Enhancing healthcare

Australia’s health system has an enviable record internationally. There are, however, significant sectors in the community where lack of access brings with it inequities. A growing demand for healthcare reform has been recognised to prepare Australia for the future and to maintain the high standards we have and demand. Drivers include an ageing population, an increase in the prevalence of chronic diseases, advances in medical technology and knowledge, better informed health consumers, and a need to strengthen the safety and quality of healthcare.

To ensure a sustainable future Australia’s governments have promoted healthcare reform. Integral to this is e-health - for the system, the individuals who will use it and those who work within it.

That’s one of the reasons why the National E-Health Transition Authority (NEHTA) was established - to develop a national approach to better collect and securely exchange health information electronically. Australian Health Ministers, through the Australian Health Ministers' Advisory Council (AHMAC), commissioned “The National E-Health Strategy”, presented in December 2008, which provides a guide to the further development of e-health in Australia. In addition, the recent National Health and Hospitals Reform Commission (NHHRC) report provided the governments of Australia with a practical national plan for health reform with e-health seen as a real driver of change that will benefit all Australians.

The benefits of implementation of a national e-health system apply to all sections of the healthcare system. They stem from safer, more accurate, timely, reliable transfer of clinical information from known reliable sources which health providers can access and use for care with certainty - securely and encompassing the confidentiality and privacy principles which remain central to care. Understanding how e-health can address patient safety is key to NEHTA’s work.

Gathering patient information from multiple sources in many formats to follow care and interventions is arduous and inefficient. Mismatching of patients’ records and results is a documented problem for the health system. A clear link has been established between avoidable delays in patient care, deaths and poor medical records management. For instance:

Preventable errors:

• up to 18 per cent of medical errors are attributed to inadequate availability of patient information;
• medication prescribing errors are estimated to cost $380 million per year in the public hospital system.

Reduced productivity:

• 25 per cent of a clinician’s time is spent collecting information rather than administering care.

Costly misuse of resources:

• up to 35 per cent of referrals to hospitals could be avoided by improved communication of health information.

Helping to inform and guide NEHTA’s work are more than 25 well-respected and experienced clinicians to inform and guide its work. As the National Clinical Lead I have responsibility for co-ordinating this accomplished and multidisciplinary group of clinicians.

A commissioner with the National Health and Hospital Reform Commission and an executive councillor with the World Medical Association, I have been a Melbourne general practitioner for more than 20 years and am also a former Australian Medical Association President.

My role with NEHTA is to ensure that the “health” is put firmly back into e-health, ensuring that the e-health developments are clinically relevant and meaningful and that they are safe and do work. We have to show benefits from the use of this new technology that supports and enhances clinical method - not replaces it!

E-health systems are already in use across Australia. To maximise the benefits and for the future, we should have a truly national system operating to the highest standards of safety and security, a focus of NEHTA’s work is to develop the specifications that will underpin a national e-health system.

Healthcare patients need to see information relating to their healthcare managed in such a way that there is no risk to their care, confidentiality or safety due to mismanagement of health records or poor systems. NEHTA’s work is helping to achieve this.

The information that will be exchanged electronically across the healthcare sector includes discharge summaries and referrals, pathology and radiology requests and reports, prescriptions and patient medication histories. There are benefits too from use of clinical decision-support information and patient self-care options.

Defining a set of secure messaging protocols for e-health will ensure that data exchanged between healthcare providers remain just that - secure but also accurate.

A requirement for a safe and secure e-health system is the ability to uniquely identify everyone involved in a single healthcare transaction.

In March this year the Australian Health Ministers' Advisory Council (AHMAC), announced that all Australians will be allocated an Individual Healthcare Identifier (IHI) number for healthcare purposes. NEHTA has contracted Medicare Australia to develop a new service to provide identifiers for patients and healthcare providers. An IHI is a unique 16-digit identifier that will be assigned to all Australian residents and others accessing healthcare in Australia. The IHIs will enable important health information about a patient to be more readily and securely linked with other information about that patient. IHIs will be available for use midway through 2010.

To ensure that only the right authorised person can access the information the National Authentication Service for Health (NASH) will provide the first nationwide authentication service for healthcare organisations in Australia.

Having an e-health system that uses a “common language” which can be interpreted accurately is critical for patient safety. The “common language” is SNOMED CT (Systematised Nomenclature of Medicine Clinical Terms). NEHTA is customising SNOMED for the Australian healthcare environment by developing supplementary terminologies for clinical concepts and conditions unique to Australia, recognising nomenclature systems currently in use.

To achieve a national interoperable e-health system vendors and healthcare providers require certification to be a part of the system. This brings with it surety for system designers and those that purchase and use them that the system is fit for task, will communicate with other systems and that the data stored and exchanged maintains safety, quality, accuracy and confidentiality.

Compliance ensures e-health specifications have been met and leads to the correct use of relevant international standards. Compliance also relates to the adherence of an individual or organisation to regulatory requirements and standards. Conformance relates to how products and services accurately implement the National e-health specifications and standards. Accreditation is associated with the recognition that an organisation or person is competent to carry out a set of tasks or functions.

Through understanding the factors affecting patient safety and being able to demonstrate the benefits of e-health and the value that the electronic exchange of information can provide to improving patient safety, NEHTA’s work as the lead organisation supporting the national vision for e-health in Australia is positioned to help overcome the challenges facing our healthcare system.