eHealth Australia, A CIO Round Table

Strategic Path invites four health experts to share their insight into a roundtable on the issue of e-health in Australia today. We welcome Bruce Winzar - Executive Director Information Services & CIO, Bendigo Health; Gary Oldman - IT & Communications Manager, Royal Flying Doctor Service and Melanie Kneale, CTO, NIB Health to this e-health conversation.

The Australian government has placed a high priority on healthcare reform and investment in transformational technologies is expected to play an important role, particularly in regards to e-health - and the decisions taken now on e-health will be felt for many generations.

According to IDC's June 2009 forecasts the Australian healthcare market is expected to increase, with total investment in ICT increasing from A$$ 2170.3 million in 2009 to $2,572.4 million by 2013, which will provide a compound annual growth rate (CAGR) of 4.0% for the forecast period. But how will these dollars be spent?

The National E-Health Transition Authority (NEHTA) vision for e-health in Australia is to enhance healthcare by enabling access to the right information, for the right person, at the right time and place. Thus, an Electronic Health Record would mean patients will be able to present for health service treatment anywhere in the country, and with patient approval, the treating health professional will be able to access a summary of the patient¹s treatment and medication history at the touch of a button.

But at this point, many questions remain in relation to the implementation, benefits, cost and privacy aspects of e-health records. An electronic health record must find the correct balance between efficiency and privacy.

Protection of patient privacy will be THE critical factor in gaining acceptance from consumers and the medical profession in the implementation of an electronic health record. With the increased amount of data being collected from various sources, a vigorous data governance framework will be needed to ensure proper use of data while protecting patient privacy.

So as the debate continues in the political arena and in the press, Strategic Path decided to get to the heart of the discussion - inviting hard-working health experts to contribute their insight into a roundtable on the issue of e-health in Australia today. We welcome Bruce Winzar - Executive Director Information Services & CIO, Bendigo Health; Gary Oldman - IT & Communications Manager, Royal Flying Doctor Service and Melanie Kneale, CTO, NIB Health to this e-health conversation.

We stand at the edge of an era of exciting and significant changes and benefits in health in this country. The efforts the government and the healthcare sector will make over the coming months and years will help build a health system to meet the needs of the current and future generations.

Melanie Teale

Can you tell us about any successful technology adoption or implementation that has led to improved patient outcomes and ROI at your institution? 

It's hard to classify any initiative as a pure 'technology initiative'.

They are business initiatives that are enabled partially by technology.  An example of this is our COACH programme which supports and counsels those with a high risk of repeated coronary episodes.  The technology has enabled us to identify those high risk customers and effectively case manage them through a proven process of counselling.
 
Another example is the analysis of our claims data for trends and issues, which has allowed us to educate customers and providers who have patterns beyond the what is considered the norm.  An example is of those providers with high caesarean versus natural delivery rates.  There may be a legitimate reason for this, but the information is none the less useful and can alter behaviours for better outcomes.
 
The last example is the use of online health and wellness information and on line health risk assessments but take up is generally poor across the insurers.

Was there anything you learnt during that rollout that your peers could benefit from?

I think the very point that it isn't about the technology but about the business objective. The biggest barriers – as we are seeing with E HR's across the world  - is not the technology but the willingness of consumers and providers to use it and trust it and how to get early adopters and build critical mass quickly.

Does your organization currently have trials / plans for implementing Electronic Medical Records (EMR) or Electronic Health Records (EHR)? 

We are watching progress closely and are currently co funding an industry initiative looking at the role the private insurers can play in this area.  I personally don't believe we can drive it – as an industry or individually  - that needs to come from the state and federal government.  We can however support the push for it (as it will drive better outcomes) and be in a position to create a unique value proposition for our customers by using the output to their advantage eg a tailored PHR – where we can take the data and tailor services specifically for them.

Is your organization creating / using standards to ensure interoperability of EHR with other key health organizations in your region? eg: HL7? 

We currently work according to government standards for medicare claiming with Eclipse, HCP data submission etc, but we have not tried to get data beyond those areas we cover ie private in hospital or ancillary related care.  We have not  used that data to create a personal health record as it would be incomplete and a weak version of the electronic health record a government driven national approach could deliver.  We haven't found the compelling customer value proposition without requesting and receiving data we currently do not receive ie medicare and outpatient data.  That discussion is fraught with privacy etc concerns , hence the need for a compelling value proposition such as disease or health management services that use the data.  This would not apply or be attractive to all consumers.

