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The Health Advocate is the AHHA's high quality, insightful and entertaining magazine filled with the thoughts and opinions of Australia's leading health managers, academics and clinicians. The …

The Health Advocate is the AHHA's high quality, insightful and entertaining magazine filled with the thoughts and opinions of Australia's leading health managers, academics and clinicians. The magazine keeps you up to date on the latest developments and thinking in the Australian health system. To receive the printed magazine please contact the AHHA by email at or on 02 6162 0780.

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  • 1. The Health ISSUE 9 • JUNE 2011The official magazine of the Australian Your voice in public healthcareHealthcare & Hospitals AssociationThe e-health imperative Clinical informaticsWhy we need to improve our for dummiese-health capability Providing better health care by using technology E-health In Australia The development of e-health A history of pathology informatics ALSO in this • Governance • Who’s moving in • AHHA news issue training for health the health sector and events
  • 2. More people in health and communityservices choose HESTA than any other fundYour super fund can make a lifetime of difference3 Run only to benefit members3 No commissions3 Low fees 7 by H.E.S.T. Australia Limited ABN 66 006 818 695 AFSL 235 249 regarding HESTA Super Fund ABN 64 971 749 321.Consider our Product Disclosure Statement before making a decision about HESTA - call 1800 813 327 or visit our website for a copy.
  • 3. The HealthAHHA Counciland supporters Prue Power Executive Director Cydde Miller Policy and Networks Manager and Editor Terrie Paul Business and Membership ManagerThe AHHA Board has overall Luise Zakosteletzki Traineeresponsibility for governance Policy and Planning Manager Adjunct Professor Annetteincluding the strategic direction Schmiede ( NSW) AHHA Officeand operational efficiency of the Ms Joan Scott (ACT) Unit 2, 1 Napier Closeorganisation, the protection of its Deakin ACT 2600assets and the quality of its Mr John Smith (VIC) Postal addressservices. The 2010-2011 Board is: Mr Mark Sullivan (VIC) PO Box 78Dr David Panter (SA) Ms Sandy Thomson (WA) Deakin West ACT 2600National President T: 02 6162 0780 Dr Annette Turley (QLD)Dr Patrick Bolton (NSW) F: 02 6162 0779 Ms Anna Fletcher (Personal E: admin@ahha.asn.auNational Vice President Member representative) W: www.ahha.asn.auDr Paul Scown (VIC)National Vice President Dr Owen Curteis (Asian Hospital Editorial and general enquiriesMr Felix Pintado (VIC) Federation) Cydde MillerNational Treasurer Professor Helen Lapsley T: 02 6162 0780Ms Siobhan Harpur (TAS) E: (International HospitalDirector Federation) Membership andDr Yvonne Luxford (AssociateMember Representative) subscription enquiriesDirector AHHA Sponsors Terrie Paul T: 02 6162 0780 The AHHA is grateful to the E: tpaul@ahha.asn.auThe AHHA National Council following companies who supportoversees our policy development Advertising enquiries our work:program. It includes the AHHA Frank RisvanisBoard above and the following Globe Publishingmembers for 2010-2011: Primary sponsor T: 03 9699 4279Mr Grant Carey Ide (ACT) HESTA Super Fund E: frank.risvanis@ Helen Chalmers (SA)Dr Stephen Christley (SA) Event sponsorsMs Rosio Cordova (NSW) TressCox LawyersDr Martin Dooland (SA)Ms Jan Evans (NT)Ms Jane Holden (TAS) Other organisations support The Health ISSUE 9 • JUNE 2011Mr Graem Kelly (VIC) the AHHA with Institutional,Ms Shaune Noble (NSW) Corporate and Associate The official magazine of the Australian Healthcare & Hospitals Association Your voice in public healthcareMr Patrick O’Brien (QLD) The e-health imperative Clinical informatics for dummies membership. To find out about Why we need to improve our e-health capability Providing better healthDr Tony O’Connell (QLD) care by using technology joining the AHHA and havingAssociate Professor Alan your organisation listed,O’Connor (QLD)Mr Ross O’Donoghue (ACT) contact Terrie Paul. E-health In Australia The development of e-health A history of pathology informatics ALSO in this • Governance • Who’s moving in • AHHA news issue training for health the health sector and events The views expressed in The Health Advocate are those of the authors and do not necessarily reflect the views of the Australian Healthcare and Hospitals Association. The Health Advocate June 2011 3
  • 4. 36 Contents 28 Every issue In depth 06 President’s view 8 Clinical informatics for 13 News dummies 16 Events By Tony Sara 39 Who’s moving 19 The development of 40 Become an AHHA Member e-health in Australia 42 Snippets By Michael Legg 25 Is the Personally Controlled Electronic Health Record Brie ng an evidence-based intervention? 34 Governance training for By David More the health sector 28 Computer says NO! 38 Book review – Improving The challenges of e-health Health Care Safety 8 implementation and Quality: Reluctant By Philip Darbyshire Regulators 30 The e-health imperative: By Christopher Baggoley the latest e-health news and developments By Peter Fleming 19 Opinion 36 What does health ICT actually achieve? By Patrick Bolton
  • 5. President’s viewDr DaviD PanterPresident of theAustralian Healthcare andHospitals Association w e are almost half way through the year already and, while health has been fairly quiet in the media, those of us in the health system have been working harder than ever. Networks in all states and territories as well as the first group of medicare locals, which will begin operating from 1 July 2011. some of the issues being immediately felt are the uncertainties around the precise roles of In this issue of The Health Advocate our these organisations and how service integration focus is on e-health and health informatics, a will be achieved – an objective we have long been critical element of health service delivery that toiling to realise in the australian health system. has received recent attention with the Federal For instance, which of these bodies will take Government’s release of the draft Concept of prime responsibility at the local level for helping Operations for the personally controlled electronic consumers and patients navigate the system?This year has health record (PCeHr) due to start in July 2012. What are the practical mechanisms for local at the aHHa we have been spending a lot of our Hospital Networks and medicare locals to workalready been a time setting up two new arms of the organisation together to ensure the right care in the right place? – consulting and research – building on our the aHHa, along with a number of otherbusy one with the already strong foundation of policy development, organisations, has also raised serious issues with advocacy and information dissemination. the Federal Government’s legislation to establishAHHA establishing JustHealth Consultants is a new service offered the National Health Performance authority. ournew arms of the by the aHHa designed to easily connect health services with experts in a range of fields. our panel members expressed consternation that state and territory governments were not consultedorganisation in already includes Chartered secretaries australia (Csa) who will be providing nationally consistent in the drafting of the legislation and that, as tabled, there was little recognition of the states asconsulting and clinical and corporate governance training for new hospital ‘system managers’ in terms of reporting and existing bodies under the reforms. We also have and accountability. You can find a more detailedresearch leaders and experts in health law, strategic planning, summary of our concerns on page 13. health service planning, industrial relations, health of course, health performance data relies informatics and financial/audit support. heavily on information and communication the Australian Institute of Health Services and technology to ensure accuracy, consistency and Policy Research is the aHHa’s second major change timeliness. In this issue we hear from some key this year, being built on university membership figures in the e-health domain, including the Chief emanating from the australian Institute of Health executive of the National e-Health transition Policy studies. the new Institute provides a central authority, Peter Fleming. point through which research and evaluation is associate Professor tony sara gives us a simple linked directly with health services – to the benefit guide to clinical informatics – that is, the use of of services themselves, managers and practitioners, electronic systems and information to help guide as well as academics and the public as a whole. and improve clinical practice. We also have the the Institute is the first active endeavour to close first of a two-part article from Dr michael legg, the loop through implementation, evaluation and Past President of the Health Informatics society improvement of health service delivery. of australia, on his personal experience during the If you are interested in being involved in these evolution of ‘e-health’ in australia through the new activities or would like to know more about lens of pathology. what services the aHHa can offer you, please Dr David more, a well-known clinician, contact our Business Director, terrie Paul, on commentator and blogger on e-health, shares his 02 6162 0780. concerns about the e-health record and the need another reason for our increased fervour is the for australia to learn from implementation of such rapidly approaching ‘go-live’ date for a number systems in other countries. of bodies and organisations being established so please read on! the next time you hear from under the National Health reform agenda. among me we will be in the full swing of making the these entities are the local Hospital and Health health reforms work.6 The Health Advocate June 2011
  • 6. “Because one blood droplet found my eye, I was at risk.” CHERYLL COLLINS, BSN, RN, OCN Needlestick safety devices have made a difference in healthcare worker protection. But any exposure to blood can still be a risk. BD is working to eliminate blood exposure from peripheral IV cannula settings. Have you been exposed to blood? Share your story and read others at Australia: Becton Dickinson Pty Ltd, 4 Research Park Drive, Macquarie University Research Park, North Ryde, NSW, 2113. Toll free telephone: 1800 656 100. New Zealand: Becton Dickinson Limited, 8 Pacific Rise, Mt Wellington, Auckland.BD and BD Logo are trademarks of Becton, Dickinson and Company. © BD 2011 ANZMED#086 Toll free telephone: 0800 572 468.
