NSW creates eHealth strategy for rural and remote areas

NSW Health is developing an eHealth strategy for rural and remote NSW that will lay out plans for the continued rollout of the statewide electronic medical record and the appointment of a rural eHealth director to oversee the strategy's implementation.

The long-awaited rollout of electronic medications management systems throughout the state's hospitals is also going ahead, with NSW Health's eHealth agency, HealthShare NSW, announcing last week that it would shortly issue a request for tender for eMM software for all NSW local health districts (LHDs).

This implementation has been funded by an allocation of $170 million over 10 years announced in the 2011 state budget. A panel of eMM suppliers will be formed as part of the tender process, from which LHDs can then choose a preferred eMM system for their area.

The draft plan for eHealth for rural and remote NSW, which will be delivered to Health Minister Jillian Skinner early next month and then sent to all rural CEOs and CIOs for their endorsement early next year, will set out an implementation strategy for a wide range of clinical and corporate health IT initiatives over the next five years.

HealthShare NSW business architect and acute care physician Will Reedy told an Australian Internet Industry Association (AIIA) function in Sydney today that the agency planned to get a memorandum of understanding signed between HealthShare and the rural and remote chief executives to commit to delivering eHealth at a more accelerated rate.

“Once we get that memorandum of understanding signed, we will have a reasonably detailed implementation from February next year,” Dr Reedy said. “There is a real desire from the rural CEOs to get as much eHealth capability as possible installed and being adopted by their end users by the end of next year.”

Dr Reedy said the strategy had been developed following consultation with the six rural and remote LHDs, none of which had their own vision or strategy for eHealth. Only one actually had an IT strategy but that was about five years old, and none had any dedicated funding for driving eHealth.

However, there was notable support for eHealth among both clinicians and patients, Dr Reedy said. “There is strong clinical support for eHealth but that is also tempered by the fact that they are frustrated by lack of progress,” he said.

“They know the technology exists but they want to know why can't they use it today. There is some real frustration with some of the clinicians.”

He said there was also a strong consumer push in rural and remote NSW for patient access to their medical records. LHDs were also keen to use the PCEHR to enable shared access to health information from a range of private and non-government providers in rural areas.

“As part of the rural strategy we need to think about what we would do differently and what we would require the rural LHDs to do differently to get this eHealth capability deployed over the next 12 to 18 months,” he said.

“There are seven areas that will looked at and the first one we need to address is governance. We have formed a rural CEO governance group for eHealth and we will bring in some clinical leadership over the next three months, but the core principle is that they have got to act as one. They can't act as individual LHDs.

“We have identified … some consolidated funding to drive eHealth forward, but again they have got to operate as one so there are economies of scale and cost efficiencies from deploying common solutions to them as one entity.”

Dr Reedy said many patients from rural NSW also access healthcare in other states, so NSW will work with the other states in terms of patient flows and sharing information. He said the mechanism for doing that was the PCEHR.

“We have a number of clinical programs and a number of corporate programs and a wide range of infrastructure programs and we need to change how we deliver some of that, so we are going to appoint a rural eHealth director to coordinate all of our programs into the rural LHDs. We will deliver capabilities as releases across those different programs rather than doing individual projects.”

One of the main barriers to wider uptake of eHealth and health technologies is the poor infrastructure, particularly broadband, experienced in regional NSW. “Network connections and broadband speeds are often less than what we have at home at the moment so it is a real challenge for them,” he said.

“We also need to address support, as there is no point in putting all of this eHealth capability in over the next 12 months and then walking away and not supporting it, so we are looking at new models of support, dedicated support locally and at state level, for the rural LHDs.

“One thing that has emerged … from the rural LHDs is the feeling that the solutions being offered to them are metro-focused, so we are introducing a process that allows them to get sight of the solutions we are proposing and allow some time for some functional enhancements to connect to business processes. There will be rural LHD beta testing and prototyping of clinical solutions.”

HealthShare has identified four strategic themes, including improving health services and infrastructure as well as change and training capability.

“But probably the most important thing for rural CEOs is just having a single patient record,” he said. “They have made that decision to have one EMR for all acute and community clinicians and one mechanism for accessing and sharing that information with other healthcare providers.”

Rural and remote LHDs will get the Cerner EMR – Hunter New England is the exception in NSW, having already installed an Orion EMR – while the mechanism for accessing and sharing the information is an Orion clinical portal that allows access to the PCEHR and a range of regional clinical repositories built as part of the HealtheNet project.

“There is also a Ministry of Health mandate to report on the activity that they are completing for both admitted patients and non-admitted patients, and there is the emerging theme of the consumer push for eHealth,” Dr Reedy said.

“There is significant priority assigned by the CEOs to giving patients access to their record and self-managing their healthcare. The PCEHR enables us to do that so that is the strategy we are going to use.”

Dr Reedy said all of these measures are funded or partially funded “but we need to get the governance, support, change and training addressed in the first three or four months of next year”.

NSW Health's outgoing CIO, Greg Wells, said the PCEHR and Medicare Locals were “fundamental” to the eHealth strategy and that NSW Health would make strong representations to the federal review into the PCEHR, and the expected review of Medicare Locals, to keep them going.

“[The PCEHR] is not perfect, we all know that, but no one is coming along with another billion dollars for eHealth in our time,” Mr Wells said.

“If we don't make this work there is not another chance and we will go backwards 10 years. Yes, there is usability and things to fix up, but it is critical. We're quite excited about this next phase, but it has to keep going.”

Posted in Australian eHealth


0 # Berne Gibbons 2013-11-22 10:26
Well done to Dr Will Reedy and Tim Blake for getting rural and Remote EHealth on the agenda and moving again.
Now, as industry, let's support then and collaborate to deliver the single patient view for the clinicians. We can make the PCEHR work but we need to stop thinking in silos, we are stifling innovation if we don't!
0 # Martha 2013-11-22 12:14
“[The PCEHR] is not perfect, we all know that, but no one is coming along with another billion dollars for eHealth in our time,” Mr Wells said.

“If we don't make this work there is not another chance and we will go backwards 10 years. Yes, there is usability and things to fix up, but it is critical. We're quite excited about this next phase, but it has to keep going.”

Absolutely true!
0 # Clive Bond 2013-11-23 09:03
As a patient, I am excited about Ehealth. I believe it has great potential. However it is not widely known in the community. Why not have posters in waiting rooms? Information leaflets at the desk! Oh, and dont forget that patients have the right to access and control 'thier' own information.
0 # Elmari 2013-11-26 13:01
As a sometimes patient but someone who is always trying to stay on top of my health records / details plus my general health / well being progress I wish the consumer side of PCEHR was as good as www.healthvault.com. These need to synchronise also.
0 # Berne Gibbons 2013-11-26 13:20
I agree with you Elmari, in another life back in 2010, we attempted to bring Healthvault into Australia, the cost was prohibitive to the market and MS were not forthcoming with the same discounts they had offered in other geographies. I am still trying to get them interested though:-)

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