The Victorian E-Health Agenda – Calling All Health Informaticians

The elective subject “ISYS90069 E-Health & Biomedical Informatics Systems” coordinated by the Health & Biomedical Informatics Research Unit at The University of Melbourne, has continued to present high calibre and topical lecture presentations. Highly relevant at the moment, is the E-Health agenda.

This week, Mr. Richard Cederberg from the Victorian Department of Health presented on “The Benefits of Electronic Medical Records (EMRs)”, focussing on the Victorian E-Health agenda. Richard was good enough to outline the agenda and has been a great resource as I write this piece.

What is E-Health?
Like many areas in health informatics, E-Health is seemingly self definitive. However, there is far more to it and before we talk about how it plans to affect the healthcare industry, we need to examine at it in more detail…

Loosely put, it is –  the gamut of information (including communication) technologies that assist stakeholders with all facets of health management (by stakeholders, that can include clinicians, patients, support staff, researchers, policy makers, and more)

At the centre lies ‘data’, in this case, EMRs. The EMR is the unit that contains all of the information pertaining to a patient’s medical care. At this level, the EMR is valuable to hospital personnel and those involved in the patient’s direct care. This is not to be confused with an Electronic Health Record (EHR), that is the information that rests with the patient themself and contains all necessary information for patients to refer to and keep track of their own medical history and management. Whether discussing an EMR or an EHR, both serve as data houses and must conform with legislative requirements and integrate with administrative, clinical care and specialist modules.

E-Health Victoria & the ‘Clinical Systems Program’
In Victoria, the ‘Clinical Systems Program’ has been underway since 2005. It’s been part of the larger HealthSMART infrastructure (designed to support all facets of E-Health, not just clinical systems).

The Clinical Systems Program itself comprises 4 major health services: medications management, pathology, radiology, orders/results – Essentially, these are the major parts of the health services  (in hospitals at least). The theory is that with these areas rolled out, the rest should then fall into place….only time will tell.

Potential Benefits:

  • Cost benefit of processing patient referrals
  • Improved clinical outcomes through the clinical pathway (i.e. improved processes)
  • Reduced surgical adverse events through better medication management
  • Reduction in errors upon discharge

What are the challenges?

The Australian Government established the “National E-Health Transition Authority” (NEHTA) as a way to create a new set of synchronous standards pertaining to the collection, storage and exchange of secure data. Whilst this aims to create a more transparent and fluid system, it slows current progress while the new terminology and data formats are standardised and implemented.

Why Informaticians can play a vital role
The ongoing hurdle faced in E-Health is highlighted in the implementation of the Clinical Systems Program. One of the major hurdles healthcare seems to face is the highly disparate nature of how health data exists. Islands of discreet information, communication systems overload, asynchronous and incompatible storage/retrieval/communications systems, different standards,  multiple work flows and varying levels of E-Health literacy amongst professionals, do not make for a health utopia!

At present, there is a significant shortage of “health informatics” professionals working to integrate these systems and provide the skills needed to inform processes and best practice. In essence, to work better, to work smarter. With this skill set comes the ability to research and collaborate to carefully implement and provide clarity and consistency to E-Health….so,………CALLING ALL INFORMATICIANS!

On a side note, with a background in clinical healthcare, I am interested in how the government plans to address carryover into the private provider sector? At present, focus is on the public health services.  For now, the roll out of Personally Controlled Electronic Health Records (PCEHRs) serves as a start. Patients are now able to register for the own EHR. Given the daunting disparity in clinical practice systems and processes across private clinics, I will be interested to see how this pans out.

Also, my final question is – What’s the endpoint? Are we looking towards a virtual oasis where paper is a thing of the past or are we aiming to find that happy middle ground where bits & bytes live in harmony with pen & paper? We all have our ideas and preferences. What do you think? Until then, I’d love to get others’ thoughts on this one.

Mark Merolli

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