  • 7. In depthCLINICALINFORMATICS for dummies8 The Health Advocate June 2011
  • 8. TONY SARA Director of Clinical Information Systems South Eastern Sydney and Illawarra Local Health Network i HAVE BEEN doing ‘clinical informatics’ becoming more public (eg the Bristol RoyalTrying to make the for more than 10 years, but was forced to Infirmary1), the information explosion, and also re-evaluate just what it is that I do, and the need to provide more care in the contextmost of health the context in which I do so, following the of the greying of the population, higher costs, request from AHHA for this article. I used to increasing expectations and increasing cost ofinformation systems give lectures to Masters students five years ago technology, but a reducing workforce. on ‘Introductory Health Informatics’, so I went Essentially, this means the need to provide back to those slides to see how little, or how demonstrably better care to more patients much, the landscape has changed. with constrained resources and proportionally The principles are the same – health fewer staff. informatics is about providing better care to patients using technology. It sits How does health at the intersection of computer science, information science, health care and informatics expect to healthcare management. achieve these aims? The definitions all congregate around the notion of the art and science of providing Let’s follow the patient journey to analyse better health care using IT. But what are the where health informatics can assist. driving forces behind health informatics? The patient presents and is registered. Firstly, there has to be a ‘desire to take Have we uniquely identified the person to better care of patients’, deep and right at ensure we have the right person and the the core. Others include the increasing right information held against them? If we power of technology and the internet, an have a robust unique person identification increasingly stronger need to demonstrate public accountability in the context of errors system and process then we have made a good start. > The Health Advocate June 2011 9
  • 9. In depth e focus of clinical informatics has narrowed onto the use of information in IT systems ” ” in health care by clinicians> Do we have relevant history available of the triggering of the rules engine noted enough about health and health care, andfrom past encounters with our practice and above, but more importantly as to outcomes its work processes, and have learnt enoughothers? Immunisation status? Medications? of care, by disease, by patient group, by about information and computer sciencesImportant lab and imaging results? Alerts ward, by operation and by clinician. that they can assist both their clinicaland allergies? Again, an encounter summary Lastly, the monitoring of the processes colleagues and the IT groups to achievewith unique person identification will help and outcomes of care should be able to be common aims.the process of care. applied to the population as a whole by the Bill Gates said it fairly succinctly in 1999 in Can we compare the images from the aggregation of de-identified patient data. his book Business at the Speed of Thought:past to those captured today? A Research An interesting example of the latter was the “It’s impossible to properly re-engineer aInformation System (RIS) or Picture analysis by Kaiser Permanente of its large data process using technology in an area withoutArchiving and Communication System store that identified that Vioxx contributed to oversight of someone who can bridge [the(PACS) program will do this, assuming it is an excess rate of myocardial ischaemia2. different] teams.”fed by the unique identity system already The various academic definitions have not The technologists just don’t understandin place. Perhaps the symptoms and signs changed in a real sense over the last decades. healthcare processes; and clinicians,are not diagnostic – decision support listing So what has changed? without further training or experience, don’tdifferential diagnoses will assist. The focus of clinical informatics has understand the technology. It has become The condition found is unusual – what narrowed during the last years onto the use the solid perceived wisdom that it is easieris the best care? Access to the internet will of information in IT systems in health care to train a doctor or a nurse to have enoughquickly determine what is evidence-based by clinicians. understanding of the broad brush strokesmedicine. The prescription process, one of the What has also changed has been the and some of the detail of technology so theyfour main sources of errors in health, should increasing pervasiveness of technology. can effectively bridge the monitored by clinical decision support Google, similarly, has made significant In fact, in the USA, there arose, insoftware that applies expert rules devised by changes to the way we work and study. 2009, the clinical sub-specialty of clinicalsenior clinicians along with graded drug/drug Some of this article was sourced from informatics3,4.interaction alerts. The process of clinical care Google, the depth and reach of which wason the ward should be monitored for unusual unthinkable when I started this job. So, what do Clinicalobservations, again by expert IT systems. Informaticians do and When the care pathway is over, the Who are Clinicaltransfer of care should be electronic and what do they use?seamless. The monitoring of the processes Informaticians?of care in the facility should be able to be Clinical Informaticians are doctors, or nurses, These professionals use their knowledgesupervised by the clinicians, by both analysis or health information managers who know of healthcare processes, of informatics10 The Health Advocate June 2011
  • 10. principles and processes, and How does the clinical from before the inception of a clinical project health informatics tools5. Clinical informatician seek to or system, to well after the (nominal) project processes need no introduction – but do this? had finished – it is a truism that health what are the latter two? Informatics information systems projects are never principles are about IT technology, privacy In essence, they achieve these goals by finished until the data and information haveand health law, database concepts, project bridging the different teams. Specifically, been passed onto the next system and themanagement, change management, this means to develop, implement and original system has been turned off.statistics, health and IT standards, refine clinical decision support systems, The last of the queries is where and themessaging, person identification and so understanding both the clinical processes in answer is fairly intuitive – wherever clinicalon. Health informatics tools are things like depth and the technology in a broad way. As care is delivered and close to the point of care.clinical guidelines, pathways, order sets and well, it means to lead or participate in the The state of play for clinical informaticsstaff education processes, to name a few. procurement, customisation, development, in Australia is not optimum – there are a So, what does the clinical informatician implementation, management, evaluation handful of doctors who do it full-time and aseek to do? (S)he seeks to: and continuous improvement of clinical much larger number who do so part-time. • Assess and inform the information needs information systems, again understanding There are no training positions and some of clinicians, managers and patients both the clinical world and the IT world5. tertiary courses. • Characterise, evaluate and improve It would be understood that clinical What I find the most gratifying, as a doctor clinical processes. informaticians, then, would do this work in this field, is the capacity to improve the care that large numbers of patients receive, and interestingly, from a ‘life satisfaction’ perspective, problem-solve with my colleagues how we will practice medicine tomorrow. References 1. Treasure T, ‘Lessons from the Bristol case’, BMJ 1998; 316: 1685-1686 2. ucm113235.htm, accessed 15 March 2011 3. Gardner RM, Overhage JM, Steen EB, et al. (2009), ‘Core content for the subspecialty of clinical informatics’, Journal of the American Medical Informatics Association 16 (2): 153–7. doi:10.1197/jamia.M3045 4. Safran C, Shabot MM, Munger BS, et al. (2009), ‘Program requirements for fellowship education in the subspecialty of clinical informatics’, Journal of the American Medical Informatics Association 16 (2): 158–66. doi:10.1197/jamia.M3046 5. informatics, accessed 14 March 2011 The Health Advocate June 2011 11
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  • 12. In the Have your say… We’d like to hear your opinion on these or any other healthcare issues. Write to us at or news PO Box 78, Deakin West, ACT, 2600 Dental probe welcome, but not the solution has been allowed to run for soCautious first steps long when it is clearly wasting valuable health resources whichin health reform could be used to help those in genuine need – particularly low income earners, Indigenous In March the ahha the states and territories. communities, others in rural➧ expressed serious concern about the lack of consultation bythe Federal Government on “as a result of the lack of consultation, the legislative framework for the nhPa has a number of critical flaws which and remote areas and older australians. the ahha urges the government to consider alegislation to establish the will reduce the body’s capacity new proposal we developednational health Performance to fulfil its role. hospital and in consultation with our Oralauthority and warned of the health service performance is and Dental health network, inrisk to future health reform if a complex area in which the conjunction with dental healthsimilar approaches continued states and territories have experts and peak groups, toto be used. considerable knowledge and the ahha WelcOMeD address the growing oral health “the Bill establishes theinfrastructure and legislativemechanisms for the nhPa.however, the legislation fails to expertise,” said Ms Power. the ahha therefore called on the commonwealth to make critical amendments to the ➧ the Federal Government’s intention to further investigate widespread misuse of the Medicare chronic crisis in the australian community. the proposal focuses on the provision of medically necessary oral health care for those withrecognise the role of state and Bill in consultation with state Disease Dental Program, but genuine chronic conditionsterritory governments as the and territory governments. We expressed disappointment and targeted assistance tomajority funders and system have also sought an ongoing that our earlier warnings went the 30 percent of australiansmanagers of our public health commitment to involving the unheeded, which has resulted who currently have difficultiesservices as agreed at cOaG,” states and territories, as system in massive over-spending on a affording private dental care.said ahha’s executive Director, managers of public healthcare, program with limited scope in It involves integrating thePrue Power. “this is despite in the following processes: the community. Medicare chronic Disease Dentalthe fact that health Ministers • nhPa strategic planning; We have for years been Program into a revised versionare accountable to their local • Developing performance highlighting the problems with of the commonwealth Dentalpopulations, along with their indicators to assess quality; the Medicare dental program health Program, which wassenior officials, to meet the and while lauding its focus on proposed by the governmentdemands of a dynamic and • Dealing with improving the oral and general before the 2007 election.complex system and for underperforming hospitals health of people with genuine the proposal focuses onmaking sure services are when necessary. chronic conditions. ensuring funding is directed toavailable at all times.” two years ago the ahha delivering cost-effective, essential the approach threatened as originally drafted, the proposed a solution to the and preventive oral health care forto undermine the national legislation prevents the problems inherent in the those who need it most. It wouldhealth reform agreement jurisdictions from participating program that would have also include universal dental careformulated at the cOaG in all these activities. We dramatically reduced spending for children aged 0-18.meeting in February as well as will keep you posted on the under this scheme and delivered You can read more about thethe commonwealth’s stated establishment of the nhPa and much better value for money. outcomes from our Oral andcommitment to a cooperative other new organisations over It is frustrating that this poorly Dental health network meetingapproach to health reform with coming issues. designed and targeted program in adelaide on page 16. The Health Advocate June 2011 13
