Closing the Gap

There is much frustration with the slow progress in e-health around the world over the past decade or more. That frustration leads to partisan views and divisiveness across and within organisations about how to improve the situation. Some argue that much more money should be spent. Others argue that the amount of money is not the issue, but that leadership is the problem. Some believe that current standards are archaic and insufficient and that we need new approaches. Some people argue that the problem is not one of standards, but merely one of conformance to those standards. Some people proclaim that introducing “disruptive technology” is the only way to make the necessary progress in the timeframes that most of us would like to see. Others warn that the costs and risks associated with disruptive technology are too great to bear, for a health system that has already been straining due to increasing demand and the overall success of new diagnoses and treatments. People argue over the amount and nature of government intervention and leadership required to increase the rate of progress.

There appears to be an increasing amount of money being directed towards e-health, much of which seems to disappear into a burgeoning bureaucracy without the necessary conditions being established for improvements at the grass roots. We need to establish an ethos of continuous quality improvement in the way we collect and use information in health, and in the way we introduce new technologies to harness, process and share that information for better healthcare.

Somewhat analogous to the situation in e-health, Australia has seen decades of well intentioned plans aimed at “closing the gap” in health and life expectancy between most of the indigenous population of Australia and that of most of the rest of the population. Approaches to this, often based on government funded and managed schemes, have made little progress and the disparity in health status seems, to many observers, to be an almost intractable problem. Are there some lessons here that can inform the current debate around e-health?

To help answer this question, I turned to an excellent analysis by Sara Hudson, published in 2009 by the Centre for Independent Studies. Some of her findings include:

“Often there is no assessment undertaken of the verifiable impact on health outcomes for the money expended. Not surprisingly, this results in a lack of evidence about the best course of action and the relative cost-effectiveness of public health and preventive policies. In the absence of any evidence-based policy, most of the commitments agreed to by COAG appear more like wishful thinking than anything else.”

“While some of the NHHRC recommendations have merit and are worth considering, many others reiterate the same old top-down approach and do not address the structural impediments to reform.”

“Over the years, there have been a number of trials and lessons learnt about what works and what does not. The government needs to start applying those lessons instead of starting from scratch and implementing new policies that often end up repeating the mistakes of the past because they lack an evidence base.”

There is no doubt that “closing the gap” is a major challenge and that there is no quick panacea that money can buy us. I think that this realisation, and much of Sara Hudson’s wisdom can well translate to our current e-health landscape. 

Tags: interoperability | strategy