6:01pm, 21 Nov 2009 bernard

eHealth should support all providers and consumers not just clinicians. The taxpayer dollars should meet the requirements of all, particularly the patients.

For instance the Discharge Summaries were designed for hospitals to communicate with GP’s without regard for the needs of consumers. When a patient is discharged from hospital the patient should be provided with a Discharge Summary which includes the medications the being taken by the patient and the required ongoing care. Designing discharge summaries for the sole use by GPs missed the opportunity to get additional benefits, since it could easily have been extended to provide this important information to the patient. . If GP’s are as busy as we are led to believe, then why not provide this information directly to the patient rather than providing a verbal commentary before leaving the hospital and then hope that the consumer remembers what was said.

The patient should not have to wait for a visit to the GP to get this information. Also the continuing care may require other providers eg physiotherapists to be involved.

12:28pm, 21 Nov 2009 Lyng

Why aren't we ensuring our Babyboomers know about how to grow old 'gracefully or disgracefully' - according to their wishes?

Vitamin B12 deficiencies (I am told by DRs) found in a lot of Dementia and Altzheimer's sufferers, I believe, needs to be looked at in more depth.

If these defficiencies can cause irreparable neuro damage - why aren't we spruking up the use of this vitamin, that apprently you can't overdose on?

Of course not everyone is going to take advice, even if we did shout it from the roof tops, but some just might - like me!

We need to provide our Hospital Drs, Nursing and support staff (the latter being predominantly an ageing workforce, caring for an ageing population) with the following:

- skills required to access on-line information

- 'Kiosks' where staff can go at any time to access information

- Secure Intranet access so, if they wish, they can access information securely at home

- Effective Digital Records Systems - both Medical and HR, so that Managers, DRs, Nursing managers, Nurses and all staff can access appropriately secured, information on-line, relevant to their position or needs

Technology:

I work as an HR Systems & Administration Manager in the Health industry and we are rolling out some great new systems across our organisation.

We will be able to provide staff and Managers with so much more information in the future and the work is extrememly exciting.

What are we doing about ensuring our predominantly part-time and casual, as well as permanent staff, can access these new super systems, services & information?

Nothing much from what I can see.

Hospital's core business is to react to community health needs - our HR and IT departments are not core business, they are support services and

they are incorrectly and poorly funded as a result. They are seen as overheads and so cuts are being made at a time when perhaps we should be looking at how these particluar areas, as well as finance, are working. The pressure felt by these areas is incredible, while they continue to provide quality services to Managers, Drs, Nursing Managers and staff, whilst being under-resourced.

Separate Staff and Public Canteens:

Staff need a private place (space) to take their breaks, without well-meaning relatives or patients interrupting them.

This space could also be used to provide Staff with Intranet Kiosk access if possible.

I'm glad I've taken the opportunity to get involved with making what I hope are useful comments.

12:25pm, 21 Nov 2009 Lyng

It is great to be given an opportunity to put forward suggestions for the improvement of our health system. A Review is long overdue and I put forward the following ideas for consideration:

Improve 'discharge procedure speeds' - patients are left not knowing if they 'can go home today' or not, and the waiting for the final discharge can cause frustrations for patients, who need to make arrangements including:

- leaving hospital

- transportation

- groccery and other necessity shopping

- chemist vists and anything else that can make their transition to wellness, smooth in the first days after hospitalisation.

Improve hospital record keeping and make follow-up access to information by GPs, easier.

On hospital discharge recently, trying to access medical records myself and through my Medical Centre, we found that Hospital Information Services (HIS) had an auto phone message that advised they were unable to take any calls, and for us to call back later, as the system had no message-taking facilities.

Improve Hospital discharge information flow and responses to GP requests for information where follow up is required.

Frustrations are caused because this is not as easy as it should be.

Improve speed and quality of dialogue between Hospitals to GPs. Communication and clearly documented or articulated procedures and processes need to be in place to ensure smooth transition into the community for all patients returning to wellness. Patients are not always sure who to contact after hospitalisation and if they are on new medications that have yet to settle into their bodies, understanding of what to do may not be all that clear.

Written medication directions upon discharge are excellent, but it can still be a scary world when you come out of hospital, as your confidence has usually taken a battering!

Discharged persons need to know who to contact if something goes 'wrong' or they go into remission, or have a re-lapse.

Possibly we should check to see how many people go back to emergency, after being discharged from hospital, because they know they will get attention ASAP?

12:34am, 20 Nov 2009 poplin

It is widely recognised overseas and in Australia that the health informatics workforce needs to be developed to support the adoption and use of eHealth including and beyond electronic health records. But the health informatics workforce should be attached to clinical services to bridge the clinical and information technology gap at the coal face and leverage the most effective use of eHealth technology. The typical health informatician is highly qualified (multiple tertiary qualifications) and often has a past clinical background. They should have the ability to support clinicians in adopting and effectively using leading eHealth technologies, which stretch scarce clinical practitioner resources further and free them from informatics duties such as data management and analysis often assigned to nursing hours. eHealth technology is recognised to support quality and safety in healthcare and it has the ability to better inform health services in planning and strategy development; but probably the most important factor for the success of eHealth and Health Information Technology in improving the efficiency and effectiveness of our hospitals will be the competencies of those who implement and use it. This will require a skilled health informatics workforce and a clinical workforce trained in core informatics competencies.

