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The eHealth Readiness of Australia’s Allied Health SectorDepartment of Health and Ageing30 May 2011

The eHealth Readiness of Australia’s Allied Health SectorISBN: 978-1-74241-537-6 Online ISBN: 978-1-74241-538-3 Publications Approval Number: D0512

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© Commonwealth of Australia 2011

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© Commonwealth of Australia 2011

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Contents1. Introduction 2

2. Acknowledgements 4

3. Executive summary 8

4. Definitions 26

5. Understanding the allied health landscape 32

6. Current and expected future uses of eHealth 44

7. eHealth readiness of Australia’s allied health sector 54

8. Intervention strategies for advancing the eHealth agenda 74

9. Conclusion 102

10. Appendicies 106

Appendix 1: Acronyms 107

Appendix 2: Research Method 108

Appendix 3: Allied health sector profiles 123

Appendix 4: eHealth readiness survey questionnaire 188

1. Introduction

3

eHealth is one of the most critical elements of health reform in Australia. eHealth will not only improve information sharing and transparency, but also help ensure better patient care, improve collegiate ties, enhance patient satisfaction and – ultimately – save lives.

It is also an area of significant investment. The Australian Department of Health and Ageing (the Department) is currently progressing key actions to underpin the Government’s eHealth agenda, including the Healthcare Identifiers Service (HI Service), which commenced operations on 1 July 2010, as well as investing $466.7 million over two years from July 2010 to establish a personally controlled electronic health record (PCEHR) system.

Proposals to develop a PCEHR system are predicated on the eHealth readiness of key populations of health professionals, including medical specialists and allied health practitioners, to provide quality healthcare along the continuum of care in the primary and ambulatory care sectors. An area that is consistently overlooked in eHealth experiences overseas is the importance of clinical engagement and clarity on the potential for eHealth in medical uses. Obtaining a better understanding of eHealth readiness is the first step towards strong clinical engagement.

To further this goal, the Department has commissioned McKinsey & Company to undertake an objective assessment of the allied health sector’s eHealth readiness.

This report aims to inform clinical engagement in eHealth-enabled, patient-centred care. In addition, it aims to benchmark the penetration of equipment and technology use in this sector (e.g. connectivity, hardware, software, platforms), the mindsets and behaviours of allied health practitioners towards eHealth adoption and usage, and the barriers and drivers for allied health practitioners to participate in future national eHealth initiatives. Each of these is a critical component in ensuring the long-term success of Australia’s eHealth agenda.

We hope this report is useful in achieving these objectives, and are proud to present it to the Department.

Charlie TaylorDirectorMcKinsey & Company

David ChampeauxPartnerMcKinsey & Company

Damien BruceAssociate PrincipalMcKinsey & Company

2. Acknowledgements

5

This report has been compiled with the assistance of the following experts, practicing health professionals and organisations. We thank them for their time and input.

Name Title OrganisationMonica Persson Chief Executive Officer Audiology AustraliaAndrew Schox President Australasian Podiatry Council (APC)Dr Sue Whicker Chief Executive Officer Australasian Podiatry Council (APC)Kandie Allen-Kelly Chief Executive Officer Australian Association of Social Workers

(AASW)Garry Pearson Chief Executive Officer

Victorian BranchAustralian Dental Association (ADA)

Dr Neil Hewson Federal Councillor, Past Federal President

Australian Dental Association (ADA)

David Collier Chief Executive Officer Australian Institute of Radiographers (AIR)Antony Nicholas Executive Director Australian Osteopathy Association (AOA)Trish Martin Senior Project Officer Australian Osteopathy Association (AOA)Jonathon Kruger Manager Policy and

Professional StandardsAustralian Physiotherapy Association (APA)

Bo Li Senior Policy Advisor Australian Psychological Society (APS)David Stokes Manager, Professional and

regulatory issuesAustralian Psychological Society (APS)

Elaine Trevaskis Chief Executive Officer Australian Sonographers Association (ASA)

Dr Stanley Goldstein Head of Clinical Advisory BUPA AustraliaKrystina Brown Chief Executive Officer Chiropractors’ Association of Australia

(CAA)Claire Hewat Chief Executive Officer Dietitians Association Australia (DAA)Anita Hobson-Powell Executive Officer Exercise and Sports Science Australia

(ESSA)Dr Louise Schaper Chief Executive Officer Health Informatics Society of Australia

(HISA)Craig Dukes Chief Executive Officer Indigenous Allied Health Australia (IAHA)Catherine McGovern Group Manager, Government

and Public AffairsMedibank Private

Bridget Kirkham Chief Executive Officer Medical Software Industry Association (MSIA)

Clarke Scott Acting Chief Executive Officer National Aboriginal and Torres Strait Islander Health Worker Association (NATSIHWA)

James ‘Brad’ Freeburn Drug and Alcohol Counsellor National Aboriginal and Torres Strait Islander Health Worker Association (NATSIHWA)

Dr Linda Banach Policy Officer National Aboriginal Community Controlled Health Organisation (NACCHO)

Dr Louise Schaper Clinical Lead National eHealth Transition Authority (NeHTA)

Jonathon Kruger Clinical Lead National eHealth Transition Authority (NeHTA)

6 The eHealth Readiness of Australia’s Allied Health Sector

Name Title OrganisationDr Neil Hewson Clinical Lead National eHealth Transition Authority

(NeHTA) David Stokes Clinical Lead National eHealth Transition Authority

(NeHTA) Gordon Gregory Executive Director National Rural Health Alliance (NRHA)Helen Hopkins Policy Adviser National Rural Health Alliance (NRHA)Ron Hunt Chief Executive Officer Occupational Therapy Australia (OTA)Genevieve Quilty National Policy Manager Optometrists Association Australia (OAA)James ‘Brad’ Freeburn Coordinator, Drug and Alcohol

UnitRedfern Aboriginal Medical Service

Rod Wellington Chief Executive Officer Services for Australian Rural and Remote Allied Health (SARRAH)

Gail Mulcair Chief Executive Officer Speech Pathology Australia (SPA)

In addition, in researching this report we conducted three series of in-depth 45-60 minute interviews with a broad spectrum of frontline allied health practitioners, as follows:

• An initial round of 20 interviews to inform the development and focus of the quantitative survey

• A second round of 15 interviews to further explore a number of the key themes and insights emerging from the quantitative survey

• A third round of 6 interviews to drive a detailed understanding of the attitudinal clusters found throughout allied health

We wish to acknowledge the contribution of all these professionals, and express our gratitude for their assistance and insights.

3. Executive summary

9

eHealth technologies and solutions offer the Australian healthcare system significant benefits, from better collaboration between practitioners and continuity of care, through to better efficiencies and quality of care. Realising these benefits, however, requires a high degree of connectivity and coordination between numerous players within a complex health ecosystem.

Allied health practitioners are critical information and delivery hubs within that health ecosystem. As a body, allied health contains a broad spectrum of work practices, care provision processes, proximity to primary care, education and accreditation requirements, and public or private sector engagement. They play crucial roles in episodic intervention and care, ongoing patient education and management in support of chronic conditions, diagnosis and transfer to further therapy, amongst much more. Their engagement is essential to promote eHealth use and health outcomes across the system. Yet insufficient research exists on their use of eHealth applications, on their attitudes to current and intended future eHealth uses, and on how to drive further adoption and use.

This report sets out the findings of significant new research on the use of, and attitudes towards eHealth (the combined use of electronic communication and technology in healthcare) among the 15 major sectors of allied health practitioners prioritised by the Department – Aboriginal and Torres Strait Islander health workers, audiologists, chiropractors, dental allied health professionals, dietitians, exercise physiologists, occupational therapists, optometrists, osteopaths, physiotherapists, podiatrists, psychologists, radiographers and sonographers, social workers and speech pathologists.

Our research has been framed around three “anchor” questions:

1. Are Australian allied health practitioners ready to adopt and use eHealth technologies and solutions, today and in a way consistent with policy direction in the future?

2. What are the barriers impacting eHealth readiness and adoption and how can we minimise them?

3. What are the eHealth enablers and how can we apply them to drive adoption and effective usage?

To answer these questions, we analysed the eHealth readiness of Australia’s allied health practitioners along three dimensions: their infrastructural readiness (their IT hardware and connections, as well as the software and solutions available to them); their aptitudinal readiness (depth of skills and capability to use eHealth solutions); and their attitudinal readiness (willingness to use current and future eHealth solutions).

We conducted 20 initial qualitative interviews to design a quantitative survey, ran that survey with 1,125 allied health practitioners, and interviewed a further 21 practitioners in-depth on the themes that emerged from the survey. The quantitative survey was targeted at a random sample of 6,500 practitioners across the 15 professions, designed to incorporate geographic and demographic stratifications, and secured a response rate of 17.3%. All questions within the survey were mandatory. The sample sizes achieved imply an error of estimation of approximately 11% at the 95% confidence level for sector-level analyses. While the sample was designed to capture key demographic lenses, for analysis purposes the responses have been weighted such that responses, and the high-level results drawn from them, are representative of the allied health population as a whole.

The high-level findings are that, though attitudes vary, most allied health practitioners see the potential benefits of eHealth to their practice and health outcomes, and can and will use well-designed solutions if the perceived benefits clearly outweigh the costs and barriers. Self-contained administrative, research, professional education and note viewing applications are already being widely used. However, when considering more networked, care-focussed solutions, most practitioners see the potential costs and barriers currently outweighing the benefits.


Attitudes to eHealth vary between allied health professions, reflecting to some extent the differences between the professions, the services they provide and the applications that would prove most useful to each. Yet each profession contains eHealth early adopters and enthusiasts, as well as risk-averse and eHealth resistant practitioners. These variations underscore the need for engagement that accurately responds to practitioner perceptions of benefits and barriers, and to the drivers that will influence them. To better understand attitudinal differences, our research went deeper into an attitudes-based analysis across all allied health sectors. This revealed six separate groups of allied health practitioners, distinct “clusters” in their potential eHealth engagement, which occur across the practitioner sectors. Each cluster exhibited differences in perceived benefits, perceived barriers and the likely enablers that will drive their use and adoption of eHealth practices and solutions.

This report works through the above analysis. It opens by identifying the 15 allied health sectors that we researched, and by detailing their current and expected future uses of eHealth solutions. The report then sets out the readiness of allied health practitioners to use eHealth solutions now and in the future. Through our analysis of the six attitudinal clusters that exist across allied health, and the eHealth benefits and barriers they perceive. Finally, we demonstrate how these cluster insights should be used in developing a strategy for eHealth adoption - determining the interventions most likely to be effective, and set out a considered approach to applying those interventions.

Current and expected eHealth use The National E-Health Strategy (2008)1 identifies both current and potential future eHealth applications. Current uses span practice management tools, information sharing and sources, and service delivery tools such as chronic disease support and telehealth. Intended future uses would expand the use of telemedicine into video-conferencing, expand remote care management with remote health monitoring and feedback on behaviour, and better support clinical decisions, electronic health records, and public health intelligence. Importantly, these future uses would share information through reliable, connected eHealth platforms.

1 National E-Health and Information Principal Committee, National E-Health Strategy, September 2008

11

?

60585856

4037

322726252322

1210554

1723

1212

273031

4939

2555

2950

736972

8284852

3

Show patients health-related information 37View/record patient info during consultationsEnter patient notes after a consultation

18Patient booking and scheduling 22

3333

Complete continuing education and training courses 32Access online clinical reference tools 30Billing and patient rebates

17Sharing health records with my patients 38Sharing health records with other practitioners 49Viewing diagnostic imaging results 22Sending/receiving referrals from practitioners 50Communicate with patients outside consultations 35Completing event summaries

12Ordering pathology testsTransferring prescriptions to the pharmacy

25

13Decision-making support for prescription ordering 14Decision-making support for ordering diagnostic tests 24Ordering diagnostic imaging 26Viewing pathology results

SOURCE: eHealth readiness survey

% of respondents

Use of computers for eHealth applications

Please indicate whether you use, don’t use but would like, or don’t use and don’t need a computer for each of the following activities

Allied health practitioners computer usage by activityDon't use, but don't need

Don't use, but would like

Use

Exhibit 1

Allied health practitioners’ most common uses of computers are those that drive practice efficiency, and those for which mature solutions exist, typically practice administration, professional reference materials and Continuing Professional Development (CPD) support: see Exhibit 1. In particular, appointment scheduling and financial packages are ubiquitous in their design and applicability across allied health, and have a clear efficiency and financial justification. Specific eHealth applications in use include viewing and recording patient information (40%, 37% respectively of respondents are currently using), sharing patient information and event summaries with other health professionals (22%, 27%), and viewing diagnostic imaging (23%). Currently, 70% of practitioners also store some form of patient information electronically. However, only 14% rely solely on computers and our vendor and practitioner interviews suggest this is mostly for patient administrative details, rather than their clinical records.

The leading adopters of eHealth are those allied health sectors that can use existing technology and applications to meet their professional needs. Audiologists and radiographers are the sectors that most feel expected to use computers in their daily work (95%, 84%). They are also the sectors that use computers most for practice and research purposes (74%, 73%), while speech pathologists and social workers are using them least (44%, 42%). Leading uses beyond research and practice administration include radiographers viewing patient information and imaging, audiologists using clinical reference tools and showing patients health information, optometrists seeking specialist review, and Aboriginal and Torres Strait Islander health workers facilitating communication between patients and other healthcare professionals.


The eHealth applications most sought-after by allied health practitioners include sending and receiving patient referrals (50% of survey respondents don’t use, but would like) and sharing health records with other practitioners (49%). In both cases, a common system is required for communication between health professionals. Many allied health practitioners are unable to overcome the coordination requirements of implementing electronic referrals and record-sharing, given both the number and diversity of stakeholders within a patient management ecosystem, and the central role of GPs to patient management. Better communication with patients (sharing health records 38%, showing health-related information 37% and direct communication before or after consultations 35%) is also a prominent desire.

Telehealth use is currently low (13% of respondents), with the dominant use being collaboration with other practitioners. A further 40% of respondents expect they will be using telehealth services within 3 years. Their dominant interests are not patient-facing however, with the three leading applications being training (63% very interested), consulting with other practitioners (47%) and supervising (46%).

Readiness for eHealth useTo assess their readiness for further eHealth use, we analysed Australia’s allied health practitioners along three dimensions: their infrastructural readiness (their operating environment, as well as their IT hardware, software and connections); their aptitudinal readiness (depth of skills and capability to use eHealth solutions); and their attitudinal readiness (willingness to use current and future eHealth solutions). We found consistently strong aptitudinal readiness for basic, self-contained computer applications, but infrastructure readiness varied within and among sectors, and these were amplified by differences in attitudinal readiness. Attitudinal readiness requires the closest analysis due to the high degree of variation observed.

Infrastructural readinessAllied health practitioners in general have the basic IT equipment and connectivity for eHealth adoption. However, the landscape of available eHealth solutions is highly fragmented, reflecting the diversity of allied health practice, with few mainstream applications designed specifically for allied health sectors, and little connectivity between applications. Addressing system connectivity, interoperability and security barriers will help drive increased use among early adopters.

Most allied health practitioners have access to computers in their main practice setting (88% in major cities, 94% for inner and outer regional areas, decreasing to 69% in remote areas), and 58% of practitioners have access to a computer less than 3 years old. Most practitioners have internet access in the main practice setting (83% in major cities, 90% for both inner and outer regional, decreasing to 58% in remote areas), almost all of those being broadband (82%).

The relative fragmentation of the eHealth solutions space targeted towards allied health means that few disciplines are able to benefit from mature applications designed specifically for their use. In particular, the different care processes required for counselling-based, physical and specialist technical therapies require a very different practitioner interface. Over 75 commercial eHealth software solutions were observed in use across allied health, of which the top 3 comprise 22% of the market, while the top 10 comprise 42% – no system has emerged into common usage across

13

allied health. (There are several professions, notably ATSIH workers and dental allied health, where common systems are emerging, but these are the exception rather than the rule.) In addition, there are a large number of practices that have developed their own record-keeping systems, typically a series of templates in standard office software. In itself, this fragmentation would not be an issue – the broad spectrum of care processes found within allied health suggest a large number of solutions may indeed be required. However, the applications used rarely share operating platforms or interoperability standards, and rarely have the functionality, reliability and support required of integrated eHealth applications.

Allied health practitioners that have already invested in eHealth solutions also face infrastructural barriers to expanding their use. For example, any additional system should be compatible with currently used ones, and need to securely connect with external systems. The systems should also accommodate the practitioner’s work process, rather than the other way around. Chiropractors, for example, find that user interfaces are not aligned to the flow of their practice processes.

Aptitudinal readinessAllied health practitioners typically have the necessary aptitudinal readiness for eHealth, having sufficient capabilities from their combined professional and personal IT use. However several interviewees suggested the familiarisation period for the specialist applications they use has been shortened considerably through intensive introductory training.

Current eHealth usage levels suggest that most allied health practitioners are relatively technology literate. Although usage decreases with age (from 75% of practitioners aged 24-45 who use at least one eHealth application, down to 56% of practitioners aged over 55), there is high personal internet usage across the entire allied health community (97% of practitioners use the internet at home) suggesting strong basic eHealth capability and skill.

Specialised software applications will generally require a period of familiarisation and are likely to include some system training. However, the majority of practitioners do not believe that the difficulty selecting and implementing a system, or the potential for productivity drop during transition, are significant barriers to adoption. Further, practitioners who have made the transition describe the inconvenience as minor in comparison to the benefits gained.

Attitudinal readinessAllied health practitioners have varied attitudes towards eHealth, ranging from strongly convinced of its need, to expressively negative. Underlying these attitudes are their perceptions of the benefits of eHealth applications, and the barriers and risks they confront as they consider adopting those applications. These attitudes are strong determinants of adoption rates in each profession. But as with the allied health sector as a whole, each profession is heterogeneous: in each there are practitioners who are quite resistant to eHealth applications, and those that verge on being eHealth evangelists. Identifying who will be resistors and who will be catalysts for change will be critical, as will discovering what will motivate those who are eHealth’s strongest advocates to help influence others.

To better explore and understand these attitudes and underlying perceptions, we deepened our analysis to identify six clusters of allied health practitioners with quite distinct attitudes to eHealth possibilities. We now turn to that cluster analysis as the clearest way of identifying insights to


practitioner attitudes that are actionable, and upon which a meaningful strategy to support eHealth engagement and adoption can be built.

Cluster analysis of attitudes and drivers Identifying clusters in a stakeholder group is a multi-layered approach to stakeholder segmentation. To identify a stakeholder group, we would ask “what do they do?” Demographics will answer who they are. To identify needs, we ask “how do you operate?” – their revealed behaviour implies what their support requirements and preferences are. Only by analysing those needs directly can we ascertain why people behave the way they do, and what may be stopping them fulfilling those needs. A needs-based lens looks into the future: into what “could be” rather than what “is”.

Applying this needs-based approach, we uncovered six eHealth attitudinal clusters that cut across all allied health professions. Across clusters, practitioners differ in the benefits they see in eHealth applications, the barriers they perceive, and the enabling action needed for them. The biggest influence in defining the boundaries between clusters has proved to be the potential benefits of eHealth perceived by allied health practitioners. We describe the clusters below, in order of their likelihood to adopt, and influence others to adopt, eHealth solutions.

Cluster 1: Proactive pioneers (16% of all respondents)These practitioners are strong believers in the benefits of eHealth – for collaboration between practitioners (64% of cluster strongly agree), for practice efficiency (62%), and for continuity and quality of patient care. They are the only cluster whose members strongly believe that patient relationships would benefit from eHealth adoption (34%). They are typically early adopters, and perceive few barriers to adoption. Operating almost exclusively in the private sector, they are comfortable with their ability to assess, select and implement solutions, and have significant influence over the practice’s eHealth decisions. Though pro-eHealth they are pragmatic in those decisions, only adopting solutions that do not diminish either practice efficiency or patient outcomes.

In common with other clusters, they use computers heavily for patient scheduling and billing, and for professional reference and education. However, they are more likely to use eHealth solutions for referrals, patient communication and clinical notes. This cluster is well-represented in most sectors, being prominent among dentists and radiographers and found less among dietitians, occupational therapists, speech pathologists and psychologists. They are responsive to any support for eHealth, in particular peer recognition, and will likely act as role models for eHealth adoption and provide risk and benefit data for later users.

15

Leading current uses Perceived benefits Barriers Adoption drivers• Billing and patient

rebates 83%

• Patient booking and scheduling 73%

• Referencing online tools 70%

• Completing continuing education and training 69%

• Entering patient notes after consultation 63%

• Ability to collaborate with other practitioners 64%

• Increases in practice efficiency 62%

• Continuity of patient care 54%

• Maintain compatibility with existing systems 25%

• Prefer established technology 19%

• Visibility of practitioner performance data 17%

• Financial incentives 69%

• Advice of professional body 57%

• Professional respect and recognition 52%

Cluster 2: Embedded converts (20% of all respondents)Embedded converts typically work in an environment, such as public hospitals, where computer use is expected and applications are provided for use. They tend to be young and employed in the public sector, with dietitians, radiographers and aboriginal health workers prominent, and chiropractors, dentists, optometrists and psychologists underrepresented.

Where embedded converts have been introduced to eHealth solutions, they have appreciated the experience and the additional capabilities eHealth has brought them. As a result, they have become the strongest believers in the potential of eHealth solutions, seeing benefits in practitioner collaboration and continuity of care. While enthusiastic about the benefits, embedded converts are less likely to control purchasing and adoption decisions within their practices, and so adoption strategies cannot rely on their direct influence.

Being the largest cluster, enlisting their support will provide the critical mass for eHealth adoption in the public sector. They are visible to and can influence a broader base of peers and other healthcare professionals outside the public system. They also appreciate the risks and concerns that they may themselves have once had, so may be a credible influence for more resistant groups: they won’t be perceived as eHealth-enthusiasts who too-readily dismiss the risks.

Leading current uses Perceived benefits Barriers Adoption drivers• Patient booking and

scheduling 72%



• Completing event summaries 47%





• Cost of implementing new systems 28%

• Maintain compatibility with existing systems 23%




The next three clusters perceive the benefits of eHealth solutions and believe that they will be expected to adopt them, but are hesitant to adopt for different reasons.

Cluster 3: Risk-conscious (17% of all respondents) Risk-conscious practitioners are aware of the potential benefits of eHealth solutions, but see risks across the board and so remain unenthusiastic. In particular, they are about six times more likely than eHealth-positive clusters (1 and 2) to be concerned about the security and privacy of patient information, and twice as likely to be concerned about the visibility of performance data.

Though relatively young (only 16% are over 55 years of age) and city-based, they perhaps-surprisingly have the lowest average personal internet usage. This relative unfamiliarity with IT systems means they will also need reassurance on the capability and maturity of systems before they adopt them.

They consider the advice of their professional body a reliable guide, suggesting case studies of practitioner adoption and certification from professional bodies of potential system security are a potential adoption lever. This cluster is broadly represented across all allied health practitioner groups, with the exception of dietitians and speech pathologists.


rebates 70%





• Viewing/recording patient information during consultation 43%




• Patient privacy 53%

• System downtime 34%



Cluster 4: Cost-conscious (15% of all respondents)These practitioners are interested in eHealth and see a broad spectrum of benefits, in particular practitioner collaboration, practice efficiency and continuity of care. However, their primary concern is the cost of implementing and maintaining new systems and, as with the risk-conscious and doubter clusters, harbour concerns about the visibility of performance data.

Cost-conscious practitioners are receptive to financial incentives, and to evidence of efficiency benefits or to demand from patients. Otherwise, they will remain unconvinced, seeing a limited role for new technology in their practice until the technology becomes better established and the system and implementation costs come down.

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The socio-demographic attributes of this cluster are close to the norms for allied health practitioners. Cost-conscious practitioners are represented across all sectors, with psychologists the most prominent profession, and audiologists and Aboriginal and Torres Strait Islander health workers underrepresented.


rebates 60%








• Cost of implementing new systems 58%


• Can’t find a solution to meet needs 27%



Cluster 5: Doubters (13% of all respondents)These practitioners have similar concerns to those in the risk- and cost-conscious clusters, but their negative perceptions are stronger. They are uncomfortable with adopting unfamiliar technology in the face of their limited understanding of the broad system choices available. Believing practitioner collaboration to be the only clear benefit from eHealth, they don’t value the latest technology solutions, and harbour a host of concerns about system compatibility and downtime, the availability of IT support, and cost.

While financial incentives and professional body endorsement may give some reassurance, doubters will typically wait for technologies to be almost ubiquitous before they adopt them, and may need direct peer reassurance in their place of work. Besides their attitudes to eHealth solutions, they are difficult to identify in their health networks: their age, gender, experience, location and source of income are close to the norms for allied health practitioners, and no profession is overly represented.

Leading current uses Perceived benefits Barriers Adoption drivers• Patient booking and

scheduling 55%



• Billing and patient rebates 50%






• System downtime 34%




The final cluster have a negative impression of eHealth, disagreeing with the potential benefits and emphasising the barriers.

Cluster 6: Firm non-adopters (17% of all respondents)Practitioners in our final cluster are significantly more sceptical of the benefits of eHealth, and avoid eHealth use unless the benefits are undeniable and the inconvenience to their ways of work minimal. Despite acknowledging that their peers expect them to use technology in the workplace, firm non-adopters remain unconvinced. They believe that patient relationships would suffer from eHealth use, and that it would diminish patient safety and engagement as well as the delivery, access to and quality of care. They are the most likely of all practitioners to strongly agree with any barrier proposed, in particular cost, privacy, and the visibility of performance data.

Firm non-adopters are more likely to be older, female, more experienced practitioners from the counselling-based therapies of psychology and social work, and will likely delay adoption until any new technology is extremely well established in their profession (if indeed that happens before their retirement). Financial incentives or mandatory participation schemes may be required in the end.

Leading current uses Perceived benefits Barriers Adoption drivers• Referencing online

tools 54%

• Completing continuing education and training 53 %

• Billing and patient rebates 46%


• Communicating with patients before or after consultation 22 %

• N/A • Cost of implementing new systems 78%




Analysing clusters by profession

Importantly, we found that each of the six clusters is represented in all but one of the 15 allied health professions. The distribution of clusters depicted in Exhibit 2 may be explained by the work settings and clinical needs of the profession. The findings firstly reinforce the need for a cluster analysis: it identifies different attitudes within a profession, while a profession-based analysis would only ‘average out’ those attitudes in the profession and so promote a profession-wide adoption strategy for the ‘average’ practitioner. Secondly, the distribution shows that each profession has a reasonable representation of the more enthusiastic clusters – proactive pioneers and embedded converts. For example, 35% of surveyed physiotherapists surveyed fall into these two clusters, providing a solid base of support upon which to build adoption.

19

Clusters by profession


20

59

29

10

57

25

24

7

12

21

18

11

29

17

33

15

5

11

20

12

9

23

14

15

21

14

13

22

13

11

15

19

12

23

12

14

5

12

17

20

17

31

3

28

25

1

20

20 11 21

8

Physiotherapist 14 19 12

19

15

Osteopath 15 21

12

11

Optometrist 28 14 19

Occupational therapist 8

Social worker

23

Psychologist

19

Exercise physiologist

17

25

4

12 9

10

Dietician 7 1 12

15

Dentist 28 23

15

15

12

Chiropractor 14

11

22

Speech pathologist

Audiologist 21 21 5

Aboriginal Health Worker 18

Radiographer/Ultrasonologist

21

5

Average across all

23

Podiatrist

16 17 13

12

Percent of respondents

Cluster distribution by segment

Proactivepioneers

Embeddedconverts

Risk-conscious

Cost-conscious

Doubters Firm non-adopters

Exhibit 2

Practitioner engagement strategies

The purpose of the readiness and cluster analyses is to inform eHealth adoption strategies so that the right interventions can be deployed at the right time for the right group of allied health practitioners. These decisions will depend on several factors including the type of eHealth application, the extent of the desired adoption (e.g. ubiquitous, specific specialties, specific geographies), the target adoption rate and profile over time, and the budget for change and adoption actions.

Available interventionsThe research indicates that a focus on educating and training individual practitioners will be insufficient. This focus would not address some fundamental barriers to adoption, such as the suitability or limitations of available eHealth solutions, and how they are delivered across the relevant health network. Actions to influence the use of eHealth applications by allied health practitioners must work along three complementary axes, being those that:

1. Shape the eHealth products, i.e. the eHealth solutions as a whole, including any IT hardware, software, delivery and support

2. Shape the demand for those products among allied health practitioners, and

3. Shape the health ecosystems in which those practitioners work

Along each of these three axes, certain interventions will work better with some clusters than others. These are summarised in Table 1 below. Further, some interventions must be launched


before others: in any adoption strategy, there will be an establishment period, a time in which momentum is built, and a time for consolidating real change. The nature and timing of these interventions are discussed in more detail in the body of the report.

Shaping eHealth products

A number of barriers to adoption of eHealth stem from concerns about the eHealth solution itself, such as the security, privacy, suitability, interoperability, usability, reliability or cost (of installation and operation) of the solutions. Therefore an effective adoption strategy cannot be limited to engaging or shaping the demand. Interventions are needed to lower the product-related barriers (real or perceived), tailoring the product or its delivery to the differentiated needs of the allied health professions.

All the interventions listed in the following Tables 1-3 will be required to some extent. High (H), Medium (M) and Low (L) are rankings of relative efficacy for each cluster, and do not suggest whether or not a lever is fundamentally important.

Table 1: Product-shaping levers by cluster

Shape the product Proactive pioneer

Embedded converts

Risk-conscious

Cost-conscious


1. Ensure access to or provide fundamental infrastructure

L M L M H M

2. Establish, enforce and communicate compliance with clear interoperability standards

H M L L H L

3. Provide ‘backbone’ framework establishing legal, data ownership and storage, and security standards and rules

H L M L H M

4. Establish shared solution architecture platforms to ensure more efficient development and delivery of standards-compliant solutions

H H L M H M

5. Create the conditions which engage vendors in developing eHealth solutions aligned to practice and cluster type to address usability and functional requirements concerns

H L L H M M

6. Establish support mechanisms to prevent or mitigate downtime risk and other non-functional performance issues

L L H H H M

7. Assist EHR early adopters transitioning to structured record-keeping

H M L L L L

21


Embedded converts

Risk-conscious

Cost-conscious


8. Provide a ‘practice upgrade and change management’ service

L M H H H M

Shaping eHealth demand

The research identifies wide variations in the intended use of eHealth solutions, and in the attitudinal underpinnings of these variations. The clusters have markedly different perceptions of the benefits, costs and risks of eHealth. Therefore the effort to shape the demand for eHealth solutions must be grounded in the needs profiles identified in the research: by speciality and by cluster. Examples of demand-shaping interventions are outlined below, focused on defining and proving tailored value propositions, and stimulating awareness and early adoption.

Table 2: Demand-shaping levers by cluster

Shape the demand Proactive pioneer

Embedded converts

Risk-conscious

Cost-conscious


1. Define tailored value propositions by profession and/or cluster

L M L L L M

2. Empower “super-users” and professional bodies to define, establish and promote benefits

H M H M H M

3. Develop an evaluation framewoto track and report on business-, patient- and efficiency-related benefits

L L M M H M

4. Build usage expectation at practitioner and patient level

L L M H M M

5. Reduce the perception of risks in the change to an eHealth solution via peer testimonials and professional bodies communications

L L H L M M

6. Provide financial assistance at key milestones

L M L H H M

Shaping health ecosystems

Introducing eHealth solutions that affect care delivery models will require coordinated approaches across the healthcare system. The research has confirmed that allied health practitioners are influenced by overall system changes and benefits. The eHealth adoption strategy therefore needs to help create the conditions in the ecosystem that influence and support adoption, within and across clusters. This includes a regulatory and incentive environment in which vendors, professional bodies and practitioners can develop and adopt the right solutions.


