Overview of size, composition and role
Overview of group
|Description of profession||Aboriginal and Torres Strait Islander Health (ATSIH) workers are involved in addressing a range of health issues. They work as GP assistant, nurse assistant, drug and alcohol counsellor, remote outreach, mental health, sexual health and tobacco control positions. In addition, most large public hospitals employ ATSIH workers to liaise with indigenous patients and their families on admission to hospital. Those in rural areas must usually be multi-skilled.|
|Number||Approximately 2,000-2,500 ATSIH workers.
(2006 Census recorded 1,011)
EXHIBIT 38 - Distribution by Age and State
EXHIBIT 39 - Overview of practice attributes
Education, registration and accreditationIn order to be eligible to register with Medicare, ATSIH Workers practising in the Northern Territory must be registered with the Aboriginal Health Workers Board of the NT. In all other states and the Australian Capital Territory, they must have been awarded a Certificate Level III in Aboriginal and Torres Strait Islander Health (or an equivalent or higher qualification) by a Registered Training Organisation that meets the training standards set by the Australian National Training Authority’s Australian Quality Training Framework. Uniform national registration requirements are due to be introduced through the National Registration and Accreditation Scheme (NRAS) in 2012.
Funding and referral system
- Many ATSIH workers are employed in salaried roles in the public health sector or Aboriginal Medical Services.
- Eligible ATSIH workers can access Medicare on referral from a GP through the individual allied health items for people with a chronic or terminal medical condition and complex care needs (MBS items 10950-10970); the follow-up allied health items for people of Aboriginal or Torres Strait Islander descent (MBS items 81300-81360); and through MBS item 10987.
Peak National Body
|National Aboriginal and Torres Strait Islander Health Worker Association|
413a High Street
P.O Box 278
|Contact||T: (03) 9482 7799
F: (03) 9482 5628
For those ATSIH workers with positions in Aboriginal Medical Services (AMS), of which there are 145 across the country, an additional peak body, the National Aboriginal Community Controlled Health Organisation (NACCHO) represents the services. The AMS will only treat indigenous patients/clients and their families.
|National Aboriginal Community Controlled Health Organisation|
Level 2 & 3
PO Box 5120
|Contact||Ph: +61 (0)2 6248 0644
Fax: +61 (0)2 6248 0744
ATSIH workers and eHealth
Examples of relevant eHealth applicationsSome example uses of eHealth that ATSIH workers could benefit from include:
- Better connectivity and support for ATSIH workers in remote and rural areas
- Telehealth services
- Digital referrals and electronic health records
Current eHealth 'Position'The ATSI sector is dominated by concerns about privacy and confidentiality to a much greater extent than the rest of the community. This has come out of years of distrust of the health and Government sectors as a result of the ‘stolen generations’ era, and a history of discrimination in some sectors of the health industry. In some communities Indigenous people have been reluctant to attend a health service if a member of their extended family works there. As a result of these factors, there are many Indigenous people who will not routinely visit hospitals or doctors.
ATSIH workers are the link to the communities that can help address these issues. In most cases they see the patient initially, and refer them to other health workers if the problem requires significant intervention, although this can be difficult as the patient may not accept this unless a culturally appropriate service is available.
Most ATSIH workers have access to a desktop computer (either solo or shared) at the AMS, but do not carry laptops or tablet computers. This can be a problem in itself as many work in multiple locations over vast distances and cannot take information with them. This is usually a budgetary issue. The computers are used to maintain electronic health records and to collect data which is sent through to a range of Government and health agencies.
Computing skills can be a significant issue, and many ATSIH Workers require basic training in computer use. Workforce shortages reduce the ability for ATSIH workers to take time out for training. For workers in rural and remote areas, there may be limited access to training facilities.
Shared EHRs like the PCEHR would be very useful for Indigenous communities due to the mobility of populations, but there is suspicion of systems where multiple people access the record because of privacy and confidentiality issues.
There is uncertainty at the peak body level about the value of telemedicine initiatives in Indigenous communities, as the face-to-face relationship with patients is of the utmost importance culturally and it can take a long time to establish trust and rapport. It is also important to seek the permission of tribal elders when entering a community to provide health services. There is doubt that telemedicine will be acceptable if it is provided as a videoconference, and concern that this will be used by Governments to replace existing services that are working well, for financial reasons.
A great deal of education is provided by ATSIH workers at the AMS. While using email to send out culturally appropriate education may be difficult in some cases, the provision of visual information using flatscreens at the AMS has been considered.
IT infrastructure remains problematic for the AMS, as the IT platforms are all different and there is poor readiness across the whole sector to adopt proposed Government eHealth initiatives. The Northern Territory Government is the most advanced according to NACCHO, and have been developing an EHR for years, however it took 5 years to establish sufficient rapport with the communities to drive adoption.
The system in use in the communities in the NT is called Communicare, which has reasonably good technical and vendor support behind it. However it is difficult for the AMS to prioritise IT maintenance in the budget and so the systems are not used to their full potential. Uploading data to health and welfare agencies is a big part of the work of an AMS and this could be made a lot easier by having the appropriate integrated systems in place.
The work of the AMS is built on reputation and word of mouth is extremely important if the service is to be successful. Credibility and respect are hard to gain and easy to lose. There is concern the new eHealth initiatives will create more work for the services and not alleviate the time pressure on the ATSIH workers if they are not appropriately designed, leading to low uptake.
Key insights from eHealth readiness survey
- Unsurprisingly, ATSIH workers have the highest incidence of rural and remote practice (64% work daily, and only 21% never work, in a rural or remote region). Almost half (48%) work in two or more practice locations.
- ATSIH workers use computers extensively to support administration and practice efficiency (patient booking and scheduling 81%, billing and patient rebates 76%). The majority of ATSIH workers use computer-based patient notes (67% use computers to enter patient notes after a consultation, 66% to view/record patient information during consultations)
- Better access to educational materials is a core desire, with 47% using online CPD, and a further 42% reporting they do not currently use these, but would like to. 60% of ATSIH workers using online clinical reference tools. Clear unmet needs include completing event summaries online (57% currently do, a further 26% would like to), sharing health records with practitioners (36% currently do, a further 23% would like to), sending and receiving referrals (36% currently do, a further 23% would like to), and transferring prescriptions to the pharmacy (21% currently do, a further 23% would like to)
- ATSIH workers have high current and intended use of telehealth (20% currently use, a further 28% expect to within 3 years). Their leading interests are training (20%), monitoring patients remotely (15%) and consulting with practitioners (15%)
- 28% of ATSIH workers only use paper records. Of the remaining 72%, 97% use an EHR. Use of computers is perceived as expected (71% strongly agree)
- The leading benefits perceived by ATSIH workers are collaboration with other practitioners (29% strongly agree), increasing patients’ engagement in managing their health, and improving practice efficiency
- Common barriers to further adoption cited include concern about visibility of practitioner performance data (30% strongly agree) and the need to maintain compatibility with existing IT systems (30%). Utilising established technology (26%) and privacy concerns (25%) also register strongly
- ATSIH workers indicated their likely drivers of adoption to be the advice of their professional body (63%) and financial incentives (62%)