eHealth aims to improve the quality and safety of Australia’s health system by
introducing a more efficient way to collect and share information such as prescriptions
and test results. The primary health care sector could benefit substantially from the
widespread use of eHealth technologies. The National E-Health Transition Authority is
currently working with numerous stakeholders, including general practitioners and allied health
professionals to develop an eHealth uptake plan. This RESEARCH ROUNDup focuses
on the use of eHealth technologies in primary health care, by exploring the benefits
and current limitations of a number of eHealth tools

Anikeeva, Olga

Bywood, Petra Teresia

Flinders Academic Commons

 TO CONTACT PHC RIS: Web: www.phcris.org.au PHC RIS Assist: 1800 025 882 Email: phcris@flinders.edu.au RESEARCH ROUNDup: www.phcris.org.au/publications/researchroundup/ Keep up to date with new Australian primary health care research ISSN 1839-6348 eHealth aims to improve the quality and safety of Australia’s health system by introducing a more efficient way to collect and share information such as prescriptions and test results.1 The primary health care sector could benefit substantially from the widespread use of eHealth technologies.2 The National E-Health Transition Authority is currently working with numerous stakeholders, including GPs and allied health professionals to develop an eHealth uptake plan.2 This RESEARCH ROUNDup focuses on the use of eHealth technologies in primary health care, by exploring the benefits and current limitations of a number of eHealth tools. Demographic and clinical patient data are used in conjunction with guidelines to generate appropriate recommendations.8,15 The alerts, prompts and reminders are issued to providers during a standard patient consultation and can be active, in that they require a response, or passive, where no action from the provider is required.8 The main benefit for primary health care providers is instant and automated decision support.11,16 These systems have the potential to enhance practitioner performance, by improving decision making in areas that are frequently overlooked, such as diet and exercise advice.8 Computerised provider order entry and electronic prescribing Computerised provider order entry systems are designed to simplify the process of entering and reviewing orders and results for laboratory tests, radiological images and referrals.8,14 Electronic prescribing, which is an extension of these systems, is frequently integrated into the software packages. Electronic prescribing enables direct communication between health care providers and pharmacists and is used to input, modify and fill medication prescriptions.8 The systems can perform automatic dosing adjustment calculations based on stored patient information.14,15 The benefits of using these systems include:   greater efficiency, as orders and test results are no longer required to be physically transported between providers, reducing turnaround time8  direct and efficient communication between providers and pharmacies, rather than relying on patients or courier services, which may result in delays or loss of information8  improvements in legibility, which are likely to result in fewer errors and associated delays8  improved patient safety through the use of automatic dosage adjustments, which would reduce the likelihood eHealth technologies in primary health care: current strengths and limitations Issue 21 November 2011  O Anikeeva P Bywood What are eHealth technologies? eHealth involves the use of information and communication technology in the field of health care, with the aim to streamline communication between providers by enabling records, referrals, and clinical information to be stored and communicated electronically in a secure manner.3,4,5 Examples of eHealth tools include electronic health records, health information websites, decision support programs and electronic prescribing software.3,6,7 Electronic health records The central aim of electronic health records is to make health information available to all providers involved in the care of a patient, at any time and in any health care setting.8 Electronic records have the capacity not only to contain medical histories and treatment notes, but also to include digital images and scanned documents,8 enabling the creation of a complete medical history. Personally controlled electronic health records (PCEHR) are controlled by individual patients, who make decisions about what information is made available to which providers.3,8,9,10 Electronic records are easier to access, modify, store and share compared to their paper-based counterparts.8 For primary health care providers, the main advantage of using electronic health records is improved access to health information,9 which may result in better care and reduce duplication of services.8,11,12,13 These benefits are particularly important for current health challenges such as chronic disease management. Access to shared clinical information by a multidisciplinary team of providers is likely to support team-based care across geographical boundaries; and lead to improved continuity of care.13 Furthermore, electronic records increase the capacity to use clinical data, either within practices or benchmarked against similar practices, for the purposes of quality improvement.  Electronic clinical decision support systems Electronic clinical decision support systems typically involve the storage and use of electronic patient and prescription data in order to:  generate patient-specific advice  issue warnings about potential drug interaction effects  prompt reminders regarding screening and lifestyle modification.7,14 References 1 NEHTA. (2011). What is eHealth? Retrieved from  www.ehealthinfo.gov.au/what-is-ehealth 2 NEHTA. (2011). Primary Care Sector Plan. Retrieved from  www.nehta.gov.au/ehealth-implementation/sector-plans/primary-care 3 Stokes D. (2010). Electronic health records are coming! InPsych: The Bulletin of the Australian Psychological Society, 30-31. 4 Oh H, Rizo C, Enkin M, Jadad A. (2005). What is ehealth (3): a systematic review of published definitions. J Med Internet Res, 7(1), e1. 5 Pagliari C, Sloan D, Gregor P, Sullivan F, Detmer D, Kahan JP, et al. (2005). What is ehealth (4): a scoping exercise to map the field. J Med Internet Res, 7(1), e9. 6 Kreps GL, Neuhauser L. (2010). New directions in eHealth communication: opportunities and challenges. Patient Educ Couns, 78, 329-336. 7 Robertson J, Moxey AJ, Newby DA, Gillies MB, Williamson M, Pearson S-A. (2011). Electronic information and clinical decision support for prescribing: state of play in Australian general practice. Fam Pract, 28, 93-101. 