Are you happy with the progress made so far by the Federal Government on the e-health front?
We’re very happy. Health Informatics Society of Australia (HISA) as an organisation is getting up close to 20 years of working with the Federal Government on the national e-health agenda, and this goes right back to the days before there was a research and development program and then the great news was the big investment in e-health that the Federal Government made in the 2009 Budget, and particularly the investment in the Personally Controlled Electronic Health Records (PCEHR). Also from a healthinformatics perspective the continued investment in the work of The National E-Health Transition Authority (NEHTA) is really critical if we’re going to have an environment where patient information can flow across the healthcare continuum, we need to all be talking the same language so that investment is really welcomed.

Where are we at now as a nation with regards to the e-health rollout?
Australia’s doing really well in terms of where it’s at. When we think about the part of the sector that’s funded by the Commonwealth... there’s been some real success stories. We’re getting close to 100 per cent of GPs being computerised... We’ve had 100 per cent of community pharmacies computerised for a number of years. Why that’s really important is because medicine is an area where there are huge benefits in terms of quality and safety that computerisation brings. In terms of the states’ and territories’ hospitals there’s been a long period of investment, and I think they’re all at different stages. If we were to use an international measure which is the HIMMSS scale: if you’re 1 you’re completely paper, if you’re 7 you’re completely electronic; I think you’ll find that most off the states and territories start to have that scale at about a 3 and very few are above a 5, and there’s sprinkling of excitement after that but that’s about it. That’s pretty much where the rest of the world’s at. There are some pockets where they are a lot further along the e-health journey, but those are also quite small countries that don’t have the size or complexity of the scale that we have to deal with here in Australia. Like Denmark for example, it is a lot further ahead but it doesn’t have the issue that we’ve got to get everybody off paper.

What work will HISA be undertaking to ensure Australia has a vibrant health informatics community?
There’s a range of foci for the organisation for the next years going forward, we have a strategic plan in place. The national Health Informatics Conference (HIC) is the way to bring together all of the people working in this space and bring all their perspectives and issues together and actually share some of the good work they’ve been doing. One of the things is people get busy with their heads down and they actually don’t realise there’s someone else in another city or town trying to fix exactly the same problem. So coming together at a national conference, hearing about what we’re doing and hearing about what’s happening in the national space and actually attending some of the educational sessions is really key because I might come from Darwin, for example, and am trying to figure out how to make referrals work better between the GPs and the specialists. Then by coming to the conference and attending an education workshop where I don’t only find out about projects that made that happen but they actually give out intellectual property (IP) around templates and systems – so that’s great in terms of the national conference.

Within the HIC there are themes that are really around our strategic themes as an organisation, and they are more around the work program that we take forward. But there’s also an aged care stream that we have within the organisation which is promoting the use of information technology in the delivery of aged care services. There’s actually a cluster of people around that and they have their own national conference and a series of activities throughout the year to support that environment. There’s a digital hospital design group that are working quite solidly on bringing together industry, government and clinical communities to come up with blueprints and architectural designs for a digital hospital.

There’s also a community within the nursing profession – a nursing informatics group. They actually existed before HISA, they created HISA so they’re very strong and down to the point where they’ve developed curriculum and you can actually be employed as a nursing informatician.

There’s also some new and emerging groups that are a focus for us going forward, for example, Games for Health, which looks at the intersection between critical care and the utlisiation of gaming technology. Across the country there is a massive shortage within the endoscopy area, a shortage of skilled people who are able to use an endoscope to the level that they need to be able to perform an endoscopy. One of the ways you train them is you shadow your colleague for a period of time and then you’re able to take over after a period of time. It’s really manually intensive. We’ve proven that we can improve their ramp-up time by about 30 per cent by giving them access to virtual tools which are actually games based where they learn how to use an endoscope. We’re using that now.

There are some scenarios where virtualising these, in the same way that you have virtual people when you play some computer games, enables you to be able to help, train, upskill and keep your skills fresh. And there’s quite a few examples around the world of implementations of these sorts of technologies and because of that we’re opening up a new stream of work this year.

The other area is indigenous. There’s a really huge need for an e-health focus in the indigenous space. Unlike a hospital where you decide to go from paper to computers and there’s a whole bunch of people that can pitch in, from an indigenous community perspective – where are those people with those skills? How do we go on that journey? What are the issues around privacy? Are there different issues from an indigenous perspective around privacy than there would ordinarily be in the mainstream community? What are the skill sets of our indigenous health workers? Are they computer savvy? So there are a range of different issues we need to tackle around indigenous healthcare.