  • 13. In the newsIncreased ambulance useputting pressure on hospitals A study from emergency department➧ february’s Australian Health Review has found that the increased demandfor ambulance services over attendances. Pressures on hospital systems are well recognised, with congestion and overcrowding reportedthe past two decades is putting regularly in the media and peer-pressure on health care resources reviewed literature.potentially resulting in reduced this study involved a review ofaccess, safety and quality of care the literature concerning trendsfor patients. in utilisation of emergency “In Australia, as in other ambulances throughout thedeveloped countries, there is developed world and discussesan expectation that the health the major underlying driverssystem will fulfil our care needs, perceived to be contributingespecially those that are urgent to this increase. A betterand life-threatening. the role of understanding of causes ofambulance services has evolved increased demand is essential the authors recommendover the past 20 years into a vital to enable the development of further investigation of the majorcommunity resource embedded strategies to manage demand causes of rising demand. for thisin the health system,” said in the future. to be undertaken, there muststudy author, Judy Lowthian, the review found evidence be collection and recording ofan NHmrC post-graduate that patient transportation by standardised data with commonresearch scholar. emergency ambulances has definitions of demographic, Initially designed as an been increasing over the last socioeconomic and health-emergency transport service, 20 years. many contributing related factors. Effectiveambulance services now factors have been postulated, management of future demandprovide a range of healthcare related to changes in the needs will depend on a comprehensiveneeds, including pre-hospital of the community arising from analysis that goes beyondemergency and urgent primary ageing, declining health, social simple demographics of age andcare, emergency and non- structural change, and changes population growth. until we haveemergency patient transport in organisation of primary a better understanding of theand referrals to alternative healthcare. Limited price signals drivers of demand for ambulancehealthcare professionals. and improved accessibility of services we cannot ensure the In recent years escalating ambulances, alongside improved future sustainability of thisgrowth in demand for community health awareness and essential healthcare service.emergency patient services expectations possibly contribute you can access the Australianhas placed increasing strain on to a degree of avoidable use. Health Review by becomingboth ambulance and hospital the relative contribution of these a member of the AHHA. findresources. rising utilisation factors to the continuing rise in out more about the AHr andof ambulances is occurring transportations has not been our other publications on ourin common with increased well studied. website at The Health Advocate June 2011
  • 14. Private health insurance needs change The sTrucTure and regulation health status), that contributors were to take out PhI) has insulated the health ➧ of private health insurance needs to change radically in order to meet consumers’ need within our current health system. The new research treated fairly and that the organisations were prudentially managed. competition between funds on price and product innovation and funds from the conventional business imperatives to satisfy customers and contain costs in the industry, and inflated their significance in the funding of was reported in the February issue of the differentiation has been deliberately healthcare in australia. ahha’s peer-reviewed journal, Australian stifled in order to realise these objectives. If the commonwealth wishes to Health Review. This may have made good policy preserve a system of private hospital “Most australians are familiar with sense when the private health funds treatment employing user charges as an high profile private health insurance were the financial lynchpins of the alternative to its own hospital Medicare, it (PhI) companies, like Medibank Private commonwealth’s national health scheme, should consider redirecting its subsidies to and hcF, but few people understand prior to the introduction of a universal the hospitals themselves. PhI could then how this unique sector of the economy health insurance scheme. however, its be reconfigured as an option for accessing operates and the influence it exerts on rationale is questionable in the current private hospitals rather than the privileged the delivery of health care in australia,” environment given bipartisan support for mechanism for doing so. a deregulated said study author dr ardel shamsullah of Medicare as a universal public insurer. industry using insurance principles of risk- La Trobe university. The result of this system is that rating and allowing competition between The company structure of the PhI private health funds are now wedded firms would emerge, and it may attract a sector has always been markedly different to a highly regulated and subsidised more diverse contributor demographic, from typical commercial industries, in system that assures their existence which would consist of more demanding part due to the comprehensive framework while they deliver expensive insurance and price-sensitive customers. of commonwealth regulation within packages to a segment of the australian “This would result in a PhI industry that which they operate. This regulatory population covering a select set of supports, rather than hinders, innovation regime was designed to ensure that PhI, healthcare services. The commonwealth within the health sector and which is heavily subsidised from the public purse, guarantee of a certain level of income genuinely centred around consumers’ was accessible to all (irrespective of their (from subsidies and incentives for people needs,” dr shamsullah said.Safety and quality afocus for health ausTraLIans can over several years the➧ Look forward to safer health care in the future with a permanentorganisation dedicated to commission, and before it the council, has undertaken excellent work in raising the profile and evidence base for process of receiving health care. within individual hospitals.promoting safety and quality improved safety and quality in The ahha believes that every This is why it is crucial thatthroughout the health system – a range of health care settings. person has a right to receive safe we have a body dedicated tothe australian commission This has included major and high quality care and that identifying and addressing theon safety and Quality in campaigns to increase hand each avoidable adverse event is policies, structures, practiceshealth care. washing and hygiene, reduce one too many. and cultures that can make our While we were concerned hospital-acquired infections Most harm caused in health system safer.with parts of the legislation to and improve medication health care is not the result The permanent establishmentestablish the national health management. of individual errors but due to of the commission enshrinesPerformance authority, the other australia’s health system is underlying problems such as a the critical imperative for safecomponent of the Bill to make very safe by world standards lack of consistent information and high quality healthcare inthe commission a permanent but too many australians are systems across jurisdictions, all public, private and non-profitbody was most welcome. still harmed unnecessarily in the health services and sometimes health services. The Health Advocate June 2011 15
  • 15. Events & meetingsOral health experts agreeon a way forward The AhhA convened oral health reform – including health foundation year that proposal formulated at the➧ its oral and dental health network in Adelaide on 11 March 2011. The meetingbrought together directors of stronger links to the evolving national health Reform agenda, such as through the national Preventive health Agency in the first instance will be an application-based (and therefore voluntary) program. For instance, 20 foundation year placements AhhA’s oral and dental health network meeting. You can find the nRhA’s priorities on their website at:state and territory public dental and possible inclusion in the may be offered in the first year, (most of which are national health Agreement – expanding over time. Using this We look forward to workingmembers of the AhhA) as well and emphasises that the starting model, a focus can be placed with our partners, membersas representatives from the point must be a program to squarely on rural and remote and the government to ensurenational Rural health Alliance, address the oral health problems placements in the initial roll-out. that another year does not passthe Public health Association of those most in need. At the ensuing national without action on oral health.of Australia and the Australian We are seeking integration of conference of the national Rural If you would like moredental and oral health the existing Medicare chronic health Alliance held in Perth over information on the AhhA’s oralTherapists’ Association. disease dental Program into a 13-16 March, one of the priority and dental campaign, contact us The discussion centred on revised commonwealth dental recommendations agreed by on 02 6162 0780.building a campaign for the ‘poor health Program (with a new delegates was this combinedcousin’ of hospital and primary name) that will mean all carehealth care reform, oral health. provided is on the basis of highestAlong with mental health, oral need while ensuring best value forhealth has been put on the back the taxpayer dollar. As originallyburner to simmer away while intended for the cdhP, the newhundreds of thousands of needy combined program would ensureAustralians continue to struggle care for the 500,000 people onwith accessing affordable and public dental waiting lists as welltimely oral and dental care. as specific early intervention and The group worked from the treatment targets for those withbasis of the RePAIR proposal chronic conditions, Indigenousagreed during the 2010 election and rural/remote communities,campaign by the national the aged and children/youngoral health Alliance (of which people (aged 0-18).the AhhA is a member). This The group also agreed toproposal is available on the put forward more specificnohA website at: recommendations in relation the workforce plan of an intern The revised proposal reworks year for oral health professionals.some of the touchstones for We would prefer to see an oral16 The Health Advocate June 2011
  • 16. Moving towards healthgovernance in regional areas ON 18 APRIL, a beautiful➧ autumn day in Canberra, the AHHA convened its first Policy Think Tank forthe year in partnership with theAustralasian College of HealthService Management (ACHSM).Our focus for the day was on thedistinct governance issues facingrural and remote health services,particularly under the nationalhealth reforms. The day was facilitated withgreat skill by Associate ProfessorPaul Dugdale from the AustralianNational University. We had afantastic range of speakers whoimpressed the delegates withtheir perspectives:• Prue Power and Daryl Sadgrove, Directors of the host organisations, gave tranche of Medicare Locals on strategies for community As a follow-up from the event, good overviews of the reform 1 July; engagement in health service the AHHA wrote to the Federal context on which discussions • Carole Bain travelled all the governance and planning. Minister for Health, Nicola focussed throughout the day; way from Silver Chain in Roxon, to outline some of the key• Jodi Hallas and Jenni Pilcher Western Australia to discuss Delegates commented on why issues and possible strategies for from Queensland Health the issues facing a community they liked the Policy Think Tank: making health reform work in detailed state-wide work care and nursing service that “The discussion and different the bush. We will be advancing on health service planning, needs to work across all parts perspectives in the presentations the outcomes from the day in particularly to support rural and of the reforming health system and linking back to on-the-ground a formal policy development remote health service districts; in metropolitan, rural and issues. [It was] well facilitated program that will contribute• Terry Findlay from the Transition remote towns; and with a great variance of people to our inputs to the National Team in the Australian General ark • Mark Ashcroft from Alpine with real commitment to rural Rural Health Alliance. For more Practice Network shared some health, a multi-purpose service and remote health.” information or a report from the substantial insights to the in the Victorian high country, “The practical and advocacy- day, please contact us. imminent roll-out of the first shared some very interesting It was well facilitated with a great variance of people with real committment to rural ” ” directed focus of the whole day.” Our next Policy Think Tank will be focussing on community health in the reforms. We would love to welcome you to Canberra in winter (it’s not as bad as you think!) on Friday 22 July. For more information or to register and remote health your interest in attending, please email the AHHA at admin@ The Health Advocate June 2011 17
