eHealth

Digital tools for a better, more sustainable health system

By Sarah Dods, CSIRO

It seems that almost every politician, health economist, policy expert and health-care worker has a different take on the state of the nation’s health system and ways to make it more sustainable. But notably absent from the debate so far is the role of technology.

So, how can digital innovation improve the health system’s bottom line?

Rising health costs

We know that Australia’s health system, in its current form, is not sustainable. Treasury projections show that we currently spend more than 20% of all government tax revenue on health, and that if current trends continue, this will rise to 40% by 2043.

State government expenditure is even more dire, currently at 40%, and rising to 100% in the same period. Over the past ten years, health-care spending has risen faster than the growth of our gross domestic product (5.4% vs 3.1%) and in 2012 health overtook retail as Australia’s largest employment sector.


Source: Australian Institute of Health and Welfare

The drivers of this growth are an ageing population that is living longer but not in good health, increasing rates of chronic disease (such as diabetes, heart disease, cancer and asthma) that require long-term health management, and increasing expectations around medical advances and what our health system can treat.

For my grandparents’ generation, the expectation for failing hip joints was a pair of walking sticks and self-management. Today, we expect hip replacement surgery, and new hips. The social outcome today is much greater, but there is an economic cost that we need to acknowledge.

The exact maximum proportion of our national budget that can sensibly be spent on health is still up for debate, however it is clear that this limit is in sight. So, economically speaking, what are the alternatives?

Keeping a lid on spending

One approach is to look for new sources of funding into the system. Individuals already fund nearly 20% of health-care expenses through out-of-pocket payments. The current proposal of GP co-payments is one way to increase this.

But when people can choose how they interact with the health system, they will generally opt the lowest-cost option (to them) that meets their needs. So, if they have to pay to visit their GP, then they are more likely to go to the emergency department at their nearest public hospital as an alternative – at much higher cost to the health system.


Raising the out-of-pocket costs of primary care could drive more patients to emergency departments.
Ragne Kabanova/Flickr

A second approach is to look at how the system spends the current funding, and whether it is possible to improve what is achieved with the current budget. The best places to seek these improvements are the parts of the health system with the biggest expenditure, which are hospitals (40%), and medical services (18%).

Savings could be found through efficiency gains (doing the same things, but in smarter ways), better utilising lower cost parts of the health-care system that meet patients needs, and by changing operating models (doing smarter things to get desired outcomes).

Technological solutions

There is a growing collection of technological solutions that started as research to demonstrate their clinical safety and economic value, and are at, or rapidly moving towards, early roll out.

Big data analytics can predict who, when and why patients arrive at hospitals. These tools can predict emergency department arrivals and how many will need admission, and days when there will likely be insufficient beds available to meet these needs.


Patient prediction tools are beginning to be rolled out.

This kind of forecasting enables hospitals to move from reactive planning (need a bed now), to proactive planning for emergency department and elective surgery needs, and look to reduce waiting times, improve bed usage, and reduce staff stress levels along the way.

Decision-making around how patients are discharged from hospital is equally important, including understanding and overcoming the barriers that keep people in hospital after they are clinically ready to go.

Patients with chronic diseases, for instance, are high users of our health-care system. For some of these patients, there is growing evidence that their needs may be better met – clinically and economically – through guided self-care at home using broadband communications.

In rural areas, broadband can also improve access to essential health services, enabling better early diagnosis and treatment of conditions before they become major and require hospitalisation. CSIRO is helping to deliver specialist ophthalmology (eye care) services, for example, to remote communities in Southwest Western Australia and the Torres Strait Islands.


Janice from Bacchus Marsh, Victoria, measures her blood oxygen with the help of her husband and carer Bill. Her health stats are sent via a telehealth device to a local diabetes nurse who checks on her daily.
CSIRO

At CSIRO, we are also exploring the options to take patient prediction tools to the next level: whether forecasting can also predict health deterioration. This would enable simpler, earlier medical intervention, saving the social and economic cost of a visit to hospital.

The health system is going through a profound generational change in the transition from paper to fully electronic records. The computational standard SNOMED CT is emerging internationally as the tool that will enable these records to exchange detailed, precise concepts and information.

Figuring out how to implement and manage the complexities of the standard across the many non-standard (and often text-based) health record systems is a research challenge in itself. But once implemented, the potential for big data analytics, machine learning and decision support will result in higher quality and safer patient care, as well as enormous efficiency gains in reporting, health business systems, and population health.

Australia is rightfully proud of our record of medical research achievements. But there is a strong case to refocus a significant part of our investment in clinical research towards building an equally strong capability in health-care services research.

