E‐health in Australia: time to plunge into the 21st century

TO THE EDITOR: Pearce and Haikerwal state that “legislation to introduce health identifiers [was] recently passed by Parliament” and that e-health “can ease the patient journey, improve quality of care and reduce costs”. It is critically important to comprehend the purpose of the unique health identifier. Its primary function is to be the “key” to a patient’s clinical data and information. It is not a clinical decision-support tool that will improve care. There are many systems that require multiple identifiers for a given patient. However, the success of these systems is dependent on their ability to provide information management tools. The authors correctly state that “Australia’s health care system lags behind all other sectors of our economy in the use of computerised systems”. What must be debated is their statement that, although “general practice and community pharmacy are highly computerised, the hospital sector is not”. The debate should move from the uptake numbers for computerisation to the evidence of whether these implementations have improved care — for example, through fewer adverse drug events, decreased resource use, improved quality of care and better patient outcomes. I suspect the evidence is very thin in the Australian context. The authors observe: “Uncoordinated implementation of differing, incompatible systems within and between hospitals compounds a dire lack of national coordination of effort.” This is not a new phenomenon. We actually know what works and, in some advanced systems, what does not work. This evidence base should provide the stimulus for pursuing the changes necessary to implement effective health information technologies. These changes are more social, professional and cultural than technical. In their final comments on the National E-Health Transition Authority, Pearce and Haikerwal maintain their focus on the technologies. Can we wait 5–10 years for the e-health system to be connected via the National Broadband Network? The necessary information management tools can be implemented now. Care must be a priority. It would help if the focus was on successful implementation and a willingness to listen to those who have some degree of success in this field. A review of the National E-Health Transition Authority’s website list of clinical leaders suggests that there are few clinical informaticians currently involved.