Several weeks ago, Hinterland-based health consultant and futurist, Stephen Alexander facilitated a national Australia eHealth discussion with a number of leaders delivering national health outcomes. The discussion was held in Sydney at the international CeBIT conference – the world’s largest trade fair showcasing digital IT and telecommunications solutions for home and work environments.
This is Stephen’s summary of key conclusions from the discussion.
LEADING UP TO the recent federal election, both Julia Gillard and Tony Abbott promised more money to bring the health service into line with the rapidly expanding demands on the system. They both wanted to reassure voters that all is well, despite the ageing population and growth in chronic disease across all age groups.
The report from our panel discussion suggests that this promise of delivering a sustainable health service for us all is actually unachievable.
My role as facilitator was to tap into the experiences of this leadership group to see if we could get some agreement on what actually works from a patient perspective, and where to best spend the limited money available.
We saw the challenge as alternatives – either reducing the damage that the health system does to patients or identify evidence that demonstrates a tangible value in acute circumstances, managing chronic disease or generating more wellness.
It is clear that an affordable efficient health service needs to be interconnected in order to deliver what is referred to as a “continuum of care”.
Take, for example, the annual diabetes check up where coordination between the various caregivers, medical testing and hospitals are so broken that patients and their information gets lost in the system.
Early in 2010, Prime Minister, Kevin Rudd admitted that over 30% of hospital beds in Australia are filled up with patients who are direct casualties of the broken system of managing diabetes.
A recent examination in a Queensland region supported this finding and identified that 100% of GP referrals to hospitals had to be duplicated along with the medical testing because the information did not follow the patient. This also occurred in 40% of the referrals to the average of five specialists per patient per year is costing the Medicare system millions of wasted dollars.
Any proposed solution must also take into account the global trends. These include: healthcare costs going up; demand for services also going up; people’s expectations are going up; there is no more money; there is at best limited success from the large information projects; there is a growing shift towards community or home care rather than hospital; and finally, the whole health system will have to migrate towards a patient-centric model rather than the current mix of administration and clinician- oriented service.
The Australian Treasury has announced that on current projections (which does not include the cost of new treatments), state governments will spend over 100% of their entire revenues by 2040?. No mention was made of when the tipping point would occur; where the rationing of health services would have to be introduced.
The general conclusions from our discussion were in line with those of the UK’s Sir Muir Gray, Chief Knowledge Officer National Health Service (NHS), who says that funders should put the “squeeze” on health and not throw more money at it.
This would encourage innovation, make the health systems actually work, and find other ways to deliver services via latest technology. This is in keeping with the core trends of patient-led innovation, the harvesting of clinical evidence and the creation of common systems for service delivery rather than the ad hoc approach of today.
Our group made three basic recommendations: to ensure wise investment of limited dollars; to ensure a patient-centred, community / home delivery model, and to encourage greater self-responsibility and self-management of chronic disease.
So what would this mean to health outcomes on the Sunshine Coast? Well new high tech hospitals have to be built and old ones maintained just to meet the current demands. But this will not fix the current escalating problem of managing the ageing population or the explosion of chronic disease.
Kate Gunn of the Super Clinic in Cairns, indicated that the Medicare funding procedures were in part to blame as they encourage a high rate turnover rather than encouraging GP practices to manage patients through the system, and to act as honest brokers between the various specialists. Her experience was that when this can occur patients get better faster as they can coordinate with a wider range of specialists including allied health care workers.
Here on the Range, Maleny already exhibits a great deal of collaboration between the various medical fraternities including medical testing and pharmacy, plus allied health. But this works because of the level of trust between the various parties where informal communications can fill in for the lack of an electronic transaction system.
Because of its size it’s also possible to keep track of patients. However, as Maleny grows it will start to experience the problems facing the Sunshine Coast health region where if you, as a patient, do not know as much or even more about the system and your own particular condition, then you run the risk of becoming a victim of the very health system that is funded to protect you.
So, the new federal government will need to increase funding for electronic health records.
Dr Ashby of the Princess Alexandra Hospital said that we need to spend another$6.5b and not the $1.5b currently on offer just to make available the basic information about a patient to each party in the form of a health record.
An e-health record is a means to an end, where all the parties at a regional level can establish, and then publish agreed procedures for all the key chronic conditions, treating patients based on the evidence of what works from the collective experiences of the clinicians.
Greg Moran, organiser of the Australia eHealth conference, said that the cost is falling for the collecting, storing and sharing of trusted medical information in a secure manner, along with the informed consent of the patient.
Greg predicts that by next year many individual medical practitioners and patients will have information on their own phones and devices like iPAD’s and Blackberries, irrespective of government guidelines.
“The discussion should now move away from eHealth issues and challenges”, said Greg, “and more on how we can adapt and align these latest advances and adoption of technology to benefit the health system.”
Greg also said that we could learn a lot from the UK NHS. For example, the Sunshine Coast region could take advantage of initiatives like the UK’s Expert Patient Programme. This programme has helped chronic disease support groups across the country train up their own members to better manage their condition.
Despite the initial apprehension of some medical practitioners in the UK who supported a more paternal approach, the results demonstrated that these selfempowered patients with chronic diseases reduced their hospital visits by over 40%, their stays by over 35% and visits to the GP by over 40%.
The Sunshine Coast region could profitably explore what it can do to reduce the burden on the health system and at the same time improve wellness in our community.
But like the key question in our recent federal election, where is the leadership? Who will show the initiative and be sufficiently focused on the health consumer to overcome all the self interests that have so far kept a lid on these empowering initiatives?