In Queensland we are moving to community controlled health services, so indigenous communities are taking control of their own health services. One of the capabilities they need to have in place is that they actually have an information-management capability because how else do you do population health work if you don’t have the data to understand what the health of your population is? And then what do you do with that next? How does that turn into a set of prevention activities and so forth? The emergence of this new stream is about acknowledging the fact that there’s an issue here because the capabilities are there and we need to put some real energy into influencing the appropriate policy makers that this will be a new focus in terms of our programs going forward.

So, a big part of the development of e-health is collaboration then?
Absolutely. Every year I go to the HIC I love it because I actually get to learn. I have a pretty hectic job during the day and it’s in this space, and I very rarely get the chance to stop and listen. It’s really good to stop and listen and take things in and think about interesting ways to solve problems. It’s the concentrated time of the year you get to do that with government, industry, the consumers and so forth. 3

Can you elaborate on the importance of addressing the health informatics workforce shortages?
It’s a real passion of mine. We’ve internationally learnt if you make the mistake that you can move from paper to the electronic world without a significant investment in workforce capability you will fall flat. A real stark example of this has been the United Kingdom’s NHS National Programme for IT (NPfIT). They started to roll out then realised that they didn’t have a workforce ready for what they were trying to do. So they had to roll back and try and invest in some human capital to make sure they got across the line.

At HISA we’ve been on an absolute crusade to push programs, policy positions and other mechanisms of real influence for the world to acknowledge the legitimacy of the role of a health informatician – and with mixed success I have to say. We’ve seen some movement in terms of medical colleges accepting the health informatician as a professional stream, so nursing is a classic example of that. But it’s quite a mixed bag in terms of that translating into workforce capability strategies for private and government sectors and then actually seeing the fruits of that. Because we’re still in this early stage what we see is people with titles like ‘data registry manager’, ‘change manager’, ‘e-health support person’, ‘senior project officer – technology services’, ‘data coordinator – cardiac services’ – so in the professional stream there’s a bit of work to do around ensuring that informaticians are acknowledged, that there is a career pathway and then we can work with the universities to build up an education curriculum and grow the workforce. So we’re running the strategy on those fronts and we’ve had some early success because one of the reasons we have a nursing informatics position across Australia now is because of the work of the nursing informatics group to push that. The goal is to continue influencing that journey because it’s really important.

Do you think enough is being done to get rid of privacy concerns surrounding Personally Controlled Electronic Health Records (PCEHR)?
I think that we have come a long way in terms of people understanding that health information is really important and that rights, in terms of privacy, are absolutely paramount in terms of having the flexibility to be able to protect a person’s privacy if they don’t want their information shared – I think we’ve come the journey on that issue. Where I think we could improve is that often the very legislative, regulatory or IT system barriers that we put in place, because of what I just said, become a new barrier to quality care. Often what the consumer wants is safe sharing of information across their care network because they expect it. They expect that when they come from the hospital to see the doctor that the doctor knows what happened to them in hospital. We’ve made sure privacy is the foremost of our thinking in everything we do – privacy is paramount – but we need to remember what the consumer wants at the end of the day, and we need to make sure that we keep this flexible enough to achieve for the appropriate sharing of information based on their consent.

Is there a desire for HISA to be involved in a review and contribute to any potential refresh of the National E-Health Strategy?
Absolutely. I think we’ve got a really strong voice in that space and I think we’ve got something to say on all the fronts we’ve just talked about.

Do you see the National Broadband Network (NBN) as a key enabler of telehealth services in the city and in rural and remote communities?
Absolutely. In Queensland we can’t do business without telehealth. That’s why we have 900 telehealth units throughout the state, it’s just part of doing core business and it will not work unless we’ve got high-speed pipes to be able to run that service across. It’s an absolutely hopeless experience when the clinician trying to look at the patient can see a ghosting screen.

Tamati Shepherd
Executive Director, Clinical and Business Solutions Directorate, Queensland Health

Tamati (Tam) Shepherd has a background in information and communication technology (ICT), law and political science and has held leadership roles in the public and private sectors for the past 15 years, including key roles in transformation projects in the welfare, taxation and healthcare sectors. Tam is now the Executive Director, Clinical and Business Solutions Directorate which is part of Queensland Health’s Information Division. The Directorate brings all business and clinical ICT systems within the division together in a single operating unit. Tam believes that information communication technology can support Queensland Health’s employees and enable better access, higher quality and more efficient healthcare for all Queenslanders.