A new way of thinking

E-health is much more than just computers in hospitals, writes Sue McIndoe.

Australia’s health system has an enviable record internationally. However, a growing demand for healthcare reform has been recognised to prepare Australia for the future and maintain the high standards we have and demand.

Drivers include an ageing population, an increase in the prevalence of chronic diseases, advances in medical technology and knowledge, better informed health consumers, and a need to strengthen the safety and quality of healthcare.

Integral to this reform is e-health — for the health system, the individuals who will use it and those who work within it, including the nursing profession.

E-health means a lot of things to different people. I believe it is not about the technology industry, it is about the health industry. It is not about computers in hospitals; it is about information flow across general practices, specialists, hospitals, pathology labs and more. It is very much about change in management, business transformation and new ways of thinking.

As the lead organisation supporting the national vision for e-health in Australia, the National E-Health Transition Authority (NEHTA) has focused on setting up e-health infrastructure components: terminology, secure messaging, identifiers and authentication. NEHTA is also developing e-health solutions for the most commonly shared health information: referrals, discharge summaries, diagnostics and medications management.

Closing the circle of care
E-health will change the way health information is managed: from visiting a GP, to getting a prescription, going to hospital, getting test results and managing a chronic illness. This will give healthcare providers an up-to-date record of a patient’s health status and, with the patient’s permission, that information can be shared with other healthcare providers.

Whether a patient is admitted through emergency or booked in advance, the attending doctors will have access to the patient’s healthcare identifier, which will streamline transfer of information.

Paper prescriptions will eventually be a thing of the past. A GP will send a patient’s prescription to a secure prescription exchange hub, where a pharmacist will access the prescription electronically. And instead of patients travelling back to their GP after a diagnostic test with a paper report and X-Ray film, the GP will access a patient’s results and reports electronically.

Those suffering from a chronic illness (that’s one in seven Australians) will have the ability to manage their illness more effectively, regardless of age or physical location. They will experience the freedom of enhanced shared care, improved decision support, and be more involved in the management of their own health.

Nurses and e-health
As a clinical lead working with NEHTA, I am working with people who are passionate about the difference they believe e-health can make to Australia’s healthcare system. There are over 45 clinical leads at NEHTA led by National Clinical Lead Dr Mukesh Haikerwal, a practicing general medical practitioner, Commissioner to the National Health and Hospitals Reform Commission, Professor in the School of Medicine in the Faculty of Health Sciences at Flinders University in Adelaide and a former Australian Medical Association (AMA) president.

As a group we help to inform and guide NEHTA’s work. Essentially, our role with NEHTA is to ensure that the ‘health’ is put firmly back into e-health, ensuring that the e-health developments are clinically relevant and meaningful and that they are safe and do work. We have to show benefits from the use of this new technology that supports and enhances clinical method – not replaces it. It is imperative that nurses be involved in these developments.

As a nurse providing care for patients, I have to work with and liaise with a number of other healthcare providers. Enhanced communication between all healthcare providers will support a collaborative care model and will enhance healthcare - particularly for those with multiple, chronic and complex health needs.

This is where I see the real benefits of e-health. I often have to deal with incomplete and fragmented information and end up wasting valuable time chasing information that I need to provide care. Not having access to the required health information and having to manually coordinate care with other providers can lead to information being exchanged in an ad hoc and incomplete manner.
Current studies taking place indicate a growing awareness of the need to develop the ICT skills and competencies of the nursing profession.

The Australian Nurses Federation (ANF), with the financial support of the Department of Health and Ageing, engaged a research team from Queensland University of Technology to undertake a study of over 4000 nurses regarding their use of information technology in the workplace.

The aim of the project was to develop informatics competency standards for the nursing profession in Australia recognising that development of the nursing workforce is essential in order for the profession to be able to use the technology now being developed for the delivery of safe, better integrated care. Following data collection and survey processes, it is expected that the informatics competencies will be published by the end of the year.

In addition, the Australian Health Informatics Education Council is undertaking a Competency Review project. The work is being undertaken to better define the scope of health informatics and the relationship between this discipline and existing professions, and to assist in identification of the skill sets required by people working in healthcare in general, and those working with health IT.

The latest e-health news and developments
Over the past two decades there has been a substantial investment in e-health technologies by government, the private sector and healthcare providers. What is lacking is a framework for participants where they can talk to each other. The Healthcare Identifiers (HI) Service is a framework that starts to address this.

On 1 July 2010 the HI Service commenced operation. The three types of healthcare identifiers will enable accurate identification of the patient receiving the care, the clinician providing the care, and the healthcare organisation they work for. Medicare Australia is the initial operator of the HI Service.

Individual Healthcare Identifiers (IHIs) were allocated to approximately 23 million people who are currently enrolled in the Medicare or Veterans’ Affairs programs. E-health won’t happen overnight – the service is being implemented in a planned phased approach. It is expected that health professional organisations and individuals will start using the service over a period of some 12 to 18 months, with both Medicare Australia and NEHTA providing support to assist with the take-up of the service.

There are expected to be approx 700,000 Healthcare Provider Identifier – Individual (HPI-Is) – for healthcare professionals involved in providing patient care - generated: 500,000 through Australian Health Practitioner Regulation Agency (AHPRA), and 200,000 to other healthcare providers outside of the AHPRA registration process.

Lead implementation sites
A federal government announcement was made in August 2010 about the three trial sites that will be the first in Australia to benefit from national eHealth advances: Hunter Urban Division of General Practice (HUDGP), GP Partners Limited, and Melbourne East General Practice Network Limited (MEGPN).

These sites will help lead the way in developing and informing future planning of eHealth, improving technology and identifying what works well and what could work better. These early lead sites will use the identifiers for health services including electronic discharge summaries, prescriptions and referrals and, personally controlled electronic health records. The focus for NEHTA is now heavily on implementations.

For more information about NEHTA visit: www.nehta.gov.au, for more information about eHealth visit: www.ehealthinfo.gov.au.

To sign up for NEHTA’s monthly clinicians e-newsletter go to http://newsletter.nehta.gov.au/clinicians to subscribe.

Sue McIndoe has 32 years experience as a registered nurse and midwife in hospital and community health settings in Queensland, Victoria and the Northern Territory. She is currently employed by Royal District Nursing Service in Melbourne where she manages the Informatics department and is on the executive committees of Nursing Informatics Australia and the Victorian Branch of the Health Informatics Society Australia.

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