eHealth’s search for meaning – is it a rainbow journey?

All health services face the challenge of the Commonwealth Government’s health reforms, its eHealth strategy and the pivotal Personally Controlled Electronic Health Record (PCEHR). Simultaneously, innovation and change in technology seems to be accelerating. How to move forward for the benefit of the consumer, from existing ICT systems is complex, and different for every health service provider.

Introduction

Everyone wants an electronic health record. Everyone wants their health to be looked after, and thinks that someone else should be responsible for it. Yet the gap between the dreams and plans for personalised and coordinated care still seem to be just that: dreams and plans. Certainly the gap between the reality of existing healthcare systems, and what can be done with innovation and new technology, appears to be widening.

Health Reform and the Consumer

To help narrow that gap, the Commonwealth Government’s eHealth strategy is designed as an important driver to assist its hospital and health reform objectives. Australia’s health reform is a political response to democratic pressures, to people’s desire to see health services more responsive to local community needs. It has resulted in the creation of local health networks, each with their own boards for greater local autonomy.

This structural change is closely aligned with the established consensus in the healthcare industry, that there must be a shift of care, at least in emphasis, from hospital treatment to prevention and care in the community. Healthcare must become more effective in providing coordinated care in the home and community settings, promoting healthier lifestyles, and keeping people out of hospitals.

Probably the highest profile initiative of the Commonwealth Government’s E-Health strategy, perhaps its flagship, is the PCEHR. Funding for telehealth consultations is another aspect of the strategy, and can exploit the NBN to reach consumers in country and remote areas with a more timely and cost-effective service.

To support coordinated care in the community, a patient’s health information needs to be shared across a wide spectrum of healthcare providers. These include GPs, outpatient and primary care clinics, public and private hospitals, medical specialists, community health, mental health, drug and alcohol clinics, aged care facilities, pharmacies, medical specialists, diagnostic services for pathology and imaging, and many other providers.

It is hoped that the PCEHR can bring a measure of integration and interoperability of information across all healthcare providers. At a summary level the PCEHR in time can enable the sharing of the consumer’s information at any point of care, wherever it may be.

Within the national health reform agenda there is another initiative, which is gathering momentum and has enormous implications for health services and their ICT. It is the intention to introduce by July 2012, activity based costing and funding of health services. For health services to be effective and obtain their appropriate funding needs, through the input of activity data into clinical costing systems, they will require greater coverage and integration of clinical information systems.

Innovation and technology trends – what do they mean for eHealth?

Besides the impetus of the Government’s health reform on eHealth initiatives, what are the other trends in innovation and technology? Are the uncertainties and gloom of the world economy providing motivation for an accelerating surge in technology innovation and change?

At the recent HIC2011 conference in Brisbane, presenters and exhibitors displayed a bewildering spectrum of original thinking and innovative technology. The continuing challenge for healthcare providers — ‘Where do you place your bet?’ — just keeps getting harder. How do you pick a winner? And which innovation and technology, assuming a successful implementation which is far from certain, would best meet the needs of consumers served by a particular healthcare provider?

Here is a small selection from some of the HIC2011 speakers’ presentations:

Whatever the new idea or technology may be, implementation is critical to success. Yet a new idea, stated Peter Kambouris from CSIRO speaking on Innovation in E-Health, is not innovation until it has been delivered as a product and/or service, and been successfully implemented. Yet in his presentation on using KPIs to measure clinical change, Steve Shaha from Harvard University, pointed out that only measured outcomes, which are proved to be beneficial to patient care, can justify the innovation’s introduction.

Dr Ilkka Kornhonen of Tampere University of Technology in Finland, said that the consumer must make the most fundamental change. To confront the explosion of chronic disease arising from both an ageing population and lifestyle disorders, Dr Kornhonen believes the 21st century must see behavioural change by the health consumer. Through health and wellness technologies, and by using the smart phone for self monitoring, the consumer must become a co-producer of personal health. Health resources and budgets cannot keep on increasing as a share of GDP. There has to be a shift in focus from, not merely enhancing healthcare diagnosis and treatment, but to improving a person’s health and lifestyle.

Social media and mobile technology are revolutionising communication. It is projected that 500 million will be using mobile applications by 2015. Mike Walsh, CEO of innovation research company ‘Tomorrow’ asked, ‘What happens when our smart phones become our healthcare monitors?’ An attendee from the floor was more specific, asking why her GP would not accept an email from her mobile phone containing data on her health condition. There was no answer. Networks connecting everyone, and sharing healthcare information, are upon us now. In websites like ‘Cure Together’, consumers are sharing everything about their health and conditions.

In the Q&A session hosted by the ABC’s Tony Jones, one opinion was that innovation and new technologies such as mobile applications, are stifled by standard state-based systems. A clinician’s response acknowledged that they may be the case, but on the other hand recognised that standardised systems to support connectivity and interoperability were vital. Another view was that industry’s ownership of intellectual property was stifling innovation.

In NSW a majority of public health services have implemented a standardized eMR, which enables clinicians to collaborate more easily, and share information on a patient. It has introduced a new paradigm of openness and transparency in patient care. However in an alternate view, Professor Jon Patrick of Sydney University put forward the startling idea of giving clinicians full control and responsibility over design and support of information systems. He advocates the embedding of language technology within his own development of ‘generative clinical information systems’. Of course questions hanging in the air over this contrary stance are such as, ‘Who would own the intellectual property?’, and ‘Which clinicians would get this power?’

In a presentation intriguingly titled ‘Seven Heresies’, Professor Enrico Coiera of NSW University, suggested that the future is a different country, and that we will surely see changes which today we might view as revolutionary or heresy. In one heresy Enrico envisioned that we not delay progress by waiting for widespread acceptance and implementation of standards. In another he wondered if we are now at a point of such complexity, that we should not add more before identifying some which can be excised.

