Often viewed as a pipedream, eHealth is finally making its way out of the realm of imagination and into reality. But is the hype surrounding eHealth justified? PATRICK BUDMAR finds out.
As advancements continue to be made with computer technology, and the Internet becomes more commonplace in our daily work and private lives, transformation is expected to occur in many traditional work sectors.
For example, the retail industry underwent some growing pains in recent years as it was pulled into the digital age, along with the music and film industry. Another sector that is expected to follow in their footsteps is the healthcare industry under the oft quoted “eHealth” moniker.
Ehealth has not only been a buzzword for the last few years, but it has received some serious backing by the Australian government. In this year’s Federal Budget, Treasurer Wayne Swan committed more than $627 million to projects spanning both eHealth and welfare. While the government is cutting 3000 staff in the same year, with about 22 of those coming from the Department of Broadband, Communications and the Digital Economy, the increased investment in eHealth demonstrates its conviction behind the initiative.
In addition to committing $240.3 million to fund the IT behind the National Disability Insurance Scheme over four years, the government’s investment in eHealth also consists of $233.7 million on the Personally Controlled Electronic Health Record (PCEHR) initiative over three years.
Starting July 1, PCEHR will enable the digitisation of personal patient records, allowing Australians to register and create their own record online. The development of PCEHR is also tied into the funding of videoconferencing, where $6.2 million is being invested to provide Human Services to remote areas, while $22.2 million has been set aside for the expansion of teleHealth pilot projects.
With a sizeable amount of investment by the Australian government going into eHealth, it is no surprise that IT companies are seeing opportunities in the sector. Compounded by the fact that Australia is expected to have a growing aging population over the next 10 years, companies such as KPMG have been urging local businesses to look at opportunities in eHealth.
During this year’s Infrastructure, Operations and Data Centre Summit by Gartner, KPMG Australia partner, Bernard Salt, spoke about how the requirement for eHealth will rise as the baby boomer generation retires and lives longer.
With KPMG research finding that about 230,000 extra jobs created in health and community services in the last three years, Salt urged IT companies to get their foot in early in the health space to reap the benefits as the sector continues to grow over the next decade.
The only potential obstacle that Salt identified was skills shortages at IT companies, leading to opportunities being missed if there are not enough workers to meet market demands.
“Australians in their 20s and 30s are overseas and contributing to economies there, so it’s critical we try to attract them back,” he said.
While there has been talk of eHealth for some years now, it seems that discussions around the topic have picked up steam as of late. Kensington Computer Products Group marketing and business development manager, Sam Goldstein, attributes it to recent developments in technology and services, which has made the concept of eHealth seem more feasible to the average Australian than before.
“Most now recognise that the availability of fast and ubiquitous broadband will fundamentally change the delivery of many services in Australia, including healthcare,” he said.
Goldstein feels that this moment in time is even more poignant, as we are heading towards the July 1 launch of eHealth with the introduction of PCEHR. Because some experts and commentators have suggested that the system will not be ready to guarantee adequate patient privacy, he feels that the debate has become more heated than in the past.
“This had led to greater discussion in the media and communities more widely around security,” Goldstein said.
In addition to PCEHR becoming available to every Australian who chooses to have one from July, NetApp A/NZ principal technologist, John Martin, points to another major milestone that is about to be reached in the implementation of a national electronic health record system, namely IBM Australia’s $23.6 million contract to deliver the National Authentication Service for Health (NASH) service by the end of June.
“This means that we are now beginning to see the results of a decade of government and community consultation that begins to lay the foundations that will allow IT to significantly support improvement in health and health related fields,” he said.
Why is there so much buzz around the prospect of health care and patient records being digitised? Goldstein feels it is because eHealth has the potential to “revolutionise” health care in Australia. “Since the ‘90s, many developed countries have considered eHealth to be a central element in the provision of high quality care for patients in the future,” he said.
For a country like Australia in particular, eHealth is being viewed as a way of overcoming the “tyranny of distance” for both patients and health providers.
“As an immediate benefit, eHealth is set to improve medical access for regional and rural populations,” Goldstein said. “As an added advantage, eHealth is predicted to ease overall pressures within the health system, enabling greater efficiency, productivity and cost savings.”
The digitisation of data is also expected to allow for greater mobility, which in turn will provide more efficient and flexible working environments for health practitioners.
