In your experience, how has IT helped improve patient care, what are your expectations from it in the coming years?
It is not an overstatement that new information and communication technologies (ICT) have revolutionised the way people access information and communicate with each other. All spheres of human society have impacted by these developments. Undoubtedly, the impact of ICT developments on health sector and medicine has been significant. However, the changes prompted by ICT in health care are limited compared to other areas such as trade, banking or media. The influence of ICT can be seen in clinical practice, administration, education and research. The use of the Internet by patients and practitioners to access health information has tremendously increased in recent years. The Internet also has become a powerful media of public health and education. Disciplines such as teleradiology and telepsychiatry have proven being efficient and cost effective in delivering care. In general, a large number of research studies have shown the effectiveness of telehealth / telemedicine applications in providing improved care, particularly to communities otherwise are deprived of such services. These include rural and remote communities and populations in developing countries. Evidence suggests that the use of ICT in health, i.e. e-health / telehealth / telemedicine has a potential to address critical problems in the health sector. There is a growing awareness in health professionals, policy makers and business communities that ICT has a major role to play in health sector. These factors will facilitate the use of e-health in the future.
Considering that a majority of Asian countries are still developing, do you think Asia is ready for the rapid technological changes shaping healthcare globally?
The irony is that despite its limited use, e-health is better suited to address critical problems in developing countries. e-Health can be helpful to support limited (and often isolated) health professionals by providing better education, information and peer-support. E-health can also provide alternative ways of care delivery to meet needs of patients. But the main problem in developing countries has been the lack necessary infrastructure, funding and expertise to establish and sustain e-health. This is true with a substantial number of countries in Asia which fall into the category of developing countries. The level of ICT use in the health sector of these countries is limited. The barriers mentioned above will prevent these countries benefiting from this new tool.
Another reason for slow progress in e-health in Asia can be the magnitude of health problems themselves. Countries like India and China—world’s most populous countries—have enormous challenges in terms of health care provision. Restructuring health systems in these countries is an enormous task. However, the good news is that the rapid economic growth and the technological development have already begun to re-shape the health sector in these countries.
Meanwhile, it is worth mentioning that there are some good examples in Asia where progress in e-health has been substantial. South Korea, Singapore, and Taiwan, for example, have been able to use modern technological developments to advance their health systems.
What is the scenario in Australia?
The level of success in e-health in Australia, like in many other countries has been mixed. There have been some success stories in implementation and sustained use of e-health while others have shown disappointing results. In general, there is a rapid increase in the use of computers and the Internet within health care sector. A recent survey revealed that 94 per cent of GPs nationwide are computerised, 90 per cent GPs use clinical software packages and nearly 80 per cent use broadband connection. The growth of ICT use can be seen in both public and private health sectors.
As mentioned, the use of e-health in Australia is patchy. There are number of different research projects underway to investigate the effectiveness of ICT use in improving health care provision. Some e-health projects are initiated and funded by federal and state governments while others by business partners. However, the majority of these initiatives are run as research projects, but few have been integrated to mainstream care provision.
One key feature of the current state of e-health in Australia is a clear lack of coordination. This is probably due to the absence of an authorised body to oversee and coordinate e-health activities. It is expected that the National e-Helath Transition Authority (NEHTA)—nation’s peak e-health body—is to play a key role in Australia’s fragmented e-health fabric.
Having said that, a number of e-health projects have shown the potential to be feasible, cost- effective and sustainable. One good example is the telepaediatric service managed through the Centre for Online Health (website http://www.uq.edu.au/coh/) at the Royal Children’s Hospital in Brisbane which provides services to rural and remote communities in Queensland. It is estimated that some 15 per cent of all burns consultations are now done via telehealth.
Attempts are being made to use telehealth applications to improve the health services in the indigenous communities in Australia. If successful, these models can be used to in similar contexts in other parts of the world, particularly in developing countries. Australian government’s emphasis on expanding broadband coverage and funding IT education will have an impact on the growth of e-health. At the same time, Federal Government has also shown interest in supporting e-health.
How do you see the adoption of PHRs and EMRs in Asia? Do you think Asian hospitals are prepared to shift toward the trend?
Electronic storage and access of patients’ data has been a topic of the day in many parts of the world. Progress in electronic health records in Asia has been slow due to understandable reasons, such as lack of funding, infrastructure and expertise. Unlike European Union (EU) or some other industrialised nations, Asian countries have not been able to invest heavily into electronic health records. However, there are some impressive examples in Asia; for example to certain extent, Singapore, Taiwan and South Korea have made headway in implementing electronic health records. These examples show the trend in Asia. The transition from paper based patient records to electronic health records has not been an easy and smooth process even in industrialised countries. Continuing economic and social progress along with the technological advancement are the key for Asia to achieve this goal.
What are the areas of Healthcare IT that you think need to be further developed?
When you look at the global scenario, you can see that the key emphasis in ICT use in health has been on administration and education. A limited attention has been put on the use of ICT in clinical practice. I think it is vital to explore new ways of using technology for clinical practice and for better clinical outcomes.
It is also important to explore ways to use low cost technology as opposed to expensive technologies. There is some good evidence that simple and inexpensive technologies can be effectively used in providing quality health care. One such example can be email.
I strongly believe that technology must NOT be the focus of e-health / telehealth. While technology is important, the primary focus of e-health must be on the clinical need. Evidence shows that technology driven practices are doomed to fail. Technology must be a tool to address the need. Therefore, e-health practitioners must adopt a ‘techno-skeptical approach’ to treat technology as a tool to serve the purpose.
Any other comments?
I think there is a critical need for a global governing body for e-health. Setting up such an organisation with appropriate legal and regulatory rights should be a priority. While this peak body would have authority relating to e-health across the world, it should also have the necessary financial capability to fund its activities.
The importance of e-health education has so far been overlooked. Evidence shows that access to systematic education in e-health is limited in both industrialised and developing countries. Systematic education in e-health for health professionals must be at the heart of the strategy to promote e-health. It is important to increase funding for post-graduate studies in e-health/health informatics. The accreditation of e-health qualifications is another way to attract health professionals and help address the critical skills shortage.