At present, allied health practitioners are using eHealth solutions to the extent that suits their operating environments and clinical workflows, as well as their perceptions of relative benefits and barriers. This research confirms the National eHealth Strategy description of current practice: practice management tools, information sharing and sources, and service delivery tools such as chronic disease support and telehealth. Practice administration and professional research dominate these current uses, with varying levels of sophistication.
Intended future uses would expand the use of telemedicine into videoconferencing, expand remote care management with remote health monitoring and feedback on behaviour, and better support clinical decisions, electronic health records, and public health intelligence. At present, allied health practitioners are looking to use eHealth to exchange patient referrals, share health records and better communicate with patients.
The following section outlines current eHealth use by allied health profession:
- How eHealth is used today, including a detailed look at electronic health records and telehealth
- Anticipated eHealth uses
- Clinical workflows as drivers of eHealth use
How eHealth is used todayExhibit 12 captures both the current leading eHealth uses by allied health practitioners, as well as those areas where they would like to use eHealth but as yet do not. Practice administration and professional research dominate eHealth uses, with the systems used varying from bespoke software to word-processor templates. Perhaps unsurprisingly, more specific applications (e.g. transferring prescriptions to pharmacy) show lesser traction. Practitioner disinterest in these cases is driven to a large extent by relevance to profession, rather than support or lack thereof for eHealth solutions. It must be remembered that allied health is a heterogeneous group, and that applications of high importance to certain professions will be of little interest to others.
About 60% of practitioners are using computers for practice management functions such as patient booking and scheduling (60%) and billing and patient rebates (58%). Research and training is also a leading eHealth use, for online clinical reference tools (58%) and CPD (56%). Lower usage levels are then evidenced for viewing and recording patient information (40%, 37%), sharing patient information and event summaries with other health professionals (22%, 27%), and viewing diagnostic images (23%). eHealth applications such as ordering diagnostic imaging and pathology tests are rarely used (<5%), nor are decision support solutions (<5%).
The eHealth applications most sought by allied health practitioners include sending and receiving patient referrals (50% of survey respondents don’t use, but would like) and sharing health records with other practitioners (49%). Better communication with patients (sharing health records 38%, showing health-related information 37% and communicating with patients outside of consultations 35%) is also a significant desire.
The low level of usage (beyond practice administration and professional research) reflects both a lack of demand for these services across allied health, and a lack of vendor applications and coordinated communications infrastructure. As a result, the systems in use for all purposes vary from professional, interoperable eHealth suites, to practitioner-developed standalone systems and even ‘templates’ built in standard office software.
EXHIBIT 12 – Computer use, by profession
Particular applications – electronic health recordsElectronic health records are gaining traction, with over 70% of practitioners maintain some computer-based records, although only 20% of those have gone completely paperless. Of the 70% using computer-based records to store patient details, 53% use electronic health records (clinical records) while 47% only record administrative details on their patients: see Exhibit 13.
Many practices are finding the transition to computer-based records challenging, for the following reasons:
- Duplication due to incompatibility. For example, some EHR systems are unable to integrate with billing/EFTPOS systems, so a paperless process requires duplicate data entry and additional time relative to the paper-based alternative
- Risk of technical failure, which can paralyse a practice if systems are forced to go offline or are unusable for a period of time
- Medico-legal concerns about losing information or missing critical test results due to a user error or oversight
- Inability to share information with other practitioners, either because the practice is not storing data in a structured format, other practices are unable to receive structured data, or other practices are only able to receive faxes and letters
- Need for patient hardcopies. For example, patients may need print-outs of their pathology test requests so they can choose and locate a pathology lab, paper scripts so that they have flexibility in choosing a pharmacy, and physical records to share information with their families and GPs.
EXHIBIT 13 – Computer-based records, all professions
Particular applications - telehealthTelehealth use is relatively low across the allied health sector, with only 13% of those surveyed indicating they use telehealth today: Exhibit 14. Radiographers (27%), Aboriginal and Torres Strait Islander health workers (20%) and speech pathologists (18%) are the most likely to be using Telehealth services, and most are using it for training and/or consultations with other practitioners. These remain the two applications with the greatest interest in future use: Exhibit 15. Fewer practitioners are interested in using telehealth for remote monitoring or consultations with patients.
EXHIBIT 14 – Telehealth use, all professions
EXHIBIT 15 – Telehealth applications, all professions
Reference and informationOnline access to clinical reference tools and education is widespread. Approximately 60% of practitioners currently use computers to access online clinical reference tools and complete education and training. Another 30% of practitioners indicated they would be interested in doing so. This strong response is not surprising given the relatively low barriers to using these applications and the need for practitioners to complete regular educational courses, and CPD. In interviews, practitioners have indicated that online training courses are generally cheaper than, and thus preferable to, attendance at conferences to satisfy their CPD requirements.
Practice administrationPractice administration applications such as billing and scheduling are also very commonly used among allied health practitioners. These applications provide immediate efficiency and cash flow benefits at a relatively low cost, which helps explain their popularity. Use is particularly pronounced for audiologists and radiographers. Social workers and speech pathologists have the lowest current use of practice administration applications (29% and 35% respectively) and the least interest (37% and 31%) in this application.
Viewing test resultsComputerised viewing of test results is not common, with 10% of practitioners viewing pathology results on computers and 3% viewing imaging results. These low figures may simply reflect the lower incidence of this activity in allied health professions generally, rather than a strong preference for non-computer-based systems.
