Just a whisker over 10 years ago, closely following the release of the National Electronic Health Records Task Force’s landmark report, but before “e-health” or “electronic health records” became household words, a National Health Online Summit was held in Adelaide.
It seems like Australia has taken a few steps forward, but possibly even more backwards, since then. I’d like to share just a few prescient snippets from that summit. In many respects, it really makes me wish we could turn the clock back those ten years to a time when many of our e-health pioneers had more wisdom in forethought then, than most of those in responsible positions seem to exhibit (with the added benefit of hindsight) today!
“What I feel quite strongly about – and would really encourage you to consider – is how you best promote two essential qualities necessary for democratic communities to thrive: to build in appropriate checks and balances and then to boost people’s trust in those systems, confident in the belief that they are designed for the overall good of the greatest number and that they basically deliver.” Geradine Doogue – ABC journalist and commentator
“A rate-limiting step in this process is our profound national skill shortage in health informatics. Without a substantial increase in appropriately qualified people, our national capacity either to introduce the current generation of information technologies or participate in the development of the next generation is critically limited.” Enrico Coiera – Director, Centre for Health Informatics, University of New South Wales
“The road ahead for the development of a national approach to electronic health records is long and winding. It will be littered with obstacles. Many issues still need to be teased out and discussed, and much work needs to be done in establishing a consistent approach to be pursued. The key stakeholder groups, particularly consumers and providers, will need to be directly involved in the processes that follow the recent decision of Health Ministers to endorse fully the report of the National Electronic Health Records Taskforce.” Ms Lynelle Briggs -First Assistant Secretary, Portfolio Strategies Division Commonwealth Department of Health and Aged Care
“There is, I think, a rather dangerous assumption that just bringing in new technology will bring about improvements – but if it’s not done carefully then it will increase inequalities and exacerbate problems which already exist. If technology is to truly empower consumers and communities (one of the key themes in Health Online – and one of our biggest challenges) then we need collaboration between the various interests and between the different levels of government. What I am looking for is genuine partnerships where the contribution of each is equally valued.” Ms Kate Moore – Consumer representative, National Health Information Management Advisory Council
“The GPCG [General Practice Computing Group] provides a successful model for national collaboration in so far as: it is an initiative of the medical profession; it was timely; key stakeholders came together to develop plans and actually collaborated; the Commonwealth committed significant resources to achieve those plans; specific, implementable projects were identified as part of a strategic framework; the framework was implemented independently of government, with its full support; and, industry groups and consumers were directly involved in planning and implementation.
There are also limitations on the model in that: it is difficult, from a Commonwealth level, to develop structures for collaboration with the States; funding cycles are often too short to allow long-term planning; funding cycles are often too short to allow thorough evaluation; the problems being targeted have a high level of complexity; and, many Commonwealth and State initiatives appear, at times, to be occurring in parallel – even isolation.
The future agenda for national collaboration should address a number of issues: change takes time no matter how well planned and implemented, and yet, the rate of change (and demand for rapid change) will continue to increase; the views of the Commonwealth are easily fragmented; the views of the medical profession are easily fragmented; in IM & IT the medical profession and government have had a similar agenda to date but for different reasons, therefore tensions will emerge – principally around monitoring, rationing and clinical independence; in addition, consumers will develop a stronger voice and will articulate limitations and constraints based on privacy that are yet to be felt.” Mr Frank Quinlan – National Coordinator, General Practice Computing Group
“We now have the possibility that, when a patient is transferred from Box Hill Hospital [to] the Peter Mac (or is being treated for different conditions concurrently), their data could be made available directly on line” Dr David Woodcock – Peter MacCallum Cancer Institute, Melbourne, and Verinet Solutions