Finding ways to deliver high-quality care with good patient outcomes at an affordable cost to the nation is just as important as finding cures for diseases.

The Conversation

This post was written by Sarah Dods, Research Theme Leader, Health Services at CSIRO. You can find Sarah on Twitter at @sarahtmb

Sarah Dods will be holding an e-Health workshop at CeBIT. Register now to attend Sarah’s workshop!

Sarah Dods CSIRO Workshop CeBIT
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CSIRO Health Services receives funding from the Australian Government, Queensland Health, WA Department of Health, Australia’s National E-Health Transition Authority (NEHTA) and a number of individual public hospitals.

This article was originally published on The Conversation.
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Interview: Dr Annie Lau, Research Fellow, Centre for Health Informatics, AIHI, UNSW

Dr Annie Lau is a Research Fellow at the Centre for Health Informatics (CHI), Australian Institute of Health Innovation, University of New South Wales, where she leads CHI’s research program in Consumer Health Informatics.

The aim of this program is to provide empirical evidence on how E-Health and online social technologies affect the way consumers make health decisions, manage their health, and influence their health behaviours and outcomes.

She has qualifications in Health Informatics (PhD UNSW) and Software Engineering (BE Hons I UNSW). Her research interests lie in the design, development, evaluation and analysis of E-Health systems for healthcare consumers and patients. She is also interested in investigating the impact of social media and online social influences on health.

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Interview: Dr Finn Klamer, Medical Advisor Danish eHealth Portal

Dr. Finn Klamer has been the Medical Developmental Advisor to Sundhed.dk, the Danish eHealth Portal since 2001. He is a specialist in general medicine and has many years experience as a GP. Since 1988 he has been deeply involved as a medical advisor for numerous national IT projects, been on a number of boards and national development forums.

He is known as a supporter of more open health services with active participation by patients and exploitation of the IT possibilities in the dialogue with the patient.

We spoke to Dr Klamer about his Keynote address to the CeBIT eHealth conference about “Using the eHealth Portal as a National Distribution Frame and a Platform to Facilitate the Sharing of Knowledge and Patient Data”.

Amongst his responsibilities is being editor of the national handbook for professionals and patients regarding interaction with sundhed.dk – a point related to his keynote message concerning sharing of patients resources and the synergy achieved by using and sharing knowledge in the communication areas and knowledge areas of the eHealth portal.

Dr Klamer said that during his keynote he would illuminate and illustrate the following areas:

“We must in Denmark and other countries consider and exploit the synergy, as in other community contexts in harnessing the Internet’s capabilities both humanity and technology through the use of the new language through the Internet and exploit winning instead of building dams in the global paradigm shift”.

“I will illustrate how we in Denmark have enabled the public eHealth portal in our organisation structure to reflect regional and local ICT development projects and how the success can be achieved by achieving political beliefs and afterward political willingness”.

“During the period since we started we have accumulated experience about how access barriers are overcome both organisationally and in the technical and administrative interaction not at least the big challenges about system interoperability and the organisational acceptance to allow access to data and other related patient information by the responsible authorities nationally and regionally – and this an important issue in my keynote”.

“If we look more specifically, there is the possibility of trans-global exploitation and discussion about our experiences around areas as: Security, privacy, ethical, cultural differences etc. These aspects will be discussed by me in an online demonstration of an actual patient case”.

Dr Klamer said that sharing data amongst different groups is very important and he will describe examples of this between professionals themselves, between professionals and patients, as well as between the patients themselves (patient networks).

He will also explain how knowledge is shared in the Danish ehealth portal in two different languages ​​playing together, the patient’s language as well as professional language, and the data challenges associated with this.

Future Trends

Dr Klamer told us that:

“The recent steps we have taken are very visionary and we currently in a consolidation phase, however in the next phase we see strong challenges concerning our moving from system-oriented to user-oriented presentation of data including user involvement”.

“However they are certainly interested in progressing with integration of the joint health journal in the ehealth portal with common access in the same context to E-records at hospitals, primary care and special practices – The common medication card – The joint national medical profile – The common laboratory profile – The National Patient Index with image access – The common vaccination register – all in the common context and with interplay between data and data related knowledge”.

“Patient empowerment opportunities include questionnaires that link up with general data prior to hospitalization and modules for structured dialogue as well as online patient diaries to be shared with health professionals and the patient’s relatives”.

Learn more from Dr Finn Klamer at CeBIT Australia’s eHealth 2012 Conference on 23 May 2012.

Interview: Bill Le Blanc, General Manager eHealth Services, SA Health

Bill Le Blanc is the General Manager eHealth Services, eHealth Systems for South Australia Health.