8 Black AD, Car J, Pagliari C, Anandan C, Cresswell K, Bokun T, et al. (2011). The impact of eHealth on the quality and safety of health care: a systematic overview. PLoS Med, 8(1), e1000387. 9 Liaw S-T, Hannan T. (2011). Can we trust the PCEHR not to leak? Med J Aust, 195(4), 222. 10 Lehnbom E, McLachlan A, Brien J. (2010). E-Health: what are we talking about? Intern Med J, 21(1a), 72. 11 Jha AK, Doolan D, Grandt D, Scott T, Bates DW. (2008). The use of health information technology in seven nations. Int J Med Inform, 77, 848-854. 12 Georgeff M. (2007). E-health and the transformation of healthcare: Australian Centre for Health Research. Retreived from  www.achr.com.au/pdfs/ehealth%20and%20the%20transofrmation%20of%20healthcare.pdf 13 Haikerwal MC. (2010). Health reform in Australia and the place of e-health. JMAJ, 53(3), 193-198. 14 Hannan TJ. (2010). Now is the time for e-prescribing. Intern Med J, 40(3), 242-243. 15 Moxey A, Robertson J, Newby D, Hains I, Williamson M, Pearson S-A. (2010). Computerized clinical decision support for prescribing: provision does not guarantee uptake. J Am Med Inform Assoc, 17, 25-33. 16 Wright DM, Print CG, Merrie AEH. (2011). Clinical decision support systems: should we rely on unvalidated tools? ANZ J Surg, 81(5), 314-317. 17 Richards H, King G, Reid M, Selvaraj S, McNicol I, Brebner E, et al. (2005). Remote working: survey of attitudes to eHealth of doctors and nurses in rural general practices in the United Kingdom. Fam Pract, 22, 2-7. 18 Moffatt JJ, Eley DS. (2011). Barriers to the up-take of telemedicine in Australia - a view from providers. Rural Remote Health, 11, 1581. 19 Ludwick DA, Doucette J. (2009). Adopting electronic medical records in primary care: lessons learned from health information systems implementation experience in seven countries. Int J Med Inform, 78, 22-31. 20 Masters K. (2008). For what purpose and reasons do doctors use the Internet: a systematic review. Int J Med Inform, 77, 4-16. 21 Magrabi F, Coiera EW. (2009). Quality of prescribing decision support in primary care: still a work in progress. Med J Aust, 190(5), 227-228. 22 Sweidan M, Reeve JF, Brien JE, Jayasuriya P, Martin JH, Vernon GM. (2009). Quality of drug interaction alerts in prescribing and dispensing software. Med J Aust, 190(5), 251-254. 23 Liaw S-T, Humphreys JS. (2006). Rural eHealth paradox: it's not just geography. Aust J Rural Health, 14, 95-98. 24 Gunter TD, Terry NP. (2005). The emergence of national electronic health record architectures in the United States and Australia: models, costs and questions. J Med Internet Res, 7(1), e3. 25 Shachak A, Jadad AR. (2010). Electronic health records in the age of social networks and global telecommunications. JAMA, 303(5), 452-453. 26 Bacigalupe G. (2011). Is there a role for social technologies in collaborative healthcare? Fam Syst Health, 29(1), 1-14. 27 Bates DW. (2010). Getting in step: electronic health records and their role in care coordination. J Gen Intern Med, 25(3), 174-176. 28 Liaw S-T. (2011). Decision support systems: a general practice research journey. Aust Fam Physician, 40(9), 711. of dangerous or ineffective medication doses being prescribed.14,15 Current limitations and challenges While many primary health care professionals understand the benefits of using eHealth technologies, uptake of clinical decision support systems and other tools is generally low, with availability not guaranteeing uptake.7,15,17,18 Common barriers identified by primary health care professionals include lack of  training, cost and concerns about privacy, security and a potential increase in workload.14,15,17,18,19,20 Some providers feel that over-reliance on computers in the practice room may have a negative impact on the doctor-patient relationship if patients perceive the computer as an intrusion.8,14 The main barriers to the adoption of the PCEHR include concerns about privacy, unintentional leakage of information and potential withholding of information by consumers.9,11 While consumer control is a key feature of the PCEHR, it may compromise care if consumers are too focused on protecting their privacy and fail to share important clinical information.  Alert fatigue is the major limitation of clinical decision support tools. If these systems provide too many general warnings and recommendations, some health professionals may disable the alerts or become desensitised to them.7,8,21,22 On the other hand, over-reliance on decision-support systems and over-estimation of their effectiveness and accuracy could lead to a deterioration of health care providers’ skills, and ultimately contribute to poorer performance.8 Future directions While many of the identified barriers have been the focus of programs and projects undertaken by Divisions of General Practice across Australia, ongoing coordinated support and planning are required to achieve successful implementation of eHealth technologies.  Financial incentives are likely to encourage adoption of new technologies,11,12,18,19,20 and minimise the relatively higher costs faced by smaller practices and practitioners located in rural and remote areas.23,24  The poorer infrastructure in rural and remote areas would also need to be addressed.18,23  Systems need to be in place to provide ongoing and comprehensive training and technical support.18,23  It is important that the systems  are easy to use and incorporate all of the necessary tools in one place, which would ensure that providers are able to use these tools to enhance their interaction with patients, rather than detract from it.7,15,16,18,25,26  Providers using different computer systems or software programs need to be able to effectively transmit information between systems.27  In order to address alert fatigue, alerts can be graded by severity, making it difficult to ignore or override alerts of high clinical importance.15  Finally, it is important to put in place a system of accreditation and minimum standards for eHealth software.21,22,28 This would ensure that the programs are suitable for use in the Australian context and are up to date with the latest clinical guidelines. Acknowledgements Thank you to Melissa Sweet for her support and to David More, Tim Senior and Ron Batagol for their comments on the draft of this paper. 

eHealth technologies in primary health care: current strengths and limitations

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eHealth technologies in primary health care: current strengths and limitations

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