Opinion: Tasmania’s health strategy needs to look further afield

Last week, the Tasmanian Department of Health released its Digital Health Transformation – Improving Patient Outcomes 2022-2032 strategy, which outlines the state’s proposals for a digital health roadmap for the Tasmanian Health Service (THS) over the next decade.

Tasmanian physician, health informatician and former president of the Australian College of Health Informatics (ACHI), Terry Hannan, provides his analysis of the strategy, based on 17 years’ experience working in the system and experiences with national and international eHealth projects since 1984.

My first comments relate to the overall content of the document. Not unexpectedly, it presents generic statements of what the THS wishes to achieve over the 2022-2032 decade, with minimal specifics of the actual health information technology (HIT) and eHealth structures that would lead to the desired end points. From my observations, success within the 10-year timeframe can be questioned based on the existing knowledge of how successful HIT systems are implemented.

An assessment of the graphic of the current THS on page 15 raises some concerns. We know that in some healthcare institutions in Tasmania there are more than 100 independent, non-communicating, non-standardised HIT systems. These are unable to provide the information management systems that are essential for better clinical care across primary, secondary and occasionally tertiary care. I also note that there is no formal citing of organisations such as the Royal Australian College of Physicians, whose diverse sub-speciality groups are critical to managing healthcare at many levels within the THS.

Another feature of the graphic is the large bar highlighting the existence of the My Health Record (MyHR). Does this imply this has a significant role in the THS HIT implementation? It must be understood that the numbers listed in the graphic for this system are predominantly automated registrations and not longitudinal dynamic health records. Also, there would be significant doubts about MyHR functionality meeting the needs of a dynamic health system such as the THS.

My first-hand experiences indicate that patients and clinicians have no or minimal knowledge of the existence of the MyHR, and if they do they have rarely used it. For those rare individuals who use this national system, its benefit to their health management is minimal.

Based on national and international experiences, will Tasmania’s new HIT system have the characteristics of system scalability, sustainability and flexibility across the whole health system? There are several existing systems that have been able to adjust to and manage rapid and less rapid clinical scenarios such as the epidemics of COVID and Ebola and HIV, while still managing other disease states.

To achieve this flexibility the HIT interfaces must be able to create rapid form design according to the users’ needs. This is across the health spectrum from patients, to clinicians to administrators and researchers. If this latter requirement is not met, the systems will not be used. If the above requirements are met, standardised and more accurate data can then be captured and made interoperable to measure and evaluate the whole health care system.

Finally, the system must be affordable and cost effective.

Most of the population perceives that healthcare occurs mainly in hospitals, doctors’ offices, and clinics. We know the current model of care delivery is inefficient, costly, and harmful. One of the main reasons for this is that the patient is not the centre of the care process. A problem highlighted by Yale University professor Lawrence Weed, developer of the SOAP note, back in 1989. He stated the following, as to how care was emerging in the era of rapid HIT developments and now with artificial intelligence (AI).

“The patient may not seem well educated or very bright to you, but what could be more unintelligent than what we are doing? We must think of the whole information system, and not just infinitely elaborate on the parts that interests us or fit into a given specialty. Patients do not specialize, and they or their families are in charge of all the relevant variables 24 hours a day, every day.

They must be given the right tools to work with. They are the most neglected source of better quality and savings in the whole health care system. After all, they are highly motivated, and if they are not, nothing works in the long run anyway. They do not charge and hey even pay to help. There is one for every member of the population.”

The patient must become the centre of healthcare information management. With many patients traversing the healthcare system with multiple providers, we know that very few have a portable longitudinal “medical record” that is adaptable by the clinician and the patient with each encounter. One patient defines the current referral system as the “wheelbarrow syndrome”, where the patient is moved from one healthcare location to another with no idea what is happening.

Based on my experiences in Tasmania and confirmed by research, the majority of eReferrals transmitted do not have information relevant to the reason for the referral. The information within these referrals is often inaccurate nor up to date. This is particularly relevant with medications. Medication harm is a major cause for admissions and readmissions to institutions. So, just having an eReferral system does not by default improved care delivery. Currently the referral system is essentially a guarantee for fee reimbursement.

Electronic medication systems are complex and difficult to implement despite the developments in this aspect of HIT since the 1990s. Tasmania has made progress in this area with some positive outcomes. However, despite its advances towards paperless prescribing, is there evidence that show it has reduced adverse drug events, costs of medications, prevented over, under and erroneous prescribing? Is the system interoperable with all other information management systems within the THS, particularly laboratories and a summary record of co-morbidities?

These are big issues that must be addressed within a new reliable and cost-effective HIT system.

The complexities and difficulties can be seen in the evolution of primary care centres in several locations within Tasmania. These were designed to improve access to care and reduce the load in hospital centres. Their successes have led to theses centres also experiencing “appointment block” and the need to maintain the seven-minute consultation.

These outcomes strongly indicate that the care model across the whole of the THS is wrong and needs more than just a technology revision.

The THS could be wise and evaluate what has been achieved across Bass Strait, initially at the Royal Children’s Hospital (RCH) and currently to the wider surrounding medical centres in the Parkland precinct.

The approach taken at the RCH revised the rules for HIT implementation. They began with the end users and early on involved the patients through portals linked to the core HIT and eHealth structure. They achieved within five years what normally takes decades and have measured their improvements in care delivery.

With many patients from Tasmania managed in Melbourne it would be a positive move to use the knowledge, experience and the same HIT model to underpin the eHealth developments in Tasmania, and be cost effective.

Associate Professor Terry Hannan is an internal medicine specialist and consultant physician based in Launceston, Tasmania. He is a visiting fellow at Macquarie University’s Centre for Health Informatics, a fellow of the International Academy of Health Sciences Informatics, and a fellow of the Australasian Institute of Digital Health (AIDH). He recently published his fourth book, Heard Helped Healed: the healing power of storytelling.

Posted in Australian eHealth

Tags: Tasmanian Digital Health Transformation

You need to log in to post comments. If you don't have a Pulse+IT website account, click here to subscribe.

Sign up for Pulse+IT eNewsletters

Sign up for Pulse+IT website access

For more information, click here.

Copyright © 2022 Pulse+IT Communications Pty Ltd
No content published on this website can be reproduced by any person for any reason without the prior written permission of the publisher.
Supported by Social Media Agency | pepperit