Dr Margelis, showed a number of interesting before and after video segments of problems with the health system and how ICT could help. Normally I dislike company videos in presentations as they are advertisements for companies. While these were clearly produced for Intel, they were relevant to the topic.
The first video was of someone being rushed to hospital in an ambulance (which I could identify with having had it happen to me). This illustrated how currently medical staff in the ambulance and the hospital use computer based systems, but these are not linked, so that information has to be relayed by voice or paper. A future scenario showed the patent details being shared online between the ambulance and the hospital. Dr Margelis emphasised that none of the technology envisaged was exotic and was not already in use in other fields. It was a matter of integrating it into the medial system in a way which helped the medical staff and the patents.
The major issue was to network records so that dispersed medical services could serve the patient. Dr Margelis showed a scenario networking the ambulance to the hospital, to the remote specialist.
In a later scenario Dr Margelis showed patients using a home based system. This not only monitored the patent and prompted them to take medication, but also connected them to their helpers and medical staff, using a wireless mHealth device.
One problem I had with these scenarios is that they were applying computerisation to an existing system without considering how to change the system. As an example, it is difficult for a hospital to obtain patent's GP records in an emergency, because the records are stored on paper in dispersed GP offices. The Intel solution is to network the records. An alternative low technology solution would be to group the GPs in clinics. These clinics would then be large enough to employ professional record keepers and be open 24 hours a day, so they could respond to emergency record requests. My doctor would not like this as they see themselves as a provider of custom personal services, not part of a corporation. However, the alternative ICT solution will result in some loss of their autonomy.
What Dr Margelis presented was a clear logical vision. The question this raises is why has it not been done? This is not a technical issue, but still an issue for ICT professionals. It is not enough to we have a solution, it is the customer's fault for not buying it. The underlying issues as to why such systems are not implemented need to be addressed.
The Prime Minister has proposed to take over all public hospitals in Australia. As Dr Margelis pointed out, the public hospitals are the smallest and least important part of the health care system. There is a risk that the government will concentrate on hospitals, resulting in better hospitals but an overall decline in the quality of health care and an increase in costs. This would be similar to the situation where the government funded insulation in homes is likely to increase energy use, rather than reduce it. Similarly a networked national hospital system may increase costs and reduce the health of the population.
Some far less glamorous, less expensive, more local community health initiatives, might be far more effective. These could still make use of ICT.
The NBN Company provides one possible model for the health care reforms. Under this approach the government announced an impressive sounding multi-billion dollar national broadband network (NBN). They then set up a government owned company to implement it. What NBN Co has done is architect a national system, but are first implementing small scale local projects. These projects are small enough to be implemented efficiently and provide local benefits in the short term, so the government can be seen to be delivering services (in what might happen to be marginal electorates). One day all these system might join up into the envisaged national system, but in the interim they will provide useful local services to the community and political kudos to the government.
Current attempts at national e-Health standards are mired in the need to have a consultative process between government and industry. NBN overcame this problem with broadband standards by consulting with parties, but making clear that as a company they were not required to wait for everyone to agree and were going to make a decision and then implement that decision. A NHN Co (Australian National Health Network Company) could make similar decisions for e-health standards and the implement them.
The government could announce the goal that all public hospitals would be networked and all patent electronic health records would be available by a set date. Governments and companies which did not wish to cooperate would not be funded.
One interesting question asked was when will patents will be able to ask their doctor to put their records on Google health. This might be useful for the patent, but the doctor would need to be compensated for the extra effort in working out how to do this.
Another question was on casemix to provide appropriate incentives for keeping people healthy, instead of dispensing medicine to them. If there were the right incentives this would provide an incentive for better ICT systems to keep the patents out of hospital.
It was pointed out that there are now international standards for medical imaging (Xrays). There is now under way for standards for the medial records delivered to the patent in the home, so that we will not first build proprietary systems and then have to convert to real standards. It may be that Australia has to accept an international standard which is not as good as a local standard, but which is adequate and has the advantage of widespread acceptance.
See also: ICT in Health Delivery in the 21st Century in 11 November 2008.