Table 3: Ecosystem-shaping levers by cluster

Shape the ecosystem Proactive pioneer

Embedded converts

Risk-conscious

Cost-conscious


1. Establish clear and aligned eHealth adoption aspiration and timeline to facilitate decisions and commitments by practitioners and solution vendors

H M L M M L

2. Coordinate critical mass of adoption within defined health networks

M L H M H M

3. Create transparency on adoptionplans and trends

L M H M M L

4. Embed eHealth training into professional education programs, and anticipate implications of eHealth-enabled models of care in workforce planning and education and development

L H M M M L

5. Enlist the full support, engagement and influence of professional bodies and patient representation groups

H M H M M L

6. Require mandatory participation Lvia regulation or other mechanisms

L M L M H

Applying the interventions in a strategy

It is not the purpose of this assessment to determine final strategies to drive the adoption of particular eHealth solutions. Instead, we seek to establish a foundation from which targeted strategies can be developed to improve outcomes through the adoption of eHealth solutions. Accordingly, we set out a detailed example of how the findings of the eHealth readiness research may be applied in a comprehensive adoption strategy, with well-targeted interventions selected to meet practitioner and policy expectations and address the many barriers to adoption. The example strategy is to adopt telehealth solutions to improve patient outcomes in the management of chronic conditions. In overview, the described strategy would:

1. Describe the objectives and set the aspiration

2. Develop and prioritise use- and business cases

3. Identify the critical allied health sectors and their role in the use-case

4. Highlight participant clusters and their role in adoption

5. Prioritise clusters and their intervention drivers

6. Integrate intervention levers to develop a coordinated strategy

7. Measure performance and refine the approach

23

This strategic approach can be further developed for most eHealth solutions, applying the findings of this research.

Research conclusionsOn the basis of this research, we would now answer the three anchor questions as follows.

1. Australia’s allied health practitioners are ready to adopt eHealth technologies that improve either their practice’s operational efficiency or clinical outcomes – indeed many have already done so. However, the allied health professions are not yet ready for the transition to coordinated eHealth solutions across the entire health ecosystem – mature eHealth solutions accommodating allied health care processes and allowing interoperability are not commonly available.

Allied health practitioners have the fundamental infrastructural and aptitudinal readiness required for eHealth adoption and use, and are broadly optimistic about its potential. Further, six distinct attitudinal readiness clusters emerge within the allied health community, from proactive pioneers to firm non-adopters, allowing the development of targeted adoption strategies.

However, the fragmentation of the allied health community remains a key hurdle – the majority of eHealth adoption has been driven at the practice-level in relative isolation, resulting in a diverse range of system capabilities and maturities. Accordingly, practices remain incapable of direct integration into a health system-wide network. In order to realize the most valuable patient benefits outlined in the National E-Health Strategy, a coordinated eHealth framework needs to be developed, encompassing the diverse needs of the allied health community in addition to other stakeholders.

2. The dominant barrier to greater eHealth adoption across the allied health community is the accommodation of new systems within an established care process. This manifests in concerns over compatibility (both internally and to the wider health network), interruption (system malfunction and availability of support) and risk (patient privacy and the visibility of practitioner performance data).

Allied health practitioners in private practice must maintain their high standard of patient care within a demanding small to medium business environment, where the continuing patient relationship is often fundamental to care outcomes. Potential eHealth solutions must accommodate, through a series of levers outlined in this assessment, the reality that change embodies risk, that system failures have both financial and reputational impacts, that technology must support or enhance, rather than restrain patient outcomes, and that the adoption of a fundamental technology platform is a critical decision for a practice.

Addressing both real and perceived barriers to adoption is fundamental to developing an adoption strategy. Compatibility issues can be countered by establishing clear interoperability standards. A robust governance framework can address uncertainty over use or ownership of data. Technologies can be tailored to fit the care process of a specific profession given the right incentives. A transparent adoption timeline and visible commitment can stimulate critical-mass


adoption. No insurmountable barriers to eHealth adoption exist, but addressing those uncovered is critical to the development of successful adoption strategies.

3. The two key enablers of eHealth adoption by allied health practitioners are a conviction that the benefits clearly outweigh the risks, and the assurance that practitioners choosing to adopt eHealth solutions are doing so within a supportive and coordinated framework.

Within the allied health community, the potential benefits of eHealth for both patient outcomes and practice efficiency are broadly anticipated. However, realising the core benefits of eHealth requires long-term progression towards network-wide adoption, while many of the risks emerge immediately at the practice level. Accordingly, there is limited impetus for individual practices to adopt interoperable eHealth solutions beyond those that have immediate and localised benefits.

Several potential intervention levers for driving eHealth adoption and effective use emerged from this assessment. Firstly, the observation of six behavioural clusters determined that, within each profession, there are practitioners who will enthusiastically adopt, and those who will require significant persuasion and assistance. Secondly, for each cluster the strength of specific intervention levers was gauged – professional body support, peer clinical leadership and financial incentives are the major motivators across allied health.

Based on this assessment, advancing allied health practitioners’ eHealth adoption in a way that achieves widespread improvements in health outcomes requires shaping the three axes of ecosystem, product, and demand. Addressing a single axis in isolation is likely insufficient to produce significant change. Shaping the ecosystem is critical for establishing an integrated healthcare network that supports and drives change, shaping the product is necessary to overcome adoption barriers and ensure that solutions maintain or enhance practitioners’ care delivery processes, and shaping demand provides the necessary incentives to spur adoption and use.

This assessment provides a directional overview of the current state of the eHealth readiness of allied health practitioners. Further, it aims to provide a foundation from which to develop targeted strategies on the engagement of allied health practitioners with eHealth solutions for patient-centred care. In many ways this is a first step - much work remains to be done on understanding the complex interrelationships developing between eHealth solutions, health professionals, patients and other stakeholders, as Australia develops a detailed strategy for the improvement of health outcomes through the adoption of eHealth.

4. Definitions

27

Allied healthThere remains no clear and consistent agreement on what comprises the allied health workforce at either the Commonwealth or State and Territory Government levels. Indeed, the inclusion or otherwise of healthcare professions within allied health remains a matter of debate at practitioner, peak body and payer levels. The 15 professions investigated in this report balances the requirement for comprehensive understanding of the allied health sector against existing knowledge, individual sector size and homogeneity, and the cost of data collection.

Given the complexity of this space, DOHA has specifically requested prioritisation of 15 specific professions within allied health, comprising:

1. Aboriginal and Torres Strait Islander health workers

2. Audiologists

3. Chiropractors

4. Dental health professionals

5. Dietitians

6. Exercise physiologists

7. Occupational therapists

8. Optometrists

9. Osteopaths

10. Physiotherapists

11. Podiatrists

12. Psychologists

13. Radiographers and sonographers

14. Social workers

15. Speech pathologists

This report does not investigate professions acknowledged by the Australian Health Workforce Advisory Committee as being outside allied health (e.g. doctors, nurses, peripheral health workers such as dental assistants and diabetes educators, and alternative therapists), those professions covered by an adjacent study (e.g. medical specialists), those professions covered by separate agreements with the Australian Government relating to IT needs and eHealth (e.g. retail pharmacists), and those professions which are relatively small compared to other professions (e.g. othotists, prosthetists, orthoptists, and rehabilitation engineers).

Geographic classificationsOur classification of location corresponds with prior healthcare sector reviews (AHWAC 2006.12), and is based directly on the Australian Standard Geographical Classification (ASGC) as published

2 Australian Health Workforce Advisory Committee (2004), The Australian Allied Health Workforce - An Overview of Workforce Planning Issues, AHWAC Report 2006.1, Sydney


by the Australian Bureau of Statistics. In response to the limited number of allied health practitioners in remote areas, the ‘Remote’ and ‘Very remote’ categories have been consolidated into a single category, whilst the ASGC ‘Offshore’ classification is considered irrelevant in this instance.

eHealth We broadly define eHealth as the combined use of electronic communication and technology in healthcare. This definition encompasses four general categories of technology solutions – electronic information sharing, practice management tools, service delivery tools and contribution to health information sources – as detailed in Exhibit 3. While the precise future state of eHealth is difficult to predict, the current landscape and expected lead applications find broad consensus.

SOURCE: National eHealth Strategy Summary, p12 and team analysis

What are the eHealth solutions that allied health practitioners need to be ready for?

eHealth technology solutions currently in use

Electronic information sharing

Service delivery tools

Contribution to health information sources

Practice management tools

Information flow between providers

Patient records

Chronic disease management

Telehealth

Public-centred

Patient-centred

Clinical decision support

Patient booking

Billing

Resource booking

Send or receive referrals

Produce event summaries

Order prescriptions

Diagnostic test orders and results

Identification and monitoring services

Automated reminders and follow-ups

Healthcare reporting and research datasets

Health information knowledge bases

Consultations with patients

Consultations with healthcare providers

Medication management

Test ordering

Health profiles

Medications lists

Personally controlled electronic health records

Patient demographics

Training and education

Remote monitoring

Supervision

Exhibit 3

Since the initial release of the National eHealth Agenda in 2008, the health landscape has evolved significantly. In a number of areas (e.g. diagnostic radiography and sonography), it has evolved more quickly than anticipated. Likewise, technology is evolving so fast (e.g. smart-phones, mobile applications) that it is difficult for policy statements to remain current. Rather than take a static view of eHealth based on the current state, it is necessary to consider future applications, particularly in light of the PCEHR Concept of Operations and the Department’s understanding of the likely or intended role of allied health practitioners downstream. eHealth applications that have gained traction internationally and are likely to become increasingly relevant in Australia are listed in Exhibit 4.

29

Remote care management & wellness

Telemedicine

Clinical Decision Support

Health intelligence

Electronic Health Records

Technology Definition

Source: Healthcare Special Initiative solutions library

eHealth applications likely to gain relevance in Australia

▪ A subset of telehealth technologies that enable healthcare providers to administer care remotely▪ E.g., kiosks with videoconferencing and vital sign devices, mobile applications, SMS, store-forward

▪ A subset of telehealth technologies that enable healthcare providers and educators to monitor, educate and influence the behaviour of patients remotely

▪ Consists of– Remote health monitoring technologies to collect and manage data (e.g., vital signs, motion,

compliance) from passive/active/interactive devices; includes workflow and decision support systems used to drive appropriate health actions based on the collected data

– Feedback and behaviour modification technologies to affect change in patient behaviour by providing health education and feedback on behaviour relative to personalized health goal

▪ Tools used by healthcare providers or patients to aid diagnosis, treatment, or care process decisions▪ May document data, display relevant data, lookup/display reference material, flag potential errors,

implement (e.g., guided dose algorithms), and track over care pathway

▪ Systems for managing longitudinal health record spanning multiple providers across the care continuum▪ Electronic health record solution consists of:

– Electronic Medical Record (medical history within single provider) – Healthcare Information Exchange to integrate and make available electronic health records across

providers– (optionally) Computerised Physician Order Entry to allow clinicians to enter/communicate treatment

instructions electronically to staff (e.g., nurses, pharmacy, laboratory, radiology) responsible for fulfilling the order

– (optionally) Basic clinical decision support systems commonly sold as a module by EHR vendors (e.g., those which warn against drug allergies)

▪ Health intelligence is a group of technologies that enables– Public health informatics functions and analyses such as disease surveillance– HER-based outcomes analyses such as comparative effectiveness of drugs and procedures– Risk stratification analyses which enable activities such as selection of patients for disease

management programs

1

2

3

4

5

Exhibit 4

TelehealthFor the purposes of this research, telehealth has been defined more broadly than under the Medicare Benefits Schedule (MBS).3 We define telehealth as the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. We asked survey respondents and interviewees to consider both clinical elements of the health care system such as remote consultations with patients and other practitioners, and non-clinical elements such as remote training.

ReadinessWe define eHealth readiness across three dimensions:

1. Infrastructural readiness: to what extent does the practitioner’s external environment and infrastructure support eHealth adoption? For example, does the practitioner have the requisite computer systems and connectivity to use a full spectrum of eHealth solutions, and are suitable systems commonly available?

3 MBS Telehealth rebates are limited to remote consultations online or via video conference with rural, regional and outer metropolitan patients


2. Attitudinal readiness: Do practitioners believe that the benefits from adopting and using eHealth solutions outweigh the costs and risks? How willing are they to engage in new technologies?

3. Aptitudinal readiness: To what extent does a practitioner have the skills, training and IT support needed to adopt and use eHealth solutions to their full potential?

This three-dimensional approach provides a more robust understanding of the current state of readiness and likely barriers and enablers. It allows an assessment of not only the existing hardware and software used today, but also how it is used and the underlying reasons for usage or lack thereof. It also provides the foundation for understanding the gaps and barriers to eHealth and their root causes (which can range widely from concerns such as over implications for their role, implications of information transparency, or efforts or costs they anticipate relative to benefits or incentives).

Additionally, we consider eHealth readiness within the context of expected use, which often varies considerably based on the nature of a practitioner’s work (e.g. specialty, geographic location, practice setting, and type of patients).

5. Understanding the allied health landscape

33

The allied health sector has experienced dramatic growth in recent years in response to increasing demand for health services and a shift towards greater recognition of the role that the sector can play in providing healthcare. As the allied health sector takes on a more significant role in the provision of health care services in Australia, it is increasingly important to have a more detailed understanding of its size and composition and how it fits into the broader Australian health landscape.

Historically there has been limited data available on the allied health professions. A sound fact base is essential for disaggregating the drivers and barriers of eHealth adoption amongst allied health practitioners, designing interventions to promote greater engagement with the national eHealth agenda and assessing the impact of policies once they have been implemented.

This chapter provides a profile of the allied health sector. As well as an overview of the size of the professions and the growth that they have experienced in recent years, it endeavours to give an insight into the work practices, funding and education of the sector. The information presented has been drawn from the eHealth readiness survey, detailed follow-up surveys and consultation sessions conducted for this report, as well as existing research on the professions.

Appendix 3 provides a high-level profile of each of the composition, role and eHealth position of each of the 15 allied health professions. The accompanying Annexure to this report, The eHealth Readiness of Australia’s Allied Health Sector, contains a detailed breakdown of results from the eHealth readiness survey for each profession.

Size and composition Between 2001 and 2006, the number of practitioners in each of the allied health professions grew by between 10 and 36 %. In that time, the total number of practitioners in the sector expanded by 22 %: see Exhibit 5. The number of recognised professions has also grown in line with technological advancements. For example, specialist sonographers have emerged as a separate discipline from traditional radiographers following the development of sophisticated ultrasound techniques.

The number of practitioners in the 15 allied health professions included grew from 81,500 practitioners in 2001 to 99,600 in 2006 – a 22% increase

Size of the allied health sector, by profession

SOURCE: ABS 2011, customised report Note: Exercise physiologists were not recognised as a separate profession until after the 2001 and 2006 census collections

Size (Thousands)GrowthPercentProfession

14

36

20

3,865

3,065

778

2,997

2,693

2,005

1,011

1,074

2,095

2,485

2,590

6,838

9,917

11,671

12,287

12,444

29,512

920

793

1,754

2,085

5,353

8,152

9,105

10,243

9,123

25,883

420Osteopath

ATSIH worker

Audiologist

Podiatrist

Chiropractor

Dietitian

Optometrist

Speech pathologist

Occupational therapist

Radiographer/Sonographer

Psychologist

Physiotherapist

Social Worker

Dental health professional

28

22

29

14

19

35

28

29

19

10

85

2006 census

2001 census

Exhibit 5


Age and genderAllied health workers are a significantly younger workforce than those in the medical specialist, general practitioner and nursing professions, and are predominantly female: Exhibit 6 below. Further data on individual allied health profession demographics is presented in the detailed profiles of the professions in Appendix 3.

Allied health age and gender distribution

SOURCE: ABS 2011, customised report

Age (number of practitioners)

Gender (percent of practitioners)

11,692

10,722

22,713

25,120

30,822

12,419

7,475

17,300

23,196

25,550

55+

45-54

35-44

25-34

0-24

2006 census

2001 census

65

35Male

Female

Exhibit 6

Work practices The allied health professions consist of practitioners with a wide variety of workflows, philosophies and professional cultures. Understanding the work practices of allied health practitioners is needed to help interpret their eHealth readiness. Exhibit 7 describes the high-level work practice profile of allied health practitioners.

35

6

Overview of respondent attributesPercentage

Daily patient volume

53

26

>257

16-25 14

6-15

<5

Days per week at main practice

22

55 1

13

2

103

4+

Number of practice locations Frequency of rural or remote service

SOURCE: eHealth readiness survey for Allied Health Practitioners

6

7

26

Never 57

Once amonth or less

Monthly4

Weekly orfortnightly

Daily

19

126

5+ 43

4

320

21

Patients >65 years

12

19

49

76-100%

51-75%

20

26-50%

0-25%

Profiled by practitioner specialty below

Exhibit 7

Daily patient volume The significant variation between allied health professions in the number of patients a practitioner sees per day is shown in Exhibit 8. In three professions – social workers, psychologists and occupational therapists – more than 60% of respondents reported that they saw fewer than six patients per day. This reflects the type of work undertaken by these professions, as they spend more time understanding a patient’s perspective and behaviours. Other professions have much higher patient volumes. For example, over 3o% of radiographers and sonographers reported that they saw more than 25 patients per day.


Daily patient volume by profession


53

62

80

21

67

56

51

32

12

78

15

60

30

64

26

12

9

8

4

40

31

61

14

4

2

53

35

47

35

65

67

75

53

19

334

3434

1

Physiotherapist

Podiatrist

Psychologist

Radiographer, Sonographer

6

Exercise physiologist 8 11

Occupational therapist

Dietitian 1 3

1

Dentist 4 25

Osteopath

Optometrist 12

Chiropractor

Social worker

Speech pathologist

32 39

Audiologist 1 9

Aboriginal Health Worker 14 12

Total 7 14

% of respondents

Daily patient volume by segment

25+ 16-25 6-15 <6

Exhibit 8

Number of practice locationsAllied health practitioners work in a wide variety of settings, including hospitals, workplaces, sports organisations and clinics, community centres, women’s health centres, rehabilitation centres, aged care facilities, mental health facilities, GP Superclinics and other multidisciplinary care centres, private practice, schools, universities, prisons and detention centres, and Government agencies (e.g. Workcover, Centrelink, Department of Veterans Affairs).

Most respondents (55%) reported that they work in only one practice location. However, this varies strongly with the profession of the practitioner: Exhibit 9 below. While over 70% of dentists, osteopaths and chiropractor responded that they worked from a single practice location, approximately 60% of audiologists and podiatrists work at two or more, and over 35% of dietitians, speech therapists and aboriginal health workers practice from three or more locations.

This distribution will have implications for the types of eHealth applications a practitioner is likely to use. Most practitioners working in multiple locations are likely to be either employees, or providing locum services – in either case they are unlikely to make the final adoption decision for eHealth solutions. As such, they must either adapt to the systems at each location or integrate them, highlighting the requirement for system commonality. Mobile eHealth applications and web-enabled interfaces are likely to be more attractive as practitioners can experience a more consistent experience across practice locations.

37

Number of practice locations by profession


22

24

27

79

14

13

24

13

33

75

33

27

33

8

35

10

55

52

41

73

48

51

57

48

52

34

50

68

51

55

19

20

5 12

26

Podiatrist 20 19

9

Physiotherapist 6 9

Osteopath 7

Optometrist

Social worker

7 12

6

Occupational therapist 25 4

8


Dietitian 21 18

Dentist

Radiographer, Sonographer

7 6

19

Chiropractor 1

4

Speech pathologist

12 20


Audiologist

Total

Psychologist

13 10

9

% of respondents

Number of practice locations by segment

4+ 3 2 1

Exhibit 9

Frequency of rural or remote serviceLike other health professions, allied health practitioners are largely concentrated in urban areas with considerable workforce shortages relative to demand in rural and regional Australia. Almost two-thirds (57%) of practitioners responded that they never visit rural or remote locations: Exhibit 10 below. However, three professions are much more likely to do so: Aboriginal and Torres Strait Islander Health (ATSIH) workers, social workers and occupational therapists. 54% of ATSIH workers reported visiting rural or remote areas daily, reflecting the role these practitioners play in engaging with Aboriginal communities in these areas. 34% of social workers said that they visited rural or remote areas weekly or fortnightly, with many employed by Centrelink throughout its rural and regional branch network. 34% of occupational therapists also responded that they visited rural or remote areas weekly or fortnightly.


Frequency of rural or remote practice by profession


57

27

42

83

68

75

59

44

63

79

79

67

77

79

54

67

7

7

12

5

6

5

5

7

7

5

3

9

5

3

9

6

26

54

21

11

20

16

21

27

8

12

16

13

8

12

25

19

3

Optometrist 16 5

Occupational therapist 11

Exercise physiologist

10

5 9

Dietitian

Speech pathologist

9 3

Radiographer, Sonographer 6

5

Psychologist 10

2

Podiatrist 8 1

Physiotherapist 2

Osteopath

Social worker

Chiropractor 1

Audiologist

1

16 9

1

2

9 4

Total

Aboriginal Health Worker

4

Dentist 3 2

6

% of respondents

Frequency of rural or remote practice by segment

Never Once a monthor less

Monthly Weekly orfortnightly

Daily

Exhibit 10

FundingAlthough more mixed funding models are emerging, there remains a clear division between allied health practitioners employed in salaried positions in the public sector, and those in private practice.

Practitioners most likely to work in the private sector are chiropractors, dentists, osteopaths and optometrists: see Exhibit 11. Other professions derive a significant proportion of their income from the public sector. For example, 70% of dietitians reported earning less than 25% private income (although private income is growing as a result of the Medicare Chronic Disease Management items, see below). 55% of ATSIH workers and 38 % of speech pathologists also reported earning less than 25% of their income from private sources, with many employed by Aboriginal Medical Services, community health services and schools.

In professions with a more established history of working in the private sector – such as chiropractors, osteopaths, dentists and optometrists – over 80% of respondents reported that they earned more than 75% of their income from the private sector. Most practitioners in private practice have relied on fee-for-service or benefits provided under private health insurance. While some professions such as optometrists have access to subsidised services through the Medicare Benefits Schedule, most do not.

39

Percentage of income from private sector, by profession


4

9

4

4

4

7

3

4

7

8

2

22

55

27

9

70

29

31

3

12

28

20

14

29

15

38

1

71 5

Physiotherapist 69

Osteopath 88

Optometrist 87 4

Occupational therapist 65 1


Dietitian 26

Dentist 88 12Chiropractor 98 1Audiologist 59 5


Podiatrist

11

Total 70 4

Speech pathologist 57 2

Social worker 71 6

Radiographer, Sonographer 69 3

Psychologist 69 11

% of respondents

Percentage of income from private sector by segment

75+ 50-74 25-49 <25

Exhibit 11

Structural changes are allowing more public sector-based practitioners to increase the proportion of income they derive from the private sector. The introduction of the Medicare Chronic Disease Management (CDM) items (formerly known as the ‘Enhanced Primary Care program’) in 2004, and the Better Access to psychiatrists, psychologists and General Practitioners through the MBS, in 2006, gave access to Medicare rebates for certain allied health services following referral from a general practitioner: see Accessing Medicare funding below. This has made small private practice a much more viable option for many practitioners who would previously have worked on a salary in an institutional environment. They now have significant incentives to build a practice through strong relationships with GPs, specialists and other health professionals, as well as marketing and improving services to patients.

Other government or universal insurance schemes exist to fund allied health delivery. For instance, the Department of Veterans Affairs provides health benefits for veterans that may be delivered through allied health practitioners. Workcover also funds significant levels of service from occupational therapists or physiotherapists.

National registration and accreditationParticipating in Australia’s national health registration scheme has increased the recognition of allied health professions within Australia’s health sector, strengthened the role of its national professional bodies, and made Medicare funding more accessible.


Accessing Medicare fundingAn example of the way the items work is provided by the individual allied health items for people with a chronic or terminal medical condition and complex care needs – MBS items 10950 to 10970.

In summary:

• Patients must have a chronic or terminal medical condition and complex care needs and be managed by their GP under a GP Management Plan (GPMP, MBS item 721) and Team Care Arrangements (TCAs, MBS item 723), or be Commonwealth-funded residents of a residential aged care facility who are managed under a multidisciplinary care plan (MBS item 731)

• GP refers to allied health practitioner

• A Medicare rebate is available for a maximum of five (5) allied health services per patient each calendar year. (Note, however, that allied health providers may set their own fees)

• Allied health practitioners must report back to the referring GP

Patients may be eligible for individual allied health services under Medicare if their GP has provided the following MBS Chronic Disease Management services:

• A GP Management Plan (GPMP) - item 721 (or review item 732); and

• Team Care Arrangements (TCAs) - item 723 (or review item 732); or

• A multidisciplinary care plan prepared by a residential aged care facility involving GP contribution- item 731

For psychologists, social workers and occupational therapists, Medicare rebates are currently available for patients with an assessed mental disorder to receive up to 12 (in exceptional circumstances up to 18) individual, and up to 12 group allied mental health services per calendar year. The psychologist or other allied mental health professionals can provide one or more courses of treatment, with each course of treatment involving up to six services (but may involve less depending on the referral). At the conclusion of each course of treatment, the allied mental health professional reports back to the referring medical practitioner on the patient’s progress and the referring practitioner assesses the patient’s need for further services. Changes in the 2011-12 Budget mean that from 1 November 2011 the maximum number of sessions that can be received in a calendar year will be 10 individual and 10 group sessions.

The allied health services under Medicare can only be claimed by allied health professionals who meet specific eligibility criteria, are registered with Medicare Australia, and are in private practice. In addition, the providers must be registered and meet the requirements of their professional organisation. From 1 July 2011, additional continuing professional development requirements will be in place for allied health providers of focussed psychological strategies under Medicare.

41

In 2006, the Council of Australian Governments (COAG) agreed to establish a single national registration scheme for health professionals and a single national accreditation scheme for health education and training. On 26 March 2008, the Australian Government and the governments of all states and territories signed an intergovernmental agreement to establish a single National Registration and Accreditation Scheme for health practitioners (the National Scheme) to commence on 1 July 2010. This process has allowed for uniform and consistent regulation of health professions across Australia, with the associated benefits of reducing red tape, increasing the mobility of health professionals and increasing transparency around the level of registration a health professional has through a online searchable register. The Australian Health Practitioner Regulation Agency (AHPRA) was established as the organisation responsible for the implementation of the National Registration and Accreditation Scheme across Australia.

Of the ten health professions that are currently regulated under the National Registration and Accreditation Scheme (NRAS), eight are allied health professions.4 Four more allied health professions are due to join the national scheme from 1 July 2012 – Aboriginal and Torres Strait Islander Health workers, Chinese medicine practitioners, medical radiation practitioners and occupational therapists.5

EducationAlong with the changes in funding and registration, the education required to practice in allied health is being set at a higher tertiary level and is becoming more technically complex, though it has not yet been extended to eHealth.

Allied health practitioners are generally required to have university qualifications in order to be registered or to qualify for membership of their professional bodies. These requirements flow from the process of the profession’s national registration, with its emphasis on professional (university-delivered) qualifications, and standardised accreditation for university courses that are overseen by independent profession-based bodies.

As both technological solutions and clinical understanding is advancing in most professions, most have continuing professional development (CPD) programs in place to ensure that the skills and knowledge of practitioners remain up-to-date.

Professional bodies are increasingly responding to member demands for online registration, CPD and other service delivery. CPD and other professional development activities are being provided online and in electronic formats, particularly for those professions with a large percentage of rural members and those with a younger membership base. In some cases this has extended to providing business development support. For example, the Optometrists Association Australia provides assistance to members in developing their websites.

Formal training and accreditation programs in eHealth applications are not yet widespread, which is in keeping with the rest of the health industry. However the strong education and training structures that exist in the allied health professions – both at university and through CPD programs – provide a platform for further engagement on eHealth applications.

4 Chiropractic, Dental, Optometry, Osteopathy, Pharmacy, Physiotherapy, Podiatry, Psychology.5 AHPRA 2010, Annual Report 2009-10 .


SummaryUnderlying demand for health services in Australia is growing, driven by an ageing population and an increasingly health-conscious population. A substantial portion of this demand for health services is being met by the allied health sector. Participating in Australia’s national health registration scheme has correspondingly increased the recognition of allied health professions within Australia’s health sector, strengthened the role of its national professional bodies, and made Medicare funding more accessible.

Such structural changes are allowing more public sector-based practitioners to increase the proportion of income they derive from the private sector, and for those in the private sector to be more secure in their funding. Nonetheless, there remains a clear division between allied health practitioners employed in salaried positions in the public sector, and those in private practice.

The education required to practice in allied health is being set at a higher tertiary level, is becoming more technically complex (though not yet extended to eHealth), and tied to professional accreditation. Allied health workers are a significantly younger workforce than the medical specialist, general practitioner and nursing professions, and like other non-medical health professions are predominantly female.

Significant variation in practitioners’ type of work leads to significant variation in their workflow and patient rate. Most social workers, psychologists and occupational therapists see fewer than six patients per day, while over 30 % of radiographers and sonographers see more than 25 patients per day.

Though most practitioners (55%) work in only one practice location, over 35% of dietitians, speech therapists and aboriginal health workers practice from three or more locations. Setting up equipment and software at multiple sites is a barrier to eHealth adoption, so mobile eHealth applications and web-enabled interfaces are likely to be more attractive. This will also assist those practitioners with a strong rural and regional practice. Allied health practitioners are largely concentrated in urban areas, with over 68 % never visiting rural or remote locations. However, 54% of Aboriginal and Torres Strait Islander Health (ATSIH) workers visit rural or remote areas daily, while 34% of both social workers and occupational therapists visit those areas weekly or fortnightly.

6. Current and expected future uses of eHealth

45

At present, allied health practitioners are using eHealth solutions to the extent that suits their operating environments and clinical workflows, as well as their perceptions of relative benefits and barriers. This research confirms the National eHealth Strategy description of current practice: practice management tools, information sharing and sources, and service delivery tools such as chronic disease support and telehealth. Practice administration and professional research dominate these current uses, with varying levels of sophistication.

Intended future uses would expand the use of telemedicine into videoconferencing, expand remote care management with remote health monitoring and feedback on behaviour, and better support clinical decisions, electronic health records, and public health intelligence. At present, allied health practitioners are looking to use eHealth to exchange patient referrals, share health records and better communicate with patients.

The following section outlines current eHealth use by allied health profession:

• How eHealth is used today, including a detailed look at electronic health records and telehealth

• Anticipated eHealth uses

• Clinical workflows as drivers of eHealth use

How eHealth is used todayExhibit 12 captures both the current leading eHealth uses by allied health practitioners, as well as those areas where they would like to use eHealth but as yet do not. Practice administration and professional research dominate eHealth uses, with the systems used varying from bespoke software to word-processor templates. Perhaps unsurprisingly, more specific applications (e.g. transferring prescriptions to pharmacy) show lesser traction. Practitioner disinterest in these cases is driven to a large extent by relevance to profession, rather than support or lack thereof for eHealth solutions. It must be remembered that allied health is a heterogeneous group, and that applications of high importance to certain professions will be of little interest to others.

About 60% of practitioners are using computers for practice management functions such as patient booking and scheduling (60%) and billing and patient rebates (58%). Research and training is also a leading eHealth use, for online clinical reference tools (58%) and CPD (56%). Lower usage levels are then evidenced for viewing and recording patient information (40%, 37%), sharing patient information and event summaries with other health professionals (22%, 27%), and viewing diagnostic images (23%). eHealth applications such as ordering diagnostic imaging and pathology tests are rarely used (<5%), nor are decision support solutions (<5%).

The eHealth applications most sought by allied health practitioners include sending and receiving patient referrals (50% of survey respondents don’t use, but would like) and sharing health records with other practitioners (49%). Better communication with patients (sharing health records 38%, showing health-related information 37% and communicating with patients outside of consultations 35%) is also a significant desire.

The low level of usage (beyond practice administration and professional research) reflects both a lack of demand for these services across allied health, and a lack of vendor applications and coordinated communications infrastructure. As a result, the systems in use for all purposes vary from professional, interoperable eHealth suites, to practitioner-developed standalone systems and even ‘templates’ built in standard office software.


?