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  • 18. In depth MICHAEL LEGG Principal of Michael Legg and Associates The development of e-health Michael Legg provides the first instalment of a personal history of health informatics in Australiaa  LTHOUGH CHATHAM HOUSE rules were invoked at the recent meeting of the CEOs of the Medical SoftwareIndustry Association, I hope Minister Roxonwont mind me picking up on a comment she The early years It began for me in 1977 when, in my third year at Sydney University, I was in a physiology course taught by Michael Taylor - what multi track FM recorder and then digitised over hours producing washing baskets full of punched paper tape. These were subsequently submitted to Fourier analysis to determine the frequency spectrum of pressure wavesmade recognising that many in the room turned out to be his last. Michael Taylor was using the University’s SILLIAC and KDF9had been working in the field for a long time a mathematician2¬ physician-physiologist computers. The point of this is that SILLIACand that a debt was owed. Her comment interested in optimisation. Fascinated by his was the replacement for the first computerand a recent article by Robert Flanagan1 on account of this field, I undertook to do an in the southern hemisphere the CSIR Mk 1!‘why IT is all so hard’ prompted me to record honours year with him. These were computers that took up the wholesomething of what I knew of the history of Taylor had a distinguished research career basement of a very big building!3 Of coursehealth informatics in Australia. Because the looking at the physical properties of arteries now this can now be done on your is small and since I have had the privilege and how well-designed they turn out to be. He What was to be my honours year however,of spanning most of it, this will be somewhatpersonal and focused around pathology. and his colleagues had built various pressure and displacement sensors that fed into a huge saw Taylor move to be Deputy Vice > Chancellor and so I joined his student, The Health Advocate June 2011 19
  • 19. In depth>Barry Gow, who had inherited the laboratory.With Barry, I looked at the conundrum ofwhy aneurysms formed on the low pressureside of a constriction in arteries. Barry was adentist who made organs and harpsichords inhis spare time but in the lab we built our ownmicroprocessor-based computers including aDEC LSI-11 and used these to drive machinesto prod and scan arteries as well as for real-time Fourieranalysis of vibrations. Grant Carter4, a medicalstudent, helped with the programming ofthe Intel 8080 microprocessor5 following hissuccess at writing the BASIC compiler for theAustralian Microbee. Arthur Guyton, arguably the last personto have a complete understanding of knownhuman physiology, also visited during this timeand gave us his FORTRAN dynamic model ofthe human cardiovascular system; we wereable to run it on our home-grown machine. The laboratory next door was David Read’s,a respiratory physician who had formeda relationship with Ita Buttrose and the Programming then was in assembler (the bits and bytes level) because that was the only way to ” ”Australian Womens Weekly in support of hiscot-death research. Needless to say we werejealous of their funding. David, who was a make the computer work fast enoughgood scientist and great teacher, attracted anumber of bright young clinician-researcherskeen to be associated with this cutting edge GE in the US. After a spirited New Year’s party I and a couple of others ended up doing time.laboratory. Among them were those who are found myself being interviewed for the role of Interestingly, many remember these newswell recognised now in health informatics and Coordinator of Computing and Quality Control items but few could tell you that seven of thethe medical technology sector, including Vince in the largest NSW pathology laboratory 10 Australian Nobel prize winners were/areMcCauley6, David Rowed7 and Colin Sullivan8. (Macquarie). In many respects this was a role pathologists or physiologists.Vince and David were programming then in and job title well before its time. It showed a At Macquarie, I specified a laboratoryassembler (the bits and bytes level) because clear recognition of the link between quality information system and it was put out tothat was the only way to make the computer and informatics in pathology. tender. Relying on contractual promises andwork fast enough for the experiments. Macquarie Pathology was founded in a judgement that the ‘new’ language ‘C’ with the early 1970s by Tom Wenkart9. Tom was, an approach then called ‘parameter driven’Pathology and still is, a visionary in what has become (and now called archetypes) was the way to known as e-health. From the outset Tom had go, and following my forecast of the demiseYou may be wondering now how this has the vision for the digitally connected health of MUMPS, we embarked on implementationanything to do with pathology informatics. system. Indeed in the very early 1970s he had with a partner – the specification was okayWhere I had seen myself as an academic and printing computer terminals in surgeries for but the implementation a failure. For thewas set to go to UNSW in what was, and still pathology reports but these were removed record the successful non-winners, Alexis, an exciting area of research, Functional because they were seen as inducements. Anderson’s Détente10 and Sonic’s ApolloMRI, the project collapsed when at the last Times were interesting in Sydney and system, still use MUMPS (Cache) today veryminute the Australian research leader, who pathology then. It was the ‘underbelly period’, successfully.was returning to Sydney after working with during which a principal of a Sydney pathology At Macquarie we also tested the value ofthe Nobel Prize winning Nottingham Group, practice was shot outside his Concord computerisation to a pathology laboratorygot an order-of-magnitude better offer from laboratory over a ‘business related matter’ with a somewhat unnatural experiment.20 The Health Advocate June 2011
  • 20. I arrived one day to find the place on fire – an was a CIO before George. In a twist of fate siders saw a working computer for the firstarsonist had broken into the secure data I came back some years later leading the time. A patient would sit in a perspex pod tocentre, opened the data safe and set it and the ‘occupation team’ after Mayne bought answer a computerised questionnaire in fullcomputer centre alight. The laboratory, which Macquarie laboratory. view of the computer with spinning tapes andwas downstairs, was saved and continued to flashing lights behind glass. This was highlyfunction but it took a week of 24-hour days to Medicheck controversial and on a number of occasionsrebuild a computer room and to get the system made front-page news. There was real concernrunning again. There was a disaster recovery After Macquarie I moved to be CEO at another from the less well-informed profession thatplan and no loss of patient data but we went highly innovative organisation, Medicheck. In computers were being pitched to replacemanual and it was absolute mayhem. 1970 after having sold his transformer business doctors. Of the many eminent people No pathology practice would think to GE, Sir William Tyree13 established a trust. associated with this organisation, Brankoof starting (even 25 years ago) without With Sir Eric Willis14 and Sir George Halliday15 Celler17, who was Director of Research, andelectronic health records and no laboratory the funds were used to build a preventative Bruce Barraclough18, who was a leading breastcan operate now for more than a few minutes health facility which had the dual aims of surgeon at the associated Sydney Squarewithout its information systems. On the systematising medicine and moving the Diagnostic Breast Clinic, have important rolessubject of records, another well-known emphasis toward prevention. Medicheck16 in health informatics informatician George Margelis11 broke new ground in many areas. It introduced I arrived at Medicheck in the mid-1980slater joined Tom at Macquarie as CIO and mammography to Australia, created the first and led the third generation replacementtogether they worked on an early versionof the Personal Health Record. Klaus Veil12 mental health atlas of Sydney and, relevant here, it was the place that many Sydney- of the information systems in this organisation that had always had > The Health Advocate June 2011 21
  • 21. In depth>fully electronic records (replacing one from of Medical Services with the Red CrossBUPA). Having learned from my previous 5 Intel’s second-generation 8 bitexperience and with a talented computer microprocessorscientist19 we used prototyping directly 6 Emergency doctor; developer of awith the doctors, nurses and scientists who laboratory information system; Pastwere working in the organisation to build President of the Medical Softwarean information system from the ground up Industry Association and currentincluding a laboratory information system Chairman of IHE;(LIS). From the technology point of view and standards developerthis was a time when relational databases 7 Electrical Engineer; GP; one of thewere just becoming commercialised. We OpenEHR founders and standardspurchased Oracle before they had established developeran office in Sydney, ran it on one of the first 8 Respiratory physician and ResMed the Board without a knighthood for some timeMicroVAX’s and had networked PCs attached. co-founder 16 Medicheck and its sister organisation inMedicheck became a technology showcase 9 Entrepreneur, GP, private hospital operator, Melbourne, the Shepherd Foundation, werewith weekly visits from people mostly outside PHR developer and now with an interest closed down when medical benefits werehealth. Because of my role at Medicheck in Pen Computing - he was also a one-time withdrawn by DoHA because the valueI became a director of the International large-scale computer bureau operator for couldn’t be demonstrated to their satisfactionHealth Evaluation Association with Morris local government and provided microfilming – the protocols and testing have since beenCollen after whom the highest honour of the and microficheing for the NSW police among well-proven but no organisation exists whereAmerican College of Medical Informatics is others it can all be done in a single visit includingnamed. That also meant I got the privilege 10 Now Integrated Software Solutions counselling in 90 minutesof visiting with him at Kaiser and using those 11 Optometrist; medical practitioner; 17 Electrical engineer, computer scientist,learnings in the Medicheck system. informatician and now lead of the Intel GE founder of Telmedcare and now Executive In the next issue I will complete this personal Healthcare Alliance in Australia Dean of the College of Health and Science athistory of informatics in pathology and how 12 Informatician; standards developer; past the University of Western Sydneythese developments influenced the broader Chairman of HL7 Australia and Board member 18 AO, past President The International Societyapplication of ICT in healthcare. of HL7; current President of the Australian for Quality in Health Care, past Chair of the College of Health Informatics Clinical Excellence Commission and currentReferences 13 Electrical Engineer; Entrepreneur Chair of the CSIRO Australian E-Health 14 Former Premier of NSW Research Centre1 http://www.pulseitmagazine. 15 ENT surgeon and former President of the 19 Mark Abel - still an Oracle BMA in Australia. I was the only member ofcontent&view=article&id=511: why-is-it-all-so-hard-in-pathology2 Mathematics is a branch of informatics.Taylor would play chess with the head of the Take home messageselectronics workshop by making moves as Here are some morals to the story so far: science development;they passed in the corridor – without a board! • There are more than 40 years of history • Australia has been keeping pace3 The Basser Department of Computer Science in health informatics in Australia; intellectually and has led at times but(so named because Harry Messel was able to • Health is not a laggard as some argue does not always realise its potentialprocure part-funding for the computers from when it comes to the application of when it comes to recognising the value ofthe Melbourne cup winnings of jeweller Adolf information technology; what it has and commercialising that;Basser) was located in the basement of the • Some pretty smart and dynamic people • One of the reasons there hasn’t beenPhysics building have and continue to contribute to the more progress is because it is hard; and4 A fellow called Bill Gates had done a similar development of e-health; • It would be inefficient not to learn fromthing, but for the IBM microcomputer. Grant • There is more to health informatics (and the history so we must provide specificwent on to do biomedical engineering. He e-health) than shared records; education in what is a knowledgedeveloped CRS, was IT Director for Western • Pathology has been at the vanguard of domain in its own right – healthSydney, headed GE’s Medical IT group and was health informatics and computer informatics.a VP at ResMed, and is now Qld State Manager22 The Health Advocate June 2011
  • 22. Operating e ciencies up Carbon footprint downCustom-Pak™ procedure pack - Australia’s leading ophthalmic surgical pack. It’s not just twenty-first century living that leaves a measurable carbon footprint – it’s our nursing practices too. But how can we increase operating room efficiencies while limiting their carbon impact? Simple things, like choosing a surgical procedure pack that is fully customised for one ophthalmic surgical procedure can help to optimise your time and the quality ofyour patient care. While the reduction in waste generation, when compared to generic packs, can helpto reduce the negative environmental effects of our nursing activities.1 This is why Alcon®, Australia’sleading ophthalmic surgical supplier, is willing to dedicate resources to protecting the world’s resources.A greener world starts with greener practice. A greener practice starts with Custom-Pak™ procedure pack. Reference: 1. Lausten G. Reduce-Recycle-Reuse: guidelines for promoting perioperative waste management. AORN Journal, April 2007. For further information please contact Alcon Laboratories (Aust) Pty. Ltd. 10/25 Frenchs Forest Rd East, Frenchs Forest NSW 2086. ABN: 88 000 740 830. Phone: (02) 9452 9200. Customer Service Freecall: 1800 025 032. Juicy Advertising ALC088. PSUR 0899.
