The inertia embodied in the Australian health system is immense. Attempts to change it have mainly foundered over the years. Portents of failure are writ large, almost everywhere one turns.
In this context, let’s look at a favourite topic of mine, the electronic discharge summary. I view electronic discharge summaries as a barometer of e-health capability. They transcend organisational and funding boundaries. They transcend the primary and acute care sectors. They transcend many different clinical information system applications. They signal a genuine capability to share clinical information between systems at a semantic level and therefore signal a capability that many would ascribe to useful shared electronic health records.
At least they would if they existed! Unfortunately, there are no discharge summaries of this ilk to be seen.
Over the past decade or so we have witnessed countless local, regional, and national discharge summary ( or separation summary or discharge referral ) projects undertaken in Australia. In late 2002, under Healthconnect funding, the Clinical Information Project was established. Led by Dr Frida Cheok, it undertook amongst a number of other tasks determined by the Australian Health Ministers’ Advisory Council, to produce a “standard” national hospital discharge summary. In April 2004, after considerable consultation and analysis, it published a specification for the content of hospital to GP discharge summaries. In 2006, NEHTA reworked and republished the specification. NEHTA did so again, in 2009.
Some 8 years ago, South Australia already had “electronic” discharge summaries being created in the major metropolitan hospitals. But they were electronic only in the sense that a computer application helped the relevant medical officers to compile them. They weren’t sent electronically. They were printed, faxed and posted to the GPs. Eight years on they still are! And South Australia is probably ahead of most other states. Yet we are so very, very far from being able to deliver these electronically and have them incorporated into each GP’s health record system, replete with the ability for those systems to reprocess the data reliably, consistently and safely. It will not happen in one year, nor two. Probably not even in ten years!
There is far too much inertia to be overcome. Unfortunately, simply labelling something “electronic” does not overcome the inertia.