than older consumers in other surveyed countries. The majority of seniors in Spain, for example, where electronic medical record adoption is much higher, want access to online prescription refill requests (79 per cent), online access to medical information (91 per cent), and online appointment booking functionality (87 per cent).

In Australia, we tend to be a bit more conservative in this respect, from both a patient and doctor perspective, but that is likely to change, Mr Donoghue said.

“There is a lot of conservatism in the health sector: we’re creatures of habit when it comes to patient care. This is a barrier to consumer take-up of new applications and services, particularly where seniors are concerned since they have a traditional deference to clinicians (‘doctor knows best’).

“This will change and is changing as more enlightened healthcare providers refocus on creating a better patient experience – electronic repeats are a part of this – and demand more from their vendors to support this.

“It’s also happening as vendors look for new ways to differentiate and respond to the patient-centred care agenda: look at how EMIS, the leading GP vendor in the UK, has created Patient Access and promoted this among GP practices.”

Most importantly, however, increased demand for digital healthcare services is going to be driven through consumers and consumer groups, he said, with “networks of older people going online with the time and inclination to swap stories, apps and experiences”.

The proportion of American seniors active online recently passed 50 per cent and is now the fastest growing segment. Mr Donoghue said this makes it an increasingly attractive market for online services in the US, helping spawn new health products and services.

“Australia’s behind on this curve but it won’t be long. GPs and pharmacists will have to respond to this: if they don’t they risk being bypassed.”

Mr Donoghue said the level of awareness of the privacy and financial implications of more digital access to healthcare services and healthcare providers is “mixed” in Australia, but that consumers can surprise by how much information they’re willing to share online.

The financial ramifications are equally challenging in a predominantly public health system like Australia’s, he said.

“Online access could significantly increase demand for services and the number of care episodes, further compounding the affordability challenge. It may be possible to partially offset this through co-payments: asking patients who can afford to pay to contribute for a different level of service. However, this risks exacerbating the digital divide for lower income patients.”

He said new payment and governance structures will be required to provide consumers with access to digital services where appropriate, but that conversely, other online transactions have the potential to save money for healthcare providers. There is a positive financial implication for online scheduling or online assessments.

“It will be interesting to see whether healthcare providers are willing share any of these savings with consumers to increase adoption.”

Mr Donoghue said that while there was still a ‘doctor knows best’ element, as the proportion of older people increases along with levels of chronic illness, consumers will begin to demand more access to the healthcare information held on them by providers.

“Chronically ill patients are more likely to record their health and keep a record, if only to improve the continuity of care they receive as they traverse the health system and deal with multiple care providers.”

It will be consumer demand, allied to an increase in services offered by health insurers and some government intervention, that will drive the electronic sharing of information by healthcare professionals, he said.

“Government interventions typically achieve only so much, particularly in terms of compelling clinicians to share patient information. This touches upon the thorny issue of who actually owns the patient record, and the rights and obligations associated with this.

“As authors, many healthcare professionals feel a strong sense of ownership for the record and a reluctance to share this information with other clinicians and sometimes even patients. This remains a highly contentious issue in Australia, and one that governments are understandably cautious about.”

He points to the UK, which has experienced the same debate over the past decade. There, direct government interventions included funding centrally hosted systems to support sharing through programs such as the National Programme for IT, mandating patient rights as part of the NHS constitution and engaging the royal colleges and the British Medical Association to develop a charter in terms of shared record use.

“This has shifted the debate, with a consensus increasingly emerging around the electronic sharing of information,” Mr Donoghue said. “Consumer demand has been a factor in this, but more as an adjunct to public policy rather than the primary driver.

“It’s unlikely that such an approach could be replicated in Australia for a range of reasons. Here, consumer demand is likely to play a more significant role in driving the electronic sharing of information, combined with public and private health management organisations, particularly health insurers, promoting new models of care, and the increasing impact of disruptive technologies. Government interventions are likely to be crucial in enabling this.”