Healthy challenges for e-health

commentary Unless we can prove that electronic health records work, how can we justify additional IT spending to doctors, nurses, and patients?Establishing an effective electronic platform for the collection, management, and sharing of consumer health data in Australia will test our technological acumen at the highest level.



commentary Unless we can prove that electronic health records work, how can we justify additional IT spending to doctors, nurses, and patients?

Establishing an effective electronic platform for the collection, management, and sharing of consumer health data in Australia will test our technological acumen at the highest level.

Given the pervasive nature of e-mail, instant messaging, and electronic imaging, the concept of gathering patient data and making it immediately and seamlessly available to health professionals, government, and other agencies -- and the patients themselves -- is a deceptively simple one.

Projects to harness the benefits of e-health have been launched in the UK, Canada, and the US with mixed results, and the introduction of the Federal Government's HealthConnect initiative will need precise application of interconnection standards, security and privacy controls if it's not to hit the hurdles that have stalled similar e-health attempts overseas.

The benefits to our community in creating a national health information network are enormous -- not least in reducing the estimated 3500 deaths per year arising from misdiagnoses and mistreatments through critical patient information not being available when most needed.

US Health Secretary, Tommy Thompson, estimates its proposed system could save 10 percent of the US$1.7 trillion heath care bill, but others warn the national system could cost US$10 billion.
There are wider benefits too: the successful resolution of a host of technological considerations will add to our store of ICT knowledge that can be applied equally to commerce and industry.

Standards form the cornerstone of information technology, and communication at the human level is the foundation on which that stone must sit. Shortcomings in these two elements have afflicted the progress of e-health schemes overseas.

The UK National Health Service's (NHS) program to provide electronic health records for 50 million patients has been billed as the world's largest ICT project. To cost more than AU$12.5 billion, it is designed to give 30,000 British doctors access to patient records, and by 2008, support five billion transactions a year.

A recent analysis of the project by London-based think tank, the Institute for Public Policy Research (IPPR), has been scathing in its evaluation of its ability to deliver its stated benefits.

Released six months after the NHS awarded the last of a number of massive contracts to such heavyweights as Oracle, Fujitsu, CSC, BT Group, Accenture, and PwC, the IPPR report warned that "the potential benefits of such a technological overhaul could be overshadowed by a failure on the part of the NHS to provide evidence of the effectiveness of individual projects".

Trials of electronic patient records "failed to demonstrate that they would lead to more flexible services, cost savings, or improvements in treatment of patients. In addition, pilots of electronic appointment booking systems have not clearly shown that they help facilitate greater choice for patients over where, when, and by whom they are treated".

The IPPR report recommended that evaluations of ICT projects should clearly link to the projects' stated aims, that adequate time and resources should be allocated to evaluations, and that appropriate data should be collected to examine the effectiveness of projects.

The communication imperatives in this are clear: consultation between the creators, managers, and end users of the system are essential to its success. Communication increasingly underpins any ICT exercise at any level.

In Australia, the four-year, AU$128 million Health-Connect project has been piloted in communities across the country and will go state-wide first in Tasmania, then South Australia, with other states to follow.

There are lessons to be learned from the accumulated international experience and some major challenges to be met in integrating disparate legacy systems, refining connection and security standards and above all, effective communication with all stakeholders.

But Australian ICT is equal to the task.

Edward Mandla is National President of the Australian Computer Society (ACS, www.acs .org.au). The ACS attracts a membership (over 16,000) from all levels of the IT industry and provides a wide range of services. The Society can be contacted on 02 9299 3666, or email info@acs.org.au..

This article was first published in Technology & Business magazine.
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