  • 23. In depth DAVID MORE Clinician and Health Informatician Where’s the evidence? David More asks is the Personally Controlled Electronic Health Record an evidence based intervention?a  S A CONSEQUENCE of a series of recommendations in the National Health and Hospitals ReformCommissions A healthier future for allAustralians – Final Report June 2009, the basic individual demographic details and the information that is normally held, either electronically or on paper, in the General Practitioners Summary Record. This would include allergies, regular medications, key Commonwealth Government, that will be accessible via a web portal for the clinician, with permission, to review. At a later date, the patient will also be able to contribute their personal information and commentssubsequent Commonwealth Budget allocated elements of history and current diagnoses. should they choose. The system is apparentlyalmost half a billion dollars over two years to The Event Summaries are envisaged to be intended to be a lifelong record that will bemake a Personally Controlled Electronic Health such things as a set of pathology results, accumulated over time.Record (PCEHR) available to all citizens who referral letters and so on. At present the system is intended to bewanted one by July 2012. The idea is that the patient will be in control available to patients who choose to have a As the PCEHR has evolved – largely away of this information and will, if they agree and PCEHR and register for access by July 2012, nowfrom the public gaze and in secret – it has consent, make the information held in this just 14 months away. The system is presentlymorphed into a conceptual Health Summary record available to clinicians caring for them. planned to operate in an ‘opt-in’ fashion whereand a series of Event Summaries. The Health The patient PCEHR record is to be held an individual takes a positive decision >Summary contents are intended to be the by a PCEHR system, presumably run by the to register for and establish a PCEHR. The Health Advocate June 2011 25
  • 24. In depth>Concerns regarding is designed as the minimum necessary for the evidence for the value of provider emergency care, not as an information rich Electronic Medical Records (EMRs),the concept long-term longitudinal record. especially with embedded clinical decisionIn mid-April the Department of Health and Second, the evidence from the UK suggests support, is very strong indeed.Ageing released the draft PCEHR Concept that even when such summary information is Sixth, adoption of and the value of patientof Operations for public review and this made available, actual use of the information access to their clinical records is best seeninformation has been considered in the is quite low and the clinical impact, if any, is in situations where the PHR is a linkedfollowing comments. hard to determine. extension of the provider EMR (as in Kaiser On the basis of what is presently known, just Third, designing systems to be ‘opt-in’, while Permanente in the US) and where otherhow based in evidence of real positive clinical politically easier, means adoption is slow – over functions are possible.impact are the present proposals? years – and for this reason few will bother to Seventh, it is clear that the so-called ‘digital I would suggest they are not and that the look up such systems. divide’ is alive and well with patient portals,claimed rationale for this very substantial Fourth, the present plans for seeking where often those who need them most areprogram is based on a combination of consent for both access and for information the least likely to be able to obtain access.wishful thinking and ignorance. My reading provision into the PCEHR will have very Eighth, it was obvious from a recentof the global literature leads me to the significant clinician workflow impacts, i.e. slow workshop conducted by NEHTA on thefollowing conclusions. clinicians down, which will ensure that without PCEHR that there was considerable concern First, there is no working example anywhere major financial incentives to compensate for and disquiet from clinicians regarding justin the world of a parallel longitudinal patient- the time costs, clinician usage will be minimal. how well the available funds were planned tocontrolled electronic health record. There Fifth, while there has been much research be deployed given other perceived prioritiesare successful examples in small countries on the topic, it has not been possible to in e-health, such as improved standards,(Wales and Scotland) of emergency health consistently demonstrate positive clinical better clinical systems and improvedsummaries derived from GP systems being outcomes through the use of Personal Health information flows between clinicians, areimplemented, but the information content Records (PHRs). On the other hand, very high on the list. Key points of the PCEHR Key points to be noted about the presently proposed model of the PCEHR include: • The PCEHR is an additional and clearly parallel health record to that held by the health care provider. The PCEHR is conceived of being a secondary record in some senses – as far as clinician contributed information is concerned – and a primary storage of some consumer generated content. • The PCEHR will contain a summary of the full patient record, with a variety of other information (lab results, discharge summaries and so on). • There is no clarity just what arrangements are intended to ensure the copy of the clinical information held in the PCEHR is properly synchronised and consistent with the current practitioner record. • All the documentation made available to date has been silent on just how the situation of a patient attending multiple practitioners is handled. • The PCEHR is not linked / attached to the practitioner record in any direct way. This means that functionality such as secure direct communication between clinician and patient, appointment and repeat prescription requests, and access to current information in the provider system is not available.26 The Health Advocate June 2011
  • 25. e PCEHR lacks an evidence base in circumstances where there are evidence ” ” As presently announced, the entire program has unrealistic timelines, lacks clear objectives, is excessively politically driven and will, when based interventions it inevitably fails, set the prospect for rational adoption of e-health back a good decade. Ninth, there is no mention so far from based interventions that would make a more You can read David More’s blog on e-health atanyone on just what advantages the significant and important difference to health proposal has over the wide range care delivery in Australia.of alternatives that have been successfully In response to a direct question at theimplemented elsewhere and just why Health-e-Nation Conference in early April, the Useful linksclinicians would find access to a record of this Department of Health and Ageing confirmedsort of any great value compared with known that there was not an evidence base supporting Australian Government websitealternatives. Indeed the claimed benefits the planned approach but that Australia had Your Health. The draft PCEHRhave in no way been proven for the planned chosen to proceed down its own path. Concept of Operations document canapproach as pointed out above. The PCEHR has been termed by one wag the be found here – Finally, again from the recent workshop, it ‘Politically Correct’ EHR. I would suggest it isis clear many stakeholders recognise that the a proposal that requires very active evidence Seminar outcomes on the PCEHRscale and complexity of the PCEHR program based review that it is presently not receiving (30 March 2011) – successful delivery in the politically – due in part to the very large sums of money gJ9UwNdetermined time frames is very unlikely. being splashed around by the Department It is thus my contention that the of Health and Ageing on the project – which David’s submission to the NHHRCPCEHR proposal lacks an evidence base in seems to be resulting in some form of on the PCEHR – where there are evidence unthinking and uncritical e-health ‘goldrush’. The Health Advocate June 2011 27
  • 26. In depth Computer says NO The healthcare community’s current relationship with computerisation may be the biggest challenge in the future of e-health28 The Health Advocate June 2011
  • 27. t he political, technical and economic ‘challenges’ facing the federal governments e-health plans mightbe mere speedbumps compared to the moredeeply ingrained workplace culture issues professional or you could be sitting at a computer all day – what one participant called the ‘checkout chick nurses’5. it would be a mistake to dismiss such clinicians as simple technophobes or ludditesthat any future e-health or personally as these same clinicians were working in icUs,controlled electronic health record (pcehR) eRs and many other ‘high-tech’ environmentswill have to contend with. put bluntly, is it where complex machinery is a welcome and PhiliP Darbyshirepossible that hospitals and health services just omnipresent part of their job. Somehow, fordon’t like computers? them, computers, e-health and computerised Adjunct Professor, the relationship between health professionals, records were different. perhaps they had University of Westernpatients and computerisation is infinitely been jaundiced in their views by the everydaymore complex than convincing people that an ‘computer says no’ culture of it use and service Sydney and Visitingelectronic version of something is better than in their hospitals. Professor, Universitiesa paper one and there are some treacherous one of my main concerns about e-health is of Bournemouth andfallacies abound1. e-health is not primarily a that the average hospital it Department mighttechnical or electronic issue – it is a human and be involved in it. this is not a slight on individuals Swansea (UK)meaning issue and the trail of costly and failed but on an organisational it culture driven bye-health and health informatics projects over the risk aversion rather than creativity, fixatedlast few decades testifies to this2. on standardisation rather than flexibility and learn from. Mobile devices are fast replacing the Some years ago i conducted a national operating from the default position that they ‘standard desktop’ yet some hospitals still try toproject interviewing nurses and midwives are the bulwark between essentially ‘dangerous’ ban mobile phones and users no longer require,about their experiences and perceptions of staff and disaster, or ‘some idiot doing nor should they have to rely on an ‘it person’ inusing computerised information systems. something stupid’. Regardless of how tightly a the building to meet their support needs.hearing these clinicians describe the place system is ‘locked’, restricted and regulated, at if nicola Roxon is looking for a systemand purpose of computers in their everyday some point, someone will do something wrong that is beautifully designed, obsessive aboutpractice was a revelation. predictably, or inappropriate. the question for any future confidentiality and privacy, has minimalgiven the it world’s historical aversion to e-health or informatics strategy is, do you dumb problems with security and viruses, is so user-partnering with and learning from clinicians, your entire system downwards to try to prevent friendly that everyone from nippers to nanasthere were the numerous technical problems that one event happening? can use it, is so popular that people will beexperienced; different ‘systems’ that couldn’t health it blogs are replete with it staff queuing round the block to become part of itcommunicate or speak to each other (even explaining how they are the professionals in and that integrates seamlessly between mobilewithin the same hospital), unrealistically steep this area and not the clinicians who wonder and fixed applications, maybe she shouldlearning curves, user interfaces that bore no why their workplace it experiences cannot be forget about nehta and just make a phoneresemblance to anything the clinicians already even half as smooth, coordinated, user-friendly call. i don’t know the number but ask for a Mrused, inability of the systems to do ‘simple’ and accessible as that of even their mobile Steve Jobs, cupertino, california.things such as copy and paste or print out, phone. Staff will be compelled to buy agingdifficulty in getting technical support when it $3000 computer systems and wait months for Referenceswas immediately needed and more3. their delivery and ‘installation’ when infinitely 1 the human or meaning dimensions were as better equipment could be had from the major Karsh, B.