“In the future, we believe the digitisation of patient records and the use of mobile technology will not only support existing healthcare systems, but also lead to greater innovation and new processes for patient care,” Goldstein said.
For Martin, the hype around digitised patient records revolves around the potential for improved patient care outcomes, as well as more cost effective provision of health and health services. To illustrate, he says that most auto mechanics have more information about the state and repair history of a car that has been brought in for service than a doctor has about a new patient who has come in for treatment.
“With the current state of medical records in Australia, healthcare professionals are often forced to practice with incomplete or incorrect patient information,” he said. “Up to 18 per cent of medical errors result from the lack of availability of adequate patient information.”
The digital divide
Despite these advances, recent discussions about eHealth have centred around threats to privacy and security, though Goldstein feels it is important to remember that data security extends beyond anti viruses and firewalls.
“One of the first and most effective defences against data security breaches is physical security for devices, such as laptops, tablets and other devices that access this sensitive information,” he said.
Goldstein adds that overseas experience, such as healthcare data breaches in the US, have shown people that the integration of individual systems creates greater system susceptibilities and opportunities for security breaches.
“In Australia, the rapid adoption of newer technologies and large volumes of patient data presents a challenge for institutions to maintain security and will pose ongoing difficulties for a national eHealth system,” he said.
While larger organisations in the health system may have IT or security trained personnel, Goldstein points out that primary healthcare providers, such as general practitioners and smaller practices, may not.
“Personal health data is by its nature highly sensitive, so unauthorised access and disclosure is of even greater concern than other categories of data,” he said. “Without a unified policy across all eHealth providers, including software and physical security solutions, the confidential records of Australians will be at risk.”
Martin said that most of the concerns people have about eHealth tend to come down to the issue of trust, which he feels has always been a critical factor in the success of the patient/practitioner relationship.
“Trust that the data is up to date and complete on the part of the practitioner, and trust that the data will only be used for the benefit of the individual on the part of the patient,” he said.
What it comes down to is doctors knowing that critical, though potentially embarrassing, information to their clinical decision making has not been redacted.
“Patients want to know that their data is being safeguarded for their own use and benefit,” Martin said. “They also want reassurance it won’t be used in ways that may disadvantage themselves or relatives via illegal data mining, or future government sanctioning of medical profiling.”
However, the compliance to ensure the secure and reliable storage of electronic records could become a major concern for IT departments.
“As the sophistication and file sizes of digital medical images grow and the volume of patient data increase, this in turn means a larger investment in IT infrastructure,” he said.
Caring about healthcare
As medical practitioners handle some of the most sensitive personal information available, Goldstein naturally feels that it is vital that they understand the need to keep it secure at all times.
“To complement existing software security solutions, healthcare organisations must ensure they develop policies and train their staff in data protection,” he said. “Additionally, every device with access to the eHealth portal should be physically secured or locked down.”
While organisations can make efforts to train staff and end users to avoid data breaches, Goldstein sees the ability to detect all privacy incidents and all patient data loss as being more difficult.
“With this in mind, the most important consideration for health providers is to minimise the risk of data breaches in the first place,” he said.
As an example, Goldstein mentions the physical security solutions offered by Kensington as deterrents for data theft, such as ClickSafe Lock for computers and the SecureBack case for tablets.
Martin admits that by merely explaining the technical details of eHealth security may leave people feeling more confused, and in turn, less confident.
“The good news is that ultimately it is at the patient level where this data will have its greatest effect, especially benefiting the section of the populace who are elderly or chronically ill,” he said.
These groups are the ones who stand the most to gain from effective digitisation of medical records, he said.
“They will get this information, not because it is good for the hospital administration, or for any particular government agenda, but because the practitioners know that it has the potential to not only to improve patient outcomes in the larger population, but to save lives,” he said.
At the same time, Martin feels that, from a technology perspective, a lot has already been done to ensure that data is being kept securely.
At the same time, it is done in a way that is immediately accessible to practitioners to help them improve the decisions they make about the patient.
To illustrate this, he said that NetApp provides technologies around the secure storage and dissemination of eHealth information, with the aim of increasing the efficiency and scalability of storage infrastructure.
“We also integrate with best of breed hardware through partnerships with other key IT vendors, such as Cisco, though our NetApp Validated Architecture program,” he said.