Kieran Le Plastrier: Ending e-health doubts

DOCTORS as a rule are a rather sceptical bunch. This is not a criticism; in fact, such a temperament is likely to have a collective and individual overall benefit.

It means we are less likely to be overly enthusiastic about new treatments and management choices, preferring to hold off until more evidence emerges to support or refute benefits to our patients.

Most clinicians are aware of the nature and variability of the quality of sources and protocols used to generate insight into new aspects of health care. We are encouraged as part of our continuing professional development to acquire and maintain the skills, knowledge and attitudes that allow us to form critically defensible rationale for our choices in the care of our patients.

It is likely that these skills, knowledge and attitudes are reflected in the medical profession’s suspicion of the personally controlled electronic health record (PCEHR), even though mainstream and medical media have been, on the whole, cautiously supportive of the PCEHR.

As part of the rollout of the PCEHR by the National E-Health Transition Authority, I travelled across Australia last year visiting more than 20 metropolitan and regional training hospitals in an awareness-raising campaign addressing e-health.

The campaign involved more than 300 medical practitioners, mostly doctors-in-training, and they overwhelmingly reflected this generally sceptical perspective in their approach to medicine.

However, at busy hospitals where most doctors are already using e-health solutions in their daily workflow, I noted that hyperbole about the contentious aspects of the PCEHR was absent but questions and uncertainties underlying much of the public criticism of the system were pervasive.

The campaign explored these questions and uncertainties by communicating three core themes — perspective, relevance and salience. To achieve this we created a 3-minute video that shifted the emphasis from “How will it affect me?” to a deeper and more motivating question based on why doctors choose this profession — “How will this impact on my patient?”

Doctors who took part in the campaign were given detailed information on the infrastructure and evidence from Australia and overseas on how best to transition to e-health and the benefits already realised in communities where e-health was accepted and used.

Question and answer sessions highlighted that most doctors’ concerns related to accessibility, privacy, security and possible impacts on the patient–doctor relationship — just the sort of questions I hoped doctors would ask.

The effectiveness of the campaign was confirmed with feedback from attendees, many of whom reported an increased understanding of, and willingness to engage with, the PCEHR.

What I did not hear during this campaign — not even once — was that this extraordinary investment in changing the way we connect and share information with patients, each other and other health professionals was a waste of resources.

The campaign helped to remind clinicians of the salient opportunities e-health offers and what their role will be in helping patients integrate e-health into their health care.

Medical scepticism is not something we needed to “overcome” in this campaign. By recognising its value and cultural influence, we were able to create a project that managed expectations and inspired confidence in the critical role clinicians are playing in the design and rollout of the PCEHR.

The campaign confirmed that medical professionals only want to ensure that any change in how they provide care will, ultimately, benefit the most vulnerable person in any health care encounter — our patient.

Dr Kieran Le Plastrier is the principal director of Cor Mentes, a health industry consultancy contracted by NETHA to roll out a national education program on the national e-health system. He is a Sydney-based psychiatrist-in-training and is undertaking a PhD on factors affecting medical practitioner performance at the University of Western Sydney. He has created and presented programs on optimal medical professionalism.

Posted 29 January 2013