-t., et al., ‘health informationkeenly felt and go to the heart of any proposed retailers for half the price and delivered the next technology: fallacies and sober realities’.e-health initiatives. Many clinicians actively day. Staff are essentially locked out from doing Journal of the American Medical Informaticsdistrusted the ‘new technology’, seeing it as the simplest of it tasks and yet it departments Association, 2010. 17(6): p. 617-623 2some kind of managerial ploy or ‘trojan horse’ complain that the workload on the ‘helpdesk’ is leviss, J., ed. H.I.T. or Miss: Lessons for more sinister clinical or organisational unmanageable. i wonder why? this year alone Learned from Health Information Technology changes that they knew nothing of4. other i have met staff who were ‘forbidden’ from Implementations. 2010, ahiMa press: chicago 3 clinicians saw technology as being buying or using an ipad, were not allowed to Darbyshire, p., User friendliness of antagonistic and oppositional to install Skype or Dropbox on their computers and computerised information systems. Computers their essential professional who had the Survey Monkey website blocked. in Nursing, 2000. 18(2): p. 93-99 4 orientation of caring these are the very staff that will be expected to Darbyshire, p., ‘the practice politics of for patients. on an ‘embrace’ the promises of the brave new world computerised information Systems: a Focus imagined sliding of e-health and the pcehR. Group Study’. Nurse Researcher, 2001. 8(2): p. 4-17 5 scale, you over the last decade, people’s personal Darbyshire, p., Rage against the machine?: could be computing experiences have changed and nurses and midwives experiences of using a caring, improved dramatically. Social media sites show computerised patient information Systems for human, possibilities for communication and connection clinical information’. Journal of Clinical Nursing, health that hospitals often try to outlaw rather than 2004. 13(1): p. 17-25 The Health Advocate June 2011 29
  • 28. In depthThe e-healthimperaTive iPeter Fleming writes n AustrAliA we enjoy a health system health care and people they care for; that up to now has ensured we have access • supporting providers in the delivery of safer,about the latest to quality health care when we need it. more effective and more efficient health However, maintaining or improving the care; ande-health news and health outcomes of Australians requires a • enabling a more agile, self-improving and fundamental change in approach to the way sustainable health sector.developments health care is delivered. As part of the health reform process, the national e-Health strategy the national Health and Hospital reform commissioned by Australian Health Ministers Commission (nHHrC) identified that e-health in 2008 defines the transformation of the has a major role to play in: Australian healthcare system from a ‘paper- • Fostering genuine participation by based’ records system that limits access to consumers by allowing them to better a patient’s critical healthcare information to manage their own care and be more an electronic system that ensures the right informed in decision making about their information, at the right place and the right time. Sources: Historic data: OeCD (all countries) uK projections: PwC us projections: Centres for Medicare and Medicaid services, Office of the Actuary Australian projections: AiHw30 The Health Advocate June 2011
  • 29. The rising cost of We have to move away from a reliance onhealth care tools such as pen, paper and human memory PETER FLEMING to an environment where consumers, care Chief Executive ofIn most OECD countries, spending on health is providers and healthcare managers cana large and growing share of both public and reliably and securely access and share health the National E-Healthprivate expenditure: information in real time across geographic Transition Authority• The average share of GDP that OECD boundaries. The only way we can achieve this is countries devoted to health stood at 9 through world-class e-health capability. percent in 20061.• Australia is not alone among OECD countries Key bene ts for in projecting such profound and sustained growth in expenditure on health services2. consumers • Consumers or their carers will have electronicWhy do we need e-health? access to information to better manage and control personal health outcomes;• Up to one in six (18 percent) of medical errors • Consumers will have confidence that are due to inadequate patient information; their personal health information is being• 187 procedures involving the wrong patient managed within a secure, confidential and or body part occurred in Australian hospitals tightly controlled environment; and in 2007 due to failures to properly identify • Better access to healthcare services will be patients and match them to intended achieved for all Australians including those procedures; living in remote, rural and disadvantaged• Nearly one in three (30.4 percent) unplanned communities. hospital admissions in patients over 75 years are associated with medication mistakes; The NEHTA work program• Up to one in six pathology and diagnostic tests in hospitals are unnecessary duplicates, The National E-Health Transition Authoritys which cost up to $306 million annually; and purpose is to lead the uptake of e-health• The lack of information sharing and care systems of national significance by delivering management for chronic disease sufferers costs urgently needed integration infrastructure the healthcare system up to $1.5 billion a year. and standards for health information. NEHTA was funded by the Council ofA recent report published by Booze and Australian Government (COAG) to developCompany on global e-health investment said: the national infrastructure components of“e-health programs could cut healthcare terminology, secure messaging, identifiers andspending by 3 percent annually, saving at least authentication. We are also developing e-health$7.6 billion in 2020 alone. And commitment to solutions that will use the infrastructure:a full e-health program now could help save anestimated 5,000 lives annually, once the systemis fully operational. referrals, discharge summaries, diagnostics and medications management. > ” ” The “The patient journey today is hampered bydisjointed communication and limited accessto quality information. As a result, the ability E-health programs could could cut healthcareto make sound decisions about care is oftenimpaired, and there are a significant number spending by 3 percent annually, saving atof adverse effects and high levels of frustration, least $7.6 billion in 2020 aloneparticularly among patients who are elderly,disabled, or suffering from chronic conditionsor mental health disorders.” The Health Advocate June 2011 31
  • 30. In depth>The NEHTA work program also supports the The NEHTA work programnational personally controlled electronichealth record (PCEHR) system. The AustralianGovernment is investing $467 million overtwo years to develop the critical nationalinfrastructure for e-health records as akey element of the national health reformagenda. This will give all Australians from July2012 the option to sign up for a personallycontrolled e-health record. This will enablebetter access to important health informationcurrently held in dispersed records aroundthe country. It will mean that patients willno longer need to unnecessarily repeat theirmedical history every time they see a doctor • Development of business requirements and foundations can be derived to support theor other health professional. functional specifications for system software development of national infrastructure. In For the first time, all Australians who choose modifications (based on an Implementation addition to Health Summaries, Dischargeto participate will be able to see their important Planning Study); Summaries and Medications, the portfoliohealth information, when and where they need • Vendor integration within existing systems in also includes Personal Health Diary andit. They will be able to share this information states and territories; and Consumer Portal implementations; andwith trusted healthcare providers. • Development and maintenance of • Delivery of early benefits in a range of areas, implementation and deployment including improved coordination of care,Bringing the PCEHR guidelines covering software modifications enhanced continuity of care, improved (specifications), lessons learned, testing medication management and the deliverysystem to life regimes and business processes (including of sustainable components, which willThe Australian Governments vision for a ongoing quality management). enable later integration with the nationalnational, secure e-health system will benefit infrastructure.Australians in many ways. The intention is to E-health sitesestablish a secure system of personally controlled These e-health sites will be required toelectronic health records that will provide: There are 12 e-health sites currently being demonstrate tangible outcomes and benefits• Summaries of patients’ health information; funded by the Australian Government to from e-health projects, to build stakeholder• Secure access for patients and healthcare achieve national demographic coverage, support and momentum behind the system providers to their e-health records; and widespread coverage across the healthcare work program, and to provide a meaningful• Rigorous governance and oversight to sector, deliver early benefits and demonstrate foundation for the national PCEHR system’s maintain privacy. new and innovative e-health concepts. further enhancement and roll-out. Together, these e-health sites offer:Implementing e-health • Targeting of a broad number of key groups References such as mothers and newborns, aged care,across the nation people with chronic conditions, palliative 1 OECD Factbook 2009 – ISBN 978-92-64-05604-The states and territories have collaborated care and Indigenous populations; 6 - ©OECD 2009with NEHTA in a joint approach to integration • Coverage of all states and territories and 2 Commonwealth Department of Treasury.of the healthcare identifier (HI) service. rural and regional communities; Intergenerational Report 2007. Canberra:The cornerstone of this approach is early • Inclusion of a number of healthcare sectors, Commonwealth Department of Treasury; 2007.implementations to build experience in including public and private, primary care,applying the services and specifications across aged care and private specialists; For more information about NEHTA visit:the healthcare provider and vendor community. • Broad coverage of the ICT vendor for early implementations include: community, with vendors comprising the• Implementation planning study including majority of the market in acute and primary For more information about the PCEHR high level business and architecture analysis care involved in one or more of the sites; system visit: and advice as to how NEHTA services and • Projects which test and support broad You will find the recently released specifications should be integrated into consumer engagement and registration; Concept of Operations document for the clinical information systems and business • The broad set of functions that the PCEHR PCEHR on this site. processes in healthcare settings; will need to provide so that lessons and32 The Health Advocate June 2011
