Christian Rowan: E-health success

AUSTRALIA’S experiment with the personally controlled electronic health record has had a bumpy start — the resignation of key clinical advisers from the National Electronic Health Transition Authority does not augur well for its future.

Hundreds of millions of dollars have already been spent on setting up and promoting the PCEHR. Perhaps it’s time to acknowledge that our precious electronic health dollars could have been better prioritised elsewhere.

There will be many reasons given for the disappointment of the PCEHR, which had failed to reach even its own modest target of 500 000 registrations by July 2013. However, in simple terms, the success of electronic and information technology (IT) projects, large or small, depends on leadership and clinical engagement.

Both have been lacking in the rollout of the PCEHR, as borne out by low participation by GPs and the inability of public hospital systems to integrate their records successfully.

IT in health care is an enabler which augments good clinical care — projects are likely to succeed when project teams follow the basic principles of good planning, effective clinical leadership and a commitment to stakeholder engagement.

There are several successful examples in the Australian health sector where these principles have been taken seriously, including two in Queensland — the new UnitingCare Health St Stephen’s Hospital at Hervey Bay and the new purpose-designed Health City precinct at Greater Springfield, south-west of Brisbane.

At the heart of both these initiatives are clinical leaders, health planners and administrators whose aim is to share information using digital technology and create synergies between primary, secondary and tertiary care.

St Stephen’s Hospital at Hervey Bay, which opens next year (2014), will be Australia’s first fully integrated digital hospital. It is an example of a workable public–private partnership, with $47 million from the federal government’s Health and Hospitals Fund going towards the estimated $87.5 million cost.

A key objective for the hospital is to improve the patient and clinical experience, with an electronic record system a vital component in the plan. Medical staff will use shared information and wireless technologies, and all medical records, and diagnostic and pathology results will be accessible by doctors and nurses anywhere in the hospital through computers in patient rooms, electronic devices and laptop computers.

Features include patient and medical portals, an integrated voice recognition communication system to improve the speed and quality of communication, the ability to develop information linkages with other parts of the health system, and the ability to track equipment electronically to increase efficiency of use.

The other initiative, Health City, is Australia’s first purpose-designed health precinct. Part of the first stage is a private hospital incorporating the latest digital technologies. There is a long way to go, but it’s an exciting concept that is an example of sound planning.

An exciting aspect about Health City is not only its size — a 52-hectare site adjacent to a significant area of open space — but the fact it is being planned to integrate hospital and tertiary care, combine public and private initiatives, as well as provide primary health care and a host of other related services such as radiology, pathology, allied health and aged care.

Both Health City and St Stephen’s Hospital are examples of where IT professionals, health planners, industry and clinicians can work together across the private and public health systems to provide optimal health care throughout a person’s life.

The original simple objective of the PCEHR was similar — to create an e-health record that health professionals can easily access to ensure the best possible health care throughout a patient’s life.

For the PCEHR to succeed we need to return to basics — get the planning right, ensure the project is led by clinicians, and don’t forget to engage the very people who will use the system: the doctors and their patients.

Dr Christian Rowan is the President of the AMA Queensland, an Associate Professor of Addiction Medicine and Public Health at the Centre for Medicine and Oral Health, Griffith University, Queensland, and Director of Medical Services at St Andrew’s War Memorial Hospital, Brisbane.

COI: Dr Rowan is the Deputy Chief Medical Officer of UnitingCare Health