The eHealth readiness of Australia's medical specialists - Final Report

Current and future uses of eHealth

Page last updated: 30 May 2011

Medical specialists currently use certain self-contained eHealth applications in their practices: Exhibit 1. However, applications that share information within and between practice networks have been less widely adopted. The current uses identified by the National E-Health Strategy (2008) span practice management tools, information sharing and sources, and service delivery tools such as chronic disease support and telehealth. Intended future uses would expand the use of remote care management and wellness, clinical decision support (especially to aid collaborative diagnosis, treatment and care processes), electronic health records, and public health intelligence. Importantly, these future uses would share more information but would require more reliable and more connected eHealth platforms.

EXHIBIT 1
(D)

Medical specialists use computers regularly for some self-contained practice and research functions, but despite strong interest have yet to more fully embrace eHealth.

  • Computers are used for convenient access to information and education (72 percent of survey respondents used computers for reference purposes, and 70 percent for education) and for viewing results electronically (62 percent of specialists use computers to view pathology results, 53 percent to view diagnostic imaging results)
  • Diagnostic specialists (radiology and pathology) are the most likely to use computers regularly, with almost all strongly agreeing that they are expected to use computers in their daily work, and that most of their peers do so as well. About 80 percent of emergency ward specialists hold the same beliefs, a figure that drops to below half for the other specialties
  • Specialties with strong clinical workflow needs that can be met using existing technology, or who operate in a culture where computer use is expected, are the heaviest adopters. Over 90 percent of emergency specialists use computers to view pathology and diagnostic imaging results, and 74 percent use computers to complete event summaries
  • Although computerised health records are gaining traction, relatively few specialists use an electronic record-keeping system as a single repository for all relevant patient information. Only 41 percent of survey respondents used a computerised health record-keeping system, and of these just 37 percent relied solely on computerised records. Most of the specialists using computerised systems use them for administrative purposes and storing patient notes but, for data security and legal reasons, maintain separate hard-copy storage of communication to and from other providers (e.g. test results, diagnostic imaging and referral letters)
  • Of those specialists not currently using information-sharing applications (to record and share information, order electronic tests, and support interactive decisions) approximately 60 percent would like to have these capabilities in the future.

The specialists gave several reasons for not using eHealth applications more, including that the application is not available in their practice setting, particularly among those working in public hospitals, or is not seen as relevant or would not be used often enough to offer true benefits; that the specialists are unaware of the available applications; and that there is no demand or capacity to reciprocate from patients, GPs, other practitioners, or other caregivers.

Table 1 completes a specialty-by-specialty look at current and desired future use of eHealth, and some of the limitations on those uses.

Table 1: eHealth use and drivers/limitations by specialty
(Percent of specialists using or interested in using; excludes scheduling and billing)

Segment

Top 4 current uses


(percent of specialists using)

Top 3 desired uses


(percent of specialists who don’t use but would like to)

Drivers/limitations

AnaesthesiaEducation (80%)

Clinical reference (76%)

Viewing pathology (72%)

Viewing imaging (66%)

Share records with practitioners (75%)

Share health records with patients (63%)

Show patients info during consultation (63%)

Heavy use of eHealth in surrounding hospital environment

Access to accurate past medical history in the health record perceived to be very beneficial

Diagnostics (radiology and pathology)Clinical reference (86%)

Education (85%)

Viewing pathology (77%)

Viewing imaging (71%)

Order pathology (60%)

Decision support for test ordering (60%)

Send/receive referrals (58%)

Practice dynamics provide sufficient scale to justify expenditures

Digital transfer of images and test results can greatly improve practice efficiency

Emergency and intensive care medicineViewing pathology (92%)

Viewing imaging (91%)

Clinical reference (86%)

Event summaries (74%)

Order prescriptions (83%)

Decision support for prescriptions (79%)

Share records with practitioners (72%)

Timely access to patient information is critical, especially in cases where patient is unable to provide the information and GP cannot be reached

Decision support is helpful, especially for younger specialists

Internal medicineClinical reference (75%)

Viewing pathology (69%)

Education (64%)

Viewing imaging (56%)

Share records with practitioners (68%)

Order imaging (62%)

Decision support for prescriptions (60%)

Computerised records more efficient for specialists managing long-term patients

Interactive decision support appeals to those using complex diagnostic algorithms, e.g. for the prescription of specialised drugs

Obstetrics and gynaecologyClinical reference (74%)

Education (72%)

Viewing pathology (53%)

View/record patient notes during consult (45%)

Order prescriptions (48%)

Share records with practitioners (48%)

Decision support for prescriptions (45%)

High risk of medicolegal claims, resulting in strong need for documentation but also concern about privacy breaches

Interest in reducing paper files, given that files must be retained for 25 years

Other (dermatology and ophthalmology)Clinical reference (66%)

Education (63%)

Show patients info during consult (49%)

View/record patient notes during consult (47%)

Complete event summaries (54%)

Decision support for ordering tests (54%)

View diagnostic imaging (52%)

These specialists integrate less frequently with other practitioners and therefore benefit less from information exchange

Dermatologists often interested in using computers to increase practice efficiency

PsychiatryClinical reference (72%)

Education (71%)

Complete event summaries (41%)

View pathology (38%)

Order pathology (58%)

Decision support for ordering tests (55%)

Decision support for ordering prescriptions (54%)

Practitioners do not need to use computers for their specialty

Strong concerns about privacy and confidentiality

Concern that using computer during consultation interferes with patient relationships

SurgeryEducation (65%)

Clinical reference (58%)

Viewing imaging (53%)

Viewing pathology (52%)

Order pathology (52%)

Order prescriptions (49%)

Send/receive referrals (49%)

Surgeons perceive little workflow benefits from eHealth because most of their time is spent interacting directly with patients (however, practice assistants may see benefits)

Access to digital imaging and complete, accurate health records provides a benefit for some surgeons