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  • 32. Brie ngGovernancetraining for thehealth sectorEnsure thegovernance ofyour organisation t HE ROLE OF the governance professional is constantly evolving in line with changes in legislation, policy, service delivery, technology and objectives of your organisation. Topics include: • Values and focus of corporate governance • Convergence of governance, • Consumer participation in service planning and evaluation • Developing a culture of clinical leadership and lifelong learning. society’s expectations. risk and compliance Program deliveryis best practice The Australian Healthcare • The role of Board and Councils and Hospitals Association and in corporate governance The main module is a six-hour Chartered Secretaries Australia • Duties and responsibilities session from 10am to 4pm; have combined their expertise and of directors, executives and however we can adapt the resources to deliver a dedicated clinicians program to suit your needs. program of corporate and clinical • The difference between Additional modules are also governance to the health sector. directing and managing available, which can be adapted It is crucial that directors, • Conflicts of interest and how to meet detailed requirements of senior managers and clinicians to manage them your organisation. understand the common • Stakeholder engagement. Expert governance practitioners fundamentals of good governance, deliver the programs. They focus and then keep abreast of changes. Clinical on the practical implementation It is their responsibility to ensure of good governance regimes that the organisation remains Governance in both corporate and clinical compliant with its legal and Our program examines the environments. regulatory obligations, implements means by which health facilities We are available to come to best practice risk management, and practitioners can ensure your organisation in any achieves its strategic objectives high standards of health care, location to conduct the training and meets public expectations for continuously improve the quality or, if you prefer, we can arrange high quality healthcare. of their services, and create and a venue. Our program is designed to maintain an environment in which give senior decision makers all clinical excellence can flourish. the tools they need to meet these Topics include: To book a course or get more requirements in today’s complex • Standards for better healthcare information, contact: healthcare environment. • Relationship with corporate Terrie Paul governance Director - Business Services Corporate • Developing a model for sustained Email: improvements in quality Tel: 02 6162 0780 Governance • Embedding clinical governance Fax: 02 6162 0779 Our program focuses on into an organisational culture Website: governance essentials and key • Aligning clinical governance Address: PO Box 78 responsibilities for meeting with vision and strategic Deakin West ACT 2600 the compliance and strategic effectiveness34 The Health Advocate June 2011
  • 33. Breatechkthroug nolo h gy
  • 34. Opinion What does health ICT actuallyPATRICK BOLTONVice President of theAustralian Healthcare and achieve?Hospitals Association potential for quality improvement in general practice that it does in hospital medicine, my experience has been that it is often just a Patrick Bolton urges an increased focus on fancy way of carbon copying a patient’s last script, saving time real evaluation of e-health interventions in the consultation and thereby increasing throughput and billing. The risk in this situation is that medications continue to bei ’m a reasonably clever hopes, not much was said on the I wanted to make a difference. prescribed without the prescriber’s fellow. not super-smart, but conference theme, the speakers Disillusioned, I sought to achieve brain being engaged, and this can smarter than bill Gates: I didn’t were mostly gunners: “I’ve got my aims through health policy lead to risks of harm.happen to be in the right place at money for computers in health and and found myself working as a now, you might not guessthe right time as he did, I looked I’m gunner use the money in this medical administrator, although it to read my column, but I amfor the place that was going to be or that way!” In my experience this I still do occasional GP locums. inherently optimistic. so I remainright and went and stood there. is, sadly, what most people doing From those perspectives I have hopeful about the applicationGraduating from medical school things in IT in health say. only ever encountered one of IT to health care, but myin the mid-eighties, I missed about once every five years clinical application of IT that experience leads me to issue threegenetics, and biotech had not yet since that conference systematic hospital doctors value, and that is overlapping caveats about thiscome over the horizon, so I chose reviews of the impact of IT on computerised access to medical area. These are:to develop a speciality in health health outcomes have been images (“PaCs”). many doctors 1. The risk of failure is high, higherinformatics. I got a Graduate conducted. They have all said will concede the potential value than most of those makingCertificate in Computing sciences, that evidence of gain from the of computerised prescribing to decisions to invest in IT in healthdid a PhD which incorporated introduction of IT is limited avoid medication mishaps, and care allow. business cases for ITcomputerised medical records and, arguably worse, evaluation would be prepared to put up in health need to be discountedand found myself Computer is almost non-existent. Those with the additional work that appropriately for this risk;Fellow for the raCGP. but guess in the health IT industry computers seem to create in the 2. We conspire to allow the riskwhat? The promise of health have been quick to point out clinical environment to achieve to be high because we don’tinformatics never materialised to methodological weaknesses in these benefits. I am aware that evaluate the outcome of projectsmy satisfaction. these reviews. of course there computerised prescribing systems that seek to introduce IT into In about 1997 I went to an isn’t an interest group making have been introduced in hospitals health care, and we supportinternational conference in money out of not implementing at a number of sites in australia gunners over those reportingamsterdam, the title of which IT in health, only the community, where they seem to be working difficulties and failures; andwas along the lines of ‘20 years which collectively gets to foot the well and of course they approach 3. IT needs to fit in with theof computers in medicine: Why bill for these experiments. ubiquity in general practice. practices and habits ofhave we not achieved as much Part of the reason that I got While I am sure computerised healthcare users and providers,as we expected?’ Despite my into health informatics is that prescribing offers the same not the reverse.36 The Health Advocate June 2011
  • 35. The GreatHEALTHCARE Challenge! ‘ACHIEVING PATIENT-CENTRED OUTCOMES’ October 12-14 2011 Sofitel Melbourne on Collins
  • 36. BriefingImproving HealthCare Safety andQuality: ReluctantRegulators Christopher Baggoley reviews the latest book to investigate safety and quality in the Australian healthcare systemt his book is a most valuable addition to the Australian safety andquality in health care literature.starting with a punchy, balanced readers is the chapter layout: each ends with a conclusion that acts as an executive summary. A boon to the time-challenged. The author draws on her Regulating the health professions) are sure to be controversial and to stimulate debate. Most doctors would regard the comments in this chapter about them ‘signing up for Judith Healy Ashgate Publishing Group, 2011yet somewhat unsettling preface, international knowledge, study conference points in a desirable RRP $175.45Judith healy explores her thesis and research to put the Australian tourist site’, as unnecessary andthat ‘improving health care situation into a broader context. hopefully an outdated cheap shot. excellent way to finish, and with aninvolves multiple regulators and she demonstrates an The author devotes a chapter to optimistic observation that can bemultiple strategies, in other words understanding of all participants safety culture and safety systems, missing in discourses on the safetynetworked governance’ through in the Australian scene and no one the inclusion of which is both and quality of health care. Judiththe ten chapters of this is spared critical analysis. The essential and helpful. References healy writes ‘The amount ofsubstantial book. concept of ‘deference regulators’ to patient-centred care throughout activity in the short space of a As would be expected this is a (Chapter 3, Regulatory actors) reflect well on current thinking. decade is very impressive. Thewell researched, well written, who see people as ‘amoral The text is current, an achievement intention is to ensure that healthscholarly piece of work. it is no calculators’ is most salutary, given the fast pace of change and care is of a high standard and asquick page-turner. it requires the although given the description, i development of events in Australia safe as possible – which is goodreader to think and reflect, while doubt many readers would recently. There are some situations news for patients’.being informed, stimulated and identify themselves as such! where events have overtaken the in short, i highly recommendchallenged throughout. For those in spite of this critical analysis, text, such as the conclusion of the this book.with a deep interest in safety and Judith healy clearly understands Patel trial, the implementation ofquality in health care, whether the reality and complexity of the Australian health Practitioners Declaration: Judith Healy hasthey have policy, board, executive, modern health care and Registration Agency and the most undertaken contracted work for theclinician or consumer perspectives, understands the role and nature of recent changes to health reform. Australian Council for Safety andthis is a most valuable read. others the key players, as well such are the hazards of writing Quality in Health Care. This workwill find it rewarding, even if they demonstrated in Chapter 2, text books. has been presented to the successorread chapters, or sections of entitled ‘how safe is health care?’. The book ends by discussing the body, the Australian Commission onchapters to pursue their particular her views on medical important concepts of trust and Safety and Quality in Health Care,interest. of assistance to all organisations (Chapter 4, transparency in some detail, an of which I am Chief Executive.38 The Health Advocate June 2011