Protecting the rights of the consumer - privacy and individual EMR has led the centre stage debate as of late. What are your views about protecting the free flow of information and retaining ownership of health records? 

I think the fear with taking records electronic is that they can be dispersed more freely and widely than paper ever could. I do think any sharing of data within the confines of a facility should proceed without the need for approval – so if you are treated at the Royal North Shore they should be able to keep all your records and share them among providers for your treatment.  Core data such as allergies, blood type, etc should be shared and potentially stored centrally based on preregistration or approval (such as the donor register).  Information such as discharge summaries etc between services and facilities and even with your insurer should be with the patients approval on a case by case basis.  As to where it is stored or how it is accessed, I think the aggregated view should be accessed by the patient or their authorised agent but it is technology wise largely irrelevant where it is stored.  With current technology the data could be stored in multiple places and dynamically aggregated as required.  Again – I think the privacy and willingness to input and share the data is more of a challenge that the technology to deliver it.  

How could the Australian government help your organization in implementing EHR systems?

Agree on an approach, be brave enough to move forward and commit to it.  The constant trying to find the best answer could take forever. I know the UK has spent a fortune and has yet to show the results, but at least they have committed to a solution and are moving ahead.  As Private Insurers there is little we can do without the core E HR in place.  For that to work, the clinical care providers have to be entering the data and using it. To do this they need the clinical management systems in place. Only the governments can drive this and the associated investment in hardware and software required.  There isn't the value for the PHI industry to do it and definitely not a single fund.  Once the 'core solution' is in place, we can leverage off of it for our customers that want an 'nib' tailored solution or related service.

Bruce Winzar

 
Can you tell us about any successful technology adoption or implementation that has led to improved patient outcomes and ROI at your institution?

Remote Patient Monitoring

Five partner health care agencies in the Loddon Mallee region were involved in the deployment of monitors to chronic disease patients.

74 single user monitors were deployed into the homes of clients with chronic conditions (COPD, heart disease and diabetes). Clients and carers were taught to use the monitor to measure the parameters of: blood pressure, single lead ECG/heart rate, weight, blood sugar level, oximetery, spirometry, temperature and health questionnaires. Data from the monitors were transmitted over the Internet to a secure site that nurses accessed from other computers. Nurses then used this information, along with other knowledge of the client, to make clinical decisions and take the appropriate action.

The program was evaluated by an independent third party agent and results were encouraging; case workers (nurses) were able to manage an additional 25% patient increase without additional resources, there were direct savings in travel and time to visit; patients expressed a high level of satisfaction and usability of the devices and care processes and felt much more "connected" to the healthcare system

Was there anything you learnt during that rollout that your peers could benefit from?

Engage clinicians early, integrate the technology and new workflows in the model of care and support the patients / nurses with exceptional customer service.  

Be prepared to fund change management as a line item in the budget.

Does your organization currently have trials / plans for implementing Electronic Medical Records (EMR) or Electronic Health Records (EHR)?

Currently Bendigo Health is implementing a pilot EMR as part of the regional Healthconnect project.  This project integrates several legacy databases from different agencies, integrates via HL7 messaging and stores patient data (results, appointments, discharge summary) in a central repository (portal) for clinicians/GPs/nurses to view.  Only patients consenting to share their patient information are included in the project.

Is your organization creating / using standards to ensure interoperability of EHR with other key health organizations in your region? eg: HL7?

We use HL7 for all integration between new and legacy systems.

Protecting the rights of the consumer - privacy and individual EMR has led the centre stage debate as of late. What are your views about protecting the free flow of information and retaining ownership of health records?

Personally I have no issues around sharing my patient information.  In a recent survey by NEHTA 87% of Australians believe that we need a single patient identifier – Australia will have a health patient identifier by 2010 so we are set for major change.  Ownership of patient information will always be an issue.


How could the Australian government help your organization in implementing EHR systems?

•    Continue to fund innovative ehealth projects.
•    Change the MBS so as clinicians receive payment for teleconsults – i.e., understand that new technologies change the traditional models of care!
•    Continue to develop e-health policy at national level.
•    Review jurisdictional (cross border) requirements for patient care
•    Fund capital infrastructure required to implement ehealth policy, in particular change mgt, human resources, connectivity and network upgrade/equipment.

Gary Oldman

Can you tell us about any successful technology adoption or implementation that has led to improved patient outcomes and ROI at your institution?

Wireless NextG Modem -  this has allowed our medical staff to gain access to our Computer network from remote clinics locations to access patient records.  The ROI is within the accuracy of patient data when a doctor remote from home base needs information on a patients, then can access it.   Its about informed decisions.

