Combining IT Support Across All Health Sectors within an IT Teaching Centre Brian Regan*, Janet Aisbett*, Greg Gibbon, & Catherine Regan** * School of Management, University of Newcastle, NSW 2308, Australia ** RACGP Training Program, Wallsend, NSW 2287, Australia Abstract-This paper describes a plan to combine IT support for major tertiary hospitals through to independent GPs under a single application support provider. The objectives of the centre being to improve coordination between health providers, reduce GP IT support problems, provide access to Web skills to all players in order to support a thin client model for health IT delivery. I. INTRODUCTION This paper describes a proposal that is currently being moved through the various approval processes of the Australian public sector to build an application service centre which will service the IT needs of the health sector. Unlike the traditional IT outsourcing arrangements this centre will combine support for public sector hospitals with direct provision of IT for independent medical and allied health practitioners to thus facilitate the effective operation of Web based coordination technologies. In addition to these health oriented activities, the centre will use the model of a tertiary teaching hospital to implement a new model for educating IT professionals. II. AUSTRALIAN HEALTH SYSTEM STRUCTURE The Australian health system shares many features with the national health services of other developed nations, but with some of those features coloured by the particular history of the Australian health system in terms of its political evolution. Australia was formed as a federation of six states in 1901, with state governments given constitutional control of health care. As a consequence, state governments finance and operate all government hospitals and most government controlled community health services. The federal government has no constitutional role in health care, however, it is the main collector and distributor of taxation revenue. In this financing role, the federal government controls a national universal health insurance scheme, known as Medicare. Through this and a number of granting schemes, the federal government pays for a proportion of the private fees for medical practitioners, as well as supporting the supply of pharmaceuticals and special schemes targeted at disadvantaged groups. One of the by-products of this funding split, is ongoing concern over the shifting of health costs between state and federal levels. [6] If a patient is treated in a public hospital then the cost is borne by the state government, whereas if the patient is discharged into the community to be visited by their general practitioner (GP) then the cost is borne by the federal government. The result of these perverse incentives has been to bounce patients between community and hospital care with unsatisfactory impacts on their health. To address this problem, state and federal governments have experimented with improving the coordination of services to reduce this problem and improve overall levels of care. Much of this work has exploited information technology (IT) to improve communication for this coordination task. The other axis in patient care has been a split between public and private health services. The public health services consist of major tertiary teaching hospitals, rural hospitals and some community services, mostly targeted at specific health issues. The private sector contains private hospitals of varying sizes, but mostly located in urban areas, and also the provision of most medical services outside the major public hospitals. Most medical practitioners are in private practice, but their services are partially or totally funded on a fee for service basis by the federal Medicare system. In addition to the public Medicare system, individuals can obtain private medical insurance to cover the costs of some allied health services and the costs of being treated in a private hospital or in a public hospital when admitted as a private patient. One of the consequences of this private/public structural split is that most medical practitioners, in particular GPs, operate as small independent businesses.[5] III. PROBLEMS IN HEALTH SERVICE IT DELIVERY As indicated in the previous section, the fragmentation of the health sector has compromised patient care and efficient resource use. Patients can be discharged from hospital without their GP being notified of their discharge, their treatment in hospital or the treatment regime on discharge. As a consequence the patients condition may deteriorate before the GP is made of aware of the patient’s discharge, by which time the patient must be returned to hospital. Improved communication between elements of the sector could reduce adverse events and improve the delivery of care. The provision of communication systems between hospitals and community based services is complicated by a mismatch in IT resources - particularly in terms of IT skills and access to support staff. Whilst Australian hospitals are confronted by similar resource pressures as exist in other developed economies, they still have significant IT budgets. In the private GP practices, there has been a low uptake of computerised clinical records. Approximately 80% of GP practices have computerised billing systems, but only between 3% and 10% use IT for clinical records. [3][4] Through the federal government’s Practice Incentives Program (PIP), GPs have been given $10,000 for the installation of PC’s in their consulting rooms.[7] This initiative has produced a marked increase in the presence of PC’s and their use for clinical