10:03am, 18 Nov 2009 flow

I see these IT jobs in Healthcare advertised every weekend in our state papers - they pay over $100k and they have multiple positions every week available. Whilst it is important to maintain currency and applicability in our IT support for health services - there are too many roles at rates of pay that are incredibly high for the outputs delivered. We risk also creating roles in Health IT that are completely disconnected from the principle of delivering healthcare - because these IT consultants paid incredibly high wages do not negotiate or liaise with the coalface clinicians and actually ask what is needed and how to deliver it. Greater consultation is required to maximise the possible efficiency gains in healthcare of cutting edge IT support. It is worthwhile to note that just one IT manager's wages at over $100k would provide a health service with 2 RN's annually, 3 EN's annually or a senior doctor in a chosen specialty area. Lets get the balance right.

1:17pm, 06 Nov 2009 toot

Why not look at keeping people out of hospital in the first place. Set up community wellness classes in the schools that are empty in the afternoons and on the weekends. Get the consultants to realise that patients from the country can not keep coming up weeks apart for stuff to do with the one condition, so the consultant needs to be there on the day the appointment has been made and also try and get all the tests done within a day so the country patient can organise for just one visit of say two days instead of constantly having to organise one day here, one day there of time off work, children to be looked after and public transport to get to the city is often a joke. Set up the old "c class" hospitals again so that patients who are too well for the major hospital but too sick to go home have an intermediate place to go, this will then release staff and facilities in the major hospital to be used for the really ill patients and therefore it will be more efficient.

3:23pm, 03 Nov 2009 Christine

We hear quite often about people leaving hospital care with new infections, acquired while there. It seems that one of the sources of bacteria and viruses would be patients' visitors, who sometimes stream in during visiting hours. It is assumed to be a good thing for sick people to have a psychological lift from contact with family and friends, but when I recently visited a friend in a post-surgical ward, I didn't even have to put anything over my shoes (disposable covers). I might have just walked in dog poo. There was a sign in the corridor which asked people to wash their hands, beside an antiseptic hand wash dispenser, which was great, but I wonder if any researchers have done studies on how different hospitals and infection levels based on information about average patient visitor numbers, and individual hospital policies re visitors - eg, when someone rings up to say when are your visiting hours, or checks this online, there are guidelines about wearing newly-laundered clothing, not coming in if there is someone with a sniffle, etc. If there was some sort of product that could be sprayed on hands which showed up somehow the extent of 'bugs' on people's hands, this could be both an infection preventative and a learning tool.

3:12pm, 03 Nov 2009 Christine

Consider presenting people admitted to casualty as a result of brawling or antisocial behaviour will a bill once they have have their injuries treated. It could help in two ways: reducing hospital overheads, and as a psychological disincentive to the antisocial behaviour. There would be no question of the medical staff refusing care to someone in need.

8:50am, 03 Nov 2009 clevergirl

All the good ideas keep coming, however we have a fundamental problem in that the basics of the health system are not properly funded. We don't have funding for essential maintenance of our physical hospital infrastructure, so that money has to be found in general funds. Hospitlas are built for the cheapest price, but inevitably that makes them very costly to run. IT systems either don't work or are only partially built or they don't communicate with systems outside of yoru own Area Health Service. There are aspects of health care that are very difficult to estimate as factors outside of the physical illness effect how a person will be able to cope when they are discharged. We have huge gaps in community support to enable people to be discharged safely. We have community care packages that just drop clients with no other provider picking them up. A more efficient system has to be able to accommodate the individuality of different people's health needs. Just withdrawing funds beyond the "efficient cost of care" won't allow for patients with complex lives and needs.

6:03pm, 01 Nov 2009 supertooth

Hospitals that attain significantly best cost efficiency can have that aspect investigated to see if it can apply to all hospitals and the system then communicated to all hospitals via email and website.

3:21pm, 31 Oct 2009 tessa

Put softer mattresses on the trolleys in EDs so that elderly people do not leave ED or hospital with pressure sores that then have to be treated for months in their residential facility or at home.

3:20pm, 31 Oct 2009 tessa

Provide an alternative for older people to calling an ambulance - especially in the middle of the night. Calling an ambulance results in the person going to Emergency Department. The person might just need helping to get back into bed.

9:04pm, 30 Oct 2009 looky40

Activity-based funding for increased efficiency is an excellent idea if it is coupled with "on hands " training for future nursing staff to return to the direct patient contact, which we had in the past , to replace the mainly "paper work " training they are given at the present time.