He has worked in ICT for 28 years, beginning his career in a 500-bed teaching hospital before spending 21 years in the private sector. Bill has extensive international experience, including major assignments in China, Singapore, Taiwan, New Zealand, Hong Kong, and the USA. He has held senior roles in multinational IT firms and a ‘big 5′ management consultancy. He holds a mathematics degree from Flinders University and an MBA from UniSA. Bill joined SA Health 4 years ago as Director of ICT Customer Services where he led the reform program to centralise ICT services and deliver service improvements. Earlier this year Bill was appointed to the newly created position of General Manager eHealth Services at SA Health.

We interviewed Bill to learn more about “Laying the groundwork – it’s a lot more than technology”, his session at the CeBIT eHealth conference about South Australia’s journey in laying the groundwork for a state wide electronic health record (EHR) system scheduled to go live in Q1 of 2013.
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Interview: Denis Tebbutt, Vendor Engagement, National E-Health Transition Authority (NEHTA)

Denis Tebutt is an adviser to the National E-Health Transition Authority (NEHTA). Denis has spent the last 40 years in high technology businesses with over 30 in the growing information technology sector working across the globe in manufacturing, finance and for the past 10 years in healthcare.

He is a dynamic leader with strong strategic and business development skills founded on a deep understanding of the technology and its role in supporting the development of a more agile and innovative business model for the industries that he has served. The challenge faced by the healthcare sector brings together the experiences and lessons of earlier industries.

NEHTA

National E-Health Transition Authority (NEHTA)

During the past year he has been the advisor to the National Electronic Health Transition Authority on its engagements with industry to effect collaboration, change and adoption of a new infrastructure and to move the interoperability of the continuum of care into a new domain.

We interviewed Denis to learn about the latest news from NEHTA which he will discuss at CeBIT’s eHealth Conference.

He started by telling us in depth how the IT Industry can transform Australian healthcare because “this industry just keeps getting more exciting and interesting”.

Personally Controlled Electronic Health Record (PCEHR)

Moving on to the topic of NEHTA’s Personally Controlled Electronic Health Record (PCEHR) project he said that it is a pull strategy, to attract all the providers who haven’t seen the value of electronic medical records into the 21st century:
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How IT Industry Can Transform Australian Healthcare

Denis Tebutt is an adviser to the National E-Health Transition Authority (NEHTA). Denis has spent the last 40 years in high technology businesses with over 30 in the growing information technology sector working across the globe in manufacturing, finance and for the past 10 years in healthcare.

He is a dynamic leader with strong strategic and business development skills founded on a deep understanding of the technology and its role in supporting the development of a more agile and innovative business model for the industries that he has served. The challenge faced by the healthcare sector brings together the experiences and lessons of earlier industries.

NEHTA

National E-Health Transition Authority (NEHTA)

During the past year he has been the advisor to the National Electronic Health Transition Authority on its engagements with industry to effect collaboration, change and adoption of a new infrastructure and to move the interoperability of the continuum of care into a new domain.

We interviewed Denis to learn about the latest news from NEHTA which he will discuss at CeBIT’s eHealth Conference.
Read more

Interview: Dr Trent Watson, Ethos Health

Dr Trent Watson is a media spokesperson for Ethos Health and the Dietitians Association of Australia. Keeping abreast of the latest health issues, Trent is frequently asked to provide comment on topical health related matter in newspapers, magazines, on radio and television. Ethos Health recently merged with Penn Health.

The Ethos Heath team currently includes: Physiotherapists, Accredited Practising Dietitians, Exercise Physiologists, Diabetes Educators, Occupational Therapists, Occupational Health Nurses and support staff. All are motivated by a belief in the need to improve the integration of allied health professionals and services for better health outcomes.

The Ethos Health model provides individuals, workplaces and communities with a range of health, safety and lifestyle solutions to suit their individual needs. Together they endeavour to: exceed expectations; delight clients; be innovative in their approaches; and be the best in health.

We interviewed Trent to learn about his discussion topic “The critical role of technology in the primary health care reform process” at CeBIT’s eHealth Conference.
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Interview, Jason Howie CEO Kincare

After qualifying as a Chartered Accountant and working as an auditor for a large accounting firm, Jason Howie took on the challenge of running his family’s small home nursing business in 2000. Over the past 11 ½ years the organisation has grown from around 50 employees and 300 clients to 2,000 employees providing services to over 10,000 clients today.

Kincare

Kincare

This experience has given Jason an insight into the challenges of running businesses at a range of different sizes, and the value of investing in infrastructure to support future growth.

