The AMA has maintained its strong support for the vital and high level work being undertaken to develop the building blocks for e-health in Australia, and particularly those that will contribute to the reality of a shared electronic health record. Connectivity, however, is the key and, I would argue, the priority. The environment, however, is one of variable uptake of information technology within the health sector for the secure transfer of health information and indeed basic communication.
Although there remain pockets of general practice that do not have the capacity to communicate and transfer information securely, GPs are generally well connected electronically and they consistently express frustration at the fact that there are few outside general practice with whom they can communicate securely. Non- GP specialists (with the exception of pathology and radiology in particular) are behind the game in terms of electronic communication and there is significant variability across the hospital sector.
While we wait for the big issues to evolve and complex applications that are under development, it is my view that we can make important changes that will deliver significant improvements in connectivity now. Measures that will allow, encourage and perhaps even help drive basic but secure communication will in turn have an impact on culture change, an issue increasingly being recognised as vital to the successful implementation of e-health initiatives. It is relatively simple to deliver the means to get the profession/sector talking to each other and doing so securely. The basic but everyday tasks of sending and receiving referrals and discharge summaries can occur securely if, for example, both ends have Public Key Infrastructure (PKI). While developing nationally standardised electronic discharge summaries and health records are important tasks, do we have to wait for these before we can start communicating? I dont think we do.
We already have examples of hospitals that have developed electronic discharge summaries but are unable to send them securely because of the poor uptake of PKI within some areas of general practice. We know that GPs are frustrated at receiving specialist letters and reports by paper or fax and for those practices that are well set up electronically, this is a significant burden. One practice I spoke to this week has 15 doctors, is very highly computerised but has to scan around 1,000 documents per week from hospitals and specialists. This is madness.
The speedy electronic transfer of discharge summaries has been a key demand from general practice for years. Certainly we need to keep working on the quality of discharge summaries, but why cant we get discharge summaries moving along the electronic highway now? Even if the quality of an electronic discharge summary leaves something to be desired the fact that an electronic version will be legible and can be transferred in a timely manner, rather than two weeks after the patient has left the hospital, represents a vast improvement on the current situation. And the reality is, whether there is compliance with the quality standard for a discharge summary or referral is not a product of the technology itself. Standards around the type and content of information that should be contained in a discharge summary or referral already exist, and should be complied with regardless of the means used to communicate. The standards and the need to comply with those standards do not change because of the means by which they are communicated. Variable levels of compliance with the standards do not prevent paper-based communication so why should it prevent electronic communication?
We need to get the profession communicating electronically and securely now, and we must continue to promote the quality standards related to the content of information being transferred. We dont need to wait for a national standardised shared electronic health record, referral or discharge summary to begin communicating. In terms of promoting connectivity, at this point in time there needs to be less concern about what doctors, hospitals and pharmacists are communicating, and more focus on enabling them to communicate in a secure environment. To quote Professor Michael Georgeff dont spend time getting agreement on the data, dont spend time ensuring all the systems conform get connected. While there is a focus on connectivity, the profession can continue to promote compliance with quality standards related to the information being supplied and, as they are agreed, implementation of electronic system standards.
If we can create a situation where doctors and hospitals are already communicating well, change management may not be as great a challenge as more complex applications are introduced. Importantly things like electronic prescribing can be taken up with relative ease if the profession already has the means and the experience to communicate securely. Do we really want, for example, to spend the time and money developing an e-prescribing system only to realise at the 11th hour that the means for secure communication between doctors and pharmacists does not exist? Even stop-gap proposals prior to development of a national e-prescribing system such as point-to-point electronic prescribing from GPs to pharmacists identified by an aged care facility, will require basic secure communication.
The AMA will continue to lobby Government to make a real push into the uptake of PKI and/or compliance with the PKI standard throughout the sector, but particularly with GPs, non GP specialists, hospitals and pharmacists. Broad take up of the PKI standard will ensure that all types of secure communication can begin now within the health sector.
There is little doubt that incentives need to be discussed, particularly with the non-GP specialist sector, and a concerted effort needs to be applied whereby practices of all types can be assisted where necessary to register for PKI.
We can get connectivity happening now rather than waiting for, and depending on, complex applications to drive what is really quite basic communication. Doctors, non-GP specialists and hospitals could share vital patient information now with the implementation of appropriate authentication and encryption systems.
The AMA strongly believes that Government must make connectivity among all health professionals and across all modes of practice one of its highest priorities and wants to work with the Minister for Health and Ageing and his department to develop measures aimed at pursuing this objective.
Posted in Australian eHealth