Megan Robertson

THE debate about e-health has so far been short on details about the specific issues facing doctors in implementing information technology in health care.

While a recent article in MJA InSight about the lack of information technology (IT) progress deserves applause, it was disappointingly short on specific details that are directly relevant to practising doctors.

Unfortunately, motherhood statements that relate to solutions in the business sector or social media fail to consider the unique and personal nature of health care provision.

We need to clearly separate the business components of running a practice from the clinical components of providing medical care in the e-health debate.

It is relatively simple to implement commercial programs at a practice level, moving our businesses into the 21st century, and the majority of clinicians have already achieved this, including GPs, consultants and hospital practices.

Far more problematic is using IT capability or digital technology to improve and advance clinical patient care — a care paradigm that has relied on interpersonal relationships and networks since time immemorial.

Digital technologies should enhance and add value to the strong underlying personal connection inherent in the clinician–patient interaction, not replace it.

We need to reassure both our community and ourselves that this is not only possible but also essential if we aim as a society to meet both the needs of our ageing and growing population and  the increased care expectations of the patients/consumers.

Improved communication and coordination between clinicians regarding patient care (eg, electronic referral and review systems), plus increased access to clinical assessment and test results (eg, via web-based portals and electronic data transfer) to reduce repetition and wastage, will streamline care processes without undue disruption of current personal interactions.

Increased patient and consumer access to important health education information (via dedicated clinician–patient portals such as www.pronexinc.com), understandable outcomes data and treatment options will enable those consumers who wish to be involved in planning their own care pathways to be engaged.

None of these options require major redesign of current care paradigms but rather demand commitment from the health care sector to work together to achieve simple aims.

Just as important as working towards an IT-enhanced health care system, is to remember the essential basis of patient privacy.

The sensitive nature of the information being shared between health professionals means that standard underlying infrastructure requirements are typically inadequate.

Last century, a misdirected referral letter would lead to minimal exposure: today, a misdirected email can go viral on social media within minutes. Witness the recent crash on the New York Stock Exchange when President Barack Obama was rumoured to have been injured in an attack on the White House.

As well as adding value to health care, any digital technology must also protect our patients and their interests.

Currently there is a lack of good integration and collaboration between clinicians and health informatics professionals who hold the key to unlocking the true potential of digital technology in the future.

It is only by engaging with the IT experts in health care in an environment of mutual respect that clinicians can understand the pitfalls and possibilities of digital technology in our unique sector.

Similarly, clinicians need to guide health informatics professionals through the nuances of clinical medicine and the key clinician-patient relationship to ensure IT solutions respect the nature of clinical care.

These health informatics experts will move us away from a local platform-centric view to understand and embrace the possibilities with a network-centric perspective — one which enables us to engage with the broader world in order to provide more holistic multidisciplinary care, including involving patients in their own care path.
 

Dr Megan Robertson is executive director of research at Epworth Health Care, Melbourne. Professor Nilmini Wickramasinghe is the chair of health information management at Epworth.