Monday, May 31, 2010


The single most over-hyped application for the NBN is e-health. My assertion that it is over-hyped is based on two principles. The first is that there is a dearth of interoperability standards, including the most mundane of identification and security, to realise the opportunities. The second is that most of the benefits accrue through ubiquity not just the start of the network.

Writing in Communications Day today Richard Chirgwin touches on the first of these and the reasons why highly detailed imaging is both reduced to film and distributed with a DVD. The imaging often uses proprietary standards and the DVD needs to include viewing software.

The relevance of the availability of these images and the instruction to the patient "not to lose the DVD" is interesting. I've asked a few doctors whether they look at the film or the DVD and have been told they look at neither, they read the radiologist's report! That's logical, though if the imaging leads to surgery that answer might be different.

That said the standards issue is more likely to be resolved either by the existence of communications links that justify standards, or the use of cloud computing models for health care imaging.

The ubiquity question resolves around the fact there is no marginal benefit of moving from DVD to online till everyone can do it. Further, the major benefits come from tele-health to the home - remote monitoring and conferencing facilities to aid home care.

All of which leads me to a current major issue, the aging of the Australian population. We have been stunningly successful at getting our citizens to live beyonf eighty, but not at all successful in slowing the aging process itself. Many people want to stay in their own homes, and don't want medical intervention to save their lives so they can go to a nursing home.

The system for providing "advanced health care directives" is complex. Firstly it is hard to even be sure who is authorised to give the directive. Even in the case where there is an appointed enduring guardian getting the relevant piece of paper to the doctors, the doctors being satisfied that there hasn't been a subsequent appointment and the very imprecise nature of the power to decline treatment contained in it results in delay in being sure of the power.

As a consequence a doctor will act initially on the assumption they are required to intervene, and the logical point for not intervening can have passed before the decision is properly made.

An example is the situation that recently occurred with my father, who was admitted to hospital with a cough and a little breathing difficulty. The question was whether he should be given an antibiotic for pneumonia. The difficulty was in getting the right information (the choice was communicated as being antibiotic as a prophylactic measure, the reality was it was for treatment), and the doctor knowing who the decision maker was. By the time the family had really got itself up to speed on what decision to make the antibiotics had started.

The outcome is my father is getting better, but will not be well enough to return home. He now will go to a nursing home, something he was keen to avoid.

There is a better way. That is for better health record identification and management so the patient's care directives can be immediately available to any doctor in a authorised manner. There really is a case for our health ID to be implanted in a micro-chip - just as we now do for domestic pets and food animals. What could be simpler than scanning the patient to get a health ID and having a reliable record of health care directives.

Once we have a national standard for the ID, the option for micro-chipping should become an individual choice and commercial opportunity. I for one would prefer that my medical treatment could always start immediately based upon a full health record and on a full understanding of what my own health care choices are (including decisions on organ donation).

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