It is the responsibility of health professionals to become competent e-health practitioners. This means they need to develop familiarity with the e-health systems that support their practice and communicate effectively within them. Health professionals must know how to contribute to electronic clinical information and resources; use electronic information to inform clinical decisions; access information and professional development e-learning programs; and support the participation of consumers.

This chapter focuses on:

• how e-health strategies are incorporated into ways of communicating and working;
  
• the impact of e-health on consumers and their experiences of health care.

Introduction

The advancement of electronic technology has been significant over the last three decades. This has led to many opportunities and developments in e-health, including those that are designed to increase system efficiency and communication among health professionals as well as those that are more specifically consumer-oriented. The introduction of electronic repositories for the storage and sharing of health-related information about patients and the care they receive from health professionals has enabled a shift to a more streamlined approach where information accompanies patients as they move through the healthcare system. Consumer-oriented e-health connects patients with health information and services either as stand-alone services or integrated as an adjunct to existing resources (Norman, 2011).

Electronic information spaces, or portals as they are often called, make information available to health professions across disciplines, locations and sometimes organisations, enabling sharing of information and collaboration without the delays experienced previously. However, the usefulness of these systems depends on the interconnectivity of the various applications, the capacity of organisations to host the systems, and the capacity and tendency for staff to use them effectively (Goodwin, 2010).

The way in which clinicians engage with electronic systems depends on their role and the systems available to them within the organisation in which they work. Systems differ across contexts; some are relevant to all staff in an organisation and some are designed to meet the communication and information needs of particular services or sectors – for example, cancer services or community-based care.

Treating clinicians enter an electronic record of the results of their interaction with patients. Information entered by clinicians may include presenting signs and symptoms, medical and social history, clinical assessment findings, results of specific tests, treatments prescribed and any responses noted– for example, the effect of pain medication. Appointments and discharge summaries are also lodged by clinicians, care co-ordinators and discharge planners. Accurate, accessible, up-to-date information that is available to all treating clinicians helps to reduce duplication, overprescribing, and adverse events, thus ensuring patient safety (Hillestad et al., 2005).

The Person Controlled Electronic Health Record

Recent changes to the Australian healthcare system allow individuals to have an electronic health record that can be shared between healthcare providers. The idea is to reduce fragmentation and streamline care across primary and secondary sectors (van Dooren, Lennox & Stewart, 2013). The Person Controlled Electronic Health Record (PCEHR) gives individuals the opportunity to share their health information and to make clear their wishes about care they might receive in the future. The record alerts health providers to any allergies or significant health issues, and streamlines treatment by allowing new providers access to prescriptions and diagnostic test results. The PCEHR makes things simpler for patients and families by ensuring that the health professionals they consult have the information they need. While PCEHRs represent a valuable resource for continuity of care and patient safety, they are not compulsory; only those who register and provide permissions have records available.

Telehealth

Telehealth enables wider distribution of health services through the utilisation of video-conferencing facilities and internet-based services across sites. Telehealth is particularly beneficial to those who live and work in rural communities. The benefits of telehealth can be divided into four areas: benefits to patients, benefits to health professionals, benefits to participating hospitals, and benefits to society (Moffatt & Eley, 2010). Patient benefits reported in the literature include increased access to services, reduced travel-related costs, reduced waiting time, constant connection with supportive local networks, improved continuity of care and better quality services. Consumer-directed telehealth focuses on the consumer experience of the tools themselves and their influence on health knowledge, attitudes, behaviours and skills. Thus, telehealth bridges the gap between documenting information using traditional medical informatics and engaging the public in health care (Norman, 2011).

Telehealth is used to transmit voices, images, and information, reducing the need for people to travel to attend meetings and appointments:

It encompasses diagnosis, treatment, preventive (educational) and curative aspects of healthcare services and typically involves care recipient(s), care providers or educators in the provision of these services directed to the care recipient. Video-conferencing is one of the main ways in which telehealth is improving access to healthcare services for patients who live in regional, rural and remote areas.

(Australian Government Department of Health, 2012)

Health professionals benefit from telehealth through access to videoconferenced education and participation in videoconferenced consultations and multidisciplinary meetings. Videoconferencing provides excellent learning opportunities for less experienced staff and for rural clinicians as they can discuss with other more experienced clinicians in spite of geographic distance. Telehealth saves hospitals money through reduced patient transfer costs (patient can be treated in their home town) and reduced travelling time for staff (staff do not need to travel to see patients). Figure 16.1 summarises electronic health information networks.

Figure 16.1 Electronic health information networks

In sum, the quality of the services provided is enhanced through the addition of telehealth clinics and multidisciplinary team consultations and videoconferencing. Interprofessional working is enhanced when telehealth is integrated into routine care. Communities benefit when access to services is increased and when there is greater opportunity for health promotion and education through electronic and internet-based information and events (Moffatt & Eley, 2010).