‘A Health Policy for Australia': response #2

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The authors of A Health Policy for Australia are to be congratulated in taking the bold step of developing a health improvement strategy for the health sector based on rational and appropriate policy perspectives and values – values which I for one am extremely comfortable with. If ever there was a sector of our Commonwealth that requires a fundamental re-think health is it.

With that said, and whilst I am aware of the risk of being described as a hammer who sees the solution to all problems as a nail, I would like to suggest that the role of information and knowledge and the technology required for their effective management have been substantially underestimated in the authors' present policy formulation.

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Over a decade and a half ago the then NSW minister for Health, Peter Collins, described working in the health system as being similar to “operating in the dark” and despite all his efforts, as the Board Chair of the Australian Institute for Health and Welfare, little has really changed for those operationally engaged in the sector although there have been steady improvements in the gathering of statistical health information. Delivery of clinical health services is an very information intense activity with all service providers needing both patient related (current patient problem, current treatments, previous illnesses, family history etc) and technical clinical information (disease descriptions and symptoms, drug information, the evidence base for treatments and so on).

A core issue that has been emerging over the last few decades, at an accelerating rate, is the amount and complexity of the clinical information required for good (and safe) clinical and management decision making. The knowledge management task involved in delivery of quality, safe, up-to-date, evidence based patient care is rapidly exceeding the capabilities of practitioners and is having a negative impact on clinical outcomes. This recognition is part of the rationale for the push in the US, UK, Europe and Canada to provide clinicians with advanced computer systems (electronic health records (EHR) with decision support) and to ensure treatment errors are picked up at the point of care delivery before the patient comes to any harm rather than later. It is now clear such systems can save countless lives each year but to date we see no thrust to sponsor adoption of such systems in Australia. (Indeed the Australian Health Information Council — the peak body in the area — has been recently disbanded as far as anyone can tell.)

Evidence from overseas very strongly suggests that implementation of advanced Health Information Technology (HIT) can achieve improved quality of care, greater patient safety and less risk of patients “falling through the (inter-sectoral and internal) cracks” in the health system. The evidence that, on most occasions, less than half of appropriate patients receive the best care for their condition based on the best available evidence is alarming in the extreme and needs to be remedied. Technology can help with this!

Additionally the costs of care and the overall efficiency of the health sector can be improved with the possibility of very significant savings being diverted to delivery of improved services (A recent study conducted in Ireland suggested the impact of better information flows and co-ordination of care could reduce the overall cost of the their health system by more than fifteen percent and there is no reason to believe the same is not true in Australia.)

Health IT can also play a significant role in empowering patients to better control their health information through the use of electronic Personal Health Records (PHR). The PHR can be used by the patient (possibly with their clinician carer) to record their clinical information in a secure fashion which the patient can then make available to other clinicians as they choose to ensure accurate communication of information between those involved in their care.

The use of EHR and PHR technology can also, overtime, improve the quality of managerial information available in the health sector and, with appropriate privacy and confidentiality controls, assist in optimising the decision making in resource allocation etc. Additionally such information can assist in the prompt detection of changes in disease patterns which may indicate unanticipated drug side effects or even bio-terrorism.

Lastly, Health IT in more mundane areas such as the supply chain, financial and human resource management computerisation offers well understood advantages which have yet to be anywhere near fully exploited in the health sector, especially in the private hospital, office practice and aged care sectors.

In summary, there exists a very compelling business case both in terms of financial and clinical outcomes for a much larger investment in Health IT (as is acknowledged by the investments being made in the US, UK Canada and Europe) to assist in delivery of the goals of the authors proposed health policy. Australia has neither undertaken to discover if the same is true for Australia (as it surely is) nor recognised the strategies developed in the late 1990's have, with few exceptions, been comprehensive failures and wastes of money.

To not have fundamental importance of Health IT as a key enabler of improved Health Sector efficiency, equity, quality and safety explicitly stated is, I believe, a significant weakness in the present document.

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