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How do they do IT? eHealth's bleeding edge part 1

The NBN has been touted as a cure-all for eHealth but hospitals, medical schools & medical pros show eHealth is fighting fit

Ever since the Federal Government announced its plan to construct a National Broadband Network (NBN) much time and talk has been dedicated to the endless possibilities of the fibre network. In few sectors has this been more the case than healthcare.

Indeed, the potential for ultra-fast broadband to transform the health sector and make the electronic health, or e-health, a reality has often been touted as the raison d'être for the network.

However this excitement -- spurred on by the promise of specialist consultations via video conferencing and GPs being able to access digital health records -- has cast a shadow over the many layers and limitations of day-to-day technology already embedded in healthcare, whether it be hospitals, specialist clinics, nursing or medical schools.

The fact is, despite the government's hype about the NBN, hospitals, medical schools, nurses and doctors are already achieving advances in health through the use of information technology.

Electronic records

Take Bill Vargas. As the IT Manager the Children's Hospital Westmead (CHW) in Sydney Vargas has helped the organisation make the holy grail of e-health -- electronic patient records -- a reality.

While the National eHealth Transition Authority (NeHTA) has come under fire for repeatedly failing to deliver e-health projects on time -- such as the implementation of a national Personally Controlled Electronic Health Record (PCEHR) -- CHW has been working on its own decade-long electronic record journey based on Cerner.

"We've got a full electronic medical record integrated, which means we've got things such as, electronic ordering, electronic patient scheduling, results reporting including pathology," he says.

"What we do as part of the electronic medical record is scan the paper afterwards as well so we've got document imaging. That's integrated into the personal record of each patient so our transition from paper to data can be done over time... As paper is taken away and it becomes data, then we'll no longer scan the paper."

Vargas is quick to sympathise with the challenges NeHTA faces. He points to challenges with accessibility to an e-record system. "We've been at this for 10 years so it's probably been a 15 year journey now; it was about changing work practices and processes and how the system can actually enhance services and assist clinicians in patient care," he says.

"There are smart support decisions behind it and what we're finding now is our clinicians are driving requirements to the extent that our resources do not allow us to keep pace with the requirements because there's more demand for the new things to be done and our resources are limited."

Other hospitals such as St Vincent's and Mater Hospitals have been able to able to make the most of existing core competency -- in its case, writing software. The hospitals' CIO, David Roffe, says having these skills has allowed the utilisation of open source applications and tools -- such as the J-box open source Web application server and content management system Joomla -- to create its own electronic patient record.

"We're an application and development house, which is unique in Australia," he says. "There are four people in the development team and we have 32 IT staff to look after three hospitals: St Vincent's Public and two private -- St Vincent's Private and the Mater Hospital in North Sydney. We're a shared service; we provide those services across those three hospitals from a single IT department based in Darlinghurst." Further suggesting how far hospitals are ahead of the curve, Roffe says St Vincent's Private and the Mater Hospital have had an electronic medical record system for the past decade and a half.

"Everything a nurse has done in a private hospital has been electronic for 15 years and that same system is moving into the public as we speak," he says. "We've been making that transition for about eight years.

Like CHW's Vargas, Roffe stresses there are challenges, particularly around change management among senior medical staff -- read: older doctors reluctant to change their ways -- but younger staff are embracing change.

"The junior doctors just eat this stuff up and that's what we provide for them, but the senior doctors don't type, so if you put a clinical system in front of them that's electronic, they don't want to feel disenfranchised in front of the junior people," he says. "The junior people tend to do more of the work; it's a generational thing. The junior doctors interact with the system; for the senior doctors we provide view access so they know what's in it but they don't like to type so the junior doctors do it all for them."

Mobility

Out of both need and innovation, technology enabling greater mobility of staff at all levels in the health sector has been one of the great e-health success stories.

Devices and communication media such as tablet PCs, laptops, SMS, Skype and email are being trialed and used to share and communicate in hospitals around the country.

As one of the largest healthcare providers in Victoria, Southern Health comprises a number of sites including the Monash Medical Centres in Clayton and Moorabbin, Dandenong Hospital, Casey Hospital, the Kingston Centre as well as various small satellite sites. According to the organisation's CapIT manager, Donovan Ferguson, Casey Hospital is the designated guinea pig for technology trials due to its full spectrum of patients which enables staff to try different devices across a range of disciplines.

Recently the organisation trialed a "100 per cent wireless" work project that enabled staff to use laptops and tablets anywhere in the hospital. As a result, the emergency department is now about to deploy tablet devices for its staff to test and establish what works best.

"We'll be looking at whether they need a keyboard, [if they] can function using touchscreens, and what happens to these devices when they get blood, vomit or urine on them," he says.

"These things must be considered when you get rid of clipboards, which can easily be thrown in the bin. You've got to be able to clean these devices otherwise they become an infection control risk."

As with any technological implementation, mobile devices come with challenges, such as identifying the most appropriate device to support clinical workflow as well as ensuring integration with new and existing systems. An aversion to technology among senior clinicians is also not uncommon.

However, among nursing staff tablets and smartphones are being embraced, Royal District Nursing Service acting CIO, Grant Ironside, says. The technology has become so popular that training on mobile devices has become part of the organisation's induction process.

"We have two formalised session that look at familiarity with the device in general and the specific tools on the device," Ironside says. "Delivering that training we have clinical staff, so we can cover off clinical issues and technology issues as they arise on those sessions."

"It's about delivering even more mobile services to a mobile workforce. We've got a more dispersed workforce, and while that has offered us some great opportunities, it has been hard for us to create collaboration, and for our staff to get in touch with experts in [particular subjects]. Next on the agenda is that we're really trying to get a collaboration suite in place, and that's leveraging all of the things we've got in play."

Over at St Vincent's and Mater Hospitals' Roffe has started implementing tablets at the health service's public hospital -- primarily for viewing patient scans, records and other data -- and echoes this sentiment.

The hospital's public ward uses eight wireless laptops and 14 fixed desktops for entering information into a patient's electronic record, a task that is carried out by junior doctors and requires a keyboard.

"Senior doctors just want to view the information; that's where tablets come in. The senior doctors view the data and then liaise with the junior doctors about changing or entering information on the laptops," he says.

However, in the private wards the process is vastly different, Roffe says, where having only a small number of doctors mean nurses do most of the day-to-day work on their own dedicated terminal


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