1723

1212

273031

4939

2555

2950

736972

8284852

Ordering diagnostic imaging 5 26Viewing pathology results 10 17Sharing health records with my patients 12 38Sharing health records with other practitioners 22 49Viewing diagnostic imaging results 23 22Sending/receiving referrals from practitioners 25 50

Transferring prescriptions to the pharmacy 12Ordering pathology tests 3 13Decision-making support for prescription ordering 4 14Decision-making support for ordering diagnostic tests 5 24

Access online clinical reference tools 58 30Billing and patient rebates 58 18Patient booking and scheduling 60 22

Communicate with patients outside consultations 26 35Completing event summaries 27 25Show patients health-related information 32 37View/record patient info during consultations 37 33Enter patient notes after a consultation 40 33Complete continuing education and training courses 56 32


% of respondents

Use of computers for eHealth applications

Please indicate whether you use, don’t use but would like, or don’t use and don’t need a computer for each of the following activities

Allied health practitioners computer usage by activityDon't use, but don't need

Don't use, but would like

Use

Exhibit 12

Particular applications – electronic health records Electronic health records are gaining traction, with over 70% of practitioners maintain some computer-based records, although only 20% of those have gone completely paperless. Of the 70% using computer-based records to store patient details, 53% use electronic health records (clinical records) while 47% only record administrative details on their patients: see Exhibit 13.

Many practices are finding the transition to computer-based records challenging, for the following reasons:

• Duplication due to incompatibility. For example, some EHR systems are unable to integrate with billing/EFTPOS systems, so a paperless process requires duplicate data entry and additional time relative to the paper-based alternative

• Risk of technical failure, which can paralyse a practice if systems are forced to go offline or are unusable for a period of time

• Medico-legal concerns about losing information or missing critical test results due to a user error or oversight

• Inability to share information with other practitioners, either because the practice is not storing data in a structured format, other practices are unable to receive structured data, or other practices are only able to receive faxes and letters

47

• Need for patient hardcopies. For example, patients may need print-outs of their pathology test requests so they can choose and locate a pathology lab, paper scripts so that they have flexibility in choosing a pharmacy, and physical records to share information with their families and GPs.

?

Most allied health practitioners use some computer-based patient records



Do you currently use an electronic health record? In other words, do you maintain information about your patients’ health status and health care in a computer-readable format?

47

53

Do not use EHR

Use EHR

100

Means of record storage

56

30

Paper and computersPaper

only

Computers only

14

Exhibit 13

Particular applications - telehealthTelehealth use is relatively low across the allied health sector, with only 13% of those surveyed indicating they use telehealth today: Exhibit 14. Radiographers (27%), Aboriginal and Torres Strait Islander health workers (20%) and speech pathologists (18%) are the most likely to be using Telehealth services, and most are using it for training and/or consultations with other practitioners. These remain the two applications with the greatest interest in future use: Exhibit 15. Fewer practitioners are interested in using telehealth for remote monitoring or consultations with patients.


?


% of respondents

Are you already using any Telehealth services?Within the next 3 years, what is the likelihood that you will start using any Telehealth services?

11

58

Definitely will not

Probably will not

Probably will

Definitely will

Within next 3 years

28

4

Telehealth use is currently low at 13%

Telehealth use now and within the next 3 years

87 13

Do not use

Use

Current use

Exhibit 14

?

Allied health practitioners interest in telehealth is primarilyfor training and consultation with other practitioners


Within the next 3 years, would you be very interested, somewhat interested, or not interested in using Telehealth services for each of the following applications?

% of respondents

Current and planned Telehealth applications

10

6

3

17

13

13

8

8

3

2

Consultations with practitioners

Training

10

11

Supervising 16

Consultations with patients

19

Monitoring patients remotely

28

Already using

Very interested

Exhibit 15

49

Other applications Reference and information

Online access to clinical reference tools and education is widespread. Approximately 60% of practitioners currently use computers to access online clinical reference tools and complete education and training. Another 30% of practitioners indicated they would be interested in doing so. This strong response is not surprising given the relatively low barriers to using these applications and the need for practitioners to complete regular educational courses, and CPD. In interviews, practitioners have indicated that online training courses are generally cheaper than, and thus preferable to, attendance at conferences to satisfy their CPD requirements.

Practice administration

Practice administration applications such as billing and scheduling are also very commonly used among allied health practitioners. These applications provide immediate efficiency and cash flow benefits at a relatively low cost, which helps explain their popularity. Use is particularly pronounced for audiologists and radiographers. Social workers and speech pathologists have the lowest current use of practice administration applications (29% and 35% respectively) and the least interest (37% and 31%) in this application.

Viewing test results

Computerised viewing of test results is not common, with 10% of practitioners viewing pathology results on computers and 3% viewing imaging results. These low figures may simply reflect the lower incidence of this activity in allied health professions generally, rather than a strong preference for non-computer-based systems.

Dietitians (60%) are the highest users of this application. Dentists and podiatrists display the greatest interest in this application with more than 40% interested in viewing pathology results and diagnostic imaging online. Social workers, audiologists, occupational therapists and psychologists are the least interested in this application, with over 90% uninterested—in the case of social workers and psychologists, this is expected, given the nature of their work.

Record sharing

Only 22% of practitioners are currently using computers to share health records with other practitioners, yet close to another 50% would like to but don’t have the capability. Consistent with their profile as high eHealth users, audiologists and radiographers have the highest rates of record-sharing with other practitioners, while over 60% of dietitians, physiotherapists and speech therapists would like to. Practitioners are relatively less interested in sharing records with their patients, with 50% responding that they do not use and do not need computers for this application.

Electronic test and prescription ordering

Only a very small percentage of practitioners are currently ordering tests and prescriptions online, and only 12-13% are interested in doing so. This outcome is encouraging, given the small proportion of allied health practitioners for whom pathology tests and prescriptions form a part of their core business. There is greater interest in ordering diagnostic imaging online, with nearly one-quarter of practitioners interested in doing so. Again, diagnostic imaging is central to a number of allied health professions, but largely irrelevant to many others.


Over 60% of chiropractors, dentists and podiatrists are interested in ordering diagnostic images online, consistent with their high frequency of using such tools. Interest in ordering pathology tests online is overall lower, though dentists (37%) and podiatrists (44%) are interested in doing so. 50% of dentists would like to use tools to support prescription ordering, but currently do not.

Decision-making support

Interactive decision-support tools are used by only about 5% of practitioners, and interest is not strong among most professions. Interest is strongest among dentists and podiatrists: 57% of podiatrists would like to use tools to support ordering diagnostic tests.

Recording and viewing patient notes

Basic electronic medical record functions such as recording patient information and viewing notes are used by about 40% of practitioners and an additional 33% are interested in using computers for these applications. Occupational therapists, physiotherapists and dietitians are most interested in these applications, making these groups provide a likely early target to encourage adoption of electronic medical records.

Patient communication

Nearly 70% of practitioners are either using or interested in using computers to share information with patients during consultations, indicating the educational aspect of many allied health practitioners’ roles, and over 60% use or would like to use computers to communicate with patients outside of consultations.

Anticipated future applications

The national eHealth strategy6 would expand the use of telemedicine into videoconferencing, expand remote care management with remote health monitoring and feedback on behaviour, and better support clinical decisions, electronic health records, and public health intelligence. These future uses could include the following types of technologies:

• Telemedicine: A subset of telehealth technologies that enable healthcare providers to administer care remotely, e.g. kiosks with videoconferencing and vital sign devices, mobile applications and SMS

• Remote-care wellness and management: A subset of telehealth technologies that enable healthcare providers and educators to monitor, educate and influence the behaviour of patients remotely, such as:

– Remote health monitoring technologies to collect and manage data (e.g. vital signs, motion, compliance) from passive/active/interactive devices; includes workflow and decision support systems used to drive appropriate health actions based on the collected data

6 National E-Health and Information Principal Committee, National E-Health Strategy, September 2008

51

– Feedback and behaviour modification technologies to affect change in patient behaviour by providing health education and feedback on behaviour relative to personalised health goal

• Clinical decision support: Tools used by healthcare providers or patients to aid diagnosis, treatment, or care process decisions. For example, these may document data, display relevant data, lookup/display reference material, flag potential errors, implement (e.g. guided dose algorithms), and track over the care pathway

• Electronic health records: Systems for managing longitudinal health record spanning multiple providers across the care continuum, consisting of an electronic medical record (medical history within single provider) and Healthcare Information Exchange (to integrate and make available electronic health records across providers).

• Health intelligence: Health intelligence is a group of technologies that enables public health informatics functions and analyses such as disease surveillance, comparative effectiveness of drugs and procedures, and risk stratification analyses that enable activities such as selection of patients for disease management programs.

Importantly, these future uses require information-sharing through reliable, connected eHealth platforms. They will not eventuate without supportive actions, such as developing a clear business case for their use, setting clear expectations of minimum information content and enhancing practitioner skills and capabilities.

Clinical workflows as drivers of eHealth useThe use of eHealth applications is highly dependent on the clinical workflow of each profession. As Exhibit 16 reveals, practitioners with strong needs that can be readily addressed using existing technology are the leading eHealth adopters: radiographers viewing patient information and imaging, audiologists using clinical reference tools and showing patients health information, optometrists seeking specialist review and Aboriginal and Torres Strait Islander health workers communicating with patients. Two-thirds or more of each of these professions are using computers regularly for these purposes.

Conversely, particular eHealth applications relate to specific allied health professions: viewing diagnostic imaging results is a high use for a radiographer, and a low use for an ATSIH worker. Many allied health practitioner rarely write prescriptions, order pathology tests or diagnostic imaging – their relative interest in using computers to do so must therefore be considered in the context of each profession’s core business.


Leading uses of computers by allied health profession

Source: eHealth readiness survey for Allied Health Practitioners

Ranking of current use of computerised systems, by practitioner segment

2141321741354710Q12-S. S. To complete continuing education and training courses

125321441316357Q12-R. R. To access online clinical reference tools

7101381011687899986Q12-Q. Q. To communicate with patients before or after consultationsabout health-related issues

636569755554731Q12-P. P. To enter patient notes after a consultation

99101075539778565Q12-O. O. To show patients health-related information during a consultation

108765108611663843Q12-N. N. To view and/ or record patient information during consultations

5624442124131224Q12-M. M. For billing and patient rebates

341213323222112Q12-L. L. For patient booking and scheduling

1111811121212111011121110915Q12-K. K. For sharing health records with other practitioners

121215121414111012131412121111Q12-J. J. For sharing health records with my patients

45991161312691015131013Q12-I. I. For completing event summaries such as a hospital discharge summary or specialist report

131631387913131211761314Q12-H. H. For viewing diagnostic imaging results

171714171717171817161714141616Q12-G. G. For ordering diagnostic imaging

151316161615161614171818171518Q12-F. F. To provide interactive decision-making support for ordering diagnostic tests

1414111413131417161441315179Q12-E. E. For viewing pathology results

181818181818181919151517161912Q12-D. D. For ordering pathology tests

161517151516151415181616181417Q12-C. C. To provide interactive decision-making support for prescription ordering or medication management

191919191919191518191919191819Q12-B. B. For transferring prescriptions to the pharmacy

871279810981081011128Q12-A. A. For sending referrals to or receiving referrals from otherpractitioners

First Second Third

ATSIAud Chiro

Dent

Diet Ex OT

Opto Ost Phy Pod Psy Rad SW Spe

Exhibit 16

SummaryAllied health practitioners are mainly using computers for practice administration and online education. Further eHealth applications are limited to those that clearly suit their clinical workflows such as optometrists seeking specialist review. As well as purchasing purpose-built systems, practitioners are building their own systems, often as templates from simple office software.

Intended future uses would expand the use of telemedicine into videoconferencing, expand remote care management with remote health monitoring and feedback on behaviour, and better support clinical decisions, electronic health records, and public health intelligence. Patient referrals, shared health records and telehealth are the future eHealth uses most anticipated by allied health practitioners.

7. eHealth readiness of Australia’s allied health sector

55

eHealth readiness in the allied health sector varies by profession, practice and individual. Allied health professionals assess the eHealth benefits to their particular processes and practice, the risks that adopting any solutions might entail, and any barriers preventing them adopting if they were so inclined. These are practice-level rather than health system-level assessments, yet a health system-level adoption strategy that ignores practice-level dynamics is unlikely to be effective.

Accordingly, we framed our assessment of eHealth readiness with three research questions:

1. Are Australian allied health practitioners ready to adopt and use eHealth technologies and solutions, today and in a way consistent with policy direction in the future?



To answer these questions, we conducted 20 initial qualitative interviews to design a quantitative survey, ran that survey with 1,125 allied health practitioners, and interviewed a further 21 practitioners in-depth on the themes that emerged from the survey. Additional detail on our research methodology is provided in Appendix 2.

At a high level, we found that although attitudes vary across sectors, most allied health practitioners see the potential benefits of eHealth to their practice and health outcomes, and can and will use well-designed solutions if the perceived benefits clearly outweigh the costs and barriers. Self-contained administrative, research and note viewing applications are being widely used. As yet, though, when considering more networked, care-focussed solutions, most practitioners see the costs and barriers outweighing the benefits. Many barriers stem from the fragmented landscape of eHealth solutions as they serve the diverse needs of the allied health community.

Are Australian allied health practitioners ready? We analysed the eHealth readiness of Australia’s allied health practitioners along three dimensions: their infrastructural readiness (their IT hardware and connections, as well as the software and solutions available to them); their aptitudinal readiness (depth of skills and capability to use eHealth solutions); and their attitudinal readiness (willingness to use current and future eHealth solutions).

Infrastructural readinessAllied health practitioners generally have the basic IT equipment and connectivity for eHealth adoption. However, the landscape of available eHealth solutions is highly fragmented, reflecting the diversity of allied health practice, with few applications designed specifically for allied health sectors, and little connectivity between applications. Addressing system connectivity, interoperability and security barriers will help drive increased use among early adopters.

Most allied health practitioners have access to computers in their main practice setting (88% in major cities, approximately 94% for inner and outer regional areas, decreasing to 69% in remote areas): see Exhibit 17. Overall, 58% of practitioners have access to a computer less than 3 years old. Most practitioners have good internet access in the main practice setting (83% in major cities, approximately 90% for both inner and outer regional areas, decreasing to 58% in remote areas), almost all of those being broadband (82%).


Most practitioners have access to appropriate basic infrastructure in their primary practice setting



1231

Remote1

69

Outer regional

94

6

Inner regional

95

5

Major city

88

17 10 11

42

Remote1

58

Outer regional

89

Inner regional

90

Major city

83

1 Base = all practitioners that practice occasionally, but are not based, in a rural or remote area, n = 343

Access

No access

Computer access in practice setting Internet access in practice setting

Although access is lower in remote regions for visiting practitioners, 96% of practitioners based in remote areas have a computer, and 93% have internet access

Exhibit 17

Infrastructure limitationsEven practitioners who are enthusiastic for eHealth solutions, and who are armed with excellent computers and broadband connections, find it difficult to identify and adopt the solutions they need. Systems do not suit their practice, are unreliable, or do not connect with existing systems or to the systems of other practitioners with whom they want to share information.

To understand the evolution of infrastructural readiness as the adoption of eHealth increases, we profiled the “early adopters” (i.e., those that were rated as having the highest overall eHealth readiness) and their views on eHealth barriers. We found that even the practitioners that are the most eHealth-ready perceive significant barriers around compatibility: see Exhibit 18. Problems were identified with both internal compatibility (with their own systems and devices) and external compatibility (those of other providers in the health ecosystem).

A quarter of these early adopters believe that they are not adopting eHealth solutions because the solution has not been adequately proven. Qualitative interviews suggest that this group understand the determinants of their decision to adopt, and are capable of deciding quickly. However, they are also pragmatic, and adopt only where they perceive both a need and a valid workable solution. Successful systems cannot intervene with either practice efficiency or patient outcomes.

57

Early adopters are encountering infrastructure limitations as they extend their use


37

25

25

21

21

21

15

11

9

9

6

6

6

5

-20

-10

-16

-10

-17

-8

-18

-17

-19

-22

-19

-19

-3

Too difficult to select and implement

Others in practice are resistant

Don’t have adequate IT support

Concerned about productivity drop during the transition

-1

Not enough people are using

Takes too long to access and use

Can’t find a solution that meets my needs

Need to maintain compatibility with existing systems

Concerned about visibility of performance data

Need to connect with external systems

Concerned about privacy breaches

Prefer to wait for technology to be established

Cannot afford

Concerned about malfunctions or downtime

% of top quartile users that strongly agree/disagree

Strength of eHealth barriers among early adopters

Strongly disagree

Strongly agree

Infrastructure barrier

Exhibit 18

Market fragmentationMany of the infrastructural limitations perceived by early adopters stem from the highly fragmented nature of the eHealth solutions vendor market. In the market for computerised record systems (both administrative and clinical records), no application or group of applications has emerged as the preferred solution: Exhibit 19. There are over 75 commercial systems in use, and the 10 most used account for just 42% of the market. In itself, this fragmentation would not be an issue. However, the applications used rarely share operating platforms or standards, and may not have the functionality, reliability or support expected of modern IT applications.


Infrastructure – computerised record system landscape for allied health is highly fragmented

1.81.91.91.92.12.22.52.62.93.33.53.73.9

5.312.4

Communicare SystemsInterSystems TrakCareOptomate PremierProprietaryPractice Management SoftwareTM2 Practice ManagementFront DeskTitaniumOacis EMRD4W (Dental for Windows)Cerner Acute Care EMRMedical Director (HCN)Oasis Dental

Other 48.0Vision EliteCHIME

Percentage


Computerised record system in use

“Other” includes more than 60 commercial software solutions, in addition to practitioner-developed systems

Exhibit 19

Aptitudinal readinessAllied health practitioners typically have the necessary aptitudinal readiness for eHealth, having sufficient capabilities from their combined professional and personal IT use. some specialised software applications will require a period of familiarisation and/or system training.

Current eHealth usage levels suggest that most allied health practitioners are relatively technology literate. Although usage decreases with age: from 75% of practitioners aged 24-45 years who use at least one eHealth application, down to 56% of practitioners aged over 55 years, individual personal internet use remains high regardless of age (nearly all practitioners (97%) regularly use the internet in their personal lives). This suggests a strong underlying capability for basic eHealth solution use.

Specialised software applications will generally require a period of familiarisation, likely to include some system training. However, the majority of practitioners do not see major barriers in selecting and implementing a system, or risks in productivity dropping during a transition. Further, practitioners who have made the transition describe the inconvenience as minor compared with the benefits gained.

A common complaint though is that available eHealth software applications used are based on outdated programming platforms and operating systems. Though they may not be expected to be as intuitive as the personal and business software that practitioners use, their user interface may

59

need improving. Vendors of preferred eHealth applications among allied health practitioners tend to include education and training of rural students and junior workers.

It is very hard for allied health practitioners to obtain funding for these initiatives, which are either supported by the professional peak bodies, or through private practices investing their own funds in patient support, monitoring and motivational tools. Psychologists can give patients access to online cognitive behavioural therapy tools such as the iCBT program developed by the Clinical Research Unit for Anxiety and Depression at Vincent’s Public Hospital. Other examples are the ‘Pro-conditioning’ and ‘Silicon Coach’ rehabilitation tools used by exercise physiologists and physiotherapists.

Attitudinal readinessAllied health practitioners vary from those who are strongly convinced of the need for eHealth, to those who remain expressively negative. Underlying these attitudes are their perceptions of the benefits of any particular eHealth application, relative to the barriers and risks of adoption. There is some consistency in these attitudes within each allied health profession, which in turn helps determine adoption rates in each profession. However, a profession-level view cannot be the basis for an eHealth adoption strategy. As with the allied health sector as a whole, each profession is very heterogeneous: in each there are practitioners who are quite resistant to eHealth applications, and those that verge on being eHealth evangelists. A further analysis of practitioners is needed to identify these variations within professions. Identifying who will be resistors and who will be catalysts for change will be critical, as will understanding what will motivate those who are eHealth’s strongest adopters to help influence others.

Perception of benefitsAllied health practitioners believe it is expected for them to use computers, and that most of their peers use computers in their practice on a daily basis. They expect that improving collaboration, continuity of care, and practice efficiency will be the primary benefits of eHealth, far more than the potential benefits to patient engagement, satisfaction and relationships: Exhibit 20.


?

10

14

14

14

14

16

18

18

18

18

29

30

36

Improve patient relationships

Increase number of referrals

Reduce exposure to legal risk

Increase patients’ satisfaction

Broaden scope of services

Increase patients’ engagement

Increase patient safety

Increase access to care

Improve the quality of care

Improve care delivery process

Improve practice’s efficiency

Improve continuity of care

Improve collaboration


Please indicate if you (1) strongly disagree, (2) somewhat disagree, (3) somewhat agree, or (4) strongly agree that eHealth will…

% of respondents that strongly agree

Provision and quality of care

Patient relationships and engagement

Perception of eHealth benefits

Allied health practitioners perceive the primary benefits ofeHealth to be improving provision and quality of patient care

Exhibit 20

When analysing the perceived benefits by profession, it is striking how consistently the same three benefits – collaboration, continuity of care, and practice efficiency – are expected across all professions: Exhibit 21. All but two of the professions expect that eHealth will enable them to collaborate more with other care providers; all but one profession sees continuity of care as the second or third most expected benefit; while all but three professions see practice efficiency as the most likely benefit.

Although it is useful to know what benefits are most expected in a particular profession, that knowledge is not strongly actionable. Different practitioners in the same profession use computers and eHealth applications in different ways, seek different benefits, and are concerned about different risks. Interventions to drive eHealth adoption cannot target the ‘average’ dietitian or dentist.

Some other segmentation of each profession is needed to better understand the variations in eHealth motivation, and build adoption strategies that reflect those attitudes. Consider how the same list of potential benefits is perceived by the segments introduced in Exhibit 22 and 23.

61

Allied health practitioners believe eHealth will improve collaboration, continuity of care and practice efficiency


Ranking of perceived benefits, by practitioner segmentRanking of “strongly agree”

86564712847696108Improve the quality of care in my specialty4748988461075845Increase access to care in my specialty598764635846796Improve my care delivery process111313131310121112131310101110Improve relationships with my patients1289111191012101110811139Reduce my exposure to legal risk1031110813810869124117Broaden the scope of services offered by my practice951297117139411134813Increase the number of referrals to my practice712612105109131112119712Increase my patients' satisfaction level223332222222334Improve continuity of care for my patients131010412124775871352Increase my patients' engagement in managing their health6117556551195312611Increase patient safety at my practice312111111111111Improve my ability to collaborate with other care providers141223363334223Improve my practice's efficiency

ATSI

Aud

Chiro

Den

t

Die

t

Ex OT

Opt

o

Ost

Phy

Pod

Psy

Rad

SW Spe

First Second Third

Exhibit 21

Clusters perceive different benefits from eHealth (1/2)


% of respondents, strongly agree/strongly disagree that eHealth will improve …

Care delivery process

Ability to col-laborate with other care providers

Number of referrals

Scope of services

Reduce exposure to risk

Practice’s efficiency

30

443

17

1 62

24

7

6

1

14

Proactivepioneers

Embeddedactivists

5Firm non-adopters

Doubters

Cost-conscious

Risk-conscious

Strongly agree

Strongly disagree

138

67

141

1 48

5 33

116

1113

343-3

360

223

524

640 4

8

231

12

36

13

514

3

17

10

403

139

8

18

214

10

418

13

1521

406

5

3

0

8

31

4

15

13

Exhibit 22


Clusters perceive different benefits from eHealth (2/2)


% of respondents, strongly agree/strongly disagree that eHealth will improve …

Quality of care

Continuity of care

Access to care

Patient satis-faction

Patient engagementPatient safety

30

124

316

410

40 2Firm non-adopters

Doubters

Cost-conscious

Risk-conscious

Embeddedactivists

7 44Proactivepioneers

10

Strongly agree

Strongly disagree

48 0

12

0 49

6 31

95

213

321

542

9

3 51

28

23

1

7

3

14

15

5

10

33

3

510

0

3 42

39

5

10

238

3

2

34

163

5 38

3

2 40

185

3

10

3

4

7

25

6

34

1

024

2 34

1610

310

62

052

Patient relationships

Exhibit 23

Looking at the first two rows, we see that a large proportion of both ‘proactive pioneers’ and ‘embedded activists’ (more on them shortly) strongly agree that eHealth will provide all of the suggested practice and health benefits. Along the bottom row, we see that many “firm non-adopters” strongly disagree that eHealth will bring any of these improvements. The three segments that make up the middle rows seem far more neutral, though the analysis confirms that collaboration, continuity of care and practice efficiency remained the favoured perceived benefits of eHealth. Using these analyses, an adoption strategy can build on perceived benefits in different ways with different practitioners within the same profession.

Cluster analysis of allied health attitudesExhibit 24 shows six clusters of allied health practitioners with quite distinct attitudes to eHealth possibilities. Using these clusters to analyse practitioner attitudes is the most effective path to identifying insights into practitioner attitudes that are actionable, and to developing a meaningful strategy to support eHealth engagement and adoption.

Identifying “clusters” in a stakeholder group is a multi-layered approach to stakeholder segmentation. To identify a stakeholder group, we would ask “what do they do?” Demographics will answer who they are. Their revealed behaviour may imply what their needs and preferences are. But only by analysing those needs directly can we ascertain why people behave the way they do, and what may be stopping them fulfilling those needs. Only this needs-based lens looks into the future: into what “could be” rather than what “is”. (See Appendix 2 for more on this research methodology.)

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Analysis of the research data revealed that the six distinct eHealth attitudinal “clusters” within the allied health population have a relatively even distribution, with each having between 13% and 20% of total practitioner numbers: see Exhibit 24.

Six distinct clusters emerge from an eHealth attitudes analysis

Values being

up-to-date

Perceived benefits

Interest in

shared recordsAversion to

technology risk

Uses electronic health records

External expectations

Early adopter

eImagingePathology Perception of

peer usage

Inpu

t at

trib

utes

Out

put

segm

ents

Proactive pioneers

▪ Strong believers in benefits of eHealth, with very few concerns

▪ High current users of EHR and telehealth

16%

Risk-conscious

17%

▪ Neutral on the benefits of eHealth, but concerned about associated risks (e.g., patient safety and privacy)

Embedded converts

20%

▪ Optimistic about benefits of eHealth, but externally motivated by perceived expectations and peer behaviour

Cost-conscious

15%

▪ Interested in eHealth but constrained by finding an affordable, appropriate solution

Doubters

13%

▪ Interested but constrained by infrastructure (system compatibility, IT support, system downtime)

▪ Waiting for technology to mature

Firm non-adopters

19%

▪ Unconvinced of the benefits from eHealth and concerned on all dimensions


Segmentation clustering

Exhibit 24

While the biggest influence in defining the boundaries between clusters has proved to be the potential benefits of eHealth perceived by allied health practitioners (as seen in Exhibit 25), these are far from the only differences. Between clusters, practitioners are also quite distinct in their attitudes to computers, in the barriers they perceive, and in the enabling action needed for them. The two clusters most supportive of eHealth differ mainly in their work setting, though there is some crossover. Most proactive pioneers are in smaller private practice and make their own decisions on eHealth use, while most embedded converts have had eHealth decided for them in a larger public-sector setting and feel expected to use it, but have seen the eHealth benefits outweigh any earlier concerns. The three clusters that we found to be neutral on benefits are better defined by their perceptions of associated risk – safety and confidentiality, cost and reliability. These clusters may be persuaded to adopt eHealth, while practitioners in the final cluster of firm non-adopters are unlikely to be.


Clusters are defined by key attitudes, benefits and concerns


Defining characteristic

Proactive pioneers

52

Embedded converts

49

▪ High strong agreement for all benefits

▪ Low strong disagreement for all barriers

▪ Professional body strong driver

▪ High perception of use among network

Cost-conscious

32 ▪ Low agreement that up-to-date computers are important

Risk-conscious

42

26Doubters

▪ Very low agreement that eHealth will increase patient safety

▪ Zero strong agreement that up-to-date computers are important

▪ Very low strong identification as early adopters

Firm non-adopters

18

Improve patient r/ship

34

16

10

0

2

0

WorriedAfford-ability

9

28

58

9

48

78

Worried patient privacy

5

12

13

53

32

62

Worried IT compatibility

13

15

1

21

62

31

Want shared record

58

61

39

33

31

19

Believe IT use expected

68

80

50

61

39

42 ▪ High strong disagreement for all benefits

▪ Low strong agreement for all barriersO

ppos

edIn

diff

eren

tSu

ppor

tive

EHR use%

BenefitsAttitudes Concerns% strongly agree

Comments

Exhibit 25

We describe the clusters below, in order of their likelihood to adopt, and influence others to adopt, eHealth solutions. A further analysis of the most effective approach to clusters in any eHealth adoption strategy is set out below.

Cluster 1: Proactive pioneers (16% of all practitioners)These practitioners are strong believers in the benefits of eHealth – for collaboration between practitioners (64% of cluster strongly agree), for practice efficiency (62%), and for continuity and quality of patient care. They are the only cluster whose members strongly believe that patient relationships would benefit from eHealth adoption (34%). They are typically early adopters, and perceive few barriers to adoption. Operating almost exclusively in the private sector, they are comfortable with their ability to assess, select and implement solutions, and have significant influence over the practice’s eHealth decisions. Though pro-eHealth they are pragmatic in those decisions, only adopting solutions that do not diminish either practice efficiency or patient outcomes.

In common with other clusters, proactive pioneers are using computers heavily for patient scheduling and billing, and for professional reference and education. However, they are more likely to use eHealth solutions for referrals, patient communication and clinical notes. This cluster is well-represented in most sectors, being prominent among dentists and radiographers and found less in dietitians, occupational therapists, speech pathologists and psychologists. They are responsive to any support for eHealth, in particular peer recognition, and will likely act as role models for eHealth adoption and provide risk and benefit data for later users.

65

Cluster 2: Embedded converts (20% of all practitioners)Embedded converts typically work in a public-sector environment, hospitals or other care facilities, where computer use is expected and applications are provided for use. They tend to be younger, with dietitians, radiographers and aboriginal health workers prominent, and chiropractors, dentists, optometrists and psychologists underrepresented.

Where embedded converts have been introduced to eHealth solutions, they have appreciated the experience and the additional capabilities eHealth has brought them. As a result, they have become the strongest believers in the potential of eHealth solutions, seeing benefits in practitioner collaboration and continuity of care. While enthusiastic about the benefits, embedded converts are less likely to control purchasing and adoption decisions within their practices, and so initiatives to influence their eHealth adoption need also to convert their positive attitudes into pressure for organisational adoption.

Being the largest cluster, enlisting their support will provide the critical mass for eHealth adoption in the public sector. However, they are visible to and can influence a broader base of peers and other healthcare professionals outside the public system. They also appreciate the risks and concerns that they may themselves have once had, so may be a credible influence for more resistant groups: they won’t be perceived as eHealth-enthusiasts who too-readily dismiss the risks.

The next three clusters perceive the benefits of eHealth solutions and believe that they will be expected to adopt them, but are hesitant to adopt for different reasons.

Cluster 3: Risk-conscious (17% of all practitioners)Risk-conscious practitioners are aware of the potential benefits of eHealth solutions, but remain unenthusiastic as they see risks across the board. In particular, they are about six times more likely than eHealth-positive clusters to be concerned about the security and privacy of patient information, and twice as likely to be concerned about the visibility of performance data.

Though relatively young (only 16% are over 55 years of age) and city-based, they perhaps-surprisingly have the lowest average personal internet usage. This relative unfamiliarity with IT systems means they will also need reassurance on the capability and maturity of systems before the adopt them.

They consider the advice of their professional body a reliable guide, suggesting case studies of practitioner adoption and certification from professional bodies of potential system security are a potential adoption lever. Risk-conscious practitioners are found widely in across all allied health practitioner professions, with the exception of dietitians and speech pathologists.

Cluster 4: Cost-conscious (15% of all practitioners)Cost-conscious practitioners are interested in eHealth and see a broad spectrum of benefits, in particular practitioner collaboration, practice efficiency and continuity of care. However, their primary concern is the cost of implementing and maintaining new systems and, as with the risk-conscious and doubter clusters, they harbour concerns about the visibility of performance data.


Cost-conscious practitioners are receptive to financial incentives, and to evidence of efficiency benefits or to demand from patients. Otherwise, they will remain unconvinced, seeing a limited role for new technology in their practice until the technology becomes better established and the systems and implementations costs come down.

The socio-demographic attributes of this cluster are close to the norms for allied health practitioners. The cost-conscious cluster is well represented across all sectors, with psychologists the most prominent profession and audiologists and Aboriginal and Torres Strait Islander health workers underrepresented.

