Australia’s move to an electronic health system was only going to be a matter of time. Coupled with the estimated national investment of $466.7million to launch the e-health system next year, healthcare professionals and patients are contemplating the real impact this will make.

According to the Federal Government, the digital management of health information has the potential to transform the way we do things now, streamlining processes, facilitating information sharing and ultimately, making it much easier and efficient to look after the health of the nation. The specific tools that will make this happen include:

• Personally controlled electronic health records: enabling the communication of patient data between different healthcare professionals including GPs and specialists;
• Telemedicine: physical and psychological treatments at a distance;
• Consumer health informatics: use of electronic resources on medical topics by healthy individuals or patients;
• Health knowledge management: an overview of latest medical journals, best practice guidelines or epidemiological tracking;
• Virtual healthcare teams: consisting of healthcare professionals who collaborate and share patient information through digital equipment;
• M-health: including the use of mobile devices in aggregating patient data, providing healthcare information to practitioners, researchers and patients, real-time monitoring of patient vitals, and direct provision of care (via mobile telemedicine);
• Medical research using grids: powerful computing and data management capabilities to handle large amounts of information;
• Healthcare information systems: appointment scheduling, patient data management, work schedule management and other administrative tasks surrounding health.

The digital system will increase communication between healthcare professionals and the public – but what difference will it make to their everyday lives?

Patients will be able to access their personal health records and support will be at their fingertips. Ultimately, treatment will be more streamlined resulting in clearer records and more immediate access to healthcare professionals.

For healthcare providers, a seamless roll-out will enable them to access patient information at the click of a button. An electronic system will translate to improved methods for disease surveillance and being able to get a second opinion – resulting in improved patient care.

General Practitioner and former Australian Medical Association president, Dr John Gullotta says, “It’s inevitable that an implemented e-health system will alter the way patients and GPs interact. Key elements of personalised health information will be brought together and patients will be able to access their own health details and benefit from streamlined GP visits.”

Despite the anticipated benefits, there are some concerns about the implementation. The media has voiced doubts about the security of patient’s records. In addition to this, there is concern a digital system may isolate people who do not have access to a computer, particularly people living in remote areas, older generations and low socio-economic families. And like all sophisticated IT systems, there is also the risk of technical failures.

The opportunity for patients and healthcare professionals to have access to personal health information whenever needed, and the predicted streamlined treatment journey, paints a very positive picture. But until Australia’s e-health system starts operation and is assessed in practice, nobody is willing to fully sing its praises quite yet.

In Australia, 4 in 5 people have access to the internet and nearly 45% use Facebook – the largest social networking site in the world. Australians spend more time than any other country using Facebook, averaging at 7.5 hours per month. At least 4 in 5 Australian respondents in the Bupa survey were making some use of the internet to search for advice on health, medicines or medical conditions, including searching for information to make a self-diagnosis and seeking other patients’ experiences.

The internet has the potential to empower Australians to make better, more informed choices about their health and healthcare. It may facilitate economic efficiency for our healthcare system by reducing inappropriate consultations and decreasing the costs of communication between the patient and their healthcare professional.

Unfortunately, there are a huge number of websites that provide bogus information, lacking in evidence-base. This can have serious consequences, leading to needless worry, unnecessary consultations, delay in appropriate diagnosis and use of unproven, ineffective tests and treatments. How can we expect people to decipher through the thousands of results that come up within their Google or Yahoo searches? Also, most of the top 20 healthcare websites are geared towards scientific and academic communities in the US – certainly not the average Aussie.

Of the Bupa Health Pulse survey respondents, 18% are using social networking sites to find out about healthcare issues. Twitter is used by 5% for this purpose. The extent to which individuals who post comments or write blogs are representative of the broader health population is questionable, but of course this may not always be borne in mind by the individuals who take their advice.

The full potential of the internet will only be realised if there is sufficient investment in providing the tools and skills to help people discern high quality, credible content that is jargon-free and tailored to their current knowledge and skills level. Accreditation procedures might be used to ‘badge’ trustworthy websites, but support and advice on how to search for information in the first place is also a must.

What could the health system look like if the Coalition was in power?

With an election pending, there has been a lot of noise from the Opposition about potential policies and reforms. In a parallel universe, what would the Australian health system look like if the Coalition was in power?

