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

Segment-specific eHealth use

Page last updated: 30 May 2011

To a large extent, medical specialists’ eHealth use is influenced by factors associated with their specialty segment and surrounding environment. The specialties with high professional needs that can be met using existing technology tend to be the heaviest eHealth adopters (Exhibit 6). For example:

  • Diagnostics (i.e. radiologists and pathologists) most frequently use computerised information recording and sharing, and their use primarily involves capturing and recording information in an eHealth system and making it available to others. Due to the large volume of information that flows through these groups, they have been heavily incentivised to computerise operations to improve efficiency and reduce the risk of error. As a result, many are able to provide results to the referring provider online, typically through a web-based interface.
  • Emergency medicine practitioners are the most likely to use computers for viewing results. These specialists are frequently embedded in hospitals that have integrated pathology and imaging departments, making it easy for them to receive test results rapidly on their computer, iPad or iPhone. Many of them also use computers to complete discharge summaries, often through their hospital’s electronic health record system. Although these summaries are completed on a computer, they are frequently printed and faxed or mailed to the patient’s GP.

For other specialists, such as the surgeons and psychiatrists, computers are often ancillary to rather than embedded into their daily workflow. Many of these specialists are more isolated in solo or small private practices and face minimal pressure from other practitioners to change.

EXHIBIT 6

(D)

Additional details on factors influencing eHealth use by specialty segment are summarised in Table 4. In addition to environmental factors, usage decisions often hinge on whether benefits from eHealth accrue to specialists themselves, versus to someone else in their practice or the health system as a whole, and the degree of perceived risk to their care delivery process. While all specialty segments perceive pros and cons to eHealth use, the extent to which these factors influence behaviours is closely related to individual specialists’ attitudes and perceptions (discussed further in section 6).

Table 4: Factors influencing eHealth use by specialty segment

Segment

Pros

Cons

AnaesthesiaAccess to accurate past medical history in the health record perceived to be very beneficial (would improve safety)

Heavy use of eHealth in surrounding (hospital) environment

Remote supervising is appealing – supervisors could provide advice more quickly in emergency situations

‘Apps’ on portable smart devices very helpful for drug dosing calculations

Fewer directly relevant applications for eHealth use – computers can be a distraction when anaesthetists need to focus on watching their patients

Access to eHealth often limited by the environments in which they operate

Solutions must be portable between multiple locations

DiagnosticsClear safety and efficiency benefits, e.g. health identifiers to match results for same patient completed at different facilities

Practice dynamics provide sufficient scale to justify expenditures

Computers help manage information flow and improve efficiency because practitioners’ requests are legible and complete

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

Concerns about making comparisons between test results from different pathology laboratories using different rages if all results are on the same record

Errors arising from viewing digital images using incorrect equipment e.g. mobile phones

Emergency and intensive care medicineTimely access to patient information is critical, so significant perceived value for electronic health records, especially in cases where patient is unable to provide the information him or herself

Exposure to a wide variety of cases makes interactive decision support more appealing, especially for younger practitioners

Paperless systems reduce risk of contamination and improve infection control in hospitals

eHealth access largely dependent on hospital environment. More difficult to influence change due to the decision-making process in hospitals
Internal medicineComputerised records more efficient for specialists managing long-term patients

Interactive decision support appealing for those using complex diagnostic algorithms (e.g. for the prescription of highly specialised drugs)

ePrescribing, ePathology and eImaging save time upfront when ordering scripts/results and also through fewer phone calls due to illegible handwriting

Can be difficult to type and talk to patients at the same time – takes time for practitioners to adjust their workflow

Moving long volumes of paper-based patient histories and notes to computerised systems is time-consuming

Challenges with multidisciplinary care due to lack of system compatibility

Obstetrics and gynaecologyInterest in reducing physical paper files because they take up a lot of space, given that obstetric files must be retained for 25 years

Computerised systems can improve ease and legibility of documentation, which can be helpful in the event of a medicolegal claim

Prescribe a narrow range of drugs – little perceived need for decision support or ePrescribing

Increased risk of medicolegal claims, which makes them especially concerned about privacy breaches and confidentiality of shared records

Ophthalmology and dermatologyTelehealth relevant and interesting for subset of dermatologists focusing on rural and regional Australia, because they can use images to help provide diagnoses

Dermatology is a younger specialty and nearly all of the new specialists are highly computerised and comfortable with technology

These specialists integrate less frequently with other practitioners and therefore benefit less from information exchange
SurgeryeHealth can help improve efficiency of practice, although this typically benefits the practice manager or secretary rather than the surgeon

Remote access to imaging is convenient for surgeons, especially those travelling occasionally to rural or remote areas

eHealth offers little to improve their workflow because most of their time is spent interacting directly with patients

Frequently perform highly specialised, often repetitive work - little perceived opportunity to benefit from interactive decision support

Access to digital imaging can be a challenge (e.g. inability to access images if not the referring physician, slow download times)

Solo practice surgeons less likely to perceive sufficient benefit to offset the costs of new systems

PsychiatryDo not need to physically touch patients: opportunity to use telepsychiatry to reach rural and remote patients who would not otherwise have access

When extensive documentation is required, notes can often be completed more quickly on a computer

Practitioners do not need to use technology or computers for specialty and are therefore less comfortable with technology

Strong concerns about privacy and confidentiality (though some acknowledge this is better protected through electronic files)

Culture tends to be more conservative and less cutting-edge in regards to technology adoption

Perception that use of computers during a consultation can disrupt patient communication and rapport