The former editor of the BMJ, Dr Richard Smith, recently recommended ten lessons for global health, including that the rich can learn from developing countries.
He wrote that there are many examples of innovation in poorer countries spreading to developed countries, and that poorer countries have a better chance of building sustainable health systems because they don’t have the inertia and vested interest of the top heavy systems built in developed countries.
Perhaps the report below – about e-health innovation by Aboriginal health services in the NT – is an example of this rule.
Greg Henschke, of the Aboriginal Medical Services Northern Territory, reports:
“The NT is a unique place. We’ve had invasions, colonisations, salutations, neglectful situations and interventions. Wouldn’t it be nice if we could actually get some technology happening up here that would help with Comprehensive Primary Health Care delivery and to Close the Gap in Aboriginal Health?
Well the Katherine West Health Board (KWHB) and the Aboriginal Medical Services Northern Territory (AMSANT) are proving that smart technology such as IPads can help with grassroots health service delivery.
At Kalkaringi, the home of the Land Rights movement, Aboriginal Health Workers such as Dee Hampton are using the IPad, connected by Next G to Katherine West’s database located in a secure datacentre in Sydney, in her daily rounds of her elderly or “health clinic shy” clients at their home or at the shop.
Medical records on the IPad are the same as the information available to other clinicians in KWHB health clinics throughout their region. The difference though is that by connecting to this database via the IPad, healthworkers have a reasonably unobtrusive information package equivalent to the old days of taking the patients paper files with them – but far more accessible and portable.
Many people don’t attend health centres when their health demands it, due to many factors. By accessing a client’s medical data when meeting them at their home or elsewhere in the community, clinicians can remind clients of appointments due, results received or other follow up information. They can encourage clients to follow the good health pathways that have been discussed with their doctor at previous official health consultations in the health centre. This is a way of taking health service out of the health clinic into the community.
Further, using the IPad makes data entry at the time of consultation easier, rather than jotting information on a piece of paper (or even your arm) when meeting clients out of the health centre and having to then go back and enter that information into the computer. Double documenting such as this has been proved to be a hit and miss approach, as often by the time one gets back to the clinic, other important issues arise and the data entry either doesn’t happen or happens after hours in the clinician’s free time.
Why is this all important – well the golden rule of data is: rubbish in – rubbish out. Aboriginal Health Services such as KWHB rely on good data to identify population health status and thus target, plan, monitor and evaluate health programs. Approaches such as this are helping to Close the Gap – both the health gap between a mainstream and Aboriginal Australians and the credibility gap of dodgy statistics based on gaps in data entry.
By forging ahead in using affordable smart technology, Aboriginal Community Controlled Health Services in the NT are showing to the rest of Australia that remoteness and environment are not barriers to using eHealth to target and deliver good health care.
And it’s part of a bigger picture, with the Aboriginal Community Controlled sector in the Territory taking data seriously — from data flows the evidence we need to build and strengthen the Comprehensive Primary Health Care our members need.
40,000 Aboriginal people in the Territory have signed up to what is known as the Shared Electronic Health Record, which allows ease of transfer of patient data between clinics, between clinics and the hospitals, and back again. It’s the largest take up rate in the nation. Our member services are developing tools to analyse population health problems and trends — with the capacity to respond quickly to community health needs.
One of the great ironies of the Intervention was the arrival of “volunteer” doctors and nurses carrying out Child Health Checks.
None had the capacity to use the modern technologies, entering their notes and data on paper files, which then had to be collated manually. Aboriginal Health Workers have been using electronic systems for up to a decade!”
Dear Croakey,
I think Apple marketing boffins are doing well enough without your charitable assistance.
iPads are f***ing useless consumer toys, not serious work-in-the-field computers. I’m sure as shit that you could do the task described plus a multiple of others tasks on a netbook or laptop of any brand, even some other tablet devices. But with the shithouse reception of the iPad, let alone it’s inability to accept a USB, CD or almost any other form of portable storage and it’s complete lack of a file storage system renders it a complete waste of time and effort on behalf of a government health worker, let alone any other business professional.
Rant over.
Wobbly , the real story here is not about promoting IPads or comparing them to other computers, its about the great work Aboriginal Health Workers, RNS & Drs and Aboriginal Health Services have been doing quietly for years. This story is a celebration of these quiet champions for health. If we can help their job with modifying smart technology – thats our important contribution to improving Aboriginal Health outcomes.
Also, despite your doubts, the IPad does work in this application – thats all we need, technology that works for the clinicians. Gathering good data at point of consultation and having access to important medical information is not ‘a waste of time and effort’ by Aboriginal Community Controlled Health workers (note -not Governemnt).
Is it a crime for resource restricted Aboriginal Health services to ride on the coat tails of the work of big budget muli-nationals who have effectively developed useful technologies and marketed their name, by using the product and name to promote our good news story. We would rather use our budgets on targetting health service delivery, and gathering good data through ease of data entry assists this. Afterall, IPads are a sexier news grabber name than ‘a netbook or laptop of any brand, even some other tablet devices’ as you suggest.
Greg Henschke
Wobbly,
Reassess once you’ve used one. Show me a client with same usability and robustness with decent battery life.
Thin clients like the iPad definitely have the potential to expand the quantity and quality of data entry in health networks.
Pieter
Hey Wobbly, the thing you should remember is the ipad creates a secure and easy to manage environment. By isolating apps and data storage the system will be require less ICT administrator intervention. The modifications we intend to make to our clinical system will refine the user interface for a specific sub-set of tasks. The reception in these communities is actually not too bad in comparison to some urban NextG services.
The point is, staff can get out to people’s houses with an easy to maintain device (be it an iPad or an Android Pad) and help them with their health issues.
Cheers
Dave