Was there anything you learnt during that rollout that your peers could benefit from?
We had total buy in from the medical staff, it was their project and IT was just making it happen.  So its very important to have that sense of ownership from the major stakeholders otherwise it will be very difficult.

Does your organization currently have trials / plans for implementing Electronic Medical Records (EMR) or Electronic Health Records (EHR)?

We successfully implemented an EMR and centralised the system on our Citrix platform.  We consolidated 8 separate Medical Director databases into one single database and then installed the system on a SQL server which was accessible via our Citrix platform.

Is your organization creating / using standards to ensure interoperability of EHR with other key health organizations in your region? eg: HL7?

We currently use Medical Director which is HL7 compliant and shortly, Nationaly the RFDS is moving to iSoft's "Monet" system which is also HL7.

Protecting the rights of the consumer - privacy and individual EMR has led the centre stage debate as of late. What are your views about protecting the free flow of information and retaining ownership of health records?

We have had that debate on a National front, with four separate RFDS operating section each a separate company, legally could not share the patient data in one central database.  We then had to plan for four separate databases, one in each operating section.  But locally in South Eastern Section of the RFDS we are planning to share our patient information with the local Aboriginal  Health Service.  The two organisations are working together with the interest of the patient in mind.  Again its about "Informed Decisions", the better the information the better the decision.

How could the Australian government help your organization in implementing EHR systems?

They are helping at present with a grant via the "Clever Networks" program, however once very clear guidelines are laid down with regards to Unique patient identifiers and how the storage of patient data is actually going to happen then we could plan.  Otherwise we have to be the pioneers once again.



Featuring:

Gary Oldman MACS (Snr)
IT Manager with Royal Flying Doctor Service (South Eastern Section)

Started with the RFDS (South Eastern Section) in Broken Hill in 1979 as Radio Operator/Technician.  Handled telegrams over the radio, and progressed to Chief Communications Officer in 1985 managing the Radio Base at Broken Hill.  In 1997, Gary was promoted to IT Manager and was responsible for RFDS IT activities across three states.  Completed an Information Technology Degree in 2006 via Distance Education, majoring in Corporate Information Systems. Joined the Australia Computer Society as a senior member.  Gary has been responsible for database implementations covering Aviation and Medical information, the relocation of the RFDS radio base, overhauling the RFDS South Eastern IT platform to Citrix, and recently implemented centralised medical records.  Currently, seconded to the National Office of RFDS as acting National IT Manager with the task of linking our separate operating section together to form a National RFDS WAN.


Mr. Bruce Winzar
CIO Loddon Mallee Alliance

Bruce is Chief Information Officer of the Loddon Mallee Health Alliance (consortium of 25 health providers) and oversees the financial, technical and operational functions of the Alliance and is also Executive Director of Information Services responsible for ICT, applications and medical records at Bendigo Health.

Bruce has been in the ICT industry since 1976 and has held several senior ICT roles within both the private and public sector including operating his own consulting service. Bruce has pursued a lead role in specifying and supervising the delivery of new models for services in health and local government, and provided project management for a range of large projects funded by both State and Federal Government.

Bruce took a lead in role in the development of Australia's first regional telecommunications company in 1998 and was a Board member for the first 3 years of inception. Bruce project managed the development of Central Victoria's Innovation Park and was inaugural Chair of the Central Victorian ICT Cluster – a State Government initiative to promote and develop the ICT industry in central Victoria.

Bruce's expertise covers business and management systems, and he has worked across three tiers of government and facilitated a number of significant regional economic development initiatives for Central Victoria.

Melanie Kneale
CTO nib Health Funds
 
Melanie Kneale has a successful business career as an executive and Board member in the health and financial services sectors.  She is currently the Chief Operating and Technology Officer at nib health funds.  Her responsibilities cover IT, HR, Sales and Service, claims utilisation and processing and provider contracting. 

Prior to joining nib, Melanie was the Group Executive for Strategy and New Business Development at MBF for 3 years.  She joined MBF from Accenture Australia where Melanie led the private health insurance practice since 2001, as a member of the health and financial services Partner group.  Prior to this, Melanie has worked for over 14 years in the UK and South Africa, both with Accenture and for a number of key organisations in the health care and financial services industries. 

Melanie is on the Boards of the Black Dog Institute and the Hunter United Credit Union.  She has an Honours Degree in Business Science from the University of Cape Town and is a member of the AICD.