The achievement of health system reform is a major challenge for governments across the world. There are contrasting strategies about how to achieve this reform, depending upon priorities, budgets and capacities of each respective healthcare system. But there are also many commonalities that are driving the need for change, including the need to improve the accessibility of healthcare and maximise the efficiency and the delivery of quality care.
In Australia, healthcare reform continues to be a topic of major importance across the community. The National Health and Hospitals Reform Commission (NHHRC) report, published in June 2009, described Australia's health system as fragmented, with a complex division of responsibilities, accountabilities and governance. The Commission recommended major structural changes to transform funding arrangements, improve flexibility and innovation and promote greater clinical and community engagement and control (National Health and Hospitals Reform Commission 2009). Two years later, government planners, legislators and healthcare administrators are still grappling with the details of the structural changes required and the means to implement them. No one expects reform to be simple or straightforward, but there are some key factors shaping the agenda, which have major implications for how health information exchange and management is undertaken in Australia and around the world in the future.
The century of the patient?
By most accounts, rapidly changing service needs will mean that Australia's current healthcare service will struggle to maintain high levels of care for its population in the future (Productivity Commission 2011). For many key stakeholders, the task of dealing with this challenge will require: a) major redesign of health systems, processes and services to meet people's needs; b) greater emphasis on prevention as a means of dealing with rising health costs and as a means of raising health levels; and c) more thorough engagement with consumers as active participants in the management of health (Organisation for Economic Co-operation and Development (OECD) 2010; Business Council of Australia 2011; NHS Confederation 2011). Some have even described the need for a new 'century of the patient' involving shared decision making whereby the patient is an active participant in the care process (Gulland 2011).
The transformational change required to achieve person-centred models of healthcare and to overcome the fragmentation and dysfunction of current systems will require strategies underpinned by sophisticated information and communication technologies (ICT) (OECD 2010). The papers in this issue of the Health Information Management Journal (HIMJ) point to a number of the key developments related to the diffusion of ICT across the health sector and provide a valuable source of evidence and opinion about the policy implications for consumers, healthcare professionals and governments.
Antonia Hordern and her colleagues (Hordern et al. 2011) provide an outline of current evidence about the types of e-health systems in existence and their role in engaging consumers. Their review identifies five areas where e-health is helping to transform the provision of health: (i) peer-to-peer online support groups; (ii) self-management/self-monitoring applications; (iii) decision aids; (iv) the personal health record; and (v) Internet use. The authors identify the strengths and potential weaknesses of each of these areas and discuss the policy ramifications. They also highlight the importance of developing a comprehensive framework to ensure the effective, efficient and safe application of e-health. The development of an effective e-health policy framework is also an issue addressed by Christopher Showell (Showell 2011). Showell presents a case for effective citizen participation in the development of public e-health policy, stressing that its omission may impact on implementation and uptake of ICT into the future.
Wayne Usher reports on results of an online survey to identify how health information on the Internet is used by general practitioners, social workers, dieticians, physiotherapists and optometrists. Based on the study findings, the author recommended that future policy in this area should not presume that the use of the Internet is universal, or that it currently strongly affects the delivery of health care (Usher 2011). Asad Khan and Mark Western explored factors that facilitate or hinder the effective use of computers in Australian general practice. The authors concluded that the lack of use of computers is a consequence of lack of access rather than unwillingness to use computers (Khan & Western 2011). Juan Cegarra-Navarro, Anthony Wensley and Maria Sanchez-Polo (Cegarra-Navarro et al. 2011) report on an investigation of health information technologies and the quality of service for patients in a home healthcare unit within a Spanish regional hospital. Their findings used factor analysis and structural equation modelling to highlight the importance of involving patients directly in the organisational learning and implementation process as a means of securing interactive and accountable technologies.
The diversity and richness of the evidence presented and discussed in papers in this Issue emphasise the key role that e-health policy initiatives will play in helping to shape health system reform into the future. It is a common message underscored by all the contributions in this Issue and draws attention to the need for health professionals to be engaged and informed about developments in this area.
References
Business Council of Australia (2011). Using microeconomic reform to deliver patient-centredjiealth care. Available at: http://www.bca.com.au/Content/101798.aspx. (accessed 28 April 2011). Melbourne, Business Council of Australia.
Cegarra-Navarro, J.G., Wensley, J.K.A. and Sanchez-Polo, M.T. (2011). Improving quality of service of home healthcare units with health information technologies. Health Information Management Journal 40(2): 29-37.
Gulland, A. (2011). Welcome to the century of the patient. BMJ 342: d2057.
Hordern, A., Georgiou, A., Whetton, S. and Prgomet, M. (2011). Consumer e-health--an overview of the research evidence and the implications for future policy. Health Information Management Journal 40(2): 6-14.
Khan, A. and Western, M. (2011). Does attitude matter in computer use in Australian general practice? A zero-inflated Poisson regression analysis. Health Information Management Journal 40(2): 23-28.
National Health and Hospitals Reform Commission (2009). A healthier future for all Australians; Interim report of the National Health and Hospitals Reform Commission Available at: http://www.nhhrc.org.au/ (accessed 14 July 2009).
NHS Confederation (2011). Remote control: the patient-practitioner relationship in a digital age. London, The NHS Confederation.
Organisation for Economic Co-operation and Development (OECD). (2010). Improving health sector efficiency: the role of information and communication technologies. Available at: www.oecd.org/ dataoecd/62/48/45503987.pdf (accessed 23 July 2010).
Productivity Commission (2011). Caring for older Australians: draft inquiry report. Commonwealth of Australia, Canberra, ACT.
Showell, C.M. (2011). Involving citizens in policy development: a challenge for Australia's national EHR Health Information Management Journal 40(2): 38-42.
Usher, W. (2011). Developing policies for e-health: use of online health information by Australian health professionals and their patients. Health Information Management Journal 40(2):15-22.
Andrew Georgiou BA, DipArts, MSc, PhD, FACHI
Senior Research Fellow
Centre for Health Systems and Safety Research
Australian Institute of Health Innovation
Faculty of Medicine
The University of New South Wales
Kensington NSW 2052
AUSTRALIA
email: a.georgiou@unsw.edu.au
Joanne Callen BA, DipEd, MPH(Research), PhD, FACHI
Associate Professor and Senior Research Fellow
Centre for Health Systems and Safety Research
Australian Institute of Health Innovation
Faculty of Medicine
The University of New South Wales
Kensington NSW 2052
AUSTRALIA
Tel: +61 2 9385 3867
email: j.callen@unsw.edu.au
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