Cluster 5: Doubters (13% of all practitioners)These practitioners have similar concerns to those in the risk- and cost-conscious clusters, but their negative perceptions are stronger. They are uncomfortable with adopting unfamiliar technology in the face of their limited understanding of the broad system choices available. Believing practitioner collaboration to be the only clear benefit from eHealth, they don’t value the latest technology solutions, and harbour a host of concerns about system compatibility and downtime, the availability of IT support and cost.

While financial incentives and professional body endorsement may give some reassurance, doubters will typically wait for technologies to be almost ubiquitous before they adopt them, and may need direct peer reassurance in their place of work. Besides their attitudes to eHealth solutions, they are difficult to identify in their health networks: their age, gender, experience, location and source of income are close to the norms for allied health practitioners, and no profession is overly represented.

The final cluster has a negative impression of eHealth, disagreeing with the potential benefits and emphasising the barriers.

Cluster 6: Firm non-adopters (17% of all practitioners)Practitioners in our final cluster are significantly more sceptical of the benefits of eHealth, and avoid eHealth use unless the benefits are undeniable and the inconvenience to their ways of work minimal. Despite acknowledging that their peers expect them to use technology in the workplace, firm non-adopters remain unconvinced. They believe that patient relationships would suffer from eHealth use, and that it would diminish patient safety and engagement as well as the delivery, access to and quality of care. They are the most likely of all practitioners to strongly agree with any barrier proposed, in particular cost, privacy, and the visibility of performance data.

Firm non-adopters are more likely to be older, female, more experienced practitioners from the ‘conversational therapies’ of psychology and social work, and will likely delay adoption until any new technology is extremely well established in their profession (if indeed that happens before their retirement). Financial incentives to employ support staff in their practice may in the end be required, as might mandatory use secured through registration or reimbursement conditions.

67

A cluster analysis of professionsThe clusters allow a stronger analysis of attitudes to eHealth within and between professions. The distribution of clusters within professions is uneven compared to the allied health sector overall, reflecting the clinical needs of each profession: Exhibit 26. Importantly, though, each of the six clusters is represented in all but one of the 15 professions (there are no embedded converts among the largely private-sector chiropractors). This confirms that a range of interventions will be needed within the eHealth adoption strategy for each profession.

Clusters by segment


20

59

29

10

57

25

24

7

12

21

18

11

29

17

33

15

5

11

20

12

9

23

14

15

21

14

13

22

13

11

15

19

12

23

12

14

5

12

17

20

20

17

31

3

28

25

1

Speech pathologist 4 8 15

Social worker 17 15 12

Radiographer/Ultrasonologist 23 19 12

Psychologist 10 15 11

Podiatrist 20 11 21

Physiotherapist 14 19 12

Osteopath 15 21 11

Optometrist 28 14 19

Occupational therapist 8 23 19

Exercise physiologist 25 12 9

Dietician 7 1 12

Dentist 28 23 15

Chiropractor 14 22 21

Audiologist 21 21 5

Aboriginal Health Worker 18 12 5

Average across all 16 17 13


Cluster distribution by segment

Proactivepioneers

Embeddedconverts

Risk-conscious

Cost-conscious


Exhibit 26

In each profession there is as well a strong representation of the positive clusters (proactive pioneers and embedded converts), ranging from 14% for chiropractors up to 77% for ATSIH workers. Accordingly, eHealth adoption strategies will have a solid base of support within each profession. These supporting clusters are explored further in Exhibit 27 and 28, which confirms that the differing attitudes to eHealth between professions is more to do with the nature and structure of work in those professions, rather than any demographic or philosophical differences between them.


18

7

23

25

21

20

28

4

59

57

29

25

29

18

10

33

ATSI

37

Audiologist

37

Podiatrist 38

Dentist

51

SpeechPathologist

77

ExercisePhysiologist

Dietician

Radiographer,Ultrasonologist

63

52

51

Attitude – profession operating dynamics and environment drive eHealth readiness (1/2)

SOURCE: eHealth readiness survey; interviews with medical specialists

% of respondents

RationalePro-eHealth clusters by practitioner segment

Proactivepioneers

Embeddedconverts

▪ Long-standing patient relationships and history of chronic disease management across large, remote areas

▪ Strong top-down push on systems across segment

▪ High proportion of chronic care management in public sector▪ Introduction of EPC items has significantly altered landscape,

introducing significant record-keeping demand▪ Highly technology-based profession, requiring extensive

collaboration and distribution of information to many practitioners▪ Limited by specialist equipment capability▪ Strong small-business drivers but few interactions beyond GPs ▪ Enthusiasm driven by young, mobile, tech-savvy workforce,

predominantly private sector

▪ Technology-based environment requiring data-driven records▪ Strong expectation and perception of use

▪ Typically text-based notes required over long patient relationships▪ EPC and DVA interface reporting▪ Educational role although limited infrastructure or expectation ▪ Technology-based with outreach programs well-equipped▪ Strong emphasis on continuing professional development and

clinical reference materials▪ Availability of computer-based clinical reference, patient diagnosis

and therapy tools, suitability of telehealth as channel▪ Extensive patient notes and event summaries required

Exhibit 27

28

14

17

8

15

10

14

7

21

17

24

12

11

Physiotherapist

140

Psychologist 21

Chiropractor

27

Occupationaltherapist 33

Optometrist

34

Osteopath

35

Social worker

35

SOURCE: eHealth readiness survey; interviews with medical specialists

% of respondents

RationalePro-eHealth clusters by practitioner segment

▪ Typical practice includes retail format, overlap between business administration and record-keeping systems driving adoption

▪ Patient detailed examination and education role

▪ Strong interest in continuing education and professional collaboration, driven in part by progressive peak body

▪ Case management focus makes continuity of care a leading driver

▪ Older workforce with leading interest in continuing professionaleducation and clinical reference

▪ Unsure on benefits, infrastructure and support limited▪ Requirement for text-based patient records and reporting▪ Patient management role driving strong use of, and interest in

telehealth▪ Patient administration and clinical reference driving adoption▪ Insecurity about role within healthcare system – consider visibility

of performance data leading barrier

▪ Low expectation and perception of use within sector▪ Short-duration physical therapy▪ Business efficiency driving adoption

▪ Sensitive patient relationship and patient privacy and confidentiality concerns

▪ Little collaboration outside own specialty, GP’s

Proactivepioneers

Embeddedconverts

Attitude – profession operating dynamics and environment drive eHealth readiness (2/2)

Exhibit 28

69

Barriers to eHealth readiness and adoptionCompared to their perceptions of benefits, the perceptions of barriers to eHealth adoption vary greatly across allied health, whether looked at through a cluster lens (Exhibit 29 and 30) or a profession lens (Exhibit 31). The most identified barriers to wider eHealth use among allied health practitioners are:

• Affordability: the most-identified barrier for embedded converts, cost-conscious and non-adopter clusters, and the highest-ranked perceived barrier for eight of the 15 professions

• Compatibility with existing IT systems: both internal and external (the biggest barrier for the doubter cluster, with concern over internal compatibility consistently felt across all professions

There are also significant concerns about:

• Privacy: among risk-conscious and non-adopting practitioners, particularly in audiology and psychology

• Visibility of practitioner performance: felt particularly by ATSI health workers, osteopaths, chiropractors and physiotherapists

• System malfunction and downtime (particularly among risk-conscious and non-adopting dentists, chiropractors, osteopaths and optometrists)

Basic infrastructure is generally not a barrier to eHealth adoption, as most allied health practitioners in major cities and regional areas have computer and internet access in their practice. For those practitioners in rural or remote areas, this may be a limitation. Significantly, a greater proportion of allied health practitioners than other health professionals (particularly medical specialists) work regularly in remote areas, so this may have a larger impact for the allied health sector.

Strategies to minimise these barriers are discussed below.


Clusters perceive different barriers to wider eHealth adoption (1/2)


% of respondents

Practice needs to connect to external systems

Concerned about system malfunctions

Prefer to wait until technology is established

Not enough people using these systems

Others in your practice are resistant

Need to maintain compatibility with existing systems

26

55

38

26

23

25

Firm non-adopters

9

Doubters 4

Cost-conscious

10

Risk-conscious

2

Embeddedconvert 11

Proactivepioneers

3

31

62

21

10

1

17

15

1

12

7

13

0

34

50

51

19

14

11

8

23

5

5

3

2

29

33

38

56

19

14

4

13

11

9

1

2

33

40

18

19

9

1

7

5

16

3

11

13

29

13

15

12

5

22

3

23 8

17

723

33

271

3

23

3

2

18

8

2

3

16

Cannot find a solution to meet needs

Strongly agree

Strongly disagree

Exhibit 29

Clusters perceive different barriers to wider eHealth adoption (2/2)


% of respondents

Concerned about productivity drop during transition

Too long to access and use the technologies

Too difficult to select and implement

Inadequate IT support

Concerned about visibility of Performance dataCannot afford

28

58

48

78Firm non-adopters

Doubters

9

9

0

10

22

9

0

2

Cost-conscious

Risk-conscious

Embeddedconvert

Proactivepioneers

41

5

19

26

2

5

4

15

13

12

5

9

36

22

4

2

2

923

19

12

6

5

17

30

28

1

4

23

22

3

8

6

3

15

2

38

53

23

13

9

23

6

11

16

17

10

1

28

28

36

472

11

19

11

8

4

8

17

53

32

62

5

7

23

13

12

11

20

5

0

Concerned about privacy breaches

Strongly agree

Strongly disagree

Exhibit 30

71

Ranking of barriers to eHealth adoption, by profession


Ranking of barriers to adoption, by practitioner segmentRanking of “Strongly agree”

842373515692733You prefer to wait until technology-based systems are proven and well-established before adopting them

10788101067910116888There aren't enough people using these systems for them to provide a real benefit to you

141410141414131314141411121414Others in your practice are resistant22114868103371091012You don't have access to adequate IT support13111410121311141213121314127It is too difficult to select and implement a new system

987662148784271You don't think that practitioner performance data should be made public

336237386445524You are concerned about breaches of patient privacy765545237851146You are concerned about system malfunctions or downtime

69313581464937655Your practice needs to connect your IT systems with those used externally

451924922223412Your practice needs to maintain compatibility with your existing IT systems

121013111312121110561413910You can't find a solution that meets your needs1112971191091312101210119It takes too long to access and use the technologies51312129117121111139111313You are concerned about a drop in productivity during the transition

1141114511183611Your practice can't afford the initial and continued technology investment

ATSI

Aud

Chiro

Den

t

Die

t

Ex OT

Opt

o

Ost

Phy

Pod

Psy

Rad

SW Spe

First Second Third

Exhibit 31

Drivers of eHealth adoption and usageMost allied health practitioners will use eHealth to secure certain benefits, so long as the concerns they have raised are largely met. Additional measures may be taken to persuade practitioners that the benefits outweigh their concerns. Financial incentives gain strong agreement as an effective driver of adoption across clusters, as do advice from professional bodies: Exhibit 32. To varying degrees, practitioners are responsive to the expectations of their peers, and to the demands of patients and support staff.

The financial incentives contemplated by practitioners go beyond simple ‘cash handouts’ – in fact, it was suggested that these would be ineffective in the absence of tailored eHealth solutions for the allied health markets. The incentives suggested included IT support, training, and potentially tax relief for eHealth-enabling investments.

The breadth of and support for these drivers shown in the research suggest there is strong potential to increase eHealth adoption within the allied health practitioner sector. These drivers, and how they relate to other interventions as part of a comprehensive eHealth strategy, are discussed further below.


Clusters are motivated by different drivers


% of respondents

Demand from patients

Demand from support staff

Advised by professional bodies

Offered financial incentives

Gained respect and recognition

Demand from other practitioners

Firm non-adopters

Doubters

Cost-conscious

Risk-conscious

Embeddedconverts

Proactivepioneers

169

323

337

223

461

450

5

341

357

16

0 43

0 39

228

2 43

2 40

515

14

517

196

11

0 57

0 67

0 47

30

2 40

623

8

2 69

3 58

4 40

45

2 52

6 36

10

13

2813

12

272

33

4 34

3

522

Strongly agree

Strongly disagree

Exhibit 32

SummaryThe eHealth readiness of the allied health sector was explored through 40 qualitative interviews and a quantitative survey of 1,125 allied health practitioners. The high-level findings are that, though attitudes vary across sectors, most allied health practitioners see the potential benefits of eHealth to their practice and health outcomes, and can and will use well-designed solutions if the perceived benefits clearly outweigh the costs and barriers.

Computer hardware, connectivity and practitioner aptitude are not major barriers to readiness. Self-contained administrative, research and note-viewing applications are being used, and the sector is ready and very interested in more networked, care-focused solutions. However, due to the fragmented market for eHealth solutions in the allied health community, the adoption risks and barriers are currently too high. Available systems do not suit their practice, are unreliable, or do not connect with existing systems or to the systems of other practitioners with whom they want to share information. There are over 75 commercial systems in use, and few have been tailored to specific allied health needs.

Differences in practitioner readiness emerge when considering their attitudes to eHealth benefits and barriers. To analyse these differences, we considered six “clusters” of allied health practitioners with quite distinct attitudes to eHealth possibilities. Two of these six clusters, representing 36% of all practitioners, are strong eHealth supporters and are present in both public and private practice. Another three clusters may be persuaded about eHealth benefits but are defined by their

73

perceptions of risk – safety and confidentiality, cost and reliability. The final 20% of practitioners are firm non-adopters, seeing risks across the board and few if any benefits.

These six clusters are represented across all 15 allied health professions, confirming a range of interventions will be needed within the eHealth adoption strategy for each profession. In each profession as well the eHealth positive clusters are also strongly represented, so that eHealth adoption strategies will have a solid base of support within each profession.

All but the firm non-adopters are fairly consistent in believing that eHealth would improve collaboration, continuity of care, and practice efficiency, rather than suggested benefits to patient engagement, satisfaction and relationships. Access to and quality of care are also acknowledged benefits, though not strongly. The strongest perceived barriers are system affordability and compatibility. Privacy, visibility of practitioner performance, and system reliability also cause considerable concern.

Adoption of eHealth will be influenced by financial incentives and the support and advice of professional bodies. Practitioners will also be responsive to the expectations of their peers, and to the demands of patients and support staff. These and many more intervention levers will need to be integrated in effective adoption strategies to convert latent eHealth readiness into widespread use.

8. Intervention strategies for advancing the eHealth agenda

75

Our anchor questions asked us to consider (1) how to minimise barriers to eHealth readiness and adoption, and (2) how to apply eHealth enablers to drive adoption and effective usage. Achieving eHealth adoption and usage for allied health practitioners requires a strategic approach to behaviour change that must be effective across a wide array of healthcare settings and care-provision processes. It must selectively employ any number of potential interventions, directed at specific practitioner groups, at single clusters or a combination of them, or across the whole health system.

It is not the purpose of this report to lay out such a strategy in its entirety. However, in this section we:

• Summarise an effective overall approach for each cluster (defining the expected role of each cluster in adoption, the targeted timing of their adoption, approaches to influencing that cluster, and the expected impact of that cluster in mobilising others),

• Introduce a range of 20 potential high-level interventions, working in three complementary directions, and their effectiveness for different clusters, and

• Offer an illustrative example of how a strategy might be designed for driving the adoption of telehealth solutions in the management of chronic diseases.

Proposed high-level approach to each clusterClusters differ in their current or intended use of eHealth solutions, perceptions of eHealth benefits and risks, adoption barriers and influencing factors. The following approaches to clusters would reflect these differences to maximize intervention effectiveness.

Proactive pioneer Practitioners in this most proactive cluster have invested personally in the early development or adoption of eHealth systems, often in relative isolation. Their enthusiasm and vision for technology adoption implies that their foremost need is for the coordination and channelling of their effort, so that a coherent system emerges. A consistent message from both government and peak bodies will reassure this cluster that their pioneering role is on track, valued and supported. They respond strongly to all avenues of support, requiring little external motivation. In any engagement strategy, proactive pioneers need to be engaged early to play a lead role in both establishing the early design and use of coordinated eHealth technologies, and influencing eHealth adoption by the more hesitant clusters. Peer recognition is a strong driver, so opportunities should be made available for them to act as role models and formal leaders. Further findings on proactive pioneers to guide an effective strategy include:

• 52% of proactive pioneers use an EHR, with similar numbers acknowledging the benefits that shared patient records could bring (58% strongly agree they would like access to a shared patient record, 54% strongly agree eHealth would improve continuity of care),

• many proactive pioneers are concerned about the limited interoperability of available systems (25% strongly agree that maintaining compatibility with existing systems is a barrier),

• proactive pioneers make adoption decisions pragmatically: although they are technology enthusiasts (47% strongly agree they like to be an early adopter), they will defer a decision until a suitable solution becomes available and the business case and/or patient benefits are clear,

• although proactive pioneers are at the forefront of eHealth adoption in the allied health sector, financial incentives may allow them greater exploration (69% strongly agree that financial incentives are a driver), and


• proactive pioneers are looking to expand their practice capabilities and enhance their reach and care process (64% strongly agree the ability to collaborate with other practitioners is a benefit).

Embedded convertsWhile embedded converts demonstrate relatively high current use of eHealth technologies as well as desire for improvement, their motivation is driven by the perceived expectation of use as well as their experience as users. Uniquely, this cluster represents allied health practitioners whose income stems predominantly from public sources, indicating the decision to deploy eHealth solutions and their involvement with eHealth technologies has to a large extent been mandated by the public organisation in which they work, but has been a positive experience nonetheless. This will almost certainly remain an efficient approach for this cluster, as well as a means to disseminate adoption throughout the allied health sector for those practitioners that migrate to private-sector roles or a mix of public and private.

As embedded converts make up 20% of all allied health practitioners, perhaps the cluster’s most important role in an engagement strategy is as a critical mass: demonstrating the potential of adoption and its benefits at a large scale, and driving expectations of use for the more risk-averse clusters in the private sector. It is also relevant that embedded converts may not have commenced their eHealth use independently, but rather the initial uses were mandated by their organisations. They are therefore a potentially credible influence for more risk-averse groups, as they can more readily relate to the concerns or barriers that these clusters perceive.

Further findings on embedded converts to guide an effective strategy include:

• 49% of embedded converts use an EHR, and 61% strongly agree they would like access to a shared patient record,

• Embedded converts observe the benefits of eHealth solutions (51% strongly agree they will improve continuity of care) but work in a cost-conscious environment (28% strongly agree that affordability is a barrier) where a low-cost implementation option is required,

• Embedded converts feel that computer use is expected (80% strongly agree, and 83% strongly agree most practitioners in their network use computers) but compatibility with current systems (23% strongly agree) remains their leading concern, and

• Embedded converts consider the voice of other practitioners an important motivator (46% strongly agree that demand from other practitioners is a driver).

Risk-conscious In the first of three more hesitant clusters, risk-conscious practitioners acknowledge the benefits of eHealth adoption, but hold overriding concerns about data security, patient privacy, system malfunction and compatibility. Strongly swayed by peer adoption and peer expectations, they may nonetheless be the most likely of the three hesitant clusters to be influenced to adopt. To do so, they will need reassurance on the capability and maturity of systems, so should be targeted only once the proactive pioneers and, especially, the embedded converts are well underway. Lead strategies will include exposure to practitioner case studies and the certification and peer-attested evidence of system security and stability.

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Further findings on risk-conscious practitioners to guide an effective strategy include:

• Risk-conscious practitioners do use EHRs (42%), and many recognise the potential for greater collaboration (22% strongly agree) and continuity of patient care (14% strongly agree),

• 61% of risk-conscious practitioners strongly believe that computer use is expected of them, (61% strongly agree that use of computers is expected) but remain cautious on adoption. Providing a peer role-model gives the opportunity to address their specific concerns (22% strongly agree that demand from other practitioners is a driver),

• Risk-conscious practitioners require assurance on the security of data within eHealth solutions, both patient and practitioner level (53% strongly agree they are concerned about privacy breaches). A robust architecture will limit the opportunity for data corruption, system-wide malfunction or inappropriate access. A defined legal framework will establish the operating rules for the handling and storage of data,

• Risk-conscious practitioners doubt the capability of eHealth solutions to perform adequately (34% strongly agree concerns about system malfunction are a barrier) and value a robust, reliable system (29% strongly agree they prefer to wait until technology is established before adopting), and

• Even where an eHealth solution works as intended, risk-conscious practitioners have concerns about the visibility of practitioner performance data (28% strongly agree this is a barrier for them).

Cost-conscious As in the risk-conscious cluster, cost-conscious practitioners are relatively neutral to the benefits of eHealth adoption, but in this case their primary concern is in finding an affordable, appropriate solution. They require a well-established, straightforward solution appropriate to their practice that is low-cost to both implement and maintain. Potential strategies include the development and delivery of low-cost, robust systems meeting minimum capability requirements (potentially exploring ‘Cloud’-based access models to the solutions), ensuring that early releases of solutions deliver clear efficiency benefits to them and their practice, exposure to the business case experience of earlier adopters, peer recommendations and financial incentives. Again, the cost-conscious sector should be considered a follower target rather than an early adopter cluster, but should be engaged early to make sure both solution design and delivery models address their concerns.

Further findings on cost-conscious practitioners to guide an effective strategy include:

• Cost-conscious practitioners appreciate the benefits of collaboration and continuity of care in the health ecosystem (36% agree), and they would like access to a shared patient record (39% strongly agree), but their concerns over-ride these perceived benefits,

• Cost-conscious practitioners also perceive the practice benefits of eHealth adoption (30% strongly agree that eHealth would improve practice efficiency) and would appreciate the opportunity to upgrade (33% strongly agree they like to be an early adopter), but they desire affordable, mature technology (58% strongly agree that affordability is a barrier, 33% strongly agree they prefer to wait until technology is established),


• Cost-conscious practitioners need simple solutions tailored to their needs (27% strongly agree they cannot find a solution that meets their needs, 22% strongly agree it takes too long to access and use eHealth technologies, 15% strongly agree that eHealth solutions are too difficult to select and implement), and

• Although 50% of cost-conscious practitioners strongly agree that computer use is expected of them, they lag the leading adopters significantly. They would consider both demand from other practitioners and the advice of professional bodies as motivating drivers (33% strongly agree that demand from other practitioners is a driver, and 30% recognise their professional body).

Doubters The doubters cluster is the most difficult of the three hesitant clusters to influence, as its practitioners harbour strong concerns about compatibility, connectivity, downtime and IT support as well as affordability. They do not accept that computer usage is expected to the same extent as other clusters, and are similarly little impressed by peer adoption. Despite a higher overall level of concern, the engagement strategies relevant to this cluster are similar to those above – well-developed and proven systems, exposure to the experience of early adopters and financial incentives. However, their lower overall readiness implies they are a later adoption target cluster, whose confidence and ability to adopt will take longer to develop.

Further findings on doubting practitioners to guide an effective strategy include:

• Doubters understand that computer use is expected (39% strongly agree, though the lowest of all clusters), see collaboration and continuity of care as relevant benefits (34% strongly agree) and would like access to a shared patient record (31% strongly agree), but their many concerns override these attitudes. A peer role-model may address their specific concerns (32% strongly agree that demand from other practitioners is a driver),

• Doubters need reassurance on both business case (48% strongly agree they cannot afford eHealth) and the technical side of adoption (62% strongly agree the need to connect to external systems is a barrier, 55% strongly agree the need to maintain compatibility with existing systems is a barrier, 50% strongly agree they are concerned about system malfunctions, 38% strongly agree inadequate access to IT support is a barrier),

• Doubters find investing in eHealth solutions difficult and are reluctant to upgrade their systems voluntarily (16% strongly agree they can’t find a solution that meets their needs, 28% strongly agree eHealth systems are too difficult to select and implement). Accordingly, 38% strongly agree they prefer to wait until technology is established before adopting.

Firm non-adopters The most resistant of all clusters are sceptical towards the potential benefits of eHealth solutions. Although they feel the use of eHealth solutions is expected, their strong concerns about all potential consequences of adoption have limited their uptake. Firm non-adopters are typically older, more experienced practitioners. For many, the concept of wholesale change to their working environment or care delivery process at a late stage of their career is unappealing, and they will remain unwilling to participate. Further, the transformation of the health system to delivery models including eHealth enablement is likely to take place during a period of time that will see a significant portion of this cluster retire.

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Four strategies will be needed to influence those who remain in practice to adopt appropriate eHealth solutions. First, the widespread adoption and acceptance of solutions across the rest of the health system will allay non-adopter concerns over system maturity, suitability and risks, as well as driving an expectation of use. Secondly, financial incentives will motivate firm non-adopters, although their use must be carefully targeted. Thirdly, mobilising the influence and help of support staff in their practice, and identifying alternative, simpler ways for them to use the eHealth solutions, can help achieve the minimum expected level of use from this group. Finally, there will come a point at which requiring participation (e.g. via registration or reimbursement processes) becomes appropriate once adoption rates across the rest of the clusters are significant.

Further findings on firm non-adopters to guide an effective strategy include:

• Only 18% of firm non-adopters use an EHR, and only 19% strongly agree they would like access to a shared patient record. They also have a low perception of computer use amongst other health professionals (only 42% strongly agree that computer use is expected, and 48% strongly agree most practitioners in their network use computers),

• Firm non-adopters are the only cluster with a strong negative view of the benefits of eHealth (52% strongly disagree that eHealth will improve patient relationships, 48% strongly disagree that quality of care would be improved, 40% strongly disagree that eHealth will improve patient safety). Only collaboration with other practitioners (11% strongly agree) and continuity of patient care (7% strongly agree) register as perceived benefits,

• The strongest suggested driver for firm non-adopters is financial incentives, which correlates with their overwhelming perception of system affordability as a barrier (78% strongly agree),

• Firm non-adopters are reluctant to upgrade their systems voluntarily, and need to be convinced an adequate system exists (33% strongly agree they cannot find a system that meets their needs, 36% strongly agree available technology takes too long to access and use, 51% strongly agree they are concerned about system malfunctions, 53% strongly agree they have inadequate IT support),

• Firm non-adopters will undoubtedly be the hardest cluster to motivate, but peers remain an influence (16% strongly agree practitioners are influential, while 23% strongly agree professional bodies are a driver).


Allied health clusters

Sources: Team analysis

Embedded converts

Risk-conscious

▪ Neutral to use of technology, but cautious on further implementation

Proactive pioneers

Observed essence

Cost-conscious

▪ Wait to adopt second-generation technology once affordability enhanced

Underlying drivers

Doubters

▪ Uncomfortable with adopting unfamiliar technology in face of limited understanding

Objectives for engagement

▪ Continue engagement and use to spearhead further implementation, develop as user benefits example

▪ Develop robust framework, clarify risk differential from current practice and publicise patient benefits

▪ Harness enthusiasm, coordinate eHealth compatibility and direction, utilise as peer role models

▪ Focus on core potential for individual practitioner and health system, support with incentives

▪ Emphasise peer adoption and successes, provide guidance on ‘minimum capability’ systems

▪ Familiar with technology, comfortable objectively assessing and pragmatic in driving rapid adoption

▪ Limited control over choice of systems in use, but impressed with capabilities and looking to continue

▪ Patient relationship and care process coupled with business and administration efficiency

▪ Unconvinced by business case to support frontline adoption, see limited role for technology in practice

▪ Don’t believe latest technology is required for healthcare, adoption stalled by system choice

Firm non-adopters

▪ Older practitioners with ‘adequate routine’ and little desire to change

▪ Final focus, educate through peers, emphasis on financial incentives and/or mandatory adoption

▪ Perceive downside to trade-off between patient safety and security/privacy of patient data

▪ Practice manager directive, perceptions of peer adoption and discovery of efficiency benefits

▪ Don’t perceive benefits of adoption, overwhelmed by broad concerns

Exhibit 33

High-level engagement strategiesGiven the insights into infrastructural, aptitudinal and attitudinal readiness described above, it is clear that interventions that focus solely on, for example, educating and training the individual practitioner would be insufficient. They would fail to address some of the more fundamental barriers to adoption, such as real concerns about the suitability or limitation of the sets of eHealth solutions and how they are delivered, or the network- or environment-based constraints and influencers.

Drawing on the experience of the pharmaceutical industry and its approach to major product launches in the healthcare system, we believe that an effective approach to eHealth adoption by allied health practitioners and across the health system needs to simultaneously consider interventions along three complementary axes:

1. Shaping the product Interventions that modify the capability of potential eHealth solutions, their delivery or the way their potential is communicated, to address priority barriers for the clusters, real or perceived

2. Shaping the demand Interventions that focus on creating a more active and ready demand for the eHealth solutions, addressing primarily the attitude and aptitude readiness gaps, e.g. by creating more compelling and tailored benefits and value proposition cases

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3. Shaping the ecosystem Interventions that focus on putting in place the most effective enablers and influencers of adoption, within and across clusters

Accordingly, we have developed a ‘toolkit’ of potential high-level intervention levers, structured along these three interconnected intervention axes:

A. Shaping the ProductThe insights from the research into the eHealth readiness of allied health practitioners clearly identified that a number of barriers to adoption of eHealth stem from real or perceived concerns about the eHealth solutions or ‘product’ itself, such as the security, privacy, suitability, interoperability, usability, reliability or cost (of installation and operation) of the solutions.

Therefore an effective adoption strategy needs to consider explicit interventions focused on shaping the ‘product’ itself, and not be limited to engaging or shaping the demand.

The objective of these interventions is to effectively lower the product-related barriers (real or perceived), and enable an appropriate degree of tailoring of the product or its delivery to the differentiated needs identified through the clustering analysis.


Rationale

Coordinated system-wide adoption of eHealth is predicated on the availability of three fundamental infrastructure building blocks:

• Hardware, e.g. desktop, laptop or tablet computers, smart-phones, teleconferencing and video-conferencing facilities, and data-warehouses

• Communications, e.g. landline and mobile telephone networks, wired and wireless internet networks, adequate bandwidth and reliability

• Technical equipment, e.g. specialised diagnostic, imaging or pathology equipment

While hardware and communications infrastructure are universally available, practitioners without adequate infrastructure cannot adopt eHealth solutions regardless of their desire. Several interviewees have expressed their frustration over the lack of reliable telecommunications in remote areas. The least-equipped practitioners are those that practice occasionally, but are not based, in a rural or remote area.

Intervention

For these practitioners, an appropriate intervention would be to provide or support the acquisition of infrastructure enabling their participation. For example, subsidising laptops for Aboriginal and Torres Strait Islander health workers on outreach programs, providing video-conference facilities at community health centres or helping dentists upgrade to electronic rather than film-based imaging equipment.

Main clusters influenced: Embedded converts, cost-conscious, doubters, firm non-adopters



Rationale

While allied health practitioners have widely differing needs for both data access and interface design, their integration into coordinated health-system wide initiatives relies on a minimum level of interoperability. Not even proactive pioneers will push to adopt systems without that interoperability, while embedded converts have seen first-hand the advantages of reliable interoperability in their public hospital work settings.

Establishing and enforcing clear standards for that interoperability will also reduce development risk for vendors developing new platforms.

Intervention

Ensure clear standards are set and adopted which cover compatibility, interoperability and security for eHealth integration between platforms and systems. Establish appropriate mechanisms to accelerate vendor compliance of vendors with the requisite standards (e.g. accreditation, transparency on compliance, incentives, making conformance testing easier and cheaper, or providing platform architectures containing standards-compliant services or component libraries – see no. 3 below), taking care not to create an excessive certification and administration burden which would risk slowing down innovation and competition within the solutions market.

Main clusters influenced: All

3. Provide ‘backbone’ framework establishing legal, data ownership, data storage and security standards and rules

Rationale

One of the barriers to development and adoption of suitable eHealth solutions is uncertainty for practitioners, patients and vendors on the legal framework, data ownership and governance frameworks, and clarity on technical standards addressing security, interoperability and other essential system elements.

Intervention

Engage professional and patient bodies and jurisdictions to establish a clear legal, technical and ethical framework for the implementation of eHealth solutions.

An example would be to thoroughly define how data within broader health system is accessible, and to whom (e.g. ensure practitioner-level data is only visible to an appropriate audience and not the patient body, ensure health system level data maintains anonymity).

Main clusters influenced: Proactive pioneer, risk-conscious, doubters, firm non-adopters

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Rationale

The research has provided evidence of a fragmented landscape for vendor solutions, insufficient coverage of allied health specialities functionality and usability requirements by these solutions, and a concern for interoperability and standards compliance.