  • 37. BriefingWho’s moving?Readers of The Heath Advocate can track who is on moved from being CEO at Stthe move in the hospital and health sector, courtesy Andrews Private Hospital, Ipswich and Caboolture Private Hospital toof the AHHA and healthcare executive search firm, his new position as CEO at North West Private Hospital.Ccentric Group Jill Gleeson, CEO at Linacre Private Hospital will soon be CEO at Waverley Private Hospital.t ony Sherbon has moved in Wellington, to become CEO of Matthew Double has joined the Jude Emmer is heading to the from his role as CEO for the Wide Bay Health Service in Department of Health and Human north of Sydney: from Director the Department of Health Queensland. Services in Tasmania as Human of Clinical Services at St Georgein South Australia to the Health Greg Rochford, the former CEO Resources Director. Private Hospital to a new roleReform Transition Office as of Ambulance NSW is the new The world-renowned as CEO, Mt Wilga RehabilitationDeputy CEO. National CEO of the Royal Flying co-inventor of the cervical cancer Hospital. Mary Bonner is moving Doctor Service. vaccine, Professor Ian Frazer, has Linda Allen has moved fromfrom her role as District CEO at Ian Maytom moves from CEO, been appointed Chief Executive of being Director of Clinical ServicesTownsville Health Service District Northpark Private Hospital to be the new $345 million Translational at Mitcham Private Hospital toto be the CEO at Capital and Coast CEO, Newcastle Private Hospital. Research Institute. CEO at Linacre Private Hospital.District Health Board. Katarina Drazumeric, CEO Kevin Bate, currently General Filling a gap, Darren Rogers Andrew Currie has joined Mosman Private Hospital, is on Manager, Central Patient Services has moved from being GeneralHealthscope as State Manager, the move too – as the new CEO with SA Ambulance, will be joining Manager at Darwin PrivateHospitals Victoria. of Como Private Hospital, while Ambulance Tasmania as Deputy Hospital to CEO at Mitcham And up north, Richard Lizzio John Tucker has started as CEO of CEO and Director of Emergency Private Hospital.has moved from his position Nepean Private Hospital. and Medical Services. And during exciting times inas CEO of Greenslopes Private Dr Heather Buchan has Chris Went has moved from NSW government and healthHospital in Queensland to be State swapped roles from her position being Assistant Director of Clinical policy, we wish all the best toManager Hospitals Queensland, as Executive Knowledge and Services at Greenslopes Private Dr Mary Foley who has beenalso with Healthscope. Development Officer at the Hospital to CEO at St Andrews appointed as the Director-General Meanwhile, Paul Williams National Health and Medical Private Hospital, Ipswich. of NSW Health having moved fromhas joined – you guessed it – Research Council (NHMRC) to Heading in the opposite National Health Practice Leader atHealthscope as CIO. be Director of Implementation direction, Chris Murphy has PricewaterhouseCoopers. Warren Berry, a Regional Support, Australian Commission onManager with the I-Med Safety and Quality in Health Care.Network is off to the big smoke Dr Sonj Hall, formerly Director If you know anyone in the hospital and health sector who’s moving,of Melbourne to be General of Policy, Strategy and Service please send details to the Ccentric Group:, Heart Care Victoria with Planning at the Department ofGenesis Care. Health and Human Services in In New Zealand, Ken Whelan Tasmania is now Deputy CEO ofis departing as CEO of the Capital the Bureau of Health Informationand Coast District Health Board (part of NSW Health). The Health Advocate June 2011 39
  • 38. Become an AHHA member Help make a difference to health policy, share innovative ideas and get support on issues that matter to you f   Network and learn OR MORE THAN 60 years, copy and online), our magazine values your skills and expertise. the AHHA has upheld the The Health Advocate, up-to-the- The AHHA reflects your views As a member, you have access to voice of public healthcare. minute news bulletins and other and gives them a voice. Your regular professional development The Association supports professional information. ideas will help shape the AHHA’s activities and to networking your access to networks opportunities with colleagues policy positions and our highly of colleagues. It provides across Australia through our AHHA values your influential advocacy program. professional forums to stimulate stimulating and innovative events. knowledge and Our focus is on improving critical thinking. It facilitates a You also receive the Australian experience safety and quality for patients collective voice across Australia Health Review, Australia’s Whether you are a student, and consumers in all healthcare and develops innovative ideas foremost journal for health policy, clinician, academic, policy-maker settings. To do this we are for reform. systems and management (paper or administrator, the AHHA working to achieve better service integration; enhanced information management systems; efficient financing models; targeted performance Membership Fees 2011-2012 measures and benchmarking; Student Australian: $205 Overseas: $275 and a sustainable and flexible workforce. Personal Australian: $275 Overseas: $378 Your knowledge and expertise in these areas are valuable and Associate* Australian: $1103 Overseas: $1502 you can have direct input to our *Companies providing products and services to healthcare providers policy development. As a member, you and your organisation play a role in Institutional / Academic Members (Australian healthcare providers) reforming the public healthcare sector by contributing directly Gross Operating Expenditure (x 1,000,000) to the AHHA’s leading edge Equal to or greater than: Less than: Membership policies. We develop policies that reflect your views. Join our $0 $10 $1,775 think tanks or participate in our national seminars or conferences. $10 $25 $3,549 Our voice is authoritative and $25 $100 $8,285 influential. It is heard via our high-level advocacy program and $100 $250 $17,745 extensive media exposure. $250 $400 $23,625 For more information: $400 $550 $29,295 W: E: $550 $700 $36,330 T: 02 6162 0780 F: 02 6162 0779 $700 $850 $41,475Image: iStockphoto A: PO Box 78 $850 $1B $47,355 Deakin West, ACT 2600 *Fee includes GST - valid from 1 July 2011 to 30 June 2012 40 The Health Advocate June 2011
  • 39. 2011-2012 Membership Applications and Renewals Australian Healthcare & Hospitals AssociationTax InvoicePO Box 78 Deakin West ACT 2600 t: +61 2 6162 0780ABN: 49 008 528 470 f: +61 2 6162 0779E: Australian OverseasStudent* $205 $275Personal $275 $378Associate $1103 $1502Institutional(See 2011/12 fee scale)*Documentation required to verify status as a student. All prices for Australian membership include GST and are in Australian dollars.Member DetailsNamePositionOrganisationPostal addressSuburb State PostcodePhone EmailInstitutional members may specify an IP address:eSubscriptions (optional) E-Healthcare Brief - The key news and AHHA updates edited by the AHHA team (twice weekly) AHHA Events Newsletter - Regular notification of upcoming AHHA events including the annual CongressPayment DetailsAmount in AUD$ to be paid by credit card, bank transfer or cheque. Cheques should be made payable to Australian Healthcare & Hospitals Association Bank Transfer: BSB 062 900 Account 008 00811 AHHA Credit Card Payments: (Please note – an additional 3% processing fee applies) American Express Diners Mastercard Visa AmountCardholder NameCard NumberExpiry Validation NumberAuthorised Signature This membership form becomes a tax invoice upon completion and payment. Please contact us on if you requie further proof of purchase. Please retain a copy for your records. The Health Advocate June 2011 41
  • 40. Snippets The last wordConsumerperspective on What’s happening in e-healthe-health possibilities around the world?h i ealth consumers in Australia have n 2004 the European Commission which have been addressed to date, take them waited many years for the arrival of a recognised that healthcare systems were a step further where possible and provide a highly sophisticated Information and becoming increasingly reliant on information longer term vision for eHealth in Europe”.Communications Technology Strategy to and communication technologies. In response In the US, a new federal centre has been setimprove the safety quality and efficacy of it developed its eHealth Action Plan, which up to launch the US healthcare system intohealth care, of which the Electronic Health set out the steps needed for widespread the digital age.Record is an important part. adoption of e-health technologies across the The Bipartisan Policy Centre, set up under The opportunity of having the right EU by 2010. This plan covered everything from the Health and Human Services Department,information in the right place at the right electronic prescriptions and health cards to has already certified more than 600 newtime has the possibility of transforming the new information systems that reduce waiting health information technology products andway we participate in and receive services. times and errors. opened 62 regional ‘extension centres’ thatHowever, unless the policy settings and The Commission is now updating this plan aim to help providers understand and set-updevelopment by government involves and public consultation has begun as part of health IT programs. The Centre has alsoactive consumer participation at all stages the preparation of the new eHealth Action started curricula at 82 community collegesand every level of decision making on the Plan 2012-2020. Through the consultation around the country to focus on health IT.critical issues of integration across the the Commission is seeking comment on the Healthcare providers using a certifiedprimary, secondary and tertiary sectors, barriers to the large-scale deployment of health IT product can receive up to US$44,000access, ownership, privacy, consent and electronic healthcare systems and the actions in incentive payments for Medicare andpublic information, e-health technology will needed to overcome them. It also wants Medicaid Services over five years, butfounder and sink weighed down by a lack of respondents to consider ways to improve they must start using electronic healthpublic trust and confidence. interoperability and how the legal issues records next year to be eligible. After 2015, surrounding e-health should be handled. providers will take a cut in their MedicareMichele Kosky The Commission says the new plan provides reimbursements if they are not using health ITHealth Consumers’ Council WA “an opportunity to consolidate the actions up to government standards.42 The Health Advocate June 2011
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