The recent health reform plan comes down to more beds, doctors and aged-care places, the only innovation being some fancy funding footwork between federal and state governments. What's missing is the information technology infrastructure to make it happen, let alone the smart devices and software that, for instance, will keep patients out of emergency departments and elderly people out of nursing homes.
The medical software industry and doctors say it's not rocket science. Programs exist. They just need to be pulled together under commonwealth leadership.
"To get health working, we need to be able to communicate with each other," says Steven Hambleton, a Brisbane-based general practitioner and federal vice-president of the Australian Medical Association.
"The National Health and Hospitals Reform Commission said let's connect up care so that we only investigate somebody once, we hand over care once, and GPs and hospitals can operate as one health system.
"Right now, GPs cannot interface electronically with hospital systems. It's frustrating."
Hambleton says unique identifiers for patients, providers and locations are an essential first step, along with investment in electronic communication systems.
"Yes, it will be expensive to set up, but e-health will very rapidly become cost-effective," he says.
Michael Gration, Microsoft's local health director, claims the government remains focused on narrow, short-term goals.
"The exponential level of change needed in healthcare reform -- not only here but elsewhere -- will require significant investment in IT," he says.
"While the government has just committed to adding a large number of beds and doctors, the states have already made high levels of investment in acute care.
"The real demand will be in primary care, and in community and aged-care settings. We could pour as many GPs as we could train into the current system and we still won't resolve the problems of access and quality care without IT and without innovative ways of using scarce human resources."
With GPs about to take a broader role in patient management, Gration says it's essential the payment model is changed to allow more flexible arrangements.
"We need to change Medicare payments from fees for face-to-face consultations to recognise and reward different ways of delivering care," he says. "Many consultations don't need seven or eight minutes in the doctor's room. Some matters could be dealt with via video-conferencing or even a brief email, far quicker and cheaper. Other consultations could be conducted over the web or phone by a registered nurse using sophisticated decision-support software."
Doctors agree personal e-health records and telehealth services will most benefit people living with chronic illness, pregnant women and mothers with young children, the elderly, and people living in rural areas.
It seems sensible to address these populations first, they argue.
Microsoft is poised to bring its personal e-health record platform, HealthVault, to Australia and Gration says many private-sector health organisations want to offer it to their customers.
Demand is growing as health insurers realise prevention, education and supported lifestyle changes make a huge difference to the financial bottom line. Last year, HCF signed a $100 million five-year deal with Healthways Australia for just this reason: HCF's 1.3 million members can log on to a My Health Guardian account to access trained health coaches such as dieticians, personal trainers and psychologists for individual advice.
The service -- free, voluntary and provided at arm's length from the insurance division -- also offers tailored care for people undergoing medical treatment, including access to nurses working out of a call centre.
Meanwhile, heart patients in the NSW Hunter region are the first to use an in-home monitoring system linked to a private home-care nursing service. Patients simply take a daily reading of their blood pressure at home using a cuff attached to an electronic device and the data is immediately sent over the internet for review by a medical professional.
Hunter Nursing director Margaret Scott says a range of responses can be initiated, including video-conferencing. "If a patient is really unwell, we can send a nurse or contact their doctor," she says. "The system allows greatly improved monitoring of people's health problems so they are less worried about managing at home." Scott says it's an effective use of resources, particularly where community nurses may have to travel 30km to see a patient. "There's a shortage of registered nurses, so we need to make decisions about who needs help right now and who is doing fine and can be left to another day."
The system can be adapted for any chronic illness requiring continuous monitoring, such as diabetes or hypertension, while there is also scope to support people with depression or anxiety.
In Victoria, the locally developed Chronic Disease Management Network system has an international patent pending on its core technology, following successful trials with diabetes patients in Geelong and Western Australia's Eastern Goldfields.
Heralded by Communications Minister Stephen Conroy as the type of program that will be more widely available once the national broadband network is operational, CDM-Net basically provides a common platform to support team care of people with complex conditions.
Developed by Precedence Health Care and a consortium of local doctors, universities and IT firms, the system dodges the usual interoperability problems and uses intelligent software to automate management of care plans, appointment tracking, patient compliance and medical alerts.
"For the first time, we actually have an e-health record being continuously updated with data from the GP, allied providers and the patients themselves," Precedence chief executive Michael Georgeff says.
"The physiotherapist knows the patient has seen the dietician, everyone knows when tests are due and the GP knows appointments are being kept."
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Autor(en)/Author(s): Karen Dearne
Quelle/Source: The Australian, 01.05.2010
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