There is a risk, therefore, that the efforts required of these solution vendors to extend and upgrade their solutions to make them standards compliant and continuously invest to maintain this compliance would lead to delays in availability of suitable solutions, confusion for allied health practitioners, and costs that would reduce the attractiveness of the market for vendors and/or the financial affordability of solutions for allied health practitioners.

Intervention

One innovative approach, leveraging emerging trends in Cloud computing, and especially ‘Platform-as-a-Service’ (PaaS) approaches, would be for a centrally coordinated effort to establish and maintain a shared platform architecture This would include shared standards-compliant services, components libraries and a development and compliance-testing environment. This architecture would reduce the burden of compliance for individual efforts and reduce duplication of efforts, accelerate dissemination of innovations, and create greater assurance of consistent standards compliance across solutions. This is an emerging concept, but one that is championed by global software industry leaders, and is particularly pertinent to the healthcare system, given the level of fragmentation of solutions and the critical importance of interoperability.

Another opportunity to pool resources and assets via a PaaS approach is data storage and ownership, as this is of particular relevance to allied health infrastructure development. By its nature, the majority of allied health services occur outside the hospital system in small practices or community health centres. While allied health practitioners are willing to engage in system-wide eHealth initiatives, the scale of investment required for wholesale secure data warehousing requires it to be established peripherally.

Main clusters influenced: Proactive pioneers, doubters


Rationale

The fragmented allied health vendor and system landscape illustrates the limited availability of software solutions finding broad adoption in meeting the needs of allied health practitioners. Generic solutions often fail to address specific requirements of allied health specialties.

Intervention

Engage early adopters, especially in the proactive pioneer cluster, and professional bodies, in an effort to define and communicate to the vendor community their requirements in terms of either ability to customise certain elements of functionality or solution delivery, or in terms of specific


functionality required to support their processes. This would help clarify and prioritise needs and required changes for the vendor community.

For example, in developing patient records, needs identified could include a greater ability to capture diagrams for physiotherapists, focus on entry of large free text fields for occupational therapists and psychologists with facility to automatically upload key words and data.

For practitioners who have not yet adopted appropriate eHealth solutions, developing a robust, simple to use system incorporating the minimum functionality required to play their role in eHealth will spearhead adoption. Introducing practitioners to a straightforward, low-cost system also provides an avenue to enhance capabilities over time.

Main clusters influenced: Proactive pioneers, cost-conscious


Rationale

An important barrier to adoption identified in the research is the perception of risks to clinical practice in the event of downtime, or loss of efficiency if system performance does not meet practice requirements.

The research also identifies that although most healthcare practitioners believe they have and implement IT security and disaster recovery policies, in fact they lack understanding of what constitutes appropriate IT security and disaster recovery, and lack access to proper IT support, especially in private practices.

Intervention

Given the small scale of most practices and fragmentation of vendors supporting them, an intervention could be to establish shared services for eHealth solutions deployment, maintenance and support. These could be provided on a territorial basis (e.g. by a jurisdiction, a Medicare Local, an LHN), or by pairing larger institutions (e.g. a hospital or large practice network) with smaller practices.

Main clusters influenced: Risk-conscious, cost-conscious, doubters, firm non-adopters


Rationale

Many allied health practitioners have embedded some form of EHR use into their practices, yet the information content, semantics and structure are incompatible externally. In order to harness the energy of these practitioners in continuing to drive uptake and adoption, their transition to interoperable records should be accommodated. The personal investment of these practitioners implies a level of ownership of their solution – as such their efforts should be redirected rather than abandoned and replaced.

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Intervention

Engage with early adopters, their vendors and professional bodies to determine an appropriate migration path for users who have already started using eHealth solutions which are not compliant with new or upcoming standards. Consider where appropriate providing incentives for these early users to migrate to the standards-compliant solutions to establish an early expert user base and reference points.

Main clusters influenced: Proactive pioneers


Rationale

The survey highlighted widespread concern about system malfunction and downtime, as well as many practitioners using a combination of both paper and computerised records. These barriers reflect a level of discomfort amongst practitioners, not simply in the deployment of a technology solution, but also in implementing a change to the way care is delivered. Migrating to electronic patient records, for example, has the potential to fundamentally affect practitioner care delivery processes, administrative management requirements and patient-practitioner relationships. A significant level of both familiarisation and trust are required to make this transition, particularly for those not versed in the technology, for whom the support of an expert change management service would smooth the process.

Intervention

Develop a program to establish an existing practice with the fundamental suite of tools and new processes required for their engagement in eHealth, with a minimum of both disruption and personal involvement by practitioners and support staff. Aim to maintain current practice functionality, with the opportunity to further enhance system capability if required. Provide training and support to cover the transition to familiarity and capability.

Manage around firm non-adopter cluster by developing (and supporting) a generic toolkit for practice managers on ‘how to computerise you practice’ to enable adoption to occur “behind the scenes.”

Training will be most effective if it is delivered by respected peers. As early pioneers, they are especially eager to share their experiences with EHR technology and will be able to communicate benefits to their peers.


B. Shaping the DemandThe research into eHealth readiness clearly identifies wide variations in intended usage of eHealth solutions, as well as in the underlying attitudinal causes for these variations. The clusters identified have markedly different perceptions of the benefits, costs and risks of eHealth.

Therefore, a concerted effort must shape the demand for eHealth solutions and the related changes in the healthcare delivery models that they enable. This effort must be grounded in the


understanding of the current perception and needs profiles identified in the research, by speciality and by cluster.

Some examples of demand-shaping interventions are outlined below, focused on defining, proving and communicating tailored value propositions and stimulating awareness and early adoption.


Rationale

The wide variation in practice setting and care process across allied health implies that different practitioners will have very different potential utilisation of eHealth. The research clearly established different profiles of current and intended usage, as well as perception of benefits, between specialities and clusters. Therefore value propositions for eHealth solutions cannot be generically defined across the whole allied health sector, or even by speciality within the allied health sector.

Intervention

Work with early adopter leaders and professional bodies to identify relevant usage segments within and across professions, and define value propositions for specific eHealth solutions that are tailored to their needs and perceptions.

Define corresponding early implementation initiatives that will establish robust evidence of these value propositions, and identify and mobilise the most appropriate channels to communicate these value propositions, or interventions which will help target clusters or professions experience these value propositions

To generate momentum, focus initially on universal business drivers - integration of financial systems and reimbursement, reduction of operating costs and administrative efficiency, as well as on clusters or professions with the most visible early benefits potential.

Main clusters influenced: Embedded converts, risk-conscious, cost-conscious, doubters


Rationale

Both professional body and peer influences are seen as motivating drivers of technology adoption across all clusters (67% of embedded converts, and 23% of firm non-adopters, strongly agree their professional body is a driver: 46% and 16% respectively strongly agree peers are a driver). Further, the more hesitant clusters perceive significantly lower benefits to eHealth adoption than the proactive pioneer and embedded convert practitioners (14% of risk-conscious practitioners strongly agree continuity of care is a benefit, compared to 54% of proactive pioneers, and 51% of embedded converts). Utilising ‘super-users’ and professional bodies to emphasise the benefits they’ve uncovered will be a driver of perception and adoption.

Intervention

Cultivate and support a pool of skilled users who can both provide a tangible showcase of successful adoption and help develop training programs that will resonate with their peers. In

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addition to supporting more hesitant practitioners, this role provides an avenue for recognition amongst proactive pioneers, for whom this visibility is a strong driver.


11. Develop an evaluation framework to track and report on business-, patient- and efficiency-related benefits

Rationale

At early stages of an adoption curve, unconvinced practitioners can legitimately suggest there is limited data supporting an adoption decision that will potentially alter their care process and customer experience significantly. As weight of evidence builds, persuading these practitioners becomes a more straightforward task.

As adoption levels increase, the ability to quantify benefits will become increasingly critical to convince the practitioners who are less likely to reap immediate or direct rewards

Intervention

Define a clear and quantified articulation of direct and indirect benefits made possible by the deployment and use of the eHealth solutions, covering quality, access and cost benefits, to the patients, practices and the health system.

Determine the metrics and the context, scale and duration of deployment required to prove these benefits to different stakeholder groups, and engage the relevant stakeholders (e.g. professional bodies) early in the definition of benefits, metrics and proof points.

Anticipate how this evidence will be communicated to stakeholders (e.g. via professional bodies, academic publications, events, CPD training, etc.)


12. Build the expectation that practitioners “should” use eHealth solutions, at practitioner and patient level

Rationale

A strong correlation is observed between use of computers, and practitioner perceptions that computer use is expected of them, or that the majority of their peers are using computers. Although not necessarily a causative effect, the level of suggested peer and peak body influence by practitioners suggests that developing the expectation of use will drive adoption. The influence of patient expectations is less prominent, although ‘mobile’ patients shifting between practitioners also serve to reinforce practitioner perceptions about their peer’s use of technology.

Intervention

Build and maintain system-wide awareness of the level of use of eHealth solutions within the healthcare system. Keep the ongoing development of eHealth top-of-mind for allied health practitioners by coordinating campaigns highlighting the progress of general practitioners, medical specialists, community health centres, vendors and insurers. Educate patients about the benefits


to ongoing maintenance of their health through improved access to healthcare. Practitioner attitude, motivation, perception of barriers and perception of benefits all correlate with perceived expectation of use.

Main clusters influenced: Cost-conscious, doubters, firm non-adopters


Rationale

Conflicting perceptions of risk emerge between practitioners who have and have not adopted eHealth solutions. Those who rely on traditional record-keeping and communications stress that their records are locked away safely at night, reliably available when required and only available to those who genuinely require access. Those who have adopted eHealth solutions respond that electronically stored records can be backed up, can be adequately secured and provide significant patient benefits including safety, engagement in managing their own health and continuity of care. This is essentially a difference in perception, with a level of education required to circumvent the “all change is dangerous” attitude, and emphasise the collaboration and efficiency benefits for providers.

Intervention

Identify the main perceptions of risks that are likely to delay adoption by the risk-conscious and firm non-adopter clusters especially, determine the evidence that is required to allay these concerns, and scope and run demonstrations and early implementations that generate this evidence.

Determine robust mitigation approaches to the main risks perceived, and ensure these are communicated to these clusters via stakeholders they trust (e.g. peers)

Main clusters influenced: Risk-conscious, doubters, firm non-adopters


Rationale

Financial incentives are suggested as a top-two motivator by all clusters. However, while there is undoubtedly a place for financial incentives in the adoption of potentially costly or disruptive technology, they can also prove a blunt instrument unless properly targeted. For example, providing allied health practitioners with a grant to purchase EHR solutions is inefficient if the available systems are unable to communicate. Hence incentives should generally not be ‘cash handouts’ to individual practitioners, but rather productivity initiatives such as establishing profession-based network support or tax deductions for specific eHealth professional training.

Intervention

Financial interventions should be used to supplement a case for adoption where the benefits to the practitioner are insufficient, but the benefits to the overall health system justify the investment. For example, community health centres might be provided with video-conferencing facilities to promote the integration of multi-disciplinary care teams.


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C. Shaping the EcosystemIntroducing changes, such as eHealth solutions, which affect the care delivery model across the healthcare system, requires coordinated approaches to adoption across the system. The eHealth readiness research has confirmed the importance of the overall health ecosystem as a strong factor influencing individual adoption by Allied Health Practitioners.

Therefore an effective eHealth adoption strategy also needs to include specific interventions which create the conditions in the ecosystem which influence and support adoption, within and across clusters. Critically, coordinated action within an ecosystem must be guided top-down – governments must establish the regulatory and incentive environment before vendors and professional bodies can take the right initiatives along with individual practitioners.

15. Establish a clear and aligned aspiration and timeline for eHealth adoption, to facilitate decisions and commitments by practitioners and solution vendors

Rationale

A clear system-wide directive for the introduction and adoption of eHealth technologies is required to guide stakeholders whose investment relies on the actions of adjacent stakeholders.

The leading examples are eHealth system vendors and the subset of proactive pioneers who have undertaken to develop their own systems. Establishing development priorities significantly mitigates development risk. For practitioners, an adoption timeline sets expectations of use, allows forward planning and coordinates migration to eHealth solutions system-wide.

Intervention

Establish and publish clear standards early, as well a realistic but clear timeline of expected adoption by the majority or all stakeholders, including any reinforcing mechanisms which will kick in at defined times in the future (e.g. penalties for non-compliance, conditional accreditation, etc)

Main clusters influenced: Proactive pioneers, cost-conscious, doubters


Rationale

Widespread adoption hinges on the ability for practitioners to connect and share information with a large number of other care providers. Ensuring that these other providers (e.g. GPs, specialists and pharmacists) are simultaneously integrating with the systems will help encourage, and in some instances force, practitioners to come on board. The strong network effect achieved by widespread adoption calls for a coordinated push system-wide, such that all stakeholders in the ecosystem join simultaneously. (40% of firm non-adopters strongly agree there are not enough people using eHealth technologies.)

Intervention

Building on the analysis of benefits for defined clusters or specialties, identify use cases involving multiple healthcare professional categories, which have a strong potential to generate visible benefits early, and will stimulate adoption from stakeholders who are critical for the realisation of


many other attractive use cases. An example regularly mentioned by practitioners was the need for an accessible complete record of patient medications, particularly for elderly patients.


17. Create transparency on adoption plans and trends

Rationale

The eHealth readiness research has identified perceptions of adoption by other practitioners in a network of care as strong influencer.

Further, the full range and scale of benefits from eHealth solutions will only become possible once there is sufficient penetration amongst all participants in a given healthcare delivery system or network.

And finally, participation trends within a specialty or a cluster can also encourage and sustain the development and support of vendor solutions specifically addressing their needs

Intervention

Create a simple tool allowing (or requiring) participants to specify their intentions in terms of timing and extent of eHealth solution adoption, and transparently make the information available to the relevant communities, and alert these communities of opportunities presented by the rate or extent of penetration achieved.

Main clusters influenced: Pressured adopters, risk-conscious, cost-conscious


Rationale

University education and continuing professional development are cornerstones of allied health practice, and both play a lead role in shaping the expectations of the community of practitioners, as well as the dissemination of new skills into the workforce.

Intervention

Engage with early adopters, professional bodies and other relevant organisations (e.g. Health Workforce Australia), to determine how the eHealth solutions affect healthcare professional roles and skills.

Determine implications for both initial training and CPD, and how to embed eHealth training into relevant programs.

Main clusters influenced: Pressured adopters, risk-conscious

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Rationale

The eHealth readiness research has suggested that allied health practitioners are relatively interested in eHealth uses which involve sharing records with patients, and are sensitive to patient-related benefits (i.e. patient satisfaction, patient relationships and patient engagement). To a large extent this reflects the educational role played by allied health practitioners, and their requirement for influencing long-term patient behaviour. In addition, the influence of professional bodies, peers and to a lesser extent, patient groups emerged as strong levers to drive eHealth adoption.

Further, one of the main barriers identified in the survey was perception of risk (to the patient quality and the practice efficiency, as a result of concerns over privacy, data security or system malfunction or downtime).

Therefore, interventions that engage the patient and professional representation bodies in designing and communicating effective implementation of eHealth solutions which mitigate the perceived risks and deliver safety and experience improvements for patients are likely to be effective.

Reciprocally, given allied health practitioner’s overall interest in patient engagement and benefits, they and their professional bodies can be an effective influence on patient’s consent to and engagement with eHealth solutions.

Intervention

Utilise professional and patient representation bodies as key influencers by liaising early to ensure that they provide best-practice adoption and use guidelines for their members, and communicate effectively on benefits mitigations of risk and liability. Additionally, collaborate with the peak bodies to confirm the most influential benefits for their members and ensure that their communications align with these benefits.

There is a wide range of possible specific interventions involving these bodies, ranging from formal communications to inclusion of eHealth readiness training in elective or mandatory (mandatory) CPD through peak body or registration requirements, via inclusion of eHealth promotion in events hosted by these organisations, or active involvement of these organisations in early implementations.

Main clusters influenced: Proactive pioneers, risk-conscious

20. Require mandatory participation via regulation or other mechanisms

Rationale

Eventually only a subset of difficult to influence practitioners will remain and therefore requirements may be the only way to convince them to make the change.

Also, setting realistic but firm ‘deadlines’ by which participation will become mandatory can accelerate commitment and investment decisions by individuals and practices, and can also


strengthen solution vendors participations and investments, as it provides a greater certainty of the emergence of a sustainable market.

Intervention

There are a number of potential levers, including enforcing compliance through registration or CPD requirements,7 making access to MBS dependent on using mandatory eHealth solutions or components such as secure messaging use, or adjusting insurance premiums.


Engagement interventions mappingThree broad strategic families emerge above, with applicability by cluster as indicated below:

Table 4: Product-shaping levers by cluster


Embedded converts

Risk-conscious

Cost-conscious



L M L M H M


H M L L H L

3. Provide ‘backbone’ framework establishing legal, data ownership and storage, and security standards and rules

H L M L H M


H H L M H M


H L L H M M


L L H H H M

7 For the 14 health professions regulated under the Health Practitioner Regulation National Law Act 2009, the power to change registration standards, codes and guidelines resides with the National Boards.

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Embedded converts

Risk-conscious

Cost-conscious



H M L L L L


L M H H H M

Table 5: Demand-shaping levers by cluster


Embedded converts

Risk-conscious

Cost-conscious



L M L L L M


H M H M H M

11. Develop an evaluation framework to track and report on business-, patient- and efficiency-related benefits

L L M M H M

12. Build usage expectation at practitioner and patient level

L L M H M M


L L H L M M


L M L H H M


Table 6: Ecosystem-shaping levers by cluster


Embedded converts

Risk-conscious

Cost-conscious


15. Establish clear and aligned eHealth adoption aspiration and timeline to facilitate decisions and commitments by practitioners and solution vendors

H M L M M L


M L H M H M

17. Create transparency on adoption plans and trends

L M H M M L


L H M M M L


H M H M M L

20. Require mandatory participation via regulation or other mechanisms

L L M L M H

Developing coordinated adoption strategy from the interventions toolkitTo demonstrate the development of a targeted adoption strategy from the toolkit of intervention levers described above, we consider their application to a scenario where the Government wishes to drive the adoption of telehealth services across the allied health community to supplement the provision of ongoing care for patients with chronic conditions.

This is not intended to promote telehealth as a national priority; instead, it is meant to illustrate the end-to-end adoption strategy development process that could follow from the eHealth readiness research. Telehealth was selected as an example of eHealth that is generating considerable interest globally, but for which neither the use-case nor business-case is yet well-established. The research supporting this report has showed telehealth is already being adopted by allied health practitioners across Australia. Today, patient-facing use of telehealth is low, as are practitioner expectations of patient-facing use – however the potential of telehealth solutions to significantly improve healthcare outcomes for many Australians is widely recognised.

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Our approach follows the process outlined below:

1. Describe the objectivesFor any given eHealth adoption program, first clarify the objectives and aspiration in detail, along with metrics for measuring success. Understand and describe both the starting position and the intended end-state. Describe the program and its objectives in the context of the overall evolution of healthcare delivery, not as an isolated deployment of eHealth solutions.

2. Develop and prioritise use- and business casesDescribe the use-cases envisaged in achieving the program objectives. Prioritise these both on their impact – e.g. for patients, healthcare professionals and the healthcare system – and their reach – e.g. how many patients or clinicians will be touched by the use-case.

3. Identify the critical participants and their role in the use-caseWithin each use-case, identify the critical participants, the roles they play in enacting the scenario and the interactions required both horizontally, e.g. between healthcare practitioners or between systems – and vertically, e.g. from patients to healthcare providers

4. Highlight participant clusters and their role in adoptionIdentify the composition of participant groups by cluster. Clarify for each cluster their role in adoption, the timing of that role, and their relative influence and importance to overall adoption success.

5. Prioritise clusters and their intervention leversConsider the intervention strategies appropriate to targeting each cluster, along with their relative merit for the intended objective, optimum sequence and timing.

6. Integrate intervention levers to develop a coordinated strategyCombine and refine the potential interventions to develop a coordinated strategic plan, ensuring they are consistent with the objective, appropriately sequenced (both between clusters and between strategies) and can translate into a clear plan of action on the ground.

7. Measure performance and refine the approachEstablish a regular rhythm of performance measurement and review along the stated metrics. Consider progress on both how well you are doing at getting traction on adoption and use case enablement, but also whether you are achieving the targeted engagement role for each cluster and shifting core eHealth readiness attributes for these clusters (e.g. infrastructure, aptitude, and attitude). Refine the engagement approach as required.

Case study: Incorporating telehealth in the management of patients with chronic conditions1. Describe the objectivesFor the purposes of this hypothetical case study, we envisage an articulated goal of improving outcomes in the management of patients with chronic conditions through the adoption of telehealth solutions. The objective is to provide more regular touch-points with practitioners,


such that improved patient monitoring and motivation, for patients that require it, is achieved in a manner convenient to both patient and practitioner, particularly in rural and remote scenarios, but also for elderly, juvenile and time-pressed patients.

The start-point is the current management scenario:

• Access to Medicare rebates for dietetic services is achieved when a patient with a chronic or terminal medical condition and complex care needs is managed by their GP under a GP Management Plan (MBS item 721) and Team Care Arrangements (MBS item 723) and referred for dietetic services under Medicare.

• Allied health practitioners are currently unable to claim Medicare Rebates for telemedicine consultations and no health professionals are able to claim Medicare Rebates for services where a patient is not present either by videoconference or in person.8

The criteria for measurement of success include patient mortality and life-expectancy, quality of life factors, progression and adherence to care plan objectives, progress on known risk-factors such as blood glucose levels, and number of patient contacts per year.

2. Develop and prioritise use- and business casesPotential general use-cases for telehealth amongst allied health practitioners might include:

• A physiotherapist treating a chronic musculoskeletal condition utilises regular video-conferencing to monitor progress through live gait analysis

• An Aboriginal and Torres Strait Islander Health Worker supplements face-to-face contact with telephone monitoring to encourage patient self-management

• A psychologist provides web-based treatment programs allowing patients to self-manage their progression

• An occupational therapist seeking to develop a specialisation in the management of chronic conditions undertakes continuing professional development through a series of webinars

• An optometrist who believes a patient’s deterioration warrants specialist attention collaborates directly with a specialist by sharing images for diagnosis

• A coordinated care plan is developed allowing a dietitian and an exercise physiologist to manage a patient suffering Type II diabetes in a rural community (further detailed below)

One of the most difficult aspects of working with patients with chronic health problems as a result of long-term behavioural and social patterns is motivation and compliance. We will therefore consider the final case as the highest priority, and continue with this focus.

8 MBS does include case-conferencing items, although these are little used.

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3. Identify the critical participants and their rolesThe potential of telehealth as an effective delivery channel for healthcare education, collaboration, consultation and monitoring depends crucially on the care process involved. The healthcare provision process of allied health practitioners can be divided into three broad categories (below), although the diverse roles played by allied health practitioners imply significant overlap.

Care process group CharacterisationCounselling-based therapies These practitioners are heavily reliant on the practitioner-patient

relationship as a basis for patient education in the management of their own healthcare. While a level of face-to-face contact is broadly considered beneficial in establishing trust, ongoing consultation is not generally reliant on direct practitioner-patient contact. Patient history is a critical enabler of health management.

This group includes: Aboriginal and Torres Strait Islander Health Workers, Dietitians, Psychologists, Social Workers, and Speech Pathologists.

Physical therapies For these practitioners the physical presence of a patient is almost universally required. The core diagnostic and therapeutic processes involve direct interaction between patient and practitioner. Care is typically on a case-by-case basis.

This group includes: Chiropractors, Exercise physiologists, Occupational therapists, Osteopaths and Physiotherapists.

Specialist technical therapies These practitioners rely on a range of specialist equipment to accommodate patient diagnosis and therapy. Patient relationships vary from single-visit to intermittent repeat visits over many years.

This group includes: Audiologists, Dentists, Optometrists, Podiatrists, Radiographers and Sonographers

At a high level, the potential of various applications of telehealth is related to the therapy process:

Care process group CPD Collaboration with other practitioners

Patient consultation

Patient monitoring

Counselling-based therapies H H M HPhysical therapies M M L MSpecialist technical therapies L M L L


In this use-case, the critical health system participants are the patient’s GP, dietitian and exercise physiologist, whose roles are:

• General Practitioner is responsible for implementation and rhythm of review of the patient care plan, including medication requirements and practitioner roles. While they would potentially see a patient face-to-face initially, ongoing patient review could be held remotely via telephone, tele-conference or video-conference. The GP would also collaborate with dietitian and exercise physiologist to develop a care plan, monitor progress and consider refinements.

• The dietitian and exercise physiologist work together to educate the patient on appropriate lifestyle change, instil a coordinated management plan and monitor patient compliance and progress in line with that plan. For both professions, developing a close patient relationship is a key success factor to motivation, so regular communication is critical. Ongoing monitoring and support can be provided remotely through telephone, tele-conference or video-conference facilities. Patient monitoring will include tracking weight, waist circumference, blood glucose, blood pressure and cholesterol – the patient can be empowered to undertake these measurements themselves, and enter the results into an online journal, keeping both dietitian and exercise physiologist informed of progress. Nutrition and exercise analysis can be linked to this data so that kilojoule intake and exercise output can be monitored in conjunction.

4. Highlight participant clusters and their role in adoptionDietitians are overwhelmingly embedded converts (57%), while exercise physiologists have relatively even representation between proactive pioneer (25%), embedded converts (25%) and doubters (23%).

The small percentage of proactive pioneer dietitians (7%) suggests early adoption may not be spontaneous, but once underway would embed rapidly amongst embedded converts. Just 14% of dietitians are firm non-adopters, yet this use-case does not require all practitioners to adopt, so their involvement is not required. Due to their potential for negative influence amongst the profession, the approach towards them should be ‘containment’ rather than active involvement.

The large proportion of proactive pioneer exercise physiologists will drive rapid adoption of the use-case scenario, provided the infrastructure is in place - both communications and specialist applications. However the significant body of doubter exercise physiologists implies an infrastructure gap that needs to be addressed. Again, the use-case does not require all practitioners to be involved, so the smaller risk-conscious, cost-conscious and firm non-adopter clusters do not need to be actively targeted initially.

5. Prioritise clusters and their intervention leversFor dietitians, the clear priority is embedded converts, while both proactive pioneer and doubters deserve attention for exercise physiologists. Intervention levers appropriate to incorporating telehealth into their management of chronic conditions include:

• Provide fundamental infrastructure – effective use of telehealth in developing the trust required to motivate and educate a patient requires high-quality voice and video communications. Access to this infrastructure will be particularly difficult for rural and remote patients.

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• Utilise “super-users” to promote benefits – proactive pioneers will explore greater utilisation of telehealth technologies if firstly, they observe respected leading practitioners taking steps in that direction, and secondly, there is an opportunity to be recognised as a leader in the field. Identification and cultivation of proactive pioneers should occur as early as possible, concurrent with infrastructure development, to both harness their enthusiasm, and promote and capture innovations in the care delivery process.

• Build usage expectation at practitioner and patient level – although embedded converts consistently agree that the use of technology is expected of them, they are likely to be unaware of potentially new care delivery paths. It is important that embedded converts are presented a consensus adoption pathway, developed from the experience of the proactive pioneers, that establishes a clear set of steps and tools required to quickly adopt telehealth solutions, as well as expected practitioner and patient outcomes in doing so.

• Provide peer-based support for practitioners undergoing the transition – embedded converts consider peers a strong motivator, and will generally adopt eHealth solutions where the experience has been beneficial in comparison to the cost, both financial and in terms of practice efficiency. It is critical that practitioner support is fully available, and potentially proactive, in the early stages of embedded convert adoption – their positive experience of the process will drive ‘critical mass’ of adoption.

6. Integrate intervention levers to develop a coordinated strategyThe four key intervention levers uncovered can be combined to form a cohesive strategy, deployed over time:

• Underlying infrastructure is developed where required, region-by-region on a staged basis. Infrastructure is a basic ‘hygiene’ requirement for telehealth, with a regular connection between practitioner and patient required. Staged development allows pioneers to move quickly, disseminating learnings from their experience as further practitioners adopt. Practitioners may require video- or teleconference facilities, and integrated patient progress tracking as part of patient records. Patients without sufficient facilities may be able to access video- or teleconference facilities at local community centres, or alternatively rely on equipped community nursing or outreach staff. Regional prioritisation should consider both patient body and availability of suitable pioneers to lead adoption.

• Utilise the proactive pioneers to promote the concept of telehealth as a management tool for assisting patients with chronic conditions. For example, a seminar coordinated by the DAA could describe in detail the implementation process, timeline and outcomes of an initial trial by a small group of dietitians. Where infrastructure is in place, adoption of telehealth to monitor chronic patients has typically meant evolution of the patient care process – for example greater patient autonomy and self-management, a change in the role of community nurses or outreach staff, and greater collaboration between general practitioner, dietitian and exercise physiologist. Educating practitioners on the benefits these changes can bring, both to their own practice and their patients’ outcomes, is a key attitude driver.

• As practitioner familiarity with telehealth-supported care delivery grows, work with peak bodies, GPs and patient support groups to develop an expectation of use for telehealth solutions within a standard management plan. Best-practice patient management is built around


patient outcomes – as a body of evidence develops supporting the most valuable use-cases for telehealth adoption, ensure this knowledge is passed to the wider health community. The integration of telehealth is then seen as a progressive step for patient management and an indicator of leading care provision. Establishing a forum between interested dietitians could ‘keep the conversation going’ as adoption is undertaken, while regularly reporting progress to the full membership both maintains eHealth adoption as front-of-mind, and provides an opportunity for recognition of practitioners’ achievements.

• Assist practitioners that adopt telehealth solutions by ensuring they have a support network of professional colleagues undergoing the same transition process. Building on the experience of early adopters, the DAA could establish a knowledge-base of best-practice guidelines for both infrastructure questions and care delivery techniques, perhaps as an extension of the telehealth forum suggested above.

7. Measure performance and refine the approachMaintaining strategic direction in a complex environment requires regular monitoring and review. During the initial phase this may be a simple measure of infrastructure reach (e.g. accessible population) and practitioner awareness (e.g. percentage of practitioners who comprehend how patients with chronic illnesses might be better managed through incorporating telehealth initiatives). As expectations within the patient and practitioner population develop and adoption commences, establishing a rhythm of assessment of the target success criteria - mortality and life-expectancy, quality of life factors, progression and adherence to care plan objectives, and number of patient contacts per year – allows objective measurement of strategy effectiveness and refinement of interventions where required.

9. Conclusion

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On the basis of this research, we would now answer the three anchor questions as follows.

1. Australia’s allied health practitioners are ready to adopt eHealth technologies that improve either their practice’s operational efficiency or clinical outcomes – indeed many have already done so. However, the allied health professions are not yet ready for the transition to coordinated eHealth solutions across the entire health ecosystem – mature eHealth solutions accommodating allied health care processes and allowing interoperability are not commonly available.

Allied health practitioners have the fundamental infrastructural and aptitudinal readiness required for eHealth adoption and use, and are broadly optimistic about its potential. Further, six distinct attitudinal readiness clusters emerge within the allied health community, from proactive pioneers to firm non-adopters, allowing the development of targeted adoption strategies.

However, the fragmentation of the allied health community remains a key hurdle – the majority of eHealth adoption has been driven at the practice-level in relative isolation, resulting in a diverse range of system capabilities and maturities. Accordingly, practices remain incapable of direct integration into a health system-wide network. In order to realize the most valuable patient benefits outlined in the National E-Health Strategy, a coordinated eHealth framework needs to be developed, encompassing the diverse needs of the allied health community in addition to other stakeholders.

2. The dominant barrier to greater eHealth adoption across the allied health community is the accommodation of new systems within an established care process. This manifests in concerns over compatibility (both internally and to the wider health network), interruption (system malfunction and availability of support) and risk (patient privacy and the visibility of practitioner performance data).

Allied health practitioners in private practice must maintain their high standard of patient care within a demanding small to medium business environment, where the continuing patient relationship is often fundamental to care outcomes. Potential eHealth solutions must accommodate, through a series of levers outlined in this assessment, the reality that change embodies risk, that system failures have both financial and reputational impacts, that technology must support or enhance, rather than restrain patient outcomes, and that the adoption of a fundamental technology platform is a critical decision for a practice.

