Working towards an integrated system

Interview with GE Healthcare’s Vice President of eHealth Solutions, Blair Butterfield.

GE Healthcare announced to launch its eHealth Information Exchange in Australia this week which is seen will make an impact on eHealth in Australia. As current aspirations and concerns about the development of eHealth in Australia continue to unveil, Blair Butterfield shares his experience working on eHealth projects internationally and how Australia could learn and benefit from this.

Interview: Rebecca Merrett.

Transforming the Nation’s Healthcare: Explain how the eHealth Information Exchange works and how you see it being adopted in Australia?

Blair Butterfield: How the eHealth Information Exchange works is it’s based on global standards for sharing documents which can be either structured or unstructured and we believe that the architecture is very compatible with what NEHTA has chosen for the Australian national infrastructure. Our hope is that it will be able to provide some of the regional solutions that are needed to connect up to that national back-bone.

How will the eHealth Information Exchange improve efficiency, accuracy and consistency in information sharing?

We are very excited about how information exchange will improve efficiency and in fact at GE Healthcare, there are three things that we think information technology will do. It will improve quality, it will lower cost and it will improve access to care which all of course align to our global healthcare initiatives called Healthymagination. We attempt to improve healthcare and its source by addressing those three fundamental issues and IT is really at the heart of all of them because it is the thing that can avoid waste in the system by reducing paperwork, reducing over-testing by sharing results from previous tests, reducing medication errors that cause adverse medical events to occur with patients and it can also be used to deliver healthcare to remote regions over broadband Internet. There are a lot of things you can do to combine information sharing with such things as telemedicine. We believe that we’re just at the cusp of starting on a great adventure.

Regarding accuracy of information, the sources of the information need to come from trusted organisations and trusted physicians and of course the medical profession is well regulated so that doctors hopefully do make correct decisions and do enter information appropriately into the IT system. Then the IT system is responsible for sharing information in its original form without changing it and allowing the physicians to access it, to know who it came from and how it was collected.

How will the eHealth Information Exchange support the Australian Government’s eHealth and telehealth initiatives as part of the national health reform?

I think support for the national health reform through IT is a crucial component. I would even turn it the other way around and say it’s not possible to do a true reform of the healthcare system without IT. We’ve seen this in other industries that have transformed themselves and it’s always been through the use of IT. In particular, we’ve seen that efficiency and accuracy goes up, responsiveness goes up and access to information also goes up. Of course, it brings issues that have been talked about, I think fairly openly, in many forums about privacy and consent and that it’s much easier to share electronic information but there’s also a risk in it being shared with people who are not properly authorised. It’s very important that the IT systems have the capabilities built in to protect privacy and consent.

What are your thoughts on the Australian Government’s development of Personally Controlled Electronic Health Records (PCEHR) and do you see any improvements that can be made through a more integrated system?

We believe in an approach that balances consumer privacy and participation in sharing information with protecting the integrity of the data which the providers and physicians depend on. We believe in an infrastructure that is defined at national level using global standards that are not necessarily reinvented. That’s a formula for success.  Since Australia is starting on this journey in terms of implementation, I think you’re well positioned because you can hopefully learn from other countries and their mistakes and also from some of their successes.

What would be some key learnings that you think could help foster the success of eHealth and information sharing in Australia?

I would say the key learnings that we have shared with those that ask on this topic would be:

  • Define standards early
  • Involve the physicians as much as possible in the process because they are the users and custodians of the data
  • Ensure that privacy and consent issues are managed very well to avoid consumer backlash
  • Start small and build incrementally because there will be several iterations to get to the full implementation
  • Be open to learning from other countries successes and failures

If you do all those things right then I think the chances of success go way up.

The needs of patients and healthcare workers can be quite diverse – how would you endeavour to meet the diverse needs of both patients and healthcare workers through a more integrated system?

The idea is the infrastructure should support access by all different types of users. The architecture that we announced we will be bringing to the regions has data sharing infrastructure and we also have the option for portals that allow the patients, the providers and other health workers and even statisticians to be authorised to see certain elements of the data based on the need of their role. So the key is role based access to data and then cataloguing information in the system according to the level of sensitivity and the type of information. Our systems, like many others, have the capability to make those designations so different users of the system can see what they need but only what they need.

Will people living in remote areas of Australia and Indigenous communities be able to benefit from this eHealth infrastructure too?

Yes, this is a good question about rural and remote areas. Very often those areas are underserved by medical practitioners and they may not have the most sophisticated IT systems or the capability to implement them.  So what’s needed is systems that are supported, centrally web based systems which can run over broadband Internet. Usually what we found in some countries we’ve been working with is that it’s good if you can combine information and documents with telemedicine capabilities so that you can export the expertise of medical practitioners from the central expert facility out to the regions. This can give remote access for second opinions, or for image reading, or for test result evaluations and things of that nature. I do see eHealth infrastructure that’s being built has the essential national back-bone for such services.

The Australian Government is planning to launch a national eHealth framework in mid 2012 – what is next to get it operational?

One of the things that we’ve found to be a big challenge that we’ve faced in the projects we have done is getting the providers systems which have the data in them today that needs to be shared and getting those systems connected reliably and seamlessly to the infrastructure. This is really a crucial step. It’s one thing to have a back-bone built but if it doesn’t contain the data then no-one will use it. The key is making sure the implementation program gets the cooperation and trust of the users and to technically integrate the systems in a reliable, scalable way that is repeatable at low cost. We have worked through this issue in some of our regional implementations and we would not want the government to underestimate that challenge and I’m sure they have set aside resources for that.

How long do you think it would take for this eHealth infrastructure to become fully operational in Australia?

The goal is to have it running by next year. I would say that it’s certainly possible to get the core infrastructure up and running in that timeframe. I would assume, knowing the vendors that are involved, they have the capability to build it in a data centre well within that timeframe. As I mentioned, the challenge is getting it integrated out to the systems that have the data and that could take some more time. My question would really be, how many systems do they expect to connect? I think it will take several years to connect all of the existing systems.

Will there be training and technical support provided once the eHealth infrastructure is up and running?

Yes, like any IT system, it’s a living breathing thing that needs care and feeding. If it’s deployed from a central hosted infrastructure a lot of the maintenance can be handled at a national level. But there will also need to be some experts in the regions to help the local users get most value from the system, be comfortable with using it and also trust it. For example, in the United States they funded these entities called Regional Extension Centres who are responsible for training and support. I would hope that similar plans are underway here in Australia as well.

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