[LINK] Building the Australian National Health Network

[Tom Worthington]

Dr George Margelis, from Intel's Digital Health Group, talked on Tuesday
in Canberra about "The Patient Journey - What role for IT?" he will be
repeating this in Brisbane, 17 March:
<http://www.acs.org.au/index.cfm?action=load&area=9004&temID=eventdetails&eveID=10155658429706>.

Dr Margelis, showed a number of interesting before and after video
segments of problems with the health system and how ICT could help.
Normally I dislike company videos in presentations as they are
advertisements for companies. While these were clearly produced for
Intel, they were relevant to the topic.

The first video was of someone being rushed to hospital in an ambulance.
This is something I could identify with having had it happen to me:
<http://www.tomw.net.au/blog/2008/11/canberra-health-system-first-hand.html>.

The video illustrated how currently medical staff in the ambulance and
the hospital use computer based systems, but these are not linked, so
that information has to be relayed by voice or paper. A future scenario
showed the patent details being shared online between the ambulance and
the hospital. Dr Margelis emphasised that none of the technology
envisaged was exotic and was not already in use in other fields. It was
a matter of integrating it into the medial system in a way which helped
the medical staff and the patents.

The major issue was to network records so that dispersed medical
services could serve the patient. Dr Margelis showed a scenario
networking the ambulance to the hospital, to the remote specialist.

In a later scenario Dr Margelis showed patients using a home based
system. This not only monitored the patent and prompted them to take
medication, but also connected them to their helpers and medical staff.

One problem I had with these scenarios is that they were applying
computerisation to an existing system without considering how to change
the system. As an example, it is difficult for a hospital to obtain
patent's GP records in an emergency, because the records are stored on
paper in dispersed GP offices. The Intel solution is to network the
records. An alternative low technology solution would be to group the
GPs in clinics. These clinics would then be large enough to employ
professional record keepers and be open 24 hours a day, so they could
respond to emergency record requests. My doctor would not like this as
they see themselves as a provider of custom personal services, not part
of a corporation. However, the alternative ICT solution will result in
some loss of their autonomy.

What Dr Margelis presented was a clear logical vision. The question this
raises is why has it not been done? This is not a technical issue, but
still an issue for ICT professionals. It is not enough we have a
solution that the customer is not buying. The underlying issues as to 
why such systems are not implemented need to be addressed.

The Prime Minister has proposed to take over all public hospitals in
Australia: <http://www.pm.gov.au/node/6539>.

As Dr Margelis pointed out, the public hospitals are the smallest and
least important part of the health care system. There is a risk that the
government will concentrate on hospitals, resulting in better hospitals
but an overall decline in the quality of health care and an increase in
costs. This would be similar to the situation where the government
funded insulation in homes is likely to increase energy use, rather than
reduce it:
<http://www.pc.gov.au/__data/assets/pdf_file/0019/45109/sub028main.pdf>.

Similarly a networked national hospital system may increase costs and
reduce the health of the population.

Some far less glamorous, less expensive, more local community health
initiatives, might be far more effective. These could still make use of ICT.

The NBN Company provides one possible model for the health care reforms:
<http://www.nbnco.com.au/>. Under this approach the government announced
an impressive sounding multi-billion dollar national broadband network
(NBN). They then set up a government owned company to implement it. What
NBN Co has done is architect a national system, but are first
implementing small scale local projects. These projects are small enough
to be implemented efficiently and provide local benefits in the short
term, so the government can be seen to be delivering services (in what
might happen to be marginal electorates). One day all these system might
join up into the envisaged national system, but in the interim they will
provide useful local services to the community and political kudos to
the government.

Current attempts at national e-Health standards are mired in the need to
have a consultative process between government and industry. NBN
overcame this problem with broadband standards by consulting with
parties, but making clear that as a company they were not required to
wait for everyone to agree and were going to make a decision and then
implement that decision. A NHN Co (Australian National Health Network
Company) could make similar decisions for e-health standards and the
implement them.

The government could announce the goal that all public hospitals would
be networked and all patent records would be available by a set date.
Governments and companies which did not wish to cooperate would not be
funded.

One interesting question asked was when will patents will be able to ask
their doctor to put their records on Google health. This might be useful
for the patent, but the doctor would need to be compensated for the
extra effort in working out how to do this:
<http://www.google.com/intl/en-AU/health/about/>.

Another question was on casemix to provide appropriate incentives for
keeping people healthy, instead of dispensing medicine to them. If there
were the right incentives this would provide an incentive for better ICT
systems to keep the patents out of hospital:
<http://en.wikipedia.org/wiki/Case_mix>.

It was pointed out that there are now international standards for
medical imaging (Xrays). There is work on for standards for the
medial records delivered to the patent in the home, so that we will not
first build proprietary systems and then have to convert to real
standards. It may be that Australia has to accept an international
standard which is not as good as a local standard, but which is adequate
and has the advantage of widespread acceptance.

More in my blog:
<http://www.tomw.net.au/blog/2010/03/building-australian-national-health.html>.


-- 
Tom Worthington FACS HLM, TomW Communications Pty Ltd. t: 0419496150
PO Box 13, Belconnen ACT 2617, Australia  http://www.tomw.net.au
Adjunct Lecturer, The Australian National University t: 02 61255694
Computer Science http://cs.anu.edu.au/user/3890