Addressing both real and perceived barriers to adoption is fundamental to developing an adoption strategy. Compatibility issues can be countered by establishing clear interoperability standards. A robust governance framework can address uncertainty over use or ownership of data. Technologies can be tailored to fit the care process of a specific profession given the right incentives. A transparent adoption timeline and visible commitment can stimulate critical-mass adoption. No insurmountable barriers to eHealth adoption exist, but addressing those uncovered is critical to the development of successful adoption strategies.

3. The two key enablers of eHealth adoption by allied health practitioners are a conviction that the benefits clearly outweigh the risks, and the assurance that practitioners choosing to adopt eHealth solutions are doing so within a supportive and coordinated framework.

Within the allied health community, the potential benefits of eHealth for both patient outcomes and practice efficiency are broadly anticipated. However, realising the core benefits of eHealth requires long-term progression towards network-wide adoption, while many of the risks emerge


immediately at the practice level. Accordingly, there is limited impetus for individual practices to adopt interoperable eHealth solutions beyond those that have immediate and localised benefits.

Several potential intervention levers for driving eHealth adoption and effective use emerged from this assessment. Firstly, the observation of six behavioural clusters determined that, within each profession, there are practitioners who will enthusiastically adopt, and those who will require significant persuasion and assistance. Secondly, for each cluster the strength of specific intervention levers was gauged – professional body support, peer clinical leadership and financial incentives are the major motivators across allied health.

Based on this assessment, advancing allied health practitioners’ eHealth adoption in a way that achieves widespread improvements in health outcomes requires shaping the three axes of ecosystem, product, and demand. Addressing a single axis in isolation is likely insufficient to produce significant change. Shaping the ecosystem is critical for establishing an integrated healthcare network that supports and drives change, shaping the product is necessary to overcome adoption barriers and ensure that solutions maintain or enhance practitioners’ care delivery processes, and shaping demand provides the necessary incentives to spur adoption and use.

This assessment provides a directional overview of the current state of the eHealth readiness of allied health practitioners. Further, it aims to provide a foundation from which to develop targeted strategies on the engagement of allied health practitioners with eHealth solutions for patient-centred care. In many ways this is a first step - much work remains to be done on understanding the complex interrelationships developing between eHealth solutions, health professionals, patients and other stakeholders, as Australia develops a detailed strategy for the improvement of health outcomes through the adoption of eHealth.

10. Appendicies

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Appendix 1 – Acronyms

Acronym Refers toAASW Australian Association of Social WorkersABS Australian Bureau of StatisticsACPA Australian Clinical Psychology AssociationACRRM Australian College of Rural and Remote MedicineADA Australian Dental AssociationADC Australian Dental CouncilAGPN Australian General Practitioner NetworkAHPA Allied Health Professions AustraliaAHPRA Australian Health Practitioner Regulation AuthorityAHWAC Australian Health Workforce Advisory CommitteeAIHW Australian Institute of Health and WelfareAIR Australian Institute of RadiographyAMSANT Aboriginal Medical Services Alliance Northern TerritoryANZAPPL Australian and New Zealand Association of Psychiatry, Psychology and LawAOA Australian Osteopathic AssociationAOB Australian Orthoptic BoardAOPA Australian Orthotic Prosthetic AssociationAPA Australian Physiotherapy AssociationAPC Australasian Podiatry CouncilAPPA Australian Positive Psychology AssociationAPS Australian Psychological SocietyASA Audiological Society of AustraliaASAR Australasian Sonographer Accreditation RegistryASGC Australian Standard Geographical ClassificationATSI Aboriginal and Torres Strait IslanderATSIH Aboriginal and Torres Strait Islander HealthCAA Chiropractors’ Association of AustraliaCDM Chronic Disease ManagementCOAG Council of Australian GovernmentsCPD Continuing Professional DevelopmentDAA Dietitians Association of AustraliaDOHA Department of Health and AgeingDVA Department of Veterans’ AffairsEHR Electronic Health RecordEMR Electronic Medical RecordESSA Exercise and Sports Science AustraliaGP General PractitionerGPMP General Practitioner Management PlanHI Healthcare IdentifiersHIMSS Healthcare Information and Management Systems SocietyHISA Health Informatics Society of AustraliaIAHA Indigenous Allied Health Australia


IDAA Indigenous Dentists’ Association AustraliaIT Information TechnologyLMP Lifestyle Management PlanMBS Medicare Benefits ScheduleMCP Medicare Care PlanMSIA Medical Software Industry AssociationNACCHO National Aboriginal Community Controlled Health OrganisationNATSIHWA National Aboriginal and Torres Strait Islander Health Worker AssociationNeHTA National eHealth Transition AuthorityNRAS National Registration and Accreditation SchemeNRHA National Rural Health AllianceNRRAHAS National Rural and Remote Allied Health Advisory ServiceOAA Optometry Association AustraliaOCANZ Optometry Council of Australia and New ZealandOTA Occupational Therapy AustraliaPCEHR Personally-controlled Electronic Health RecordPHIAC Private Health Insurance Administration CouncilSARRAH Services for Australian Rural and Remote allied healthSCH Statistical Clearing HouseSPA Speech Pathology AustraliaTCA Team Care Arrangement

Appendix 2: Research Methodology Summary of overall approachIn forming our perspectives on the eHealth readiness of the allied health sector, we utilised both quantitative and qualitative primary research sources, supplemented by secondary research as appropriate.

By way of overview, our approach followed a four step process:

Step One: Define macro segmentation. We adopted an initial segmentation based on profession, geography and key demographic lenses for the purposes of conducting our primary research, as follows:

1. Professions (75 respondents required for each)

• Dental allied health practitioners

• Dietitians

• Exercise physiologists

• Occupational therapists

• Osteopaths

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• Optometrists

• Physiotherapists

• Podiatrists

• Psychologists

• Radiographers and sonographers

• Social workers

• Speech pathologists

2. Geography (minimum of 75 respondents required for each)

• Major city

• Inner regional

• Outer regional

• Remote and very remote

3. Other lenses (Soft targets for each based on population distributions)

• Share of public and private income

• Practitioner age and gender

• Proportion of patients aged over 65 years

• Practitioner State or Territory

Step Two: Develop hypotheses and survey: An effective survey requires both a clear understanding of hypotheses, as well as a set of questions that address – and can support or disprove - these hypotheses. To inform our hypotheses, we conducted an extensive scan of international examples of eHealth initiatives and stakeholder challenges encountered. We then built issue trees to ensure we had a complete landscape of potential areas to test, and enable us to then focus on those we felt were of critical importance. Further detail on these issue trees is contained in Exhibits 34-36.


Hypothesis development (1/3)

SOURCE: Team analysis

Are AHP’s and Medical Specialists ready to adopt eHealth solutions, both today and in a way consistent with future policy direction?

Infrastruc-tural and technical readiness

Attitudinalreadiness, mindsets and behaviours/organisational and cultural readiness

Aptitudinal, skills and capabilities readiness

Hardware

Software, systems and applications

Affect/perspective

Computer skills

Capacity to acquire and install IT

Language skills

Access to IT support

Social and environmental influences

Specialist equipment required for healthcare

General, servers, physical network, computers

eHealth tools in use (e.g., e-prescribing, EHRs, telehealth)

Non-eHealth in use (e.g., billing, appointments)

Internal/external locus of control

Level of risk aversion

Perceived costs/risks/effort (see barriers)

Perceived benefits (see enablers)

Perception of readiness in the surrounding environment

Behavioural norms and expectations

Initial question #1

Tested in surveyIssue breakdown

Impact on practitioner’s credibility

Impact on patient relationships

Quality

Access

Exhibit 34



How do we reduce or eliminate adoption and usage barriers?

Reduced ability to remain impartial

Quality data used to evaluate practitioners’ competence

Potential for mistakes/harm through user error

Illegal record tampering

Risk of selecting the wrong system

Risk of downtime due to system malfunction

Internal incompatibility

Systems may have limited or no interoperability outside practice

Systems may not meet providers’ needs

Implementation time

Operation and management time

Financial impact

How do we reducerisk?

Fixed costs of hardware and software installation

Impact of operating costs (licenses, upgrades, support)

Impact of technology

Exposure and legal implications

How do we reduce costs?

Practitioner time

Breach of patient confidentiality

Initial question #2

Tested in surveyIssue breakdown

Exhibit 35

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How do we emphasise and strengthen eHealth adoption and usage drivers?

How do we demonstrate increased productivitythrough eHealth solutions?

How do we link eHealth solutions with ability to improve patient outcomes?

How do we link eHealth adoption and usage with increased com-pensation?

How do we use social influences to accelerate adoption?

Patient safety increases due to reduced risk of error

Continuity of care is improved (especially for chronic illnesses)

Collaboration and communication between providers facilitated by information portability

Patients have greater level of engagement in managing their health through increased info and touchpoints

Greater access to knowledge and critical patient infoEnables same processes to be done better/faster

Improved provider skills

Increased automation/better tools

Streamlines existing processes

Eliminate steps/sub-tasks

Increased information reduces redundancy

Shifts non-critical tasks to support staff

Improved customer satisfaction resulting in increased retention

eHealth solutions can drive customer acquisition (e.g. more GP referrals)

Applications of eHealth can open new revenue channels (e.g. online consultations)

Internal compensation (direct patient revenue)

Providers receive incentive payments

eHealth adoption is a reimbursement requirement (amount or speed of reimbursement)

eHealth adoption can reduce liability insurance premiums

External compensation

Provide reputational benefits

Leverage influential stakeholders

Physicians, peers and other health providers

Administrative, purchasing and support staff

Patients

Professional bodies

Enables new processes

Tested in surveyInitial question #3 Issue breakdown

Exhibit 36

These initial hypotheses were then translated into survey questions, and tested in approximately 15 allied health practitioner interviews. These interviews served the dual purpose of both refining the initial hypotheses and ensuring the survey questions were interpreted by the audience as intended.

Step Three: Finalise and conduct survey.In conducting the survey, we used a combination of approaches to ensure sample biases were avoided, and the results for each profession type would be representative of the each profession. Further detail on our statistical approach is found in the conducting the allied health survey section below.

Step Four: Analyse results and test conclusions.The insights and recommendations are being developed from analysis of the raw survey data (a very preliminary work in progress draft is included in this interim report), and will be refined with and enriched with an additional approximately 25 deep-structured interviews with practitioners once the survey has closed. The analysis and interpretation of the research results will also be syndicated and refined via engagement of key stakeholders (including DoHA and NeHTA decision makers and clinical leads with a direct interest in the survey results), either individually or in workshops. This will allow us to probe and refine initial conclusions, and define and test potential engagement strategy options given those conclusions. Finally, a literature search of available secondary data will be used to support or challenge hypotheses and assumptions arising from the research.


Below is a more detailed description of the statistical methodology used in conducting the survey.

Primary and secondary data sources

To ensure this report serves as an independent assessment of the eHealth readiness of allied health practitioners, we employed a quantitative and qualitative survey of professionals in the industry as primary data source for this report (as opposed to relying on anecdotal evidence or literature reviews).

The primary data item is an assessment of the overall readiness of Australian allied health to adopt and use eHealth technologies and solutions, including the primary drivers of, and barriers to, adoption.

Our primary research approach was informed by the experience of several national peak bodies, special interest groups and other organisations with a professional interest in the content of this report. Where appropriate, the input of these bodies was considered in the formation of this report, with an understanding of the experience each organization or group brought to bear in providing their input.

Secondary data sources for this research include background data from other institutions including but not limited to Australian Bureau of Statistics, Australian Health Workforce Advisory Committee, Australian Institute of Health and Welfare, Department of Health and Ageing, Medicare Australia, National eHealth Transition Authority, National Health and Hospitals Reform Commission.

Key questions of Research

The research aims to address the following key questions:

1. Are Australian allied health practitioners ready to adopt and use eHealth technologies and solutions, both today and in a way consistent with future policy direction?



Conducting the allied health surveyThe survey target population is the entire Australian allied health workforce. According to the ABS Labour Force Survey 2008, this comprises approximately 127,200 individuals within the 15 practitioner specialties: Aboriginal and Torres Strait Islander health workers, Audiologists, Chiropractors, Dental health professionals, Dietetics, Exercise Physiologists, Occupational therapists, Optometrists, Osteopaths Physiotherapists, Podiatrists, Psychologists, Radiographers, Social workers, and Speech pathologists.

The allied health survey frame aims for as complete a coverage of the target population as possible. Hence we will use a variety of sources to obtain a large and representative frame, including:

• Directories (e.g. business and specialist directories)

• Professional organizations and associations, peak national bodies

• Purchased practitioner lists

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The survey involved creating a list of possible respondents with the primary information as practitioner name, specialty, gender and contact details. Typically each practitioner will also have a postcode, although many work across multiple postcodes, with their appropriate region determined during the survey.

The frame aims for as complete a coverage of the target population as possible. Based on the contracted survey provider’s past experience, there are expected to be fewer than 5% of the respondents out of business, and fewer than 5% will be out of scope.

Approximately 10% of the total population are expected to have previously opted out of participating in market research. However, the support of the allied health and various sector peak national bodies is expected to reduce this incidence.

The primary limitations of sampling will be (i) practitioners who do not have their contact details listed through directories or peak national bodies, and (ii) practitioners who specifically opt out of survey participation.

There are no efficient actions to fully counteract (i) although their prevalence is considered low for allied health practitioners. Typically peak national bodies comprise 70-100% of the practitioner workforce, with many specialties requiring registration. Independent research by several allied health peak national bodies has indicated that their membership base is highly representative of the broader population. Improving (ii) relies on bolstering survey legitimacy and personal engagement, for which we have engaged the peak national allied health bodies.

To ensure participation of the allied health sector, McKinsey entered into an agreement with AHPA on 31 March 2011 for the duration of the contract for AHPA to provide an Independent Expert Reference Group to:

• Provide input on survey interpretation, insight generation and guidance on approach at times requested by McKinsey

• Provision of each profession’s support of the survey by encouraging member participation with the express objective of increasing response rates to the survey and accuracy of response

• Provision of currently held demographic information for each profession plus a statement containing contextual aspects for that profession, and facilitate access to a structured sample of members and enabling linking to any survey proposed by McKinsey.

Determining the appropriate sample size

As a methodological note, the statistic error (i.e., generalising from the survey results to the whole population of allied health practitioners – 127,200) of a representative sample (approximately 1000) is +/- 3.1 % at the 95% level of confidence. This means that if 50% of professionals in the sample agree with a particular proposition, it can be assumed with 95% confidence that, had the whole population of professionals been interviewed, between 46.9% - 53.1% would also have agreed with the proposition at the time of the survey.

When the survey results are broken down into subgroups of allied health practitioners (e.g. audiologists), the error of estimation will be higher for smaller sample sizes, in the order of 1


divided by the square root of the sample size. Table 7 below shows the error of estimation at a 95% confidence interval based on specific sample sizes:

Table 7: Error of estimation at 95% confidence interval

Total population sizeSample size 100 200 400 800 1000 1500 1500+25 17.1 18.4 19.0 19.3 19.4 19.4 19.650 9.8 12.0 13.0 13.4 13.5 13.6 13.975 5.7 9.0 10.2 10.8 10.9 11.0 11.3100 0.0 6.9 8.5 9.2 9.3 9.5 9.8125 5.4 7.3 8.1 8.2 8.4 8.8150 4.0 6.3 7.2 7.4 7.6 8.0175 2.6 5.6 6.6 6.2 6.5 7.4200 0.0 4.9 6.0 6.2 6.5 6.9250 3.8 5.1 5.4 5.7 6.2300 2.8 4.5 4.7 5.1 5.7400 0.0 3.5 3.8 4.2 4.9500 2.7 3.1 3.6 4.4600 2.0 2.5 3.1 4.0700 1.3 2.0 2.7 3.7800 0.0 1.6 2.4 3.5900 1.0 2.1 3.31000 0.0 1.8 3.1

As Table 7 illustrates, the maximum error of estimation when comparing any two allied health practitioners using a sample size of 75 for each profession is 11.3%. What this means is that regardless of whether a population of a given profession is 500, 5,000 or 50,000, the maximum error of estimation is approximately 11.3%.

To help illustrate the implication of this approach and to interpret the above table, two short case examples are helpful.

Case example 1: Single practitioner group confidence

To determine error for a single population, we read the relevant cell in the above table for both population and sample. For example if Profession A had a population of 400, a sample size of 75, and a score of 50% eHealth ready, the result would show 95% confidence that 39.8% - 60.2% (i.e., 50% +/- 10.2%) of the population is eHealth ready.

Case example 2: Comparing two practitioner groups using confidence

Assume Profession A had a population size of 400, and Profession B had a population size of 5,000. Assume also that the objective is to determine whether the mean eHealth readiness of each profession is statistically different, with 40% of Profession A responding they are eHealth ready and 65% of Profession B responding they are eHealth ready. Assume a sample size of 75 across each profession.

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Using the above table and given the assumptions described, we can see that a sample of 75 of the 400 Profession A results in an error of estimation of 10.2%. A sample of 75 of the 5,000 Profession B (i.e., 1500+) results in an error of estimation of 11.3% - the theoretical maximum error of estimation when surveying 75 professionals from a very large population. So, what we can say is that it can be assumed with 95% confidence that, had the whole population of:

• Profession A been interviewed, between 29.8% - 50.2% (i.e., 40% +/- 10.2%) would be eHealth ready

• Profession B been interviewed, between 53.7% - 76.3% (i.e., 65% +/- 11.3%) would be eHealth ready.

Given these two ranges do not overlap, we would conclude that there was a statistically significant difference between these two professions.

For this survey, we selected a sample size of 75 responses for each of the 15 categories of allied health practitioner. The selection of 75 responses represents a balance between a desire to minimise the error of estimation, the likely variance between each allied health profession, and the financial resources available by the Department for this work. While surveying 1,000 allied health practitioners in each profession would have reduced the error of estimation from 11.3% to 3.1%, this would have resulted in an inefficient use of resources given the specificity required for the hypotheses in this project and been impractical given the relative size of some of these professions and anticipated yield rates.

This constraint is meaningful. By way of illustration, there are approximately 22 000+ physiotherapists in Australia. Even if responses had been in the order of 150 for this group (approximately 0.7% response rate), we can see from the above table the error of estimation would still have been in the order of +/- 8 %.

Therefore, although the general maxim of ‘bigger is better’ for surveys such as the one in this project is true, we feel confident that 75 allied health practitioners per profession provides an acceptable level of sampling error to identify outlier professions. This is particularly so given the focus of this effort is to identify directional trends (rather than a precise point estimate).

Caveat: appropriate use of dataGiven the nature of the underlying hypotheses, and the desire to identify outliers, the primary research approach was calibrated to an acceptable level of residual error as described above (maximum of 11.3%, depending on the type of analysis being undertaken). The output of the research identified directional differences between clusters and specialties. The nature of this approach means that future research studies cannot be directly compared to the outcome of the primary research in this report without replicating the research methodology.

Sampling, biases and response rate

Research based on sampling from a population necessarily inherits a level of uncertainty in drawing conclusions from incomplete data. Statistical analyses are based on the assumption of


unbiased responses – therefore maximising the usefulness of a survey dataset requires the survey design to address potential biases that may be introduced through sampling method. The two key potential biases for many surveys are selection biases (the possible exclusion of a relevant strata, e.g., physiotherapists from the Northern Territory) and non-response biases (e.g., the data collection requirement is so onerous that only a few practitioners complete the survey). Both can be countered through careful sampling design.

We applied several survey techniques to control for selection biases in this survey. For example, we:

• Collected approximately 75 respondents across per category selected with representation across Australia’s regional breakdown

• Ensured representativeness of the sample by replicating the demographic profile of each allied health profession in the sample.

To ensure all strata of interest were adequately represented, the allied health survey used a simple stratified random sample. We stratified invitations by two primary segmentations - profession and geographic location. The survey used a single-phase sample of 75 respondents per specialty strata, as the balance point between required accuracy and survey expense. Further, we required a minimum representation of 75 respondents per location type strata. For private/public practice, gender, state/territory, and age, we set soft quotas based on population distribution statistics from the Australian Institute of Health and Welfare, the ABS 2006 Census and registration data for those allied health professions requiring registration.

The survey was designed to collect a sufficiently detailed data set without over-imposing on practitioner time. For example, we:

• Allowed survey participants to respond to the survey by either completing an online form or undertaking a telephone survey

• Ensured surveys were 15 minutes in length to minimise imposition on respondents.

Additionally, we used two approaches to address potential non-response bias. Firstly, we engaged the AHPA to reach out to practitioner members in support of the survey, for those professions where their membership is comprehensive. In these cases (chiropractors, dental allied health professionals, dietitians, exercise physiologists, osteopaths, physiotherapists, podiatrists and psychologists) we designed a specific target population (of 5-600 practitioners) from de-identified membership lists. Secondly, where peak body membership was either unavailable or less than comprehensive (Aboriginal and Torres Strait Islander health workers, audiologists, occupational therapists, optometrists, radiographers and sonographers, social workers and speech pathologists) our survey vendor, Sexton Market Research, compiled a comprehensive list of allied health practitioners from business directories, professional associations and lists available for purchase. Again, a target population was designed and contacted directly by phone.

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In total, the quantitative survey contacted approximately 6,500 allied health practitioners in order to return 1,125 responses, for a response rate of 17.3%.

Data weighting methodology

Any survey relying on a limited sample size may cover segments of the target population in proportions that do not match their proportions in the population itself. In this case clear differences arise from our deliberate sample design, intended to capture the full spectrum of perspectives across a diverse population. In such situations we can improve the relation between the sample and the population by weighting sample responses such that each response is attributed its appropriate level of emphasis as determined by the overall population distribution. This operation is known as sample-balancing or raking, and the population totals are usually referred to as control totals.

The adjustment to control totals is sometimes achieved by creating a cross-classification of the control variables (e.g. age categories x gender x remoteness x % private income) and then matching the total of the weights in each cell to the control totals. This approach, however, can spread the sample thinly over a large number of cells. It also requires that the control totals exist for all cells of the cross-classification. Often this is not feasible (e.g. control totals may be available by age x gender x remoteness but not when those cells are subdivided by income source). The use of marginal control totals for single variables (i.e., each margin involves only one control variable) often avoids many of these difficulties. In return, of course, the two-variable (and higher order) distributions of the sample are not required to mimic those of the population.

The procedure known as raking adjusts a set of data so that its marginal totals match specified control totals on a specified set of variables. (The term “raking” is employed in analogy with the process of smoothing the soil in a garden plot by alternately working it back and forth with a rake in two perpendicular directions.) In a simple 2-variable example the marginal totals in various categories for the two variables are known from the entire population, but the joint distribution of the two variables is known only from a sample (such as a 5% sample). In the cross-classification of the sample, arranged in rows and columns, one might begin with the rows, taking each row in turn and multiplying each entry in the row by the ratio of the population total to the sample total for that category, so that the row totals of the adjusted data agree with the population totals for that variable.

The column totals of the adjusted data, however, may not yet agree with the population totals for the column variable. Thus the next step, taking each column in turn, multiplies each entry in the column by the ratio of the population total to the current total for that category. Now the column totals of the adjusted data agree with the population totals for that variable, but the new row totals may no longer match the corresponding population totals. The process continues, alternating between the rows and the columns, and agreement on both rows and columns is usually achieved after a few iterations. The result is a tabulation for the population that reflects the relation of the two variables in the sample.


Case example 3: Iterative rim weighting

To determine the appropriate weighting for a simplified 2-variable case, we first find the sum of the sample size across each dimension (numbers for illustration purposes only):

ATSIH worker

Audiologist Chiropractor Dentist Dietitian Sum of sample size

NSW 300 1200 60 30 30 1620Vic 150 1080 90 30 30 1380Sum of sample size

450 2280 150 60 60 3000

We then compare the sample size with the known distribution in the population. To develop weights for each of the categories required (e.g. Audiologists in Victoria), we alternately rake by each dimension, until sample weights converge to the actual population size.

For example, commencing with the population by state:

Sum of sample size Known population Rake factorNSW 1620 1510 1510/1620Vic 1380 1490 1490/1380

Multiplying each row by its rake factor gives the correct distribution by state, but fails to account for known population by profession:

ATSIH worker

Audiologist Chiropractor Dentist Dietitian Sum of weights

NSW 279.63 1118.52 55.93 27.96 27.96 1620Vic 161.96 1166.09 97.17 32.39 32.39 1380Sum of weights

441.59 2284.61 153.10 60.35 60.35 3000

Alternately raking by profession, we determine rake factors across columns using the same method:

ATSIH worker

Audiologist Chiropractor Dentist Dietitian

Sum of weights

441.59 2284.61 153.10 60.35 60.35

Known population

600 2120 150 100 30

Rake factor 600/441.59 2120/2284.61 150/153.10 100/60.35 30/60.35

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Now, multiplying each column by its rake factor gives the correct distribution by profession, but unbalances the distribution by state:

ATSIH worker

Audiologist Chiropractor Dentist Dietitian Sum of weights

NSW 379.94 1037.93 54.79 46.33 13.90 1532.90Vic 220.06 1082.07 95.21 53.67 16.10 1467.10Sum of weights

600 2120 150 100 30 3000

Iterating the raking process until convergence gives a series of weights to be allocated to each population category (e.g. Audiologists in Victoria), such that their emphasis within the survey analysis matches their representation in the population as a whole.

Weighting variables used

As described, the allied health sample was iteratively weighted across four variables:

1. Practitioner type

Practitioner type Sample distribution Population distributionAboriginal Health Worker 7% 3%Audiologist 7% 2%Chiropractor 7% 3%Dentist 7% 13%Dietitian 7% 2%Exercise physiologist 7% 1%Occupational therapist 7% 5%Optometrist 7% 3%Osteopath 7% 1%Physiotherapist 7% 16%Podiatrist 7% 2%Psychologist 7% 20%Radiographer/Sonographer 7% 12%Social worker 7% 13%Speech pathologist 7% 5%


2. State

State Sample distribution Population distributionNSW 28% 33%VIC 27% 25%QLD 19% 19%WA 9% 11%SA 9% 7%TAS 3% 2%NT 1% 1%ACT 4% 2%

3. Region

Region Sample distribution Population distributionMajor city 62% 77%Inner regional 22% 16%Outer regional 12% 6%Remote 4% 1%

4. Gender

Gender Sample distribution Population distributionMale 41% 33%Female 59% 67%

Clustering analysisPurposeWe used cluster analysis to group practitioners with similar needs and attitudes. This allowed us to develop tailored interventions based on each cluster’s distinct motivations.

Through this process, we sought to define clusters that are:

1. Reachable – i.e., we can target specific interventions to each group

2. Interpretable – i.e., we can understand who they are and what matters most to each

3. Distinct – i.e., different from each other on key attitudes and behaviours.

We can easily define reachable clusters based on demographic criteria. However, by adhering to a strictly demographic approach, we lose the ability to incorporate the needs-based insights required to develop targeted interventions. In contrast, while a needs-only approach provides rich and robust insights on attitudes and behaviours, it falls short on the reachability dimension. Therefore, we applied a hybrid “needs-plus” clustering approach, which combines needs-based and demographic dimensions so that we can identify targeted interventions that can be effectively delivered to the relevant practitioners: Exhibit 37.

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Reachability can often be enhanced with little or no damageto needs insight by using a ‘needs-plus’ approach

Needsinsight

High

Low

HighLow

Reachability*

Needs-onlyclustering

‘Needs-plus’clustering

▪ ‘Needs-plus’ means supplementing needs with demographic or behavioural variables for building clusters

▪ May result in a more complex solution –decision on how to balance needs insight and reachability must be weighed carefully

Reachability is important for the delivery of the value proposition, not its design

CONCEPTUAL

* Reachability means communications and interventions can reach segment members collectively with little waste

Demographic clustering

Exhibit 37

We need strong variation in at least some attributes or variables to define groups that are distinct. A ‘needs plus’ clustering approach enables us to identify much greater variation in responses, especially when compared with basic demographic measures such as age, gender and region.

Process to develop ‘needs-plus’ clustersThe ‘needs plus’ approach follows a two-step process, described below.

Step 1: Select variables and create clusters based on needs dimensions:

• Identify attitude “themes” – We used a factor analysis across all eHealth attitudinal variables to identify themes across attitudes

• Identify & retain relevant “themes” – We identified a set of themes (approximately 7-8) that were the most representative of eHealth attitudinal dimensions

• Select final list of variables – We identified 1 or 2 variables that were strongly related to each theme and that also exhibited sufficient variability in the sample


• Conduct 1st stage segmentation – We used hierarchical clustering (Ward’s method9) to fold similar respondents into increasingly larger groups – this approach yielded an initial “coarse” solution to assess

• Select ideal cluster solution – We ran multiple iterations of the hierarchical clustering analysis and identified the cluster solution that offered the most effective target groups.

Step 2: Refine needs-based clustering by adding behavioural and profile variables to create ‘needs plus’ clusters:

• Improve needs-based cluster solution – We used k-means clustering on existing hierarchically derived clusters to improve on our solution by adding % private as a variable to enhance reachability

• Profile the final solution – We profiled the final solution on all variables to make a comprehensive, final assessment of its quality, relative to the segmentation objectives

• Refine and ‘bring to life’ the profiling description – We used deep-structured interviews and stakeholder discussions and workshops to test and refine the profiles and ensure that they were both insightful and actionable (i.e., helpful to define relevant intervention strategies, meaningful and reachable).

Compliance and regulationThe research survey and all related materials were reviewed and approved by the Australian Government Statistical Clearing House. The approval number is 02172-01.

9 For more detail, refer to Joe H Ward’s “Hierarchical Grouping to Optimise an Objective Function”, Journal of the American Statistical Association, Volume 58, Issue 301 (Mar 1963), 236-244

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Appendix 3 – Allied health sector profiles This appendix provides a high-level overview for each of the 15 allied health practitioner bodies included in the quantitative survey. A further breakdown of the quantitative survey results by practitioner specialty is provided in the separate Annex to the Report on the eHealth Readiness of Australia’s Allied Health Sector.

Aboriginal and Torres Straight Islander health workers 124

Audiologists 128

Chiropractors 132

Dental allied health practitioners 136

Dietitians 142

Exercise physiologists 146

Occupational therapists 150

Optometrists 154

Osteopaths 158

Physiotherapists 162

Podiatrists 166

Psychologists 170

Radiographers and sonographers 174

Social workers 179

Speech pathologists 183


Aboriginal and Torres Strait Islander health workersOverview of size, composition and role

Overview of group

Description of profession Aboriginal and Torres Strait Islander Health (ATSIH) workers are involved in addressing a range of health issues. They work as GP assistant, nurse assistant, drug and alcohol counsellor, remote outreach, mental health, sexual health and tobacco control positions. In addition, most large public hospitals employ ATSIH workers to liaise with Indigenous patients and their families on admission to hospital. Those in rural areas must usually be multi-skilled.

Number Approximately 2,000-2,500 ATSIH workers.

(2006 Census recorded 1,011)Gender mix n/a

State

6

1

0

23

11

15

23

20

2

19

1

26

11

23

5

14

ACT

NT

TAS

SA

WA

QLD

VIC

NSW

Distribution by age and location – ATSIH workers


Percent of practitioners

Age Remoteness

31

27

9

9

33

21

9

9

24

28

55+

45-54

35-44

25-34

0-24

31

11

14

12

11

8

13

34

Outer regional

Inner regional

Major city

Remote

2006 census 2001 census

Exhibit 38

125


Overview of respondent practice attributes for ATSIH workers% of respondents


62

1214

12

25+

16-25

6-15

< 6

Number of practice locations

24

52

16

9

Four or more

Three

Two

One

Frequency of rural or remote service

9

7

54

4

Weekly or fortnightly

DailyNever

27

Once amonth or less

Monthly

Percentage of income from private sector

5575+

34

50-74 11

25-490

<25

Exhibit 39

Education, registration and accreditation

• In order to be eligible to register with Medicare, ATSIH Workers practising in the Northern Territory must be registered with the Aboriginal Health Workers Board of the NT. In all other states and the Australian Capital Territory, they must have been awarded a Certificate Level III in Aboriginal and Torres Strait Islander Health (or an equivalent or higher qualification) by a Registered Training Organisation that meets the training standards set by the Australian National Training Authority’s Australian Quality Training Framework. Uniform national registration requirements are due to be introduced through the National Registration and Accreditation Scheme (NRAS) in 2012.

