Australia behind on e-health: HealthLink

Tom Bowden, chief executive of Auckland-based secure messaging and integration specialist HealthLink, said Australia had failed to do the hard work on building basic capacity, setting standards and improving data quality.

"All the really flash stuff has been worked on and there's been lots of bright ideas, but the real effort is still to be done and we won't see solid progress until that occurs," he said.

"Nowhere near enough effort has gone into getting the quality of GPs' electronic patient records up to scratch, and organising standardisation of the information that's to be exchanged."

In contrast, 100 per cent of GPs were using fully functional e-medical records by 2000; 100 per cent have been doing clinical messaging and 95 per cent of hospitals have provided e-discharge summaries over the same period. Because of this infrastructure, New Zealand has been able to build and release a raft of more sophisticated applications.

The latest is electronic referrals from a GP's office to hospital specialists. HealthLink has completed the rollout of a web services e-referral platform across half the country. New Zealand celebrates the 10th anniversary of its universal patient record system this year.

"A hospital offers a menu of referral types depending on specialty, the GP picks one and the GP's system automatically picks up all the required information with one click," Mr Bowden said.

"The referral is then submitted electronically to the hospital, where it becomes part of the patient's incoming record.

"Where the system is in use, some 80 per cent of referrals are being done while the patient is in the GP's room, during a 10-minute consultation.

"The specialists like it because they get all the information they need, and the inclusion of test results or digital photos cuts waiting time because they have a much clearer understanding of what's wrong."

Mr Bowden said New Zealand achieved its connectivity using the messaging standard HL7 version 2, while most labs in Australia still used the outdated pathology reporting format PIT.

"I'm sad to say PIT should have been replaced long ago by HL7v2, but its use for pathology messaging is still rising," he said. "This gets back to basic messaging not being properly run here.

"Every lab is supposed to go through testing with the Australian Health Messaging Laboratory to ensure their conformance with HL7v2.

"I rang the AHML the other day, and not one lab had done the test.

"This means you have a tower of Babel - and if you can't get your lab data into a standardised format you can't do things like e-referrals."

Even where HL7v2 was used, "there must be more than 30 different variations" out there.

"I've had full and frank discussions with the National E-Health Transition Authority over this issue, but I don't feel I have been listened to at all."

In Australia, around 70 per cent of GPs are using HealthLink services of some kind, but their usage is quite limited.

"A typical Auckland or Christchurch medical practice will be communicating with 50 or 60 other parties electronically," Mr Bowden said.

"There's very little paper coming into those practices.

"In Australia, it's more common for a practice to only be communicating with two or three parties.

"And where they are communicating, typically the communications are of relatively poor quality, and therefore the reuseability within a patient record is fairly negligible."