1.1 Australia's Health Care System
1.2 Health System Challenges
1.3 Health Sector Response
1.4 The National Response
Australia has one of the best health systems in the world based on the health outcomes of its citizens. However, maintaining or improving the health outcomes of Australians will require a fundamental change in approach to the way health care is delivered in this country.
The Australian health system is straining to deal with increasing cost and demand pressures and a shortage of skilled health care workers. Given this reality, we need to move to a system where every interaction between consumers and care providers achieves maximum impact on health outcomes and where scarce financial and human resources are deployed as effectively as possible. Most of all we must draw upon the latent capacity in the system represented by consumers themselves playing a more active role in the protection and management of their personal health outcomes.
This change will require a fundamental shift in the way information is accessed and shared across the health system. We have to move away from a reliance on tools such as pen, paper and human memory to an environment where consumers, care providers and health care managers can reliably and securely access and share health information in real time across geographic and health sector boundaries. The only way this can be achieved is through the implementation of world class E-Health capability.
The World Health Organisation defines E-Health as ‘the combined use of electronic communication and information technology in the health sector.’ In more practical terms, E-Health is the means of ensuring that the right health information is provided to the right person at the right place and time in a secure, electronic form for the purpose of optimising the quality and efficiency of health care delivery. E-Health should be viewed as both the essential infrastructure underpinning information exchange between all participants in the Australian health care system and as a key enabler and driver of improved health outcomes for all Australians.
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1.1 Australia's Health Care SystemThe Australian health care system is one of Australia’s largest and most complex industry sectors. It employs over 850,000 people and delivers services to a diverse population of approximately 21.3 million residents across a very wide range of geographic and socioeconomic settings. Services are provided by a complex network of largely autonomous public and private care providers working across over 1,000 public and private sector hospitals and tens of thousands of additional general practice, clinical specialist, community health, allied health and aged care settings. In 2005-06 Australia spent one in every eleven dollars on health which equated to nearly $87 billion or approximately nine per cent of GDP1.
The Australian health system is fundamentally important to the country from both an economic and social perspective. A healthy population underpins strong economic growth and community wellbeing and prosperity. Australia is performing very well relative to its international peers in this regard. OECD and Australian Institute of Health and Welfare (AIHW) data indicates that at an average of 81.4 years, Australians enjoy one of the longest life expectancies in the world and falling incidences of many major diseases2. This headline performance, however, hides a number of significant challenges and issues which threaten the future performance and sustainability of the Australian health system if not addressed.
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1.2 Health System Challenges
Health Sector TrendsThe Australian health sector, similarly to other developed nations, faces a set of increasingly significant challenges in continuing to deliver high standards of health outcomes. These include:
• Significant differences between the health outcomes for advantaged and disadvantaged, particularly indigenous, Australians
• A large ageing population
• The increasing incidence of chronic disease
• Increasing consumer demand for more costly, complex and technologically advanced procedures
• The supply and distribution of skilled health sector workers.
Together these challenges are inexorably driving increased health care service demands, costs and complexity and are already testing the limits of the financial, physical and human resources of the Australian health system.
Health expenditure as a proportion of Australian GDP has more than doubled over the last four and a half decades, from 3.8% in 1960-61 to 9.0% in 2005-06.3 The growth of health care spending as a proportion of GDP is expected to continue, increasing to an estimated 16 to 20% of GDP projected by 2045.4 At the same time Australia is facing real challenges finding sufficient numbers of skilled health care workers across many parts of the sector to satisfy current, let alone future, levels of demand. These trends call into question the very sustainability of the Australian health care system in the medium to long term.
Use of Information TechnologyThe second set of challenges relates to the way information is stored, shared and used across the Australian health system. At its core, health is a knowledge industry with information being central to all aspects of care planning, management and delivery. Despite this, the primary information tools used to manage health care in this country still revolve around pen, paper and human memory. The use of such fallible tools to manage a sector as complex and critical as health care should be a cause of profound concern for 21st century Australia.
Other information centric consumer industries such as telecommunications and financial services have undertaken sustained investment in information technology over a 20 to 30 year period. This investment has enabled companies in these sectors to integrate systems and databases across all parts of their national and global businesses and business partner networks. As a result an Australian consumer can use an ATM anywhere around the globe to access their bank accounts. Australian consumers can also seamlessly transfer their telephone and broadband services from one provider to another and can access global telecommunications networks from any point in the developed world. By contrast, the health care sector struggles to share potentially critical patient information between service providers within the same post code.
Despite its size, complexity and information intensiveness, the Australian health sector has invested well less than half of the amount sectors such as these have spent on information technology over the same period of time. As a result, the general state of health IT across Australia and the realisation of associated service quality, safety and efficiency gains lags behind that of comparable industries by many years, in some cases decades.
The Australian health information landscape is characterised by many thousands of discrete islands of information, many of which are paper based. This has created significant barriers to the effective sharing of information between health care participants, an issue compounded by Australia’s multiple health service boundaries and geographic distances. It also poses real challenges when trying to understand and report what is really happening in the Australian health care system to support population health surveillance and guide policy, service planning, innovation and clinician and operational decision making.