Funding and referral system

• Many ATSIH workers are employed in salaried roles in the public health sector or Aboriginal Medical Services.

• Eligible ATSIH workers can access Medicare on referral from a GP through the individual allied health items for people with a chronic or terminal medical condition and complex care needs (MBS items 10950-10970); the follow-up allied health items for people of Aboriginal or Torres Strait Islander descent (MBS items 81300-81360); and through MBS item 10987.


Peak National Body

National Aboriginal and Torres Strait Islander Health Worker Association www.natsihwa.org.au 413a High Street Northcote, VIC 3070 P.O Box 278 Northcote, VIC 3070 Contact T: (03) 9482 7799 F: (03) 9482 5628

For those ATSIH workers with positions in Aboriginal Medical Services (AMS), of which there are 145 across the country, an additional peak body, the National Aboriginal Community Controlled Health Organisation (NACCHO) represents the services. The AMS will only treat indigenous patients/clients and their families.

National Aboriginal Community Controlled Health Organisation www.naccho.org.au Level 2 & 3 3 Garema Place Canberra City ACT 2601

PO Box 5120 Braddon ACT 2612 Contact Ph: +61 (0)2 6248 0644 Fax: +61 (0)2 6248 0744

ATSIH workers and eHealthExamples of relevant eHealth applications

Some example uses of eHealth that ATSIH workers could benefit from include:

• Better connectivity and support for ATSIH workers in remote and rural areas

• Telehealth services

• Digital referrals and electronic health records.

Current eHealth ‘Position’

The ATSI sector is dominated by concerns about privacy and confidentiality to a much greater extent than the rest of the community. This has come out of years of distrust of the health and Government sectors as a result of the ‘stolen generations’ era, and a history of discrimination in some sectors of the health industry. In some communities Indigenous people have been reluctant to attend a health service if a member of their extended family works there. As a result of these factors, there are many Indigenous people who will not routinely visit hospitals or doctors.

ATSIH workers are the link to the communities that can help address these issues. In most cases they see the patient initially, and refer them to other health workers if the problem requires

127

significant intervention, although this can be difficult as the patient may not accept this unless a culturally appropriate service is available.

Most ATSIH workers have access to a desktop computer (either solo or shared) at the AMS, but do not carry laptops or tablet computers. This can be a problem in itself as many work in multiple locations over vast distances and cannot take information with them. This is usually a budgetary issue. The computers are used to maintain electronic health records and to collect data which is sent through to a range of Government and health agencies.

Computing skills can be a significant issue, and many ATSIH Workers require basic training in computer use. Workforce shortages reduce the ability for ATSIH workers to take time out for training. For workers in rural and remote areas, there may be limited access to training facilities.

Shared EHRs like the PCEHR would be very useful for Indigenous communities due to the mobility of populations, but there is suspicion of systems where multiple people access the record because of privacy and confidentiality issues.

There is uncertainty at the peak body level about the value of telemedicine initiatives in Indigenous communities, as the face-to-face relationship with patients is of the utmost importance culturally and it can take a long time to establish trust and rapport. It is also important to seek the permission of tribal elders when entering a community to provide health services. There is doubt that telemedicine will be acceptable if it is provided as a videoconference, and concern that this will be used by Governments to replace existing services that are working well, for financial reasons.

A great deal of education is provided by ATSIH workers at the AMS. While using email to send out culturally appropriate education may be difficult in some cases, the provision of visual information using flatscreens at the AMS has been considered.

IT infrastructure remains problematic for the AMS, as the IT platforms are all different and there is poor readiness across the whole sector to adopt proposed Government eHealth initiatives. The Northern Territory Government is the most advanced according to NACCHO, and have been developing an EHR for years, however it took 5 years to establish sufficient rapport with the communities to drive adoption.

The system in use in the communities in the NT is called Communicare, which has reasonably good technical and vendor support behind it. However it is difficult for the AMS to prioritise IT maintenance in the budget and so the systems are not used to their full potential. Uploading data to health and welfare agencies is a big part of the work of an AMS and this could be made a lot easier by having the appropriate integrated systems in place.

The work of the AMS is built on reputation and word of mouth is extremely important if the service is to be successful. Credibility and respect are hard to gain and easy to lose. There is concern the new eHealth initiatives will create more work for the services and not alleviate the time pressure on the ATSIH workers if they are not appropriately designed, leading to low uptake.


Key insights from eHealth readiness survey

• Unsurprisingly, ATSIH workers have the highest incidence of rural and remote practice (64% work daily, and only 21% never work, in a rural or remote region). Almost half (48%) work in two or more practice locations.

• ATSIH workers use computers extensively to support administration and practice efficiency (patient booking and scheduling 81%, billing and patient rebates 76%). The majority of ATSIH workers use computer-based patient notes (67% use computers to enter patient notes after a consultation, 66% to view/record patient information during consultations)

• Better access to educational materials is a core desire, with 47% using online CPD, and a further 42% reporting they do not currently use these, but would like to. 60% of ATSIH workers using online clinical reference tools. Clear unmet needs include completing event summaries online (57% currently do, a further 26% would like to), sharing health records with practitioners (36% currently do, a further 23% would like to), sending and receiving referrals (36% currently do, a further 23% would like to), and transferring prescriptions to the pharmacy (21% currently do, a further 23% would like to)

• ATSIH workers have high current and intended use of telehealth (20% currently use, a further 28% expect to within 3 years). Their leading interests are training (20%), monitoring patients remotely (15%) and consulting with practitioners (15%)

• 28% of ATSIH workers only use paper records. Of the remaining 72%, 97% use an EHR. Use of computers is perceived as expected (71% strongly agree)

• The leading benefits perceived by ATSIH workers are collaboration with other practitioners (29% strongly agree), increasing patients’ engagement in managing their health, and improving practice efficiency

• Common barriers to further adoption cited include concern about visibility of practitioner performance data (30% strongly agree) and the need to maintain compatibility with existing IT systems (30%). Utilising established technology (26%) and privacy concerns (25%) also register strongly

• ATSIH workers indicated their likely drivers of adoption to be the advice of their professional body (63%) and financial incentives (62%)

AudiologistsOverview of size, composition and role

Overview of group

Description of profession Audiologists see patients that are experiencing hearing loss. Services provided by audiologists can include hearing assessments, hearing conservation programs, rehabilitation, fitting hearing aids and cochlear implants and community awareness programs and counselling on hearing issues.

Number 2,000 – 2,200 (ASA membership)

(2006 Census recorded 1,074)Gender mix 77% female, 23% male

129

Distribution by age and location – audiologists



Age State Remoteness

21

6

21

6

8

26

40

5

25

43

55+

45-54

35-44

25-34

0-24

31

9

1

2

1

7

20

29

2

2

2

7

8

16

32

32

ACT

NT

TAS

SA

WA

QLD

VIC

NSW

3

1

15

79

1

5

14

80

Remote

Outer regional

Inner regional

Major city


Exhibit 40


Overview of respondent practice attributes for audiologists% of respondents


80

9

25+

116-259

6-15

< 6


27

41

Four or more

12Three

20

Two

One


16

12

21Never

42

Once a month or lessMonthly

9


Daily


9

27

75+

59

50-74

5

25-49

<25

Exhibit 41



• To qualify as an audiologist it is necessary to undertake a Masters of Clinical Audiology which is a post-graduate degree.

• In order to be eligible to register with Medicare Australia, Audiologists must be either a ‘Full Member’ of the Audiological Society of Australia Inc, who holds a ‘Certificate of Clinical Practice’; or an ‘Ordinary Member- Audiologist’ or ‘Fellow Audiologist’ of the Australian College of Audiology.


• Australian Hearing Services pays hearing service providers for the delivery of services under the voucher system to eligible clients. The services include hearing assessments, the cost of the hearing device and its fitting, and the government contribution to the maintenance and repair of hearing devices.

• The Office of Hearing Services oversees at present around 200 contracted Hearing Service Providers that operate in all states and territories in the country in almost 2,000 Permanent, Visiting and Remote sites.10

• Eligible Audiologists can access Medicare on referral from a GP through the individual allied health items for people with a chronic or terminal medical condition and complex care needs (MBS items 10950-10970); and the follow-up allied health items for people of Aboriginal or Torres Strait Islander descent (MBS items 81300-81360).

• The majority of income for audiologists in the private sector is derived from fee-for-service.

Peak National Body

Audiological Society of Australia www.audiology.asn.au Suite 7, 476 Canterbury Road Forest Hill VIC 3131 PH: 61 3 9416 4606 Fax: 61 3 9416 4607 Email: [email protected]

Audiologists and eHealthExamples of relevant eHealth applications

Some example uses of eHealth that audiologists could benefit from include:

• Telehealth and online initial assessments of patients, particularly in rural and remote areas.

• Online education and Continuing professional development (CPD)


10 Australian Department of Heallth and Ageing website 2011 – ‘Australian Hearing Services’

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In terms of eHealth, audiologists working for the public sector, especially Australian Hearing Services, tend to be the most technically skilled as a result of the requirement for extensive data entry and case management by this agency.

Many audiologists in the private sector however find it hard to prioritise administrative and clerical tasks which are usually left to receptionists, and so have tended to lag behind their peers in terms of IT skills. The ASA has struggled to engage this group in eHealth activities for this reason as they have been slow to see the benefits, although it is reported that those who have made the effort to ‘go paperless’ are very happy with the time savings and efficiencies that this has introduced to their practice.

There are few software products on the market that are tailored for audiologists - 3-4 software programs are currently in use, but all have required some adaptation to be completely appropriate. About 50% of audiology practices are using electronic practice management, and a further 40% are using some form of electronic health record. The high-tech equipment used by audiologists generates information and screens that can easily be added to an EHR or attached to an email.

Most audiologists are highly technically skilled in their personal use of IT, and are extensive users of social networking and discussion forums for example. It is perceived by the ASA that Telehealth in audiology will make a big improvement to rural and regional services, as it can be used for audiological assessments prior to referral to a surgeon for example. The rollout of the NBN should also improve access considerably.


• Audiologists have a consistent patient load, with 78% seeing 6-15 patients per day. Over half (59%) work in two or more practice locations. 60% undertake some work in rural and remote areas.

• Audiologists exhibit very high use of computers for relevant applications, both administration and practice efficiency (patient booking and scheduling 91%, billing and patient rebates 76%) and recording patient information (entering patient notes after a consultation 74%, view/record patient information during a consultation 76%).

• Education is considered important both for the patient body (69% use computers to show patients health-related information) and for practitioners (68% access clinical reference materials online, 61% undertake CPD online).

• The strongest unmet needs for Audiologists are communications-related, particularly sharing health records with practitioners (43% currently use, a further 35% would like to), sending or receiving referrals (23% currently use, a further 41% would like to) and communicating electronically with patients (42% currently use, a further 29% would like to).

• Audiologists have average use of telehealth and in general don’t envisage a large role within their profession (13% currently use, 19% of those not currently using expect to be within 3 years). Interest is strongest in training (15%) and collaborating with other practitioners (12%).

• Only 7% of Audiologists use paper records alone, with 88% using a combination of computer- and paper-based records. Of those using computers in some form, 68% have an EHR.


Audiologists have the highest expectation of computer use within their profession (95% strongly agree computer use is expected, 89% strongly agree most practitioners use computers).

• The leading benefits perceived by Audiologists surround provision and quality of care, including improving collaboration (41% strongly agree), improving continuity of care (28%) and improving access to care (19%). Practice efficiency is important (28%), and patient engagement (19%), safety (17%) and satisfaction (16%) rank highly.

• Audiologists have almost universal access to basic computer and connections infrastructure, except those visiting remote areas (of whom 78% have access to a computer and 43% have internet access).

• The leading barriers observed by audiologists include maintaining IT compatibility with existing IT systems (33% strongly agree), concern about breaches of privacy (27% ) and a preference to wait for established technology before adopting.

• Audiologists listed their top three drivers of adoption as the advice of their professional body (55% strongly agree), pressure from their patients (48%) and financial incentives (47%).

Chiropractors Overview of size, composition and role

Overview of group

Description of profession Chiropractic is a health-care discipline based on the scientific premise that the body is a self-regulating, self-healing organism. These important functions are controlled by the brain, spinal cord, and all the nerves of the body. The practice of chiropractic focuses on the relationship between structure (primarily the spine and pelvis) and function (as coordinated by the nervous system) and how that relationship affects the preservation and restoration of health. Chiropractic also places an emphasis on nutrition, exercise, wellness and healthy lifestyle modifications. Chiropractors manage chronic and acute conditions. They do not prescribe drugs or perform surgical procedures, although they do refer patients for these services if they are medically indicated.

Number 4,300 (CAA membership)


133

Distribution by age and location – chiropractors




20

13

29

34

4

18

30

4

15

34

55+

45-54

35-44

25-34

0-24

88

29

2

1

1

10

18

32

28

1

0

1

10

17

34

ACT

NT

TAS

SA

WA

QLD

VIC

NSW 73

18

7

1

1

9

22

67

Remote

Outer regional

Inner regional

Major city


Exhibit 42


Overview of respondent practice attributes for chiropractors% of respondents


21

8

25+32

16-2539

6-15

< 6


20

79

Four or more

0

Three1Two

One


511

Never 83

1

Monthly0


Daily


75+

98

50-74

0

25-49

1

<251

Once amonth or less

Exhibit 43



• Successful completion of a 5 year university degree program is a pre-requisite for registration. (The degree program must be accredited by the Council on Chiropractic Education Australasia).

• In order to be eligible to register with Medicare, Chiropractors must be registered with the Chiropractic Board of Australia, which is one of the national boards established under NRAS.

• After entering practice, and as a compulsory pre-requisite for ongoing registration, all registered chiropractors must complete continuing professional development in line with the requirements set by the Chiropractic Board of Australia.


• The majority of chiropractors operate predominantly in private practice, for which fee-for-service is charged. Rebates are available from the private health insurance funds.

• Eligible Chiropractors can access Medicare on referral from a GP through the individual allied health items for people with a chronic or terminal medical condition and complex care needs (MBS items 10950-10970); and the follow-up allied health items for people of Aboriginal or Torres Strait Islander descent (MBS items 81300-81360).

Peak National Body

Chiropractors’ Association of Australia http://chiropractors.asn.au 2/36 Woodriff Street, Penrith NSW 2750 Telephone: +61 (2) 4731 8011 or 1800 075 003 Facsimile: +61 (2) 4731 8088 E-mail: [email protected]

Chiropractors and eHealthExamples of relevant eHealth applications

The key uses of eHealth that chiropractors will benefit from include:

• Electronic patient education resources – a large amount of educational information is commonly conveyed to patients electronically, either online or through DVDs.

• Digital image transfer and storage – the storage requirements for plain films which must be kept for medicolegal purposes are driving uptake of these applications amongst many chiropractors.

• Patient behaviour monitoring – recently a mobile telephone application for iphones and Google android has been developed called ‘Just Start Walking’.11 It converts your mobile into an electronic pedometer. Supported by a national education campaign conducted by the CAA on the importance of posture and regular exercise, uptake of the application has reportedly been very high.

11 <http://www.juststartwalking.com.au/> (accessed 16 May 2011).

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• Electronic health records – only a minority of chiropractors are using an electronic health record, however the rates are increasing quite rapidly, particularly for new graduates.

• Digital referrals and patient histories – automate aspects of taking patient history so that the chiropractor can spend more time with the patient addressing actual problems rather than duplicating histories and data entry.


Chiropractors aged under 50 tend to be highly technically competent, with those aged over 50 slightly slower in their adoption of new technologies. 60% are currently using email to access educational material and journals from the CAA.

There are about 3 or 4 software programs targeted at chiropractors, however a number of individual practices have gone ahead and designed or customised their own systems, the reason for this is unclear.

The proposed PCEHR has had a mixed response from chiropractors. On one hand the access to a patient’s past medical history is considered clinically useful. On the other hand the profession is wary of scrutiny of its style of record-keeping by other health professionals due to the perception that its holistic philosophy of patient care is generally poorly understood. They are also concerned about the confidentiality issues around records given the personal information provided by the patient due to chiropractors’ client-centred and bio-psychosocial approach to clinical care.


• Chiropractors are the youngest of the allied health professions (30% under 35 years of age), see high patient volumes (32% see more than 25 patients per day) and rarely practice in remote locations (83% never work in a rural or remote location)

• Chiropractors’ leading uses of computers are administrative, including billing and patient rebates (76%) and patient booking and scheduling (76%). Educational tools are also widely used (59% have adopted online clinical reference tools, while 30% have not, but would like to; 56% use online CPD materials, and 31% have not, but would like to).

• For many other potential uses of eHealth, Chiropractors have not yet adopted as much as they would like. Leading examples include viewing and ordering diagnostic imaging (30% and 12% respectively use, but a further 52% and 65% don’t use, but would like to).

• Communicating with patients is also sought-after (32% use, while a further 47% would like to), as well as showing patients health-related information (37% use, a further 41% would like to). Referrals, sharing records with other practitioners and recording patient information show a similar latent need.

• Chiropractors rarely use telehealth (9% currently use) and see only minor applications in the near future (19% expect to be using within 3 years). Interest is strongest in training (12%) and collaborating with other practitioners (11%).

• 36% of chiropractors rely solely on paper records. Of the remaining 64%, just 41% use an EHR. Chiropractors have the lowest expectation of computer use amongst allied health practitioners,


with 17% suggesting they are expected to use computers, and 28% agreeing that most of their colleagues use computers.

• The leading perceived benefits for chiropractors include indicators of provision and quality of care, including improving collaboration (21% strongly agree) and improving continuity of care (11%). Business efficiency also registers strongly, for example improving practice efficiency (16% strongly agree) and increasing number of referrals (9%). Potential benefits for patient relationships and engagement do not resonate for chiropractors, for example just 5% strongly agree eHealth could help improve patient relationships.

• Chiropractors have reasonable access to computer and connectivity infrastructure (approximately 80% have access across major city, inner and outer regional practices) but those practicing in remote areas have very low access (29% have computers, 56% have internet access).

• The strongest barriers for chiropractors include concerns about malfunction and downtime (35% strongly agree), the visibility of practitioner performance data (31%), and affordability (30%).

• Chiropractors listed their top drivers of adoption as financial incentives (29% strongly agree) and the advice of their professional body (24%).

Dental allied health practitionersOverview of size, composition and role

Overview of group

Description of profession Dental health professionals are concerned with maintaining patients’ oral health. A range of occupations are involved in dental health including dentists, dental therapists, dental hygienists, oral health therapists and dental prosthetists. Only dentists were included in the eHealth readiness survey as they not only have a direct role in patient care, but they are the primary decision-makers in terms of IT and eHealth in a practice.

Number 11,100 dental practitioners and 23,200 allied dental professionals and assistants*

(2006 Census recorded 29,512 in total)Gender mix 22% female, 78% male*** Australian Institute of Health and Welfare 2010, Australia’s health 2010, based on unpublished data from ABS Labour Force Survey 2008.** Australian Institute of Health and Welfare 2010, Australia’s health 2010. Number refers to dental practitioners. A much higher percentage (89 percent) of dental associate professionals and assistants are female.

137

Distribution by age and location – dental allied health practitioners




25

10

8

21

24

20

27

17

27

21

55+

45-54

35-44

25-34

0-24

11

23

2

1

2

9

11

21

32

23

2

1

2

9

20

32

ACT

NT

TAS

SA

WA

QLD

VIC

NSW 75

1

7

16

1

8

17

73

Remote

Outer regional

Inner regional

Major city


Exhibit 44


Overview of respondent practice attributes for dental allied health% of respondents


67

425+

4

16-25 25

6-15

< 6


14

73

Four or more7

Three

6

Two

One


6

20

Never 68 Once amonth or less

3 Monthly2


Daily


9

75+88

50-74

1

25-49

2

<25

Exhibit 45



• 5-year undergraduate or 4-year postgraduate degree program required (degree must be accredited by the Australian Dental Council.

• Registration required for dentists, students, dental specialists, dental therapists, dental hygienists, oral health therapists and dental prosthetists with the Dental Board of Australia, one of the national boards established under NRAS.

• After entering practice, all registered dental practitioners must complete 60 hours every 3 years of continuing professional development activities.12

• Specialist dental qualifications require further university training. There are about 12-13 recognised subspecialities, some of which are really tiny like oral medicine and oral radiology, which only have a handful of practitioners in the whole country. Orthodontics is the biggest with about 550 practitioners in Australia. A few dentists go on to obtain a medical qualification and undertake advanced training in oral surgery, these are considered medical specialists.

• Allied dental professionals and assistants (e.g. dental hygienists and therapists) require a 3-year university degree such as a Bachelor of Oral Health. Dental prosthetists complete a TAFE diploma.


• Dentistry is overwhelmingly a private profession, with about 85% of dentists are providing services in the private sector. In contrast to Medicare, around 60% of the cost of services provided in the private sector comes from patient out-of-pocket costs; around 15% comes from private health insurance, which pays around half the cost of services covered.

• Public sector dentistry represents only a small part of dentistry, and is funded by State and Territory governments, and delivered through public clinics, dental hospitals and academic institutions to health-care card holders and children. A small proportion of publicly-funded services are outsourced to the private sector due to local shortages of public sector workforce

• The Commonwealth funds a limited range of dental services to particular population groups:

– A comprehensive range of dental services are provided to veterans through the Department of Veterans’ Affairs (DVA).

– The Chronic Disease Dental Scheme (CDDS) funds a broad range of dental services for people with chronic conditions and complex care needs, on referral from a GP. Eligible patients can access up to $4,250 in Medicare benefits for dental services over two consecutive calendar years. Services covered by the scheme include dental assessments, preventive services, extractions, fillings, restorative work and dentures. Public-sector services, those provided to hospital inpatients and services that are purely cosmetic in nature are excluded. (The Government has announced its intention to close this scheme, in order to fund a new Commonwealth Dental Health Program. However to date the Senate has prevented this.)

12 Dental Board of Australia 2010, Continuing professional development registration standard.

139

– The Cleft Lip and Cleft Palate Scheme provides for the payment of Medicare benefits for orthodontic and associated treatment rendered by accredited dentists to persons with cleft lip and cleft palate conditions, or similar conditions requiring major dento-skeletal treatment. Approved dental patients may receive treatment under the relevant Medicare Benefits Schedule items until the age of 28 years, provided they register with the Scheme prior to turning 22 years of age.

– The Scheme also provides assistance for a range of medical services of an oral surgical nature which attract Medicare benefits when performed by a medical practitioner, anaesthetist or an approved dental practitioner (oral and maxillofacial surgeon). These benefits are payable for various private and public hospital services in addition to various non-hospital services.

– Dentists also provide prescriptions under the Pharmaceutical Benefit Scheme.

– The Medicare Teen Dental Plan provides financial assistance to families to of eligible teenagers to receive a preventative dental check from a dentist who is registered with Medicare Australia. Dental therapists and dental hygienists can also provide services under the supervision or oversight of a dentist.

• Medicare rebates will not be paid for dental services that are purely cosmetic in nature. Medicare rebates can also not be claimed for dental treatment provided by public dental clinics or where the patient is an in-patient (ie an admitted patient) in a hospital, even if the patient is admitted to a hospital solely for the purpose of that dental treatment.13

Peak National Body

A number of peak national bodies exist which relate to dental health professionals. The national governing body for dentists is the Australian Dental Association (ADA).

Australian Dental Association www.ada.org.au PO Box 520 St Leonards NSW 1590

14-16 Chandos Street St Leonards NSW 2065 T: +61 2 9906 4412 F: +61 2 9906 4917

13 Department of Health and Ageing website – Dental Health Fact Sheet for Patients


The national governing body for Dental Prosthetists is the Australian Dental Prosthetists Association (ADPA).

Australian Dental Prosthetists Association www.adpa.com.au Suite 2/ 9 Church Street Hawthorn, Victoria 3122 P: 03 9852 9969 E: [email protected]

There is a also a peak body for hygienists and therapists called the Dental Hygienists Association of Australia.

Dental health professionals and eHealthExamples of relevant eHealth applications

The key uses of eHealth that dental health professionals will benefit from include:

• Electronic health records

• Digital referrals and patient histories

• Electronic patient education resources

• Digital image transfer and storage

• Patient behaviour monitoring.


Dentists are generally technologically competent and comfortable with IT due to the nature of their work. A few older sole practitioners are very attached to card file systems but these tend to be the exception. The trouble is that technical support in the private sector tends to be poor and does not meet their needs, leading to problems with the security and backup of most systems. This could be a problem if minimum standards are set for privacy and data integrity, which require upgrades to current facilities.

For busy practices, the clinical interface needs to be really simple and easy to use, with minimal technical explanation required. Ideally a product would be created which would provide clinicians with the building blocks of the ideal eHealth system at the practice level as well as the system level.

In terms of dentists’ engagement with eHealth reforms, the ADA takes the view that what is missing is a road map of the ‘need to know’ requirements of each allied health profession, which would accurately chart what needs to be done to establish and use eHealth facilities. Dentists are concerned they will be excluded from a shared medical, despite the fact that oral health is inextricably linked to the health of the whole body. So too, many systemic conditions affect the mouth.

In terms of the new health identifiers, it is critical that this information is integrated with dental records for forensic purposes. This is a key issue for the ADA. Forensic identification through dental records identified 60% of all victims of the ‘Black Saturday’ bushfires as DNA had been destroyed.

141

This is an essential part of investigating crime and disasters that cannot be replaced or replicated by other technologies.

The National eHealth Transition Authority’s use of SNOMED classifications and codes is inappropriate for Australian dentists as the SNODENT component uses charting and classification systems which are only used in the US, but not in Australia, Europe or the rest of the world. The July 1, 2012 deadline for many of the Government’s eHealth initiatives is not realistic for dentists as a result of this oversight, and the lack of available dental software that meets interoperability and other NeHTA standards.


• Dental allied health practitioners are the oldest of the allied health groups, with 65% over 45 years of age. 73% practice from a single location, and 68% never visit rural or remote areas.

• Dental allied health practitioners’ leading uses of computers are administrative, including billing and patient rebates (85% use) and patient booking and scheduling (65%). Recording patient information is also a common use, both during consultations (64%) and afterwards (62%).

• In many areas, adoption of eHealth solutions by dental allied health practitioners does not currently match their desire. In particular, diagnostic imaging (6% currently order via computer, but 66% would like to; 42% view on a computer, a further 42% don’t, but would like to), and communicating with other health professionals (29% currently send or receive referrals electronically, while a further 54% would like to; 20% share health records with other practitioners electronically, a further 56% would like to).

• Few dental allied health practitioners currently use telehealth solutions (8%), although interest is strong (35% expect to be using within 3 years). The top 3 desired uses are training (16%), supervising (11%) and consulting with other practitioners (10%).

• 21% of dental allied health practitioners maintain all records in paper form, although 29% only use computers. Of the 79% storing some form of records electronically, 73% use an EHR. 47% strongly agree that computer use is expected, while 39% believe their colleagues are using computers.

• The perceived benefits of eHealth solutions to dental allied health practitioners are improving collaboration (32%) and continuity of care (21%). Improving patient safety (22%) also ranks highly.

• Several barriers resonate with dental allied health practitioners, including concerns about malfunctions or downtime (40% strongly agree), a preference for established technology (40%), and the need to maintain compatibility with existing IT systems (40%). Privacy of both practitioner performance data (39%) and patient records (35%) are also foremost.

• Dental allied health practitioners listed their top drivers of adoption as the advice of their professional body (47% strongly agree) and financial incentives (41%).


DietitiansOverview of size, composition and role

Overview of group

Description of profession Dietitians are responsible for providing advice on diet and nutrition. The patient mix seen by dietitians is very diverse. It includes all types of diabetes, obesity, eating disorders, aged care menu reviews and malnutrition, liver and kidney failure, assisted and tube feeding, paediatric failure to thrive and HIV/AIDS.

Number 4,000*


* Dietetics Association of Australia, Annual Report 2009

Distribution by age and location – dietitians




7

17

23

39

13

40

6

19

26

9

55+

45-54

35-44

25-34

0-24

2624

3

1

2

7

7

19

35

3

2

2

7

8

15

39

ACT

NT

TAS

SA

WA

QLD

VIC

NSW

2

7

16

74

2

8

15

74

Remote

Outer regional

Inner regional

Major city


Exhibit 46

143


Overview of respondent practice attributes for dietitians% of respondents


56

40

25+

1

16-253

6-15< 6


13

48

Four or more21

Three18

Two

One


5

16

Never 75

Once amonth or less

1

Monthly

2


Daily


4

70

75+ 26

50-74 025-49

<25

Exhibit 47


• University degree required, either a four year under graduate Bachelor of Health Sciences Degree or a two-year postgraduate Masters degree in one of fifteen Universities accredited by the Australian Dietetics Council.

• Successful completion of university study is followed by a provisional year practicing under supervision.

• In order to be eligible to register with Medicare, Dietitians must be registered as an Accredited Practicing Dietitian (APD) as recognised by the Dietitians Association of Australia (profession is not yet subject to national registration through AHPRA).

• To maintain this qualification it is necessary to undertake at least 30 hours of Continuing Professional Development annually.


• Outside the hospital sector ambulatory patients can access a dietitian by self-referral, or referral through a GP or medical specialist. In a private practice setting self-referred patients either pay full-fee for service, or if privately insured may obtain a rebate for the service from their health fund if they hold ancillary or ‘Extras’ cover.

• Eligible Dietitians can access Medicare on referral from a GP through the individual allied health items for people with a chronic or terminal medical condition and complex care needs (MBS items 10950-10970); the follow-up allied health items for people of Aboriginal or Torres Strait


Islander descent (MBS items 81300-81360); and the group allied health items for people with type 2 diabetes (MBS items 81100-81125).

• GPs and hospital specialists can also refer patients to dietitians practising in publicly-funded Community Health Centres. Here the service is provided either free at the point of service or there is a nominal fee charged to help with compliance and attendance. In this setting, waiting lists to access dietitians can be very long as sessions are limited by the Centre’s budget.

Peak National Body

Dietitians Association of Australia www.daa.asn.au 1/8 Phipps Close DEAKIN, ACT 2600 T: 02 6163 5200 F: 02 6282 9888 T: 1800 812 942 [email protected]

DAA maintains a membership of approximately 4000 dietitians with an additional 450 student members. It retains responsibility for accrediting university curricula as well as CPD provision. The DAA also provides a pathway for international graduates to achieve recognition as Australian APDs, which involves examinations and a period of practice under supervision.

Dietitians and eHealthExamples of relevant eHealth applications

The key uses of eHealth that dietitians will benefit from include:

• Use of electronic patient education resources from kilojoule-counting, to food-label interpretation – many of these programs are available as ‘apps’.

• Electronic health records – must be shared to avoid serious errors involving allied health like missing food allergies and incorrectly transcribing the composition of tube feeds – this occurs already in public hospitals. Software should enable the dietitian to summarise their extensive notes and upload the summary to a shared record. A template should be created to better enable this approach containing the ‘nutrition diagnosis, issues for management and recommendations.

• Nutrition analysis software is currently available and this should be developed to directly interface with the electronic record to avoid duplication of data entry.

• A template for electronic referrals and doctor letter to automate care planning so that the dietitian can spend more time with the patient addressing actual problems rather than duplicating histories and data entry.


Dietitians view themselves as technologically savvy and early adopters of technology. This is related to both their young age as most have grown up with computers, and the emphasis on calculations and analysis in their day-to-day work. They mostly use smartphones and many have iPADs in

145

their personal lives, however those working in the public sector are very limited by the available infrastructure and software programs. Many public hospitals require that allied health practitioners share one computer between several people and the functions are limited. Dietitians also take extensive notes, particularly during the initial consultation and there is a lack of products available that meet this need. Those software products that have been developed for doctors do not take this requirement into account, which is a common problem faced by many allied health practitioners.


• Dietetics is a young field, with 56% of practitioners under 35 years of age. 52% work in more than one practice location. 16% of dietitians reported they worked daily in rural or remote areas, while 75% suggested they never did.

• Educational needs lead the current uses of eHealth solutions for dietitians, with 72% accessing online clinical materials, and 68% utilising online CPD. A further 24% and 27% respectively would like to use these tools.

• Recording of patient notes is a clear need, with 49% of dietitians suggesting they do so after a consultation, and a further 46% who would like to. 43% view or record patient information during a consultation, with a further 43% who do not, but would like to.

