Medical specialistsWe defined medical specialists according to the Health Insurance Regulations 1975 (the Regulations), which describes relevant specialist medical organisations and qualifications for the purpose of access to Medicare. Under this definition, to be eligible for recognition as a specialist, a doctor must either:
- Be registered with the Australian Medical Board to practise as a specialist in accordance with the Health Practitioner Regulation National Law Act 2009; or
- Have obtained, as a result of successfully completing training in the specialty, the appropriate qualification for the nominated specialty (as listed in Schedule 4 of the regulations), and be a Fellow of the relevant medical college.
Doctors undertaking specialist training are not recognised as specialists under the Regulations 1
Some qualifications that are recognised by the Australian Medical Council (AMC) 2. are not included under the definition of specialists provided above, specifically those that describe primary care such as general practice and rural general practice, and specialties that do not involve direct patient care such as medical administration. Accordingly, those groups were considered out of scope for the purposes of this research.
This report considers 8 primary categories of medical specialists, as follows:
- Internal medicine
- Emergency Medicine
- Diagnostics (radiology and pathology)
- Obstetrics, gynaecology (includes neonatology)
- Other (e.g. dermatology and ophthalmology)
Further details on sampling rationale and approach are included in Appendix 2: Research methodology.
Geographic classificationsOur classification of location corresponds with prior healthcare sector reviews (e.g. The Australian Medical Specialist Workforce, An Overview of Workforce Planning Issues, Australian Health Workforce Advisory Committee Report 2006.1), and is based directly on the Australian Standard Geographical Classification as published by the Australian Bureau of Statistics. In response to the limited number of medical specialists in remote areas, the ‘Outer Regional’, ‘Remote’ and ‘Very Remote’ categories have been consolidated into a single category, whilst the ASGC ‘Offshore’ classification is considered irrelevant in this instance and accordingly has been discounted.
eHealthWe broadly define eHealth as the combined use of electronic communication and technology in healthcare. This definition encompasses four general categories of technology solutions. While the precise future state of eHealth is difficult to predict given ongoing technology advancements, the current landscape and expected lead applications find broad consensus.
In the wake of the National E-Health Strategy (2008), the health landscape has evolved significantly. Rather than take a static view of eHealth based on the current state, it is necessary to consider future applications, particularly in light of the PCEHR Concept of Operations and DoHA’s understanding of the likely/intended role of medical specialists downstream.
TelehealthFor the purposes of this research, telehealth has been used more broadly than the Medicare Benefits Scheme (MBS) 3. definition. We define telehealth as the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. During the primary research, survey respondents and interviewees were asked to consider both clinical elements of the healthcare system such as remote consultations with patients and other practitioners, and non-clinical elements such as remote training.
Electronic health recordFor the purposes of our survey, we used the term electronic health record 4. to refer to all patient records that are stored in hospital or clinic settings in a computerised format. We included both stand-alone electronic medical records and records with the capability of being shared across different healthcare settings.
ReadinessWe define eHealth readiness across three dimensions:
- Infrastructural readiness: to what extent does the practitioner’s external environment and infrastructure support eHealth adoption? For example, does the practitioner have the requisite computer systems and connectivity to use a full spectrum of eHealth solutions?
- Attitudinal readiness: do practitioners believe that the benefits from adopting and using eHealth solutions outweigh the costs and risks? How willing are they to engage in new technologies?
- Aptitudinal readiness: to what extent does a practitioner have the skills, training and IT support needed to adopt and use eHealth solutions to their full potential?
This three-dimensional approach provides a more robust understanding of the current state of readiness and likely barriers and enablers. It allows an assessment of not only the existing hardware and software used today, but also how it is used and the underlying reasons for usage or lack thereof. It also provides the foundation for understanding the gaps and barriers to eHealth and their root causes (which can range widely from concerns such as over implications for their role, implications of information transparency, or efforts or costs they anticipate relative to benefits or incentives).
Additionally, we consider eHealth readiness within the context of expected use, which often varies considerably based on the nature of a practitioner’s work (e.g. specialty, geographic location, practice setting, and type of patients).
1 Australian Government Medicare Australia ‘Guidelines for the Recognition of Medical Practitioners as specialists or Consultant Physicians for Medicare purposes under the Health Insurance Act 1973’. 2 Australian Medical Council – List of Australian Recognised Medical Specialties. 3 MBS telehealth rebates are limited to remote consultations with rural, regional and outer metropolitan patients via video-conference or online. 4 Refer to the NeHTA’s ‘List of acronyms, abbreviations and glossary of terms’ for additional details on the definitions of electronic health records and electronic medical records.