Eric Dishman from Intel asked how can technology help to drive more healthcare out of large hospitals and nursing homes, and back into the home. Eric believes that large institutions of hospital centric facilities cannot keep growing, and are unsustainable. The aged population will double by 2025, and then double again by 2050. We should take on a challenge to move 50% of healthcare from hospitals to the home by 2020.

In a presentation on the growing use of conversational robotics for customer support and companionship solutions, Ms Liesl Capper-Beilby, CEO of ‘MyCyberTwin’ company, described their success with major customers such as NAB, HP, NASA and Westpac, and their work on prototypes for healthcare. Against the impact of an ageing population and an increasing shortage of clinicians and other healthcare professionals, Liesl posed the question, ‘Is a robot companion better than no companion at all?’ Just like Enrico Coiera, Liesl sees the future as a very different country!

For healthcare providers to improve and be relevant in the future, Dr Simon Kos from Microsoft stressed that change is essential, and embracing it now is necessary. The current models of care cannot be sustained. In a concluding session of the conference, perhaps it all came together when the question was asked, ‘Are we good enough at understanding all the innovation going on, and how to apply it for the benefit of the consumer?’ It appeared that no-one was prepared to answer in the affirmative.

The reality of health services’ ICT, and how to embrace eHealth

So how can health services and the reality of their current information systems, embrace eHealth and all its manifestations of accelerating innovation? Apart from new start-up hospitals such as the Macquarie Private in Sydney, which has recently opened with some of the latest technology, most health services have valued information systems and ICT infrastructure, built up from many years of staff effort and capital investment. To invest in new technology, requires significant planning, resources, funding and the inevitable, painful disruption to daily activity during implementation. Above all the introduction of innovative new systems, demands difficult process and work practice changes, where not everyone can come out a winner.

Despite the continual improvement in diagnostic and treatment procedures, compared with many other industries and their investment in ICT, healthcare has for many years been chronically under resourced and under funded in ICT. Inevitably healthcare ICT has to cede priority for resources and funding to clinical services. Remuneration rates cannot attract the best quality of ICT professionals. There is also a tendency for some clinicians and managers to view ICT as a third or fourth order priority, not dissimilar to maintaining the telephone lines and switchboard. That is the reality of health services ICT.

Amidst the incessant daily demands of delivering healthcare, often on a 24x7 basis, the glitter of potential innovation and technical wizardry is not enough to accelerate the take-up of eHealth initiatives. Something else is required.

The search for an eHealth Strategy

To make sense of the potential of innovation and technology trends, match them with the Government’s eHealth strategy, as well as reconcile them with existing ICT operations, current projects and future demands, every health service faces a daunting challenge. Every health service is different and has its own drivers and priorities, with services and processes which are continually changing and evolving. Resources, time deadlines and budget constraints are different for every provider, and ever present. For some health services with their own EMR and own eHealth strategy, the PCEHR can seem to be a low priority. For others it can look attractive, but not above more immediate needs. Somehow a balanced and informed judgement must be made on how to embrace eHealth.

That judgement must be made in the context of what innovation and technology will best improve patient care in each health service. What will most benefit the consumer?

In some ways it is like a search for the end of the rainbow. And there at its end is the legendary pot of gold, which in healthcare is coordinated patient care and the integrated health information to support it, anywhere, any time.

In Australia’s predominantly urbanised population, it is said that an average of only around 2-3% of patients move from one health service to another. Eventually the PCEHR may address that, but it is only one element, it is not a silver bullet. For many health services, just as important or more so, are their own EMRs, new clinical applications, secure messaging and electronic referrals between all providers etc., in other words their own eHealth priorities suitable for their own particular requirements.

How to follow the rainbow

So the challenge for every health service, is how to find the best way forward, with the best mix of eHealth priorities and solutions for their needs. The answer has to be, eHealth and ICT strategic planning. But not for the sake of producing a voluminous document which is out of date before it is approved. Rather it is for the journey of discovery, insights, and knowledge of the business, which the ICT planning process reveals. Only then can an informed decision be taken on which eHealth technology should be adopted.

In essence eHealth planning for a health service is an exercise in self examination. Recognise it or not, information, eHealth and ICT have become the life blood and sinews of health services. Every year at least, health services should re-evaluate all existing systems, review ongoing and planned projects, assess new and innovative clinical information systems and technologies such as: medication management, the PCEHR, anti-microbial systems, mobile applications, robotics etc, for the feasibility of introduction. In parallel examine what is practicable in terms of resources and funding. Above all, identify what will most improve patient care, and benefit the organisation’s consumers.

It may sound hard and complex, but the planning process is in effect a productivity check of every aspect of a health service’s operations, to identify its changing priorities. The discovery process is in many ways as important as the planning’s conclusions. And is it a heresy to propose that every health service should survey its consumers, as part of the planning, to understand what technologies and services consumers want?

Like gazing at the colourful strands of the rainbow, eHealth planning becomes a fascinating journey. And the journey’s goal gets ever closer, the tantalizing pot of gold — a consumer’s coordinated care.

‘E-Health and ICT planning’ sounds boring and difficult. Perhaps we should rename it — ‘Planning for a rainbow journey!’

Bryn Evans
Director, JEMS Consulting
This email address is being protected from spambots. You need JavaScript enabled to view it.

Bryn Evans is a management consultant, with many years experience as a CIO in healthcare, and as chief executive of a clinical software supplier. He writes extensively across a range of categories and genres, notably in the areas of management, information technology, sport, travel, history and fiction.

Posted in Australian eHealth

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