Recent proposals  from the Federal Opposition include cutting funding from current Labor health reforms including…

• Medicare Locals
• GP infrastructure to upgrade primary care facilities 
• A national e-health system
• 24 hour GP phone helpline grants

…and using this cash to roll out a $1.5 billion plan to improve mental health services, including:

• 20 new early psychosis intervention and prevention centres 
• 60 additional Headspace sites for young people with mental illness  
• 800 early intervention beds

Whilst Tony Abbott claims Labor has been inactive in mental health reform, Nicola Roxon was quick to hit back against the proposals, saying national hospital and health reforms will be at risk if Labor is voted out of office

“It’s very important we do not neglect mental health and one of the disappointing aspects of the Government’s health reform proposals is that there’s been so little on mental health.”

Tony Abbott

 “The Coalition’s policy is undermined by the fact it is funded by cutting Labor’s health reforms, such as GP super clinics and e-health.”

Nicola Roxon

What are the stakeholders saying?

The AMA is currently sitting on the sidelines and waiting for further updates on what funding would be left for GPs, whilst the Mental Health Foundation of Australia expects the Federal Government to announce its own mental health reforms in the near future.

Australian of the Year, Professor Patrick McGorry, has called on the Federal Government bring physical and mental health together under a new mental health plan, whilst speaking at the National Press Club last week.  

The Coalition said last week they would unveil their primary care policy before the election, in response to concerns about how much (if any) funding would remain for primary care.

With a few months to go until an election, there is plenty of time for further announcements, proposed reforms and complete u-turns, so watch this space!

As predicted, health is high on the priority list in this year’s budget. A total new investment of $7.3 billion in the National Health and Hospitals Network over five years hit the headlines yesterday, funded by major reforms and tax increases across three economic sectors.

Where have the savings been made?

The 2010 Federal budget – a healthy balance?

Increases in tax revenue across three core sectors will be used to fund the pledged health reform. As pre-announced in the media two weeks ago, taxes on tobacco have increased by 25%; a $9 billion Resource Super Profit Tax on the mineral industry was announced last week; and significant reforms within healthcare through the Pharmaceutical Benefits Scheme (PBS) and a new Community Pharmacy Agreement are predicted to deliver a total $2.5 billion in net savings over five years from 2010-11.

PBS reform plans began back in 2007 and are expected to generate about $6 billion in savings. Designed to take advantage of patent expiry, cuts to the price of prescription medicines are expected to generate $2 billion savings to the Government and about $300 million to patients over four years. Economic experts at the post-budget discussion suggested that leaning against the steady growth in PBS spending seen in recent years was an appropriate measure.

Where is the money going to be spent?

Whilst tax increases are not always popular and reforms can take time, the cuts will help fund the Government’s new health commitment. These savings will provide an additional $2.2 billion to meet the needs of Australia’s healthcare system, including:

1. $355 million for almost 450 GP ‘Super Clinics’
2. $417 million to enhance after-hours services, making them more streamlined
3. $523 million to provide practice nurses in all GP surgeries  
4. $467 million to rollout the national e-Health strategy, introducing individual electronic health records

Distilling the debate down to a grassroots level, patients may receive cheaper scripts, better access to GPs and practice nurses, shorter waiting lists for elective surgery and emergency department care, and better chronic disease management.

The current Government has placed a major focus in the national health system in an election year and time will quickly show the outcome of its decisions.

A new e-health dilemma?

The battle for world search engine dominance enters a new phase this month with the arrival of a new ‘health’ search capability from Microsoft’s Bing, which seeks to challenge Google’s seemingly impenetrable global position. With health being one of the most commonly searched-for topics online, this could represent a very smart competitive move!

For those spending regular time researching health diagnoses or specific medical information (see our recent blog on ‘cyberchondriacs’), Bing does offer the potential to introduce some changes to their web search style. The .com community state Bing prioritises nine trusted and verified medical resources – such as the Mayo Clinic – as the basis of its search capabilities, making it easier to find results that can be trusted.

The declaration that Bing joins Yahoo in the war against the ‘ten blue links’ approach to reporting search results does not in fact appear to be the case in reality! But what Bing does offer is a Quick Preview feature giving text based summaries of pages displayed in the search results. An Explorer Pane also allows quick access to symptoms, causes and treatments. 

Bing offers good practical features to support general health searches – but cannot surpass Google’s unique health strategy which offers the potential for secure and private storage of medical records, easy reference to relevant health information and connection to service providers. This personal, secure medical storage capability could gain greater attention as the Federal Government make moves mid-year to integrate and digitise medical records. Discussion has already commenced on the security of the new national identity system – a key component of this new legislation.

So will health prompt the masses to start ‘Binging’ instead of ‘Googling’?  Some say if Microsoft continues to make ongoing improvements and embark on a massive advertising initiative, Bing does stand a chance in converting more than an impressionable few! Watch this space.