Health Care's Information Age - Tech Solutions for Medical Care and Research

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Sophie Blackshaw talks eHealth with Dr Yvette Blount, Research Coordinator for the Australian Anywhere Working Research Network and Lecturer for Macquarie University’s Faculty of Business and Economics. Dr Blount is an expert on how telework provides organisations with sustainable competitive advantage by enhancing service quality.

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How do you define eHealth?How does it differ from telehealth?
There are a number of terms and definitions relating to this area.
Some terms include eHealth, telehealth, telemedicine and mHealth. eHealth includes all uses of information and communications technology (ICT) in delivering healthcare. Tele from the Greek means ‘at a distance.’ Therefore telehealth is healthcare delivered over a distance and is a subset of eHealth. Telehealth includes preventative (for example screening, immunisations, genetic testing), promotive (healthy lifestyles and wellbeing) and curative healthcare (diagnosis and treatment of a medical condition) delivered over a distance. Telemedicine is the curative aspect of telehealth (a subset of telehealth). mHealth includes eHealth, telehealth and telemedicine using mobile devices. There is some disagreement as to whether mHealth is an appropriate term because it focuses on the technology instead of healthcare delivery.
How do you believe the new system will improve on the current one?
As for any information system, and particularly in this context, the data needs to be accurate. The data also needs to be timely. If the data is out of date then it will not be useful for either the clinician or the patient. The data needs to be complete. If there is data missing from the patient’s record, the clinician will not be able to make appropriate decisions relating to the care of a patient.
If the information is not accurate, timely or complete it will effectively be useless regardless of whether this is an opt-in or opt-out process. Doctors are not using the system according to reports (see https://ama.com.au/ausmed/1bne-health-record-system-shunned). Secondly, if patients can choose what they disclose the PCEHR the health record will not be complete and therefore not very useful for clinicians to make healthcare decisions.
How will eHealth affect the role of medical professionals?
The first issue is whether or not health professionals believe the PCEHR will benefit them and their patients. This is not a technology issue per se. There are a number of issues that relate to the quality of the information and privacy - who has access to the data? Who checks the accuracy of the data? How are the inaccuracies corrected? Who is responsible?
In a review of the implementation of the EHR in the United States, healthcare providers did not believe that care disparities were reduced or that the accuracy of information about patients was increased. The perception from clinicians/ providers was that the EHR increased workload and reduced productivity because of the additional reporting requirements. That is, clinicians believed that using the system diverted attention away from treating patients¹.
How do you think PCEHR will affect doctor-patient relations?
If clinicians believe that the PCEHR does not contribute to better patient care/outcomes or takes them away from quality interactions with patients, it is difficult to see how the PCEHR will be adopted in a sustainable way. The questions that need to be addressed here are how/when/where is the data entered? For example while talking to the patient or after the patient has left? How can the data entry be efficient? How can the doctor find the information he/she needs to communicate with the patient? The design of the PCEHR should consider all the needs of the stakeholders.
What are the ‘appropriate healthcare services’ that people in remote, rural and disadvantaged communities will have access to?
Telehealth is one way of providing access to specialists and other health providers that a patient in remote, rural or disadvantaged communities may not otherwise have access to. The patient may have difficulties travelling to see a specialist because of cost, health, family or community constraints (and also may be on a long waiting list). Telehealth potentially can provide more equitable access to health services. Recent Australian research reveals rural patients wait, on average, twice as long to see a general practitioner compared to their city counterparts (>6 days compared to 3 days), and in some regions wait four times as long (>13 days)². People living in rural areas “are more likely to have cancer, diabetes and heart disease”, “die two and a half years earlier”, “get 12.6 million fewer Medicare services, 11 million fewer prescription medicines and $800 million a year less dental and allied health care” and “as a result, they are 30% more likely to end up in hospital as a result of an avoidable cause than people living in cities” ³ (p1).
To what extent will eHealth incorporate social media? If the answer is a lot, what portion do you think will be government controlled or privately run?
eHealth already incorporates social media to some extent. Many organisations (examples include those supporting breast cancer and ovarian cancer, mental health organisations; the Cancer Council; QLD Health; NSW Health; the Commonwealth Department of Health) use Facebook, Twitter and other social media channels to provide information and to promote healthy lifestyles. Social media channels are being used by both government departments/ agencies and private operators.
If consumers are able to seek advice or treatment from clinicians through the web, how will the fees system work? How will changes to fees be approached?
The funding/business model is critically important because clinicians still need to be paid and patients need to be able to afford the services. The funding model is unclear although the Commonwealth and state governments, health funds, technology providers and patients are key stakeholders.
Do you think the government is doing enough to implement the eHealth system in a timely manner?
The implementation of an eHealth record is not just an issue Australia is grappling with. The adoption of eHealth records is being attempted in many countries with varying levels of success. The PCEHR has predominantly been driven by technology rather than the clinical problem. It doesn’t appear to be a question of timeliness, more a question of usefulness. How does the PCEHR support a clinician in providing better quality care? What are the benefits for patients? Have all stakeholder views been considered?
References
1 Weeks, D., Keeney, B., Evans, P., Moore, Q., & Conrad, D. (2015). Provider Perceptions of the Electronic Health Record Incentive
2 Sheppeard, A (2014) GP waiting times can be double for rural patients, Australian Rural Doctor, 28 November http://www.ruraldr.com.au/news/gp-waiting-timescan-be-double-for-rural-patients [Accessed 3 Dec 2014].
3 Cornish, S D (2014) Living in Australia’s rural areas will cut your life short, News.com. au June 8, http://www.news.com.au/lifestyle/health/living-in-australias-rural-areaswill-cut-your-life-short/story-fneuzlbd-1226947018877 [Accessed 3 Dec 2014]
Dr Yvette Blount
Research Coordinator for the Australian Anywhere Working Research Network and Lecturer for Macquarie University’s Faculty of Business and Economics
Dr Yvette Blount focuses her expertise on how telework provides organisations with sustainable competitive advantage by enhancing service quality and the implications for employee management when implementing new technologies in the service sector.
Her current project Connected Care, sponsored by Macquarie University Centre for the Health Economy, investigates the delivery of telehealth services and the implications for service quality, productivity and wellbeing of the clinical health professionals that deliver telehealth.
Dr Blount’s research program employs a multidisciplinary approach to investigate how information systems are utilised by organisations to achieve their business objectives.