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A brave new world

Nurses will be integral to the smooth rollout of e-health from this month, but the profession’s leaders still see potential stumbling blocks, reports Flynn Murphy.

Australia’s health sector has begun a monumental shift towards a networked, national electronic health system – better known as e-health. It starts with the digitising and consolidating of patient record keeping, through Personally Controlled E-Health Records (PCEHR).

Australia’s nurses make up more than half of the health workforce and will be vital to the successful implementation of e-health, particularly in regional and rural areas. The leaders of the profession’s peak bodies say they see both challenges and opportunities for nurses during the rollout in the weeks and months ahead.

Nurses and midwives understand the importance of increased connectivity across the health and aged care sectors, according to Australian Nursing Federation (ANF) federal secretary Lee Thomas.

They will be able to access a person’s personal health history, meaning the patient won’t need to recite their full history every time they visit a different health professional or remember their medicines regime. Nurses would be able to consult, diagnose and advise treatment across remote sites in a more interactive manner, she said.

Thomas said a structured e-health system would help bridge the chasm between the public and private sectors – one which often led to frustration and impacted care when patients moved between sectors.

“E-health should improve inter-professional practice, with all health professionals contributing to the same set of records aspiring to ‘one source of truth’ for clinical decision making,” she told Nursing Review.

For Julianne Badenoch, president of the Australian Practice Nurses Association (APNA), e-health will be particularly beneficial for rural and remote nurses. “E-health will break down some of the barriers of isolation. For patients it will mean they have absolute control – they know what they’re doing and when they’re doing it. We’re very isolated out there.”

Badenoch said the days where critical patient information is lost would be a thing of the past.
Notwithstanding the potential benefits, Thomas said there were still issues which needed to be resolved.

The lack of, or limited access to, computers in aged care and general practice settings posed a problem, as did the reality that some nurses and midwives were not computer literate to a level that would enable them to operate e-health software.

She said that in 2007 the ANF undertook a project to identify the issues nurses and midwives encountered using information management systems. Many were unsure of how successfully individually developed systems would be able to talk to each other and safely transfer data, she said.

Given that training would be paramount, Thomas said the union had been working with the National E-Health Transition Authority (NEHTA) and the federal government to develop an awareness campaign for nurses and midwives on the PCEHR.
“Some e-health and PCEHR training modules are available but are not specifically available to and contextualised for nurses and midwives,” said Thomas.

Fellow of the Australian College of Nursing (ACN), Tracey Osmond agreed training for nurses and healthcare staff would be essential for the successful implementation of e-health.

Osmond is the former chief executive of the College of Nursing, which recently merged with the Royal College of Nursing to form the ACN.

She said nurses need to lobby professionally for e-health training and education programs, and these would come from the Department of Health and Ageing, not NEHTA.

“Nurses must be educated in using these systems. The federal government needs to be constantly reviewing the level of funding being allocated to support the uptake of electronic records across all health professionals,” Osmond told NR.

Raising awareness

Osmond dismissed media reports of a delay in the implementation of the PCEHR and said any Australian would be able to sign up for one from July 1. However, she said the launch might seem lacklustre to some who don’t understand the system.

“The best analogy I’ve heard is like when the World Wide Web first started. Anyone could log on, but there wasn’t anything there. With the web it took a community of users to make it what it is today.”

She said people needed to understand the records wouldn’t be retrospective and they would have to request previous information to be added.

“We need to be aware and pro-active – this is the role I think nurses will play. It’s a step into the future for sharing information, reducing the incidence of medication errors and other errors that occur as a result of not having timely information at hand when clinical decisions are at hand.”

Osmond said it wouldn’t be a panacea to all of the ills of the health system, but it would go a very long way to reducing the errors.

Issues around security

A system of encryption and user tokens would make e-health vastly more secure than the current system, said Osmond, who added that current fears were based on misapprehensions about the security of the present system.

Badenoch said it was helpful to debate questions about safety and quality. “Primary healthcare nurses and all professional nurses hold clinical governance as paramount in their professional lives. And that requires absolutely being mindful day-to-day, minute by minute of both risks and opportunities. There aren’t many things in life that aren’t an opportunity without a risk. I wouldn’t want to hinder progress by being fearful of that risk.”

Badenoch said APNA encouraged all its members to have individual professional indemnity insurance.

Nurses can familiarise themselves with the new e-health system by visiting www.ehealth.gov.au

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