Thursday, 17 May 2012
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Healthcare IT
Healthcare delivery model a primary consideration
“With an ageing society and shifting disease patterns, you cannot keep building big hospitals without a requisite investment in primary and community based care systems,” says Prof Steve Boyages, Chief Executive of NSW Health Clinical Education and Training Institute in Australia.
“You don’t want a situation where you only have a strong flagship with a brave captain,” he adds. “That will expose you to a lot of vulnerabilities, including an inability to cope with demand, and an inability to focus on key strengths.”
He makes these comments to FutureGov, discussing the recent mandate by the Government of China for each locality to build its own Regional Health Information Network (RHIN).
The lessons from the US, where most state-of-the-art hospitals with sophisticated information technology are found, offer a warning to Asian countries.
Per capita healthcare spending is the US is more than two and half that of the Organisation of Economic Co-operation and Development (OECD) average, yet the US lags behind many other member countries in a range of key health indicators including infant mortality rate and diabetes.
The problem, highlights Prof Boyages, is that the country has traditionally been focusing on building big, sophisticated hospitals, but not improving healthcare delivery network in a holistic manner.
“Too much focus on acute care treatment is not the best way for chronic disease management,” Boyages says. “With an ageing society and shifting disease patterns, you cannot keep building big hospitals without a requisite investment in primary and community based care systems.”
The key, Boyages believes, is primary and community care, which is often, neglected in many countries’ health modernisation practices. Having an effective primary care network will offer better chronic disease management and reduce the need and pressure on tertiary care systems.
He comments that senior decision makers need to be very clear about the raison d’être of any major initiative in healthcare. “Clear objectives and understanding why you must do this are often lacking in the rush to improve healthcare infrastructure.”
Countries in Asia should not go down the American path, cautions Prof Boyages, who points out that the high cost of chronic disease management is simply prohibitive.
“The two key elements for effective healthcare delivery are standardisation and parameters for performance evaluation,” Prof Boyages says, adding that the delivery model of healthcare as a whole, determines the IT structure to be implemented.
“Being a tool, IT itself is not the solution to healthcare’s problems, clinical service delivery model is,” he notes. “Only when you get the delivery model right can IT work at its best by accelerating delivery, improving safety and reducing costs.”
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1 Comments
On 3 January 2011 peter macisaac wrote:
Stephen makes excellent points around the need for a balanced approach to healthcare delivery focusing as much if not more on primary or community healthcare than hospital care however.. there is an implication made that because the US is not a model to emulate that any initiatives such as their regional health information exchange (HIE) model are also flawed and should not be emulated. Can nothing good come out of the US system?.. What appears to be lacking in this report is this critical analysis. The whole idea of a regional health information exchange is about strengthening the roles of both parts of the system (especially primary care which is usually operating in an information deficit after the patient has been to hospital). While the idea of doing health information exchange using a distributed and regional model may have arisen in the US (as opposed to centralised EHR models such as Denmark, UK and Canada - to a lesser extent) this is now a world wide model and to my knowledge no country in the last 5 years has tried to go down the centralised pathway!. Information exchange standards have been developed by groups such as HL7 and are being implemented in a systems architecture using profiles developed by Integrating the Healthcare Enterprise (IHE - www.ihe.net). Most of the large international and a lot of national level vendors have implemented these standard profiles and infrastructure is appearing in many regions internationally .
I hope that China is adopting a standards based approach as a system built on standards and the collective experience of industry and many countries will be more likely to work that one developed from a blank page - So I was puzzled by the report of Stephens comments and would suspect that like many media reports Stephen has been abridged and taken out of context.
There are a lot of lessons in this also for Australia in the context of our efforts to develop a PCEHR - it would appear that we also are going down a regional model.
The Chair of the AIIHA made some excellent points in support of the above at the recent eHealth conference.
So the implied conclusion reportedly attributed to Stephen that because the US healthcare system is not to be emulated, and that primary care is vital, means that the regional health information exchange model is flawed by association is not a logical connection of observations and the conclusion is at best simplistic and more likely to be misleading