Dietitians (60%) are the highest users of this application. Dentists and podiatrists display the greatest interest in this application with more than 40% interested in viewing pathology results and diagnostic imaging online. Social workers, audiologists, occupational therapists and psychologists are the least interested in this application, with over 90% uninterested—in the case of social workers and psychologists, this is expected, given the nature of their work.
Record sharingOnly 22% of practitioners are currently using computers to share health records with other practitioners, yet close to another 50% would like to but don’t have the capability. Consistent with their profile as high eHealth users, audiologists and radiographers have the highest rates of record-sharing with other practitioners, while over 60% of dietitians, physiotherapists and speech therapists would like to. Practitioners are relatively less interested in sharing records with their patients, with 50% responding that they do not use and do not need computers for this application.
Electronic test and prescription orderingOnly a very small percentage of practitioners are currently ordering tests and prescriptions online, and only 12-13% are interested in doing so. This outcome is encouraging, given the small proportion of allied health practitioners for whom pathology tests and prescriptions form a part of their core business. There is greater interest in ordering diagnostic imaging online, with nearly one-quarter of practitioners interested in doing so. Again, diagnostic imaging is central to a number of allied health professions, but largely irrelevant to many others.
Over 60% of chiropractors, dentists and podiatrists are interested in ordering diagnostic images online, consistent with their high frequency of using such tools. Interest in ordering pathology tests online is overall lower, though dentists (37%) and podiatrists (44%) are interested in doing so. 50% of dentists would like to use tools to support prescription ordering, but currently do not.
Decision-making supportInteractive decision-support tools are used by only about 5% of practitioners, and interest is not strong among most professions. Interest is strongest among dentists and podiatrists: 57% of podiatrists would like to use tools to support ordering diagnostic tests.
Recording and viewing patient notesBasic electronic medical record functions such as recording patient information and viewing notes are used by about 40% of practitioners and an additional 33% are interested in using computers for these applications. Occupational therapists, physiotherapists and dietitians are most interested in these applications, making these groups provide a likely early target to encourage adoption of electronic medical records.
Patient communicationNearly 70% of practitioners are either using or interested in using computers to share information with patients during consultations, indicating the educational aspect of many allied health practitioners’ roles, and over 60% use or would like to use computers to communicate with patients outside of consultations.
Anticipated future applicationsThe national eHealth strategy National E-Health and Information Principal Committee, National E-Health Strategy, September 2008 would expand the use of telemedicine into videoconferencing, expand remote care management with remote health monitoring and feedback on behaviour, and better support clinical decisions, electronic health records, and public health intelligence. These future uses could include the following types of technologies:
- Telemedicine: A subset of telehealth technologies that enable healthcare providers to administer care remotely, e.g. kiosks with videoconferencing and vital sign devices, mobile applications and SMS
- Remote-care wellness and management: A subset of telehealth technologies that enable healthcare providers and educators to monitor, educate and influence the behaviour of patients remotely, such as:
- Remote health monitoring technologies to collect and manage data (e.g. vital signs, motion, compliance) from passive/active/interactive devices; includes workflow and decision support systems used to drive appropriate health actions based on the collected data
- Feedback and behaviour modification technologies to affect change in patient behaviour by providing health education and feedback on behaviour relative to personalised health goal
- Clinical decision support: Tools used by healthcare providers or patients to aid diagnosis, treatment, or care process decisions. For example, these may document data, display relevant data, lookup/display reference material, flag potential errors, implement (e.g. guided dose algorithms), and track over the care pathway
- Electronic health records: Systems for managing longitudinal health record spanning multiple providers across the care continuum, consisting of an electronic medical record (medical history within single provider) and Healthcare Information Exchange (to integrate and make available electronic health records across providers).
- Health intelligence: Health intelligence is a group of technologies that enables public health informatics functions and analyses such as disease surveillance, comparative effectiveness of drugs and procedures, and risk stratification analyses that enable activities such as selection of patients for disease management programs.
Clinical workflows as drivers of eHealth useThe use of eHealth applications is highly dependent on the clinical workflow of each profession. As Exhibit 16 reveals, practitioners with strong needs that can be readily addressed using existing technology are the leading eHealth adopters: radiographers viewing patient information and imaging, audiologists using clinical reference tools and showing patients health information, optometrists seeking specialist review and Aboriginal and Torres Strait Islander health workers communicating with patients. Two-thirds or more of each of these professions are using computers regularly for these purposes.
Conversely, particular eHealth applications relate to specific allied health professions: viewing diagnostic imaging results is a high use for a radiographer, and a low use for an ATSIH worker. Many allied health practitioner rarely write prescriptions, order pathology tests or diagnostic imaging – their relative interest in using computers to do so must therefore be considered in the context of each profession’s core business.
EXHIBIT 16 – Applications for computers, all professions
SummaryAllied health practitioners are mainly using computers for practice administration and online education. Further eHealth applications are limited to those that clearly suit their clinical workflows such as optometrists seeking specialist review. As well as purchasing purpose-built systems, practitioners are building their own systems, often as templates from simple office software.
Intended future uses would expand the use of telemedicine into videoconferencing, expand remote care management with remote health monitoring and feedback on behaviour, and better support clinical decisions, electronic health records, and public health intelligence. Patient referrals, shared health records and telehealth are the future eHealth uses most anticipated by allied health practitioners.
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