E-health big picture thinking-action to follow?

The National Health and Hospitals Reform Commission Report on the future of the health system was released earlier in the week. The discussion of e-health is in Chapter 5 of the Report.

Generally positive reactions to the reform proposals overall, and although the Government has some runs on the board and plans to continue to move ahead on a number of fronts, disappointment about what is seen as more talk, not enough action on another big high priority. For example this editorial in the Sydney Morning Herald today says too much dithering, and the PM must have loved the George Bush comparison. Yesterday Ross Gittins said he wasn't optimistic about health reforms because "(i)n the short time he’s been in office, Rudd has established a record of over-promising and under-delivering." Although there is something to all this, with his ratings around 66% the PM continues to blog away on health and other topics and is probably not losing sleep at this stage.

On e-health the experts seem to see the general direction as the right way to go and want to see action and leadership from the Federal Government. But some cautionary flags for example from Dr David More about a Personal Electronic Health Record where everyone gets to choose their provider unless we can ensure "a secure, inaccessible, un-data-minable environment where the terms of service were such that the public would be entirely comfortable to have their information stored by whoever provided the service."

The e-health recommendations are:

115. We recommend that, by 2012, every Australian should be able to:
• have a personal electronic health record that will at all times be owned and controlled by
that person;
• approve designated health care providers and carers to have authorised access to some or
all of their personal electronic health record; and
• choose their personal electronic health record provider.

116. We recommend that the Commonwealth Government legislate to ensure the privacy of a
person’s electronic health data, while enabling secure access to the data by the person’s
authorised health providers.

117. We recommend that the Commonwealth Government introduce:
• unique personal identifiers for health care by 1 July 2010; unique health professional
identifiers (HPI-I), beginning with all nationally registered health professionals, by
1 July 2010;
• a system for verifying the authenticity of patients and professionals for this purpose – a
national authentication service and directory for health (NASH) – by 1 July 2010; and
• unique health professional organisation (facility and health service) identifiers (HPI-O)
by 1 July 2010.

118. We recommend that the Commonwealth Government develop and implement an appropriatenational social marketing strategy to inform consumers and health professionals about thesignificant benefits and safeguards of the proposed e-health approach.

119. Ensuring access to a national broadband network (or alternative technology, such as satellite) for all Australians, particularly for those living in isolated communities, will be critical to the uptake of person-controlled electronic health records as well as to realise potential access to electronic health information and medical advice.

120. We recommend that the Commonwealth Government mandate that the payment of public and private benefits for all health and aged care services depend upon the ability to accept and
provide data to patients, their authorised carers, and their authorised health providers, in a
format that can be integrated into a personal electronic health record, such that:
• hospitals must be able to accept and send key data, such as referral and discharge
information (‘clinical information transfer’), by 1 July 2012;
• pathology providers and diagnostic imaging providers must be able to provide key data,
such as reports of investigations and supplementary information, by 1 July 2012;
• other health service providers – including general practitioners, medical and non-medical
specialists, pharmacists and other health and aged care providers – must be able to
transmit key data, such as referral and discharge information (‘clinical information transfer’),
prescribed and dispensed medications and synopses of diagnosis and treatment, by
1 January 2013; and
• all health care providers must be able to accept and send data from other health care
providers by 2013.

121. We recommend that the Commonwealth Government takes responsibility for, and accelerates the development of a national policy and open technical standards framework for e-health, and that they secure national agreement to this framework for e-health by 2011-12. These standards should include key requirements such as interoperability, compliance and security. The standards should be developed with the participation and commitment of state governments, the IT vendor industry, health professionals, and consumers, and should guide the long-term convergence of local systems into an integrated but evolving national health information system.

122. We recommend that significant funding and resources be made available to extend e-health teaching, training, change management and support to health care practitioners and managers. In addition, initiatives to establish and encourage increased enrolment in nationally recognised tertiary qualifications in health informatics will be critical to successful implementation of the national e-health work program. The commitment to, and adoption of, standards-compliant e-health solutions by health care organisations and providers is key to the emergence of a national health information system and the success of person-controlled electronic health records.

123. With respect to the broader e-health agenda in Australia, we concur with and endorse the
directions of the National E-Health Strategy Summary (December 2008), and would add that:
• there is a critical need to strengthen the leadership, governance and level of resources
committed by governments to giving effect to the planned National E-Health Action Plan;
• this Action Plan must include provision of support to public health organisations and
incentives to private providers to augment uptake and successful implementation of compliant
e-health systems. It should not require government involvement with designing, buying or
operating IT systems;
• in accordance with the outcome of the 2020 Summit and our direction to encourage greater
patient involvement in their own health care, that governments collaborate to resource a
national health knowledge web portal (comprising e-tools for self-help) for the public as well
as for providers. The National Health Call Centre Network (healthdirect) may provide the
logical platform for delivery of this initiative; and
• electronic prescribing and medication management capability should be prioritised and
coordinated nationally, perhaps by development of existing applications (such as PBS online),
to reduce medication incidents and facilitate consumer amenity.