The relative lack of maturity of information technology within the health sector has important implications for patient safety. In a complex, multi point service delivery environment with hundreds of millions of service encounters each year, reliance on largely manual processes and information flows creates the potential for a truly significant amount of errors and inefficiencies. It is very difficult to accurately estimate the real impact of these issues because of the poor quality of Australian health system information. However, studies have found that up to 18 per cent of medical errors are due to the inadequate availability of patient information5 and that adverse events broadly account for as much as three per cent of total costs of care each year. This represents approximately $3 billion6 in avoidable annual expenditure, money that could be better spent absorbing additional health sector demands driven by an ageing and sicker population.
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1.3 Health Sector ResponseThe challenges and issues facing the Australian health care sector will not be solved by doing more of the same, particularly given the limited nature of available human and financial resources. There is a widespread recognition within the sector that better use of information technology should play a critical enabling role in implementing national health care reform and policy agendas and improving the efficiency, safety and ultimately the sustainability of the Australian health care system. There is also a greater recognition of the role that individuals can play in protecting their health and more actively participating in the care process to improve personal health outcomes. At the same time, broader social trends have increased the demand for, and acceptance of, the use of information technology to meet personal and community needs.
These sentiments, combined with mounting frustration at the severely limited ability to effectively access and share health information, are driving a substantial amount of E-Health activity across all parts of the Australian health sector. Since 2005, the Commonwealth, States and Territories have been investing, through the National E-Health Transition Authority, in key building blocks for a national E-Health platform. At the same time, every
Australian State and Territory is in the process of either defining or implementing some form of jurisdiction wide E-Health strategy, and making significant investments in foundational infrastructure in the health sector. Within the private health sector, individual clinicians, professional groups and organisations are also investing in E-Health infrastructure and initiatives. The result is a very large and growing number of disparate E-Health initiatives being delivered within local geographic regions, within acute and primary care settings, and across health sector disciplines in this country.
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1.4 The National Response
The ChoiceAs a nation Australia now faces an important choice. Do we allow this inevitable and increasing E-Health activity to continue to progress in an unfettered manner or do we take action to more strongly coordinate and align activity on a national basis?
A number of Australian E-Health projects have already delivered promising results and have allowed individual parts of the health care system to address specific local needs. However, the reality is that in almost all cases these projects have produced IT solutions that cannot be easily connected with other health information systems or scaled to support larger consumer and care provider populations. This severely limits the ability for these solutions to provide more than a narrow, localised set of benefits and, at a system level, undermines the nation’s ability to promote equity in health outcomes, drive meaningful safety and efficiency gains and ensure appropriate safeguards for personal health information.
The amount of dollars invested in E-Health by Commonwealth, State and Territory governments alone over the past ten years is estimated to be in excess of five billion dollars. Despite this investment Australia has only made marginal progress towards being able to electronically exchange information across different parts of the health sector due to the limited coordination of E-Health plans and investments.
Without some form of national coordination there is a very real risk of extensive duplication of E-Health effort and expenditure and the creation of a whole range of new solutions that cannot be integrated or scaled across the continuum of care. There is a point at which the number of these disparate systems will be so great, and integration so difficult, that the ability to realise the gains from creating an integrated system may be prohibitively risky and expensive to attain. This would represent a major lost opportunity for Australia to take a very significant, technology enabled step towards the delivery of safer, more efficient and sustainable health care services for all Australians.
The ActionTo capitalise on this once in a generation opportunity, Australia should embark on a strategy of national E-Health coordination and alignment. This would involve the establishment of national frameworks and infrastructural components that can be leveraged at State and Territory, regional and local levels to deliver solutions that are able to be integrated and shared data across geographic and health sector boundaries. The recommended strategy encourages national alignment and connectivity whilst providing the Commonwealth, States and Territories, individual care providers and care provider organisations with the ability to take different approaches to solving their specific E-Health challenges.
National action should be focused in four key areas:
• Implementing the national ’health information highway’ infrastructure and rules to allow information to be seamlessly accessed and shared across the Australian health system
• Stimulating investment in high priority computer systems and tools that can deliver tangible benefits to Australian consumers, care providers and health care managers
• Encouraging health sector participants to adopt and use high priority systems and tools as they become available
• Establishing an E-Health governance regime to enable effective coordination and oversight of national E-Health activities.
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1Australian Institute of Health and Welfare (AIHW) , Australia’s Health (2008)
2Australian Institute of Health and Welfare, Australia’s Health (2008)
3Australian Institute of Health and Welfare. Health Expenditure Data Cubes, September 2008
4Australian Institute of Health and Welfare. Long term trends in health expenditure, September2008
5Australian Institute of Health and Welfare, Australia’s Health 2002, 2002
6Jonathon P Ehsani, Terri Jackson and Stephen J Duckett The incidence and cost of adverse events in Victorian hospitals 2003–04, Medical Journal of Australia, 2006
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