[Another well argued plea for action by Michael Georgeff - Executive
summary appended].
In this respect, people might be interested in the draft ALP health
policy to be debated at the 44th National Conference to be held in
Sydney, 27th - 29th April 2007.
I've made "Chapter Ten, Improving Health and Well-Being: A Health System
that Delivers" available as a discrete 81 kb download from:
http://www.kooyongalp.org.au/
In particular, GPCG members might like to read paragraph 67-73,
"Harnessing New Technology and Managing Patient Information".
I'll be attending the ALP National Conference and I'd be happy to pass
on any comments people would like to make.
The Conference program and the entire draft platform is available at:
http://www.alp.org.au/features/conference.php
Cheers
Ken
Dr. Ken Harvey
Adjunct Senior Research Fellow
School of Public Health, La Trobe University
http://www.medreach.com.au
VOIP: +61 (03) 9029 0634; Mobile +61 (04) 1918 1910
------------------------------------------------------------------------
E-Health and the Transformation of Healthcare
http://www.achr.com.au/
Professor Michael Georgeff, April 2007
Executive summary
Of all the industries whose consumers stand to benefit from the wider
application of technology to enable connectivity and knowledge sharing,
it is difficult to go past health.
No less than 25% of all Australians suffer from a chronic illness and
nearly every one of them would be better off if the medical
practitioners who care for, and treat them were more in touch with each
other. It is hard to understand how Australians can tolerate the fact
that they’re not.
This paper sets out the cost – both to the patients and to the nation –
of a system in which providers of health care to chronically ill people
operate in disconnected silos where one doctor often does not know what
another has tested for and prescribed, sometimes even when they are
members of the same care team.
The figures for this lack of information-sharing and co-ordination are
starkly worrying.
• More than 50% of doctors do not follow best practice guidelines;
• Between 30 and 50% of patients with chronic disease are hospitalised
because of inadequate care management
• Fewer than 14% of people with chronic disease are placed on care
plans; and
• Less than one per cent of patients are tracked to see if they adhere
to care plans.
Thus, all but a tiny portion of those plans created are all but useless.
The impact on the individual can be imagined; the cost to the nation is
immense. In Australia, it’s estimated that improved knowledge sharing
and care plan management for patients with chronic disease would
generate direct savings to the health care system of more than $1.5
billion per annum. Savings to the community from associated non-health
care costs are of the same order. And increased workforce participation
and productivity could add a further $4 billion per annum to the economy.
For the patients, home monitoring could reduce emergency room visits by
up to 40%, hospital admissions by 30-60% and length of hospital stays by
up to 60%.
The evidence for better outcomes through more proactive patient
interaction is persuasive – one study demonstrated that better disease
management improved patient satisfaction (71%); patient adherence to
care plans (47%); and disease control (45%).
Clearly, the benefits are there to be had. This paper posits that the
two key characteristics of health care that should drive the type of
Information and Communications Technology (ICT) are:
1. an acknowledgement that the fundamental business of health care is
knowledge;
2. the need to be fully cognisant of the inherent complexity of health
care composed as it is, of a large variety of highly autonomous,
independent practitioners, all with their own systems and practices.
This Paper submits that – given the business environment – three
elements have proven to be keys to success:
1) a business model based on the knowledge enterprise;
2) a focus on connectivity; and
3) internet-like ICT solutions.
The knowledge enterprise is characterised by networked information,
support for autonomy and personalisation and use of systems that are
open, adaptive and distributed. This is the business model that has
proven to be successful for knowledge-based industries which, after all,
health care is. Yet, the business model we use in health is based on an
industrial enterprise where the focus is often on the management of
physical resources with very little attention to the management of
knowledge.
The second key is connectivity where competitive advantage accrues to
those who invest in connecting power, not raw computing power and large,
monolithic applications. The more connections, the better – don’t spend
time ensuring all the systems conform, get connected. Once connected,
individual value propositions will drive stakeholders toward agreements
and standards, continually increasing the value of the data in an
evolutionary way. This is not what we have in health care where most
investment has been directed at the development of large, closed
monolithic systems.
The third key to success is the development of open, internet-like
networks of businesses and users. We must design our systems to accommodate:
• the heterogeneity and incompleteness of information,
• the distributed and diverse nature of the information sources and
users; and
• the various forms of autonomous and governed institutions and
businesses that are part of the health care system.
What we currently have are attempts to remove the heterogeneity and
autonomy from the system so that it can be better run, a bit like a
well-organised bank.
The internet is the clearest example of a system which accommodates
autonomy and heterogeneity because it
1) connects anything, anybody, anywhere and
2) divests investment and control of the network (and its services) from
a central authority to suppliers and users.
Taking these three elements seriously will involve a fundamental change
in the way we see both ICT and health care and opens the way to
transform chronic disease management in this country.
Moving forward
We should focus on three important areas:
1. get healthcare providers connected to one another
2. track health events across the continuum of care
3. create a broadband network of health services
In business, most high priority and high volume communications are
handled electronically. But in health care, high-importance
communications – e.g. referrals and hospital discharge summaries – are
created using paper and pen and delivered via fax, letter and even by
hand. This is the point where we should begin – simply, aim to get
referrals and discharge summaries to be delivered electronically in a
convenient and secure form.
Each of these important areas is discussed in some detail in the body of
this Paper. Once health information is flowing electronically and is
able to be accessed through open services interfaces, it will then be
possible to add incrementally a wide range of value-adding services to
this network. The Paper offers some examples in this area. The Paper
raises one final, important point - that of incentives. There is a cost
to building this connectivity and information sharing but there is a
mis-alignment between those who pay and those who receive the benefit.
This barrier needs to be breached by:
• partnerships between government and industry
• governments, private insurers and employers offering incentives for
using electronic services, broadband health network and best practice
processes.
While it is difficult to provide incentives based on health outcomes
(given the difficulty of measurement and variability of outcomes) it is
relatively easy to measure, and therefore provide incentives for, the
use electronic services and best practice processes. All this will take
money, partnerships between government and industry and, of course,
goodwill. However, with the right conceptual framework and by taking
seriously the knowledge enterprise and the autonomy of care providers
and consumers, we can start to transform the way we look after
Australia’s chronically-ill patients.
http://www.achr.com.au/
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