A US study showing electronic health records failed to have any impact on outcomes for stroke patients highlights the pitfalls of simply mechanising paper-based processes, says the head of Australia’s e-health authority.
Dr Steve Hambleton, chair of the National E-Health Transition Authority (NEHTA), said e-health was unlikely to be effective if it was simply providing an electronic record of sub-standard care.
“Electronic health records (EHRs) alone — just making a computerised record of what used to be paper — isn’t helpful”, Dr Hambleton told MJA InSight. However, by interrogating the data and applying benchmarks, it’s possible to pinpoint unwanted clinical variation and improve health outcomes, he said.
“If you mechanise medical records by creating an EHR, there will be no change. But if you re-engineer what you do with that information, that’s when we should get some leverage.”
Dr Hambleton’s comments came after the Journal of the American College of Cardiology reported that e-health had no impact on the quality of care and outcomes for ischaemic stroke patients. (1)
The 3-year study evaluated outcomes for 626 473 patients in 1236 US hospitals, including 511 hospitals with EHRs by the end of study period, that had signed on to the Get With The Guidelines-Stroke (GWTG-Stroke) program. (2)
An editorial accompanying the US study described the findings as a “wake-up call” and noted the original “triple aim” of e-health in the US was to improve the quality of health care, the health of populations and the efficiency of health care systems. (3)
“An EHR’s first priority must be support of clinical care, not documentation for billing and reimbursement that adds a burden translatable into neither value nor patient health or safety”, the editorial authors wrote.
Dr Hambleton said the study findings were at odds with the experiences of US integrated managed care consortium Kaiser Permanente.
A review released last year on the introduction of a personally controlled electronic health record (PCEHR) in Australia noted that Kaiser Permanente had recorded a 66% reduction in sepsis-related mortality, a 40% drop in stroke deaths and a 50% reduction in deaths caused by heart attacks since introducing e-health systems. (4)
Dr Hambleton said the foundations were now in place for e-health to make a significant impact on clinical outcomes in Australia. He said two million Australians had a PCEHR; all Queensland, ACT and Tasmanian hospitals were now capable of engaging with PCEHRs; and, by the end of 2015, all NSW hospitals would have this capability. Some hospitals in Victoria, SA and WA were also able to engage with PCEHRs.
He said health care providers now required a clear signal from the federal government on the future funding and the strategic direction of e-health in Australia.
But Alison Verhoeven, CEO of the Australian Healthcare and Hospitals Association, said there was still a long way to go to achieve an e-health system in Australia that effectively met the needs of clinicians, health service providers and consumers.
“Recent reviews have proposed a number of recommendations for system improvement but these are yet to be implemented. We now run the risk of trying to build on a flawed system, based on yesterday’s technology, and not fully informed by either comparative experience internationally or the views and requirements of key stakeholders”, she told MJA InSight.
Ms Verhoeven said e-health systems had been deployed across most hospitals for a range of purposes, but their variability and interoperability with systems used by other health service providers was problematic.
“The requirements of clinicians and consumers, and the goal of improving health outcomes, are not central enough to e-health development”, she said.
E-health systems had the potential to improve information sharing between hospitals and general practice at clinical handover, contribute to better integration between acute and primary care, and to drive greater efficiency in the health system. “But it is unlikely this will be realised under current arrangements”, Ms Verhoeven said.
Last month, the chair of the AMA Victorian section of general practice Dr Michael Levick said poor communication between hospitals and general practices in the state was putting patients at risk. He cited the case of a patient who had died because their GP did not know they had been prescribed warfarin in hospital. (5)
Dr Hambleton said the Victorian case highlighted the importance of sharing information and the need for hospitals to better engage with existing e-health processes.
“It’s all part of the e-health strategy — we have to hand over information. There are 230 000 hospital admissions as a result of medication misadventure in Australia, and 20 000 deaths.”
He said he could not see why we should not target a 90% reduction in medication errors with proper communication and consistent e-health systems.
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