The role of e-health in responding to health system pressures

Dr Brian RichardsPrincipal Medical AdviserDepartment of Health & Ageing

Health care in Australia

• Australia’s health sector is complex:

- service delivery split across public, private and not-for-profit sectors

- financing arrangements split between public (Australian / State / Territory Governments) and private sectors

- antiquated information systems

• Patients (and providers) encounter discontinuities across sectoral boundaries (eg hospital / community interface) and between regions (eg rural/urban)

Intergenerational Report (2002)

• The Treasurer released a report in the 2002 Budget that warned that the standard of living of the next generation of Australians would be lower than we currently enjoy unless we address issues relating to:– Population– Participation– Productivity

• Much of the fiscal pressure arises from increasing health program expenditure in the context of an ageing population with rising levels of chronic illness

Growth in expenditure

Source: Intergenerational Report

Growth in health programs

Source: Intergenerational Report

Population ageing

Source: Australian Bureau of Statistics

Rate of population ageing

Source: Australian Bureau of Statistics

Health expenditure rises with age

Source: AIHW

Examples of age-related costs

Source: Productivity Commission

Burden of disease 1996

Source: AIHW

Burden of disease 2003

Source: AIHW

Cost of disease burden

Source: AIHW

Socio-demographic change

• Key points – the percentage of the population aged over

65 years will more than double between 2001 and 2051

– the number of people aged 60-64 is expected to double in the next ten years

– health care costs for people aged over 65 are triple that of the general population

– the highest rate of growth of the over 65 age group will be in 2012

Changing models of health care

• New models of care emerging to address chronic illness (80% of current burden of disease) – multidisciplinary teams– supported self-management– home-based and ambulatory care– care plans, recalls, reminders– remote monitoring

• These models of care are heavily dependent on access to and sharing of information

A mud map of Australia

Health system coverage

• 99.6% of Australia’s population resides within 80 kilometres of the nearest primary health care service;     

• 99.2% of Australia's population resides within 80 kilometres of the nearest GP;    

• 99.2% of Australia's population over 65 years of age resides within 80 kilometres of an aged care facility (95.2% live within 20 kilometres);

• 99.2% of Australia's population resides within 80 kilometres of the nearest pharmacy and dispensing agency;

• 98.9% of Australia's population resides within 80 kilometres of the nearest Home and Community Care services (95.9 live within 20 kilometres);

• 98.8% of Australia’s population resides within 80 kilometres of a hospital;        

• 98.3% of Australia's population resides within 80 kilometres of the nearest Medicare facility.

…so what does this look like in reality?

Practitioner : population ratio

Policy considerations

• Government policies are increasingly addressing socioeconomic issues in terms of:

– Employment (participation and productivity)

– Social participation (mutual obligation)

– Government services (accessible and seamless)

– Industry (development and sustainability)

– Infrastructure

– Environment

Effect of health care on economy

• Increased participation– Increased capacity for full-time work (less time

off work)– Longer working life (ill health is the largest

reason for early retirement)• Increased productivity

– Increased hourly work output per worker– 70% of absences from work are due to ill health

• Reduced reliance on income support (welfare)– 44% of disability pensions are paid due to

musculoskeletal disorders, and 24% due to mental health disorders

GDP contributions

Source: Australian Bureau of Statistics

Average productivity growth

Source: Australian Bureau of Statistics

GP workforce projections

Joyce CM, McNeil JJ and Stoelwinder JU, More doctors, but not enough: Australian medical workforce supply 2001–2012, MJA 2006; 184 (9): 441-446

Information revolution – health impacts

• Rapid growth in scientific medical knowledge and in available diagnostic and therapeutic technologies

• Better informed consumers, reduced ‘tyranny of distance’

• Increasing proportion of GDP spent on health care (from 4.2% in 1961, to 8.4% in 1996, and to 9.7% in 2005)

• Increased scrutiny of health system efficiency (value for money) and effectiveness (quality and safety)

e-Health and productivity

• Use of information and communications technology (ICT) underpins productivity growth, as well as empowering citizens and improving their quality of life

• The use of ICT in health care (e-health) improves health outcomes (quality and effectiveness of care), safety (reduced adverse events), and efficiency (value for money)

How does e-health help?

• Improves quality of care by– Prompting adherence to guidelines– Enhancing disease surveillance– Decreasing medication errors

• Major effect shown in primary care and in secondary prevention

• Improves health sector efficiency, particularly by reducing utilisation (reduced inappropriate services)

Source: Chaudry et al, Systematic Review: Impact of Health Information Technology on Quality, Efficiency, and Costs of Medical Care, Annals of Internal Medicine, 144 (10), 16 May 2006

e-Health ‘movement’

• Both internationally and in Australia, the health sector is adopting information and communication technologies

• Public and private health care providers are investing to improve the efficiency and effectiveness of health services

• However, without an interoperability framework and a change management strategy, this investment could result in islands of disconnected health data

• Adopt agreed national interoperability standards

• Promote electronic clinical records at point of care

• Exchange clinical data electronically between providers (with patient consent)

• Develop a shared summary EHR over time (with patient consent and access)

e-Health pathway

Levels of Interoperability

Level 1: Non-electronic data (eg mail, telephone)

Level 2: Machine-transportable data (eg faxed or scanned documents)

Level 3: Machine-organisable data (eg e-mail, proprietary file formats)

Level 4: Machine-interpretable data (eg structured data within standardised messages)

Source: Walker et al, 2005

$(200)

$(100)

$-

$100

$200

$300

$400

0 1 2 3 4 5 6 7 8 9 10

Years

Return by Interoperability Level – US net cumulative estimates

Level 1 Level 2 Level 3Level 4

in

$US

bil

lio

ns

Source: US Centre for IT Leadership

Sources of savings

Managing change

NEHTA

Standards

Interoperabilityarchitecture

Core national infrastructure

NationalGovernance

(Health Ministers)

Safer care

Efficiency

Change Management

Regional priorities

Industryinnovation

Clinical adoption

e-Health outcomes

Consumer support

Involved consumers

Betterhealth

Safety and Quality

HealthOutcomes

Health Needs

Health Services

HealthFinancing

Mechanisms

HealthInformation

Management

HealthWorkforce

Organisation

ChangeManagement

Risk Management

Performance Management

Access and equity(including rural/remote

and indigenous)

E-health

Accreditation

Evidence-BasedPractice

Health System Infrastructure

HealthFacility

Operation

StructuralReform

Structural context

Conclusion

• The Australian health sector is under pressure from an ageing population, an increase in chronic disease, increasing health care costs, and workforce shortages

• e-health provides some potential opportunities to respond to these pressures, provided that it is aligned in a structural context with health financing, workforce and facility management

• Change management (workflow, roles, skills) is critical in making the most of this opportunity

• Leadership is required to optimise the productivity gains available from e-health to respond to health system pressures

Thanks for your attention

brian.richards@health.gov.au