Jason’s 11 ½ years in the Health and Community Services industry has also provided experience in a challenging people based environment, where customer service is becoming increasingly important.

We spoke with Jason Howie to learn more about his discussion topic “Changing the dynamic of the healthcare system by putting the consumer at the centre” at CeBIT’s eHealth Conference.
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Federal Government Health & eHealth Reform Agenda

The Federal Minister for Health, Hon Tanya Plibersek MP recently made several public statements about the Federal Government Health And eHealth Reform Agenda explaining that any change so large and so complex with a significant infrastructure investment, needs solid foundations.


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Panasonic Toughbooks Withstand Harshest Treatment

Panasonic Toughbooks are well known for allowing you to productively complete business tasks anywhere, anytime, while being confident that your laptop is designed to withstand the toughest treatment.

They are available in 3 varieties: Business Rugged, Fully Rugged and Medical Rugged. The level of ruggedness is demonstrated by this video of a factory standard specification Toughbook 19 model being dragged behind a snowmobile through rough terrain. At the end of the test it functioned fine.


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DoHA Inviting Comments on Proposed PCEHR Rules

The eHealth Division of the Department of Health and Ageing (DoHA) is inviting comments on the proposals for regulations and rules for the personally controlled electronic health record (PCEHR) system . Feedback will help develop and refine the proposed rules and regulations which will support the PCEHR system.

Personally Controlled Electronic Health Record (PCEHR)

Personally Controlled Electronic Health Record (PCEHR)

The PCEHR System: Proposals for Regulations and Rules (‘proposals paper’) was publicly released today and the opportunity for comment closes at 5 pm (Australian Eastern Standard Time), Wednesday 11 April 2012.
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Delivering Health Services Remotely Using Broadband

eHealth is one of the key sectors that will benefit from the rollout of the federal government’s National Broadband Network (NBN).

Ambulance Service of NSW Photo Credit: Neerav Bhatt (Creative Commons)

With this in mind a new $20.6 million telehealth program was recently announced, with the intent of using the NBN to provide new and innovative in-home telehealth services to older Australians, people living with cancer and those requiring palliative care.
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Benefits of eHealth Records to Patients

Discussions about eHealth are often around the technologies being used and how the planned rollout is progressing but it’s good to step back and also consider the practical benefits for patients.

Life or Death Situation - Ambulance Service of NSW Photo Credit: Neerav Bhatt (Creative Commons)

Andrew Leigh, federal member for Fraser recently commented on the eHealth issue pointing out that key benefits such as:
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Wired Magazine Editor: Technology is Coming to Healthcare

Thomas Goetz personal interest is in Healthcare and Information Technology

Thomas Goetz, Wired magazine editor, has one of the most interesting jobs in the world. He gets to pick and choose among hundreds of topics, and exposed daily to cutting edge technologies and the forefront of ideas that advance humanity.

But what is Goetz personal passion and interest? It happened to be the trend of technology and healthcare finally coming together. Goetz means information technology, creating new concepts, enabling feedback loops and empowering people.

Goetz defines the purpose of the media as conduit for content, and as such, he sees conferences as part of the media world – deliver ideas, content and create the right social environment that allows a feedback loop and conversation to happen.

CeBIT Australia’s eHealth 2012 Conference will take place on 23 May 2012.

NEHTA: eHealth specifications testing resumes

The National E-Health Transition Authority (NEHTA) has now resumed testing specifications after halting eHealth records trials, said NEHTA CEO Peter Fleming.

Back in January, NEHTA discovered that due to detected technical incompatibilities for specifications pushed to the eHealth trial sites, the implementation of primary care eHealth software has paused.

However NEHTA has now re-commenced testing for the national Accenture platform to support the eHealth records this month, ensuring the system interoperates with other vendors’ software.

Mr. Fleming spoke in a Senate estimates hearing on Wednesday, confirming NEHTA tested the revamped specifications internally before pushing it to the trial sites.

“The actual problem that was detected has been fixed, and we’re now testing that. One of the things that we do ourselves is that we build out the system ourselves. So everything we write a specification for we actually build it.”
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Infographics: Electronics Health Records Concept Explained

Creative Canadians Ira Hardy and Ryan Smith presents the case for Electronics Health Records in British Columbia in just 1:48 minutes. Your Immunisation, Medication, Surgical and Physiological records along with other information such demographics are put in a single data file, accessible by the Healthcare system. But this concept impose some privacy and access risks. Can we get around it?


The Wikipedia entry for EHR explains in further details.

CeBIT Australia’s eHealth 2012 Conference will take place on 23 May 2012.