by James Hutchinson

Change management key to e-health

Sep 22, 2010

The ultimate success of e-health programs in Australia will come down to how change management and adoption processes are put in place for clinicians, patients and politicians alike, a key industry leader told attendees of the World Computer Congress 2010 in Brisbane.

Adam Powick, a consultant with Deloitte and lead author of the 2008 Australian National eHealth Strategy report approved by health ministers, said that political programs had to be geared towards financials and other motivations that would create incentives for clinicians to adopt programs such as the individual e-health identifier released by Medicare in July, and the personally-controlled voluntary e-health record the Government plans to roll out by 2012.

“To get e-health to work, you have to answer ‘what’s in it for me?’ for every single part of the sector, and I think we don’t do that well enough,” he said.

Powick noted that such programs were already happening, pointing to the $392.3 million telehealth program announced by the Labor party during the Federal election campaign. The program, to begin in 2012, will see doctors paid to conduct about 495,000 online consultation services over four years to rural, remote and outer metropolitan areas — an initiative Powick said was a vital piece of the e-health puzzle.

“It’s not about the technology — technology is about 20 per cent. It’s about the change process we have to take consumers on, and politicians as well,” he said. “There’s a whole range of things that need to be done in change adoption.”

The voluntary nature of the health record would likely provide incentives for patients to adopt the system, while the continuation of a Labor government, albeit in a minority capacity, would provide at least some form of stability for existing e-health initiatives, according to Powick. However, he said the continued underfunding of the health sector for the past 30 to 40 years relative to other information industries put e-health and the entire health industry on the back foot.

Westmead Children’s Hospital chief information officer, Bill Vargas, agreed with Powick’s sentiments, adding the necessity for a “stepping stone” in the journey between pure, paper-based records to computerised data.

Since 2003, the hospital has gradually transitioned to a customised Electronic Medical Record (EMR) which, on a consensual basis, provides all clinical data for a patient on a three-month rolling cycle. Despite facing similar change management issues in enforcing new practices, Vargas claimed success in that clinicians voluntarily scanned all data for a patient within 48 hours of being recorded, which removed the information from the clinician’s control and tied it directly to the patient.

Regardless of the privacy concerns often raised in relation to e-health records, the hospital had seen widespread take-up, a key Vargas said was critical to mass take-up of electronic means

“Our consumer consultation finds parents, and in particular mothers, are saying ‘why haven’t I got this information online?’” he said.

The two industry leaders clashed, however, on how this data should be displayed. Powick pushed mobility devices as a key to presenting this information to clinicians, while Vargas said the hospital’s trials of the devices hadn’t settled well with end users. “They don’t work and they don’t think that way,” he said. “They are people so they have different ways of communicating and it’s not that structured.”

Vargas’ views on the topic cohere with that of Macquarie University Hospital CIO, Geoff Harders, who said devices like the iPad were good for patient lists and reference manuals, but easy to lose and ultimately counter-intuitive for clinicians.