Australia's ailing e-health policy

The Australian Government should build infrastructure instead of forming endless committees, says its NZ counterpart.

By Paul Montgomery

The Federal Government has caught the information technology bug well and truly, and the health sector is just one of the many areas in which it has been planning and funding major projects to digitise the delivery of services to the public.

A report in October 1997 by the Federal House of Representatives Standing Committee on Family and Community Affairs on health information management and telemedicine recommended that the National Office for the Information Economy (NOIE) "implement or monitor" the development and installation of new IM technologies.

"One of the main reasons which influenced the committee to recommend this Office is its three-year life span," the report stated. "In that time, Australia must deploy technology within the health system, or lag behind highly industrialised countries."

The unwieldiness of the Australian Government's committee structure for handling the policy and implementation of what it calls "e-health" can be seen in this organisational chart. Source: "Health Online: A Health Information Action Plan for Australia".

"Without a national cooperative approach across all interests to inform planning in Australia, telehealth and health informatics are unlikely to be deployed systematically and the potential of these processes will be lost to the Australian community," the Standing Committee's report stated.

Two and a half years later, only part of that vision has been realised. Another report prepared by NOIE last September trumpeted Australia's "strong progress" in what it called "e-health" (www.noie.gov.au/ehealth). On looking at the actual work done, it is clear that health informatics has taken a back seat to "telemedicine", which is centred around videoconferencing, wireless devices, and other telecommunication technologies.

"It is unwise to solely emphasise the distance factor, the 'tele', in telehealth," the report warned, amid case studies which emphasised the communication aspect of technology. "The combination of information technologies and telecommunications (IT&T), of information technologies and telehealth, is beginning to have a significant effect on healthcare."

Belatedly, the Government set up the National Health Information Management Advisory Council (NHIMAC) to advise ministers last April. It released a statement in November entitled "Health Online: a health information action plan for Australia". This detailed yet another blueprint for implementing a New Zealand-style health informatics system in Australia, with NHIMAC itself taking on some of the responsibilities outlined in the 1997 Standing Committee report. State and Federal Health Ministers agreed to this blueprint in August, and it was endorsed in an article published on the Internet by The Medical Journal of Australia (www.mja.com.au).

The Federal Government's vision of technology in the health sector. Source: "From Telehealth to E-Health: The Unstoppable Rise of E-Health", NOIE.

However, the action plan did not contain some necessary elements. While the NHIMAC took on the load of "monitoring and evaluating progress in implementation of the plan", it has no power to actually build any parts of the system. The plan contained no provision for the establishment of a controlling body such as the NZ Health Information Service which would construct and maintain a system for capturing and storing a centralised database of health records.

Paul Cohen, group manager of the New Zealand Health Information Service (see case study, page 22) said that his organisation had learned a lot from the Australian example, as there were experiences and issues which were generic to health industries across the world.

"The further away you get from the interface between the patient and the health provider, the less able to understand you get," said Mr Cohen. "There are so many committee structures in Australia, and things get passed from one to another. There are components of infrastructure which are necessary to have a healthy system, and the government's role has to be putting these infrastructure components together. I would encourage our colleagues in Australia to focus on that."