Remote Aboriginal people have more to gain from electronic-health than most.

120818 Glance

Picture: Richard Polden Source: The Australian

By: Stephen Pincock The Australian August 18, 2012

Glance and his colleagues developed the system, known as Medical Message Exchange, with the Kimberley Aboriginal Medical Services Council, an umbrella group for Aboriginal Community Controlled Health Services in towns and remote communities in the region.

BY the time David Glance joined the University of WA’s Centre for Software Practice in 2001, life had already handed him a number of rewarding experiences.

After finishing a doctorate in physiology in the mid 1980s, Glance shifted his focus to the intersection of high finance and high technology and started designing the digital innards of trading room technology for London firms.

A few years later, with the dotcom bubble deflating, he found himself in the US headquarters of Microsoft in Redmond, Washington.

But he considers working with health workers in remote northwestern Australia for the past five years “the single most significant project I’ve worked on”.

Put simply, the project enables doctors, nurses and other health workers to co-ordinate the care of about 26,000 mostly indigenous patients across the vast distances of the Kimberley, by accessing medical records online.

Glance and his colleagues developed the system, known as Medical Message Exchange, with the Kimberley Aboriginal Medical Services Council, an umbrella group for Aboriginal Community Controlled Health Services in towns and remote communities in the region.With a patient’s consent, GPs, hospitals, visiting specialists and allied and mental health professionals can share their record, which includes all care plans, medications and communications.

There may appear to be something incongruous about developing a digital solution to the health needs of people living the least urban, least technologically connected lives in the country.

But remote Aboriginal people have more to gain from electronic-health than most, says Tamati Shepherd,, chair of the National Indigenous Informatics Special Interest Group in the Health Informatics Society of Australia.

The very remoteness of many indigenous communities, and the nomadic lifestyles of many Aboriginal people in places such as the Kimberley, make it difficult for healthcare workers to keep the detailed medical records considered vital for good healthcare.

“Keeping track of their health can be really hard,” says Shepherd. An e-health record can serve as a kind of digital glue, he says, keeping the healthcare system together.

This is critical as indigenous people are at high risk for chronic conditions such as diabetes that require careful, long-term monitoring, and have an unconscionably low average life expectancy. These are problems that have defied many well-intentioned initiatives, but Shepherd believes IT can make a difference: “Technology can have a huge impact in the health of indigenous communities.”

Trevor Lord, a GP who has worked in the Kimberley for the past two years, can testify to the difference MMEx makes. “One of the really nice things about this record is if I’m on call in Broome and a nurse calls from Beagle Bay about a patient, I can look up their record and check the details.”

And when Lord prescribes a drug, the nurse on the other end of the line doesn’t need to scribble down the information on the back of her hand. Lord enters the details on to the e-record. “It doesn’t matter where you are or where the patient is. We can all keep in contact with each other and do the best for the patient.”

According to Lord, an antenatal record added to the MMEx system about a year ago is invaluable. Previously, hospitals often had to ring three or four clinics to piece together a woman’s pregnancy record. “Now it doesn’t matter where the lady has her antenatal care done, because its all in the record.”

The project garnered global attention in 2010 when the Organisation for Economic Co-operation and Development produced an e-health report and chose an early version of MMEx as a case study. Regionally, health organisations in other states and in New Zealand adopted it. “We have around 250,000 patients in MMEx and about 10,000 health providers,” Glance says.

One key to the project’s success was the input from clinicians from the start.

“That’s what’s exciting about this project. It’s not just us as a software supplier sitting in Melbourne or Sydney … dreaming up what a disconnected group of GPs want. I’ve held meetings with customers in the emergency department. It’s that level of engagement that really triumphs what we’re doing.”

At a health informatics conference in Sydney last month, University of Tasmania IT expert Terry Hannan described an international example of the difference e-health records can make.

The story begins with a group of academics, including Hannan, brought to Kenya by Indiana University in the US and sitting in the dirt outside a remote village clinic. It ends with a web-based e-health record system, now used to treat 140,000 HIV-positive people, that reaches more than half a million people through home-based counselling and testing and has reduced mother-to-child transmission rates of HIV to below 2 per cent.

Known as the Academic Model Providing Access to Healthcare, the philanthropically funded service expanded its scope to include delivery of essential primary care services, and control of communicable diseases and chronic illnesses. Clinicians can use a smartphone to instantly access patient-specific data and also receive alerts when a scheduled test is overdue, or when a needed medication has not been started.

They can respond to reminders by wirelessly printing requisitions for laboratory tests, with all patient information pre-filled.

It now extends to social and economic benefits, Hannan claims: “The social effects of information management just exploded through society.”

Out of the Kenyan experience grew a wider project called OpenMRS. This free, open-source medical record software supports the delivery of healthcare elsewhere in Africa, North and South America, Asia and Europe.

Back in WA, Glance says hearing stories of how access to information has helped save lives is enormously satisfying. But he acknowledges it’s the doctors, nurses and health workers who make the biggest difference.

“I pale into insignificance compared to the efforts they’re putting in.”