• Collaboration is the leading unmet need for dietitians, for although 27% share health records with other practitioners electronically, a further 67% do not, but would like to. The educational role dietitians play is also evident, with 42% using computers to show patients health related information, and a further 44% wanting to. Just 12% currently share health records with patients electronically, while a further 55% would like to.

• Telehealth use amongst dietitians is above average (15% use), and 34% expect to be using telehealth solutions within 3 years. Although training (32% expect to be using within 3 years) and consultations with other practitioners (28%) are the leading desired uses, patient monitoring (23%) and consultations with patients (22%) also show significant interest.

• 29% of dietitians maintain all records in paper form, while 13% only use computers. Of the 71% storing some form of records electronically, 65% use an EHR. 81% of dietitians strongly agreed they would like access to a shared patient record. 80% strongly agree that the majority of their colleagues are using computers, while 78% strongly agreed that computer use is expected in their profession.

• Top perceived benefits of eHealth for dietitians include improving collaboration (67% strongly agree), improving continuity of care (62%) and improving practice efficiency (55%). Although dietitians also perceive strong benefits to the care delivery process (38%), patient safety (35%) and quality of care (33%), the extent to which this improves patient satisfaction (16%) and relationships (15%) is less clear to practitioners.

• Affordability is the leading adoption barrier for dietitians (43% strongly agree), followed by compatibility (31%) and connectivity (29%) concerns.

• Dietitians listed their top drivers of adoption as the influence of other practitioners in their network (56% strongly agree), financial incentives (55%) and the advice of their professional body (51%).


Exercise physiologistsOverview of size, composition and role

Overview of group

Description of profession Accredited exercise physiologists provide services for patients in a variety of settings including assessing movement capacity, rehabilitation at later stages of patient recovery, ‘return to work’ activities, and designing individualised exercise interventions for people at risk of chronic illnesses (e.g. type 2 diabetes, coronary heart disease).

Number 1,700 qualified exercise physiologists

(Not recognised in 2006 census)Gender mix 47% female, 53% male

Distribution by Age and State

Exercise physiology is one of the newest allied health professions – the peak body Exercise and Sports Science Australia (ESSA) has only been operating for about 20 years, and they have only been recognised as a separate specialty by the Government since 2006 – accordingly no census data is available for the distribution of exercise physiologists by age, state and remoteness.

Distribution by age and location – exercise physiologists

SOURCE: Exercise & Sports Science Australia



1

14

56

6

23

55+

25-34

0-24

45-54

35-44

12

2

1

2

5

23

18

38

QLD

WA

SA

TAS

ACT

NSW

VIC

NT

7

17

75

1

Inner regional

Remote

Major city

Outer regional

ESSA, 2011

Exhibit 48

147


Overview of respondent practice attributes for exercise physiologists% of respondents


51

31

25+8

16-2511

6-15

< 6


24

51

Four or more

16Three

9

Two

One


5

5

21

Never59

Once amonth or less

Monthly9


Daily


4

29

75+

64

50-743 25-49

<25

Exhibit 49


• University degree accredited under the National University Course Accreditation Program conducted by Exercise & Sports Science Australia (ESSA).

• Two types of registration are available. An ‘exercise physiology’ registration is required for practitioners working in a clinical setting. Registration with ESSA as an ‘Accredited Exercise Physiologist’ is required in order to hold Medicare, DVA and WorkCover provider numbers. A ‘sports science’ registration is for practitioners working in the elite sports science industry.

• Continuing professional development is compulsory for accredited members.


• Eligible exercise physiologists can access Medicare on referral from a GP through the individual allied health items for people with a chronic or terminal medical condition and complex care needs (MBS items 10950-10970); the follow-up allied health items for people of Aboriginal or Torres Strait Islander descent (MBS items 81300-81360); and the group allied health services for patients with type 2 diabetes (MBS items 81100-81125).

• Many exercise physiologists provide services under the Australian General Practice Network (AGPN) – Lifestyle Modification Programs (LMP) for the prevention of Type 2 Diabetes. General practitioners are able to refer patients who are at risk of developing Type 2 Diabetes, as determined by the AusDrisk tool, to eligible LMP programs in their area at little, or no cost.

• WorkCover recognises exercise physiologist services in a variety of states.


• Patients are also able to attract private health fund rebates from a number of private health insurers, depending on their level of health cover.

Peak National Body

Exercise and Sports Science Australia www.essa.org.au Suite 1a, AMA Place 88 L’Estrange Tce Kelvin Grove, Queensland 4059

P.O. Box 123 Red Hill, Queensland, 4059 Phone: +61 (07) 3856 5622 Fax: +61 (07) 3856 5688 email: [email protected]

Exercise physiologists and eHealthExamples of relevant eHealth applications

Some example uses of eHealth that exercise physiologists could benefit from include:

• Electronic access of other health professionals to ongoing monitoring of patient condition as part of exercise physiologist program – further automation of the Chronic Disease Management process would enable ongoing monitoring of cholesterol, blood glucose and body mass index by exercise physiologists to be fed back to GPs so that they can make the proper adjustments to medication like insulin in response.

• Telehealth tools for designing and monitoring patient exercise programs – there is a growing interest in using eHealth tools for patient education and motivation, particularly as patient compliance is a major issue in exercise physiology. ExercisePro is one such program that allows the exercise physiologist to design compliance programs and monitor patients online with their participation. As patient motivation is such a major issue there is considerable interest in use of TeleHealth technology to better enable this. At the moment email and SMS contact is used during the exercise program with the chronically ill, however funding for this type of thing is a significant limitation.

• Continuing professional development– ESSA provides some continuing professional development online, but usually outsources this to other companies due to financial constraints, would ideally like to do it all this way if they had the funding.


Exercise physiologists are generally a younger group of practitioners that are early adopters of technology and avid users of social media. However this does not always translate into use of technology in the workplace. Most of the multidisciplinary clinics use practice management software, but individual practitioners may have difficulty accessing computers and appropriate software for eHealth purposes. There are few products around that are suitable for exercise physiologist workflows, although some have designed their own software.

149

Key enablers for eHealth for EPs are financial assistance with capital expenses, education and training on software and an education campaign on the benefits to Allied Heath Professionals.


• Exercise physiology is the newest of the allied health professions, so perhaps not surprisingly 70% of practitioners are under 35 years of age. 49% work in more than one practice location, and 41% practice at least occasionally in a rural or remote area.

• Educational needs lead the current uses of eHealth solutions for exercise physiologists, with 76% completing CPD online, and 61% accessing online clinical materials. A further 23% and 33% respectively would like to use these tools.

• Administrative functions also utilise computers heavily, for example booking and scheduling (73% currently use) and billing and patient rebates (56%).

• Note-taking and communication needs are less comprehensively met. For example, 32% of exercise physiologists send or receive referrals electronically, although a further 58% would like to, while 33% are able to share health records with other practitioners electronically and a further 55% would like to. 49% of exercise physiologists use a computer to enter patient notes after a consultation, while 35% do not, but would like to.

• Telehealth use amongst exercise physiologists is low at 7% of practitioners using, although 36% suggested they would be using within 3 years. The top three uses were training (24%), consultations with practitioners (21%) and monitoring patients remotely (20%).

• 17% of exercise physiologists maintain all records in paper form, while 15% only use computers. Of the 83% storing some form of records electronically, 55% use an EHR. 75% of exercise physiologists strongly agreed they would like access to a shared patient record. 73% strongly agree that the majority of their colleagues are using computers, while 69% strongly agreed that computer use is expected in their profession.

• Top perceived benefits of eHealth for exercise physiologists include improving collaboration (60% strongly agree), improving continuity of care (52%) and improving practice efficiency (48%). Although exercise physiologists did perceive a benefit to patient engagement (32%), patient satisfaction (24%) and relationships (16%) were considered less likely to improve.

• Affordability is the leading adoption barrier for exercise physiologists (33% strongly agree), followed by the need to maintain IT compatibility (31%) and the absence of adequate IT support (27%). Privacy of both patient and practitioner data registered some concern (24% and 21% respectively) while finding an adequate eHealth system (23%), system maturity (21%) and concern about system malfunctions (20%) were also visible.

• Exercise physiologists suggested their top three drivers of adoption were financial incentives (57%), the advice of their professional body (55%) and the recognition afforded practitioners that drive new solutions (47%).


Occupational therapistsOverview of size, composition and role

Overview of group

Description of profession Occupational therapy is a profession concerned with promoting health and well being through occupation. The primary goal of occupational therapy is to enable people to participate in the activities of everyday life. Occupational therapists achieve this outcome by enabling people to do things that will enhance their ability to participate or by modifying the environment to better support participation.

Number 13,000 (estimated by OTA)

4,700 (OTA membership)


Distribution by age and location – occupational therapists




24

6

16

15

5

17

40

14

25

39

55+

45-54

35-44

25-34

0-24

1314

2

1

2

8

19

25

31

2

1

2

7

16

25

32

ACT

NT

TAS

SA

WA

QLD

VIC

NSW 74

7

1

16

2

7

17

73

Remote

Outer regional

Inner regional

Major city


Exhibit 50

151


Overview of respondent practice attributes for occupational therapists% of respondents


32

61

25+1

16-256

6-15

< 6


13

57

Four or more25

Three 4

Two

One


11

7

27Never

44

Once a month or less Monthly

10


Daily


4

31

75+

65

50-741 25-49

<25

Exhibit 51


• An OTA-accredited university degree required. There are two tracks available, either a 4-year undergraduate university degree, or a 2-year postgraduate university degree (after completing an eligible undergraduate degree).

• In order to be eligible to register with Medicare, occupational therapists practicing in Queensland, Western Australia, South Australia and the Northern Territory must be registered with the Occupational Therapists Board in the state or territory in which they are practicing; in all other states and the Australian Capital Territory, they must be a ‘Full-time Member’ or ‘Part-time Member’ of Occupational Therapy Australia. Uniform national registration requirements are due to be introduced through NRAS in 2012.

• Occupational therapists who wish to maintain membership with OTA are required to complete 30 hours continuing professional (CPD) per year. From 1 July 2011, Occupational Therapists who provide focussed psychological strategies services must complete 10 hours of CPD if they wish to be registered for Medicare funding under the Better Access to psychiatrists, psychologists and general practitioners through the MBS items.


• Eligible Occupational Therapists can access Medicare on referral from a GP through the individual allied health items for people with a chronic or terminal medical condition and complex care needs (MBS items 10950-10970); the follow-up allied health items for people


of Aboriginal or Torres Strait Islander descent (MBS items 81300-81360); the Focussed Psychological Strategies services under the Better Access to psychiatrists, psychologists and General Practitioners through the MBS (MBS items80100 - 80170); and the Helping Children with Autism or any other Pervasive Developmental Disorder items (MBS items 82000-82025).

Peak National Body

Occupational Therapy Australia www.ausot.com.au 6/340 Gore St Fitzroy, Vic, 3065 Tel: 03 9415-2900 Toll free 1300 OT AUST [68 2878] Fax: 03 9416-1421 E-mail: [email protected]

Occupational therapists and eHealthExamples of relevant eHealth applications

Some example uses of eHealth that occupational therapists could benefit from include:

• Treatment applications and telehealth – occupational therapists can have patients undertake a treatment program through the use of programs such as Nintendo Wii Fit (some examples of this being adapted already exist). provide and monitor treatments.

• Continuing professional development (CPD) – OTA already provides training courses and CPD seminars online.

• Digital referrals and electronic health records – this will assist with multidisciplinary care, in particular the documentation of information flows around care plans under the Medicare Chronic Disease Management items.


Occupational Therapists can be technologically capable, particularly the younger ones, but frequently they do not have access to computers in the workplace. Access is particularly bad in the public sector. Few software programs are specifically tailored to occupational therapists in the market.

Occupational therapists would like greater engagement in Government initiatives such as TeleHealth and the PCEHR.

OTA believes important incentives to drive adoption include:

• Access to the appropriate technology in all sectors.

• Training and education in the use of eHealth and related technologies.

• Streamlining of the national registration process and the access to Medicare provider numbers so that there are no delays in accessing health identifiers when the time comes to participate in Government programs like the PCEHR.

153

Barriers include the fact that occupational therapists are highly focussed on face-to-face patient care in their work culture which can be easily disrupted by poorly designed technology. Also occupational therapists tend to be among the lower-income earners amongst allied health practitioners, placing them at a higher risk of cost being a barrier.


• Occupational therapists typically see a smaller number of patients per day (61% see less than 6 patients per day). 56% report they practice at least occasionally in a rural or remote area.

• Educational needs lead the current uses of eHealth solutions for occupational therapists, although adoption remains low in comparison with interest, with 55 accessing online clinical materials while a further 39% would like to. Similarly, 51% access CPD online, and a further 43% do not, but would like to.

• Patient administration uses are relatively common, with 52% using computers for booking and scheduling, and 49% for billing and rebates. Again, desired use is significantly higher, with a further 33% and 22% respectively.

• 50% of occupational therapists complete event summaries on a computer, although the proportion entering patient notes after a consultation on a computer (37%) and viewing or recording patient information via computer during a consultation (23%) are significantly lower – in both cases 56% don’t currently use computers, but would like to.

• Telehealth uses amongst occupational therapists is relatively common, with 17% of practitioners currently using telehealth solutions, and 34% of those not using expecting to within 3 years. The two dominant interests are training (15% strongly agree) and consulting with other practitioners (15%), with lower interest in patient consultation (10%) and monitoring (9%).

• 26% of occupational therapists maintain all records in paper form, while 7% only use computers. Of the 74% storing some form of records electronically, 45% use an EHR. 70% strongly agree that the majority of their colleagues are using computers, while 68% strongly agreed that computer use is expected in their profession. 50% of exercise physiologists strongly agreed they would like access to a shared patient record.

• The three dominant benefits perceived by occupational therapists are improving collaboration (47% strongly agree), improving continuity of care (37%) and practice efficiency (36%). Business improvements are perceived less strongly (e.g., only 9% strongly agree the benefits of eHealth solutions include both increasing the number of referrals and reducing exposure to legal risk).

• Affordability is the leading adoption barrier for occupational therapists (45% strongly agree), followed by the need to maintain IT compatibility (38%) and the absence of adequate IT support (30%).

• The dominant adoption driver suggested by occupational therapists was the use of financial incentives (59%), while 38% suggested the influence of their professional body, and 37% suggested the expectation of their patients would be motivating.


OptometristsOverview of size, composition and role

Overview of group

Description of profession Optometrists are primary health care providers, being the first point of professional contact for people experiencing problems with their eyes or have difficulty seeing. Optometrists are experts in: the optics of lenses, eye health and visual performance. They assess, diagnose and manage ocular diseases, injuries and disorders across a wide range of patients. Where clinically necessary, optometrists prescribe spectacles, contact lenses and devices for the visually impaired.

Number 4,400*

(2006 Census recorded 3,065)Gender mix 45% female; 55% male *** ANPHA data released 18 April 2011** Clinical Experimental Optometry, 2010; 93: 5: 330-340.

Distribution by age and location – optometrists




25

29

29

9

8

17

32

10

7

34

55+

45-54

35-44

25-34

0-24

2

1

25

2

1

24

1

6

9

21

36

1

6

9

20

37

ACT

NT

TAS

SA

WA

QLD

VIC

NSW

6

16

77

0

1

7

17

75

Remote

Outer regional

Inner regional

Major city


Exhibit 52

155


Overview of respondent practice attributes for optometrists% of respondents


75

12

25+

016-25

12

6-15

< 6


33

48

Four or more7Three

12

Two

One


16

78

Never63 Once a

month or less

Monthly5

Weekly or fortnightlyDaily


73

75+87

50-744

25-49<25

Exhibit 53


• An OCANZ-accredited university degree required. There are two tracks available:

– 5-year undergraduate university degree; or

– 4-year postgraduate Doctor of Optometry degree (after completing biomedical science undergraduate degree of 3 years).

• Registration required with Optometry Board of Australia, which is one of the national boards established under NRAS.

• Optometrists must complete a minimum of 40 points of CPD activities each year. The Optometry Board of Australia is responsible for setting criteria for these courses and approving courses offered by education providers.


• Optometrists currently have access to 26 MBS item numbers, as set out in the Optometrical Services Schedule of the MBS14 Unlike other allied health items, no GP referral is required to access an optometrist. Due to the Common Form of Undertaking – Participating Optometrists, optometrists (unlike doctors) are not permitted to exceed the Medicare Schedule fee for any

14 To access the OMBS see here: http://www.health.gov.au/internet/mbsonline/publishing.nsf/Content/Downloads-201101


Medicare service, except in the case of a domiciliary visit or a patient being billed an item 10907 attendance.

• In addition to the Medicare rebate, which can be claimed for the consultation with an optometrist, patients may claim a private health insurance rebate to contribute to the cost of spectacles or lenses if they hold private health insurance, ancillary or “extras” cover

Peak National Body

Optometrists Association Australia www.optometrists.asn.au 204 Drummond St, Carlton, Vic 3053

PO Box 185, Carlton South, Vic 3053 Telephone: (03) 9668 8500 Fax: (03) 9663 7478 E-mail: [email protected]

Optometrists and eHealthExamples of relevant eHealth applications

Some example uses of eHealth that optometrists could benefit from include:

• Electronic transfer of diagnostic scans – optometrists may send retinal scans and OCT images to ophthalmologists for assistance with diagnosis and treatment or for referral purposes. Sending these scans electronically increases speed of service for patients (particularly for optometrists based in remote locations).

• Continuing professional development (CPD) – OAA and other CPD providers already provides CPD training courses, discussion forums and journal libraries online.

• Electronic health records – 95% of optometrists are already using an electronic health record system.

• Digital referrals and electronic health records – this will assist with multidisciplinary care, in particular the documentation of information flows around care plans under the Medicare Chronic Disease Management items.

• Medicine record management


Optometrists are highly technologically competent and place a high value on having access to the latest diagnostic equipment. They do tend however to be very business-focussed as a result of competition on the sector and are unlikely to invest in anything which does not have an immediate return on investment.

Many optometrists in rural areas send through retinal scans and OCT images to ophthalmologists located in the larger rural centres or cities to assist with diagnosis and treatment or for referral purposes. For this reason they have applied to the Federal Government for access to the Telemedicine items as they feel this is a relevant service.

157

There are four EHR providers for optometrists – two are in-house providers for Luxottica and Specsavers and the other two are available for independent providers. The OAA are hoping that Government plans for the health identifiers and the PCEHR will be compatible with the existing software programs with minimal adjustments. They hope that the PCEHR will be accessible with a single system without the need to switch between software programs.

The OAA also assists individual practices with website development.


• 75% of optometrists see between 6-15 patients per day, 48% working from a single practice. 37% of optometrists practice at least occasionally in a rural or remote area.

• Administrative efficiency drives the computer use of optometrists, with billing and patient rebates (76% of practitioners use), and patient booking and scheduling (65%) both prominent. Educational applications are less ubiquitous but desire to adopt is evident in the remaining population (57% access clinical reference materials online, a further 27% don’t currently do so, but would like to; 55% of optometrists access CPD online, a further 25% would like to).

• Computers are used broadly within patient consultations, with 61% of optometrists showing patients health-related information, 59% viewing or recording patient information during a consultation and 61% entering patient information after a consultation.

• The greatest unmet need for optometrists is collaboration. 20% of optometrists currently share health records with other practitioners electronically, while 40% do not, but would like to. 27% send or receive referrals electronically, although a further 39% would like to.

• Telehealth use is almost absent for optometrists, with just 2% currently using any telehealth solutions. Of the 98% not currently using telehealth, only 18% expect to adopt within 3 years. Training is the only application commonly envisaged (13% very interested).

• 19% of optometrists only use paper records, and equivalently 19% only use electronic records. Of the 81% using some form of computerised record, 61% use an EHR. 46% strongly agree that the majority of their colleagues use computers, while 42% agree computer use is expected.

• The provision and quality of care registers the greatest benefits for optometrists, with improving collaboration strongest (31% strongly agree), improving continuity of care (18%) and the care delivery process (13%) also resonating. Patient engagement (10%) and satisfaction (9%) were expected to see some benefit, although business drivers were considered the weakest benefits (e.g., reducing exposure to legal risk, 8%).

• The three leading barriers to adoption for optometrists are technology concerns, including the need to use established technology (39% strongly agree this is a barrier), maintaining compatibility with existing IT systems (38%) and concerns about malfunctions or downtime (36%). Selection and usability of eHealth systems do not register as strong concerns for optometrists, for example just 8% strongly agree eHealth systems are too difficult to select and implement, and only 15% strongly agree they can’t find a solution that meets their needs.


• Optometrists indicated their most influential drivers of adoption would be financial incentives (47% strongly agree), the advice of their professional body (36%) and the recognition of practitioners who adopted technology early (30%).

OsteopathsOverview of size, composition and role

Overview of group

Description of profession Osteopathy is a form of manual medicine which recognises the important link between the structure of the body and the way it functions. Osteopaths focus on how the skeleton, joints, muscles, nerves, circulation, connective tissue and internal organs function as a holistic unit. Using skilled evaluation, diagnosis and a wide range of hands-on techniques, osteopaths can identify important types of dysfunction in your body. Osteopathic treatment uses techniques such as stretching and massage for general treatment of the soft tissues (muscles, tendons and ligaments) along with mobilisation of specific joints and soft tissues.*

Number 1,580 registered osteopaths

(2006 Census recorded 778)Gender mix 60% female, 40% male

* <http://www.osteopathic.com.au/> (accessed May 2011)

Distribution by age and location – osteopaths




21

49

10

15

6

11

23

19

39

9

55+

45-54

35-44

25-34

0-24

2

39

6

2

47

3

0

1

4

11

32

0

4

1

9

39

ACT

NT

TAS

SA

WA

QLD

VIC

NSW

6

0

79

15

0

1

23

75

Remote

Outer regional

Inner regional

Major city


Exhibit 54

159


Overview of respondent practice attributes for osteopaths% of respondents


78

14

25+3

16-255

6-15

< 6


19

75

Four or more0

Three7

Two

One


512

Never 79

Once amonth or less

1

Monthly

3


Daily


12

75+88

50-740

25-49

0

<25

Exhibit 55


• A 3-year undergraduate degree followed by a 2-year Masters program. Degrees must be accredited by the Australian and New Zealand Osteopathic Council.

• In order to be eligible to register with Medicare, Osteopaths must be registered with the Osteopathy Board of Australia, which is one of the national boards established under NRAS.

• Osteopaths must complete a minimum of 25 hours of CPD activities each year which includes a mandatory CPD activity approved by the Osteopathy Board of Australia.


• Osteopathy is a private sector-based profession offering ambulatory care in private rooms. 10% of patients receive some Government rebate from either Medicare, DVA or Workcover, the remainder pay full fees or receive a rebate from the private health funds.

• Eligible Osteopaths can access Medicare on referral from a GP through the individual allied health items for people with a chronic or terminal medical condition and complex care needs (MBS items 10950-10970) and the follow-up allied health items for people of Aboriginal or Torres Strait Islander descent (MBS items 81300-81360).


Peak National Body

Australian Osteopathic Association www.osteopathic.com.au Suite 4, 11 Railway Street Chatswood NSW 2067

PO Box 5044 Chatswood West, NSW 1515 Ph: 1800 467 836 Fax: 61 2 9410 1699 Email: [email protected]

Osteopaths and eHealthExamples of relevant eHealth applications

Some example uses of eHealth that osteopaths could benefit from include:

• Electronic transfer of diagnostic scans

• Continuing professional development (CPD)

• Electronic health records



Willingness to adopt new technologies and receptiveness to eHealth is generally related to age in this profession, however as only 10% are over 50, this is becoming less of an issue. Most new graduates are keen to use computers and adopt new technologies.

80% of osteopathy clinics are using computers for practice management functions, however only 20% are using computers for other functions like electronic records management. This is improving because practices are consolidating and getting larger, generating greater cash flow.

The main non-administrative uses of IT for osteopaths are related to online CPD, patient education and research. Most practices have internet access although practitioners may need to share a computer.

Cost is a barrier to greater adoption of eHealth applications by osteopaths. Financial assistance to help cover upfront costs of hardware and software would drive greater uptake.

Many osteopaths are not convinced of the benefits eHealth applications bring for patients. Greater education on the benefits of eHealth applications may therefore help drive further adoption. Skills training is also important, as basic competencies in eHealth applications cannot be assumed. It is the position of the Australian Osteopathic Association that a basic ‘generic’ software program with an easy-to-use interface should be made available at a subsidised rate for allied health practitioners, as they have the view that only the really expensive software packages will comply with the evolving NeHTA standards.

161


• 75% of osteopaths work from a single practice location. 78% see between 6-15 patients per day. Only 21% indicated they practice even occasionally in a rural or remote location.

• Osteopaths have broadly adopted eHealth solutions for educational purposes including CPD (63% currently use) and accessing online clinical reference materials (57%), as well as administrative tasks such as billing and patient rebates (68%) and booking and scheduling (64%).

• The use of computers for other purposes is less prevalent but practitioners indicate a desire to adopt. For example, 15% view diagnostic images online but a further 52% would like to. 5% order diagnostic imaging online, yet a further 55% would like to. Collaboration is a similarly unmet need – 13% of osteopaths send or receive referrals electronically, although a further 45% would like to. 15% share patient records with other practitioners electronically, while a further 42% would like to.

• Telehealth use is low, with just 5% of osteopaths involved. Of the remnant 95%, just 19% expect they will probably be using telehealth solutions within 3 years. Training (12%) and consultations with other practitioners (9%) register the most interest.

• The majority of osteopaths only use paper records (56%), although 17% suggest they only use electronic records. Of the 44% using some form of computer records, 61% reported they use an EHR. Expectations of computer use are low – while 24% strongly agreed they would like access to a shared patient record, 21% believed they were expected to use a computer professionally.

• The provision and quality of care registers the greatest benefits for osteopaths, with improving collaboration strongest (23% strongly agree), improving continuity of care second (17%). 13% strongly agreed eHealth would improve practice efficiency, and 12% that it would improve patient engagement. Potential improvements to patient satisfaction and patient care both registered only 5% strong agreement.

• Computer and connectivity access for osteopaths is prevalent but not ubiquitous. 20% of practitioners in major cities reported they did not have access to a computer in their practice. Osteopaths practicing in outer regional or remote areas suggested connectivity was unavailable (50% and 43% respectively did not have internet access in their practice).

• Privacy and data security are the foremost concerns for osteopaths, both a concern about the visibility of practitioner performance data (35% strongly agree) and breaches of patient privacy (31%). Technology concerns also register strongly, particularly malfunction or downtime (31%) and a desire for established technology (25%).

• Three drivers resonate most strongly for osteopaths – financial incentives (41% strongly agree), the advice of professional bodies (39%) and the expectations of patients (36%).


PhysiotherapistsOverview of size, composition and role

Overview of group

Description of profession Physiotherapists assist people with movement disorders. Physiotherapy uses a variety of techniques to help muscles and joints work to their full potential. It can help repair damage by speeding up the healing process and reducing pain and stiffness. Physiotherapists also have an important role in rehabilitation, for example, helping people who have had strokes to relearn basic movements. Preventive management plans are also important.*

Number 22,186 registered physiotherapists**

(2006 Census recorded 12,287)Gender mix 73% female, 27% male* <http://www.physiotherapy.asn.au/> (Accessed May 2011).** Australian Health Practitioner Regulation Agency, Registrant Snapshot, media release (19 April 2011).

Distribution by age and location – physiotherapists




32

10

26

22

10

19

10

8

30

33

55+

45-54

35-44

25-34

0-24

2

2

1

9

11

18

25

32

2

2

1

9

11

17

25

34

ACT

NT

TAS

SA

WA

QLD

VIC

NSW 76

15

1

6

1

7

16

74

Remote

Outer regional

Inner regional

Major city


Exhibit 56

163


Overview of respondent practice attributes for physiotherapists% of respondents


67

1516-2519

6-15

< 6


33

52

Four or more6

Three

9

Two

One


16

Never 79

Monthly2


3

Daily


28

75+

6925-493

<25

Exhibit 57


• University degree required. Two principal tracks exist:

– 4-year undergraduate degree in Physiotherapy or Applied Science (Physiotherapy)

– 2-year graduate Masters degree (after completing an undergraduate degree).

• Most physiotherapy courses will have both a theoretical and practical component. Students undertake placements at different health care centres, including acute hospitals, private practice, community health centres or rehabilitation hospitals.

• In order to be eligible to register with Medicare, Physiotherapists must be registered with the Physiotherapy Board of Australia, which is one of the national boards established under NRAS.

• Specialist qualifications in physiotherapy can be obtained through university degrees or through programs in one of the special interest groups of the Australian Physiotherapy Association (APA).


• Eligible Physiotherapists can access Medicare on referral from a GP through the individual allied health items for people with a chronic or terminal medical condition and complex care needs (MBS items 10950-10970) and the follow-up allied health items for people of Aboriginal or Torres Strait Islander descent (MBS items 81300-81360).


Peak National Body

Australian Physiotherapy Association www.physiotherapy.asn.au Level 1, 1175 Toorak Road, Camberwell VIC 3124

PO Box 437, Hawthorn BC VIC 3122 Phone: +61 3 9092 0888 Fax: +61 3 9092 0899 E-mail: [email protected]

Physiotherapists and eHealthExamples of relevant eHealth applications

Some example uses of eHealth that physiotherapists could benefit from include:

• Treatment applications and telehealth – for example physiotherapists can provide extra guidance on exercise programs as well as monitoring patient progress and compliance with that program. For example iPhone apps that have been developed with exercise programs and which can be used by physiotherapists.

• Education and senior supervision – for example a ‘TeleRehab’ program that operates in Queensland which enables junior physiotherapists to get supervision online.

• Continuing professional development (CPD).

• Digital referrals and electronic health records – 10% of all GP referrals are to physiotherapy, and physiotherapists could benefit from streamlined access to data through digital referrals and access to shared patient records.


Physiotherapy remains a ‘low-tech profession’. There are few early adopters. This has been confirmed by a recent study undertaken by the APA in 2009. In private practice the receptionist usually has the IT skills, and these are limited to practice management and billing. Use of electronic health records remains low, and GP letters tend to be typed out and sent in the mail. Use of electronic health records and secure messaging remains low.

There are one or two software programs around that physiotherapists can use, but they tend to be poorly customised for the profession which has heavy reliance on drawings and diagrams in the health record. The Medicare Chronic Disease Management process has been streamlined by software a little, but incentives to change still remain low. Physiotherapists also take extensive notes on the patient’s social history, including details about how they are likely to cope at home post-discharge, which are not easily entered into commercially available software packages which are designed for the medical market.

Many physiotherapists working is hospitals are greatly limited by the available IT infrastructure which is difficult for allied health practitioners to access, and allows only the most basic levels of office functions to be performed.

165


• 52% of physiotherapists work in a single practice. 67% see between 6-15 patients per day. Only 21% indicated they practice even occasionally in a rural or remote location.

• Physiotherapists have broadly adopted eHealth solutions for educational purposes including CPD (62% currently use) and accessing online clinical reference materials (64%), as well as administrative tasks such as billing and patient rebates (53%) and booking and scheduling (60%).

• The most prominent unmet need for physiotherapists is sharing patient records with other practitioners (19% currently use, but a further 62% don’t use, but would like to). The ability to send and receive referrals is a similar collaboration need (24% currently use, a further 50% would like to).

• The patient interface also reflected the adoption desires of physiotherapists, with 35% currently using computers to show patients health-related information and a further 41% suggesting they would like to. 20% currently communicate with patients electronically, while 48% would like to. Note-taking shows a similar dynamic – 21% of physiotherapists enter patient notes on computer after a consultation, 19% use a computer to view or record patient information during a consultation. Of these, a further 45% and 47% respectively would like to have this functionality.

• Telehealth use is above average, with 16% of practitioners reporting some involvement. Of the remaining 84%, 42% expected to adopt in the next three years. Training (38%) and consultations with other practitioners (24%) register the most interest, although a small amount of patient consultation and monitoring does occur remotely.

• The majority of physiotherapists only use paper records (55%), and only 6% suggest they only use electronic records. Of the 45% using some form of computer records, 51% reported they use an EHR. 49% of practitioners strongly agreed that computer use is expected, and 48% strongly agreed they would like access to a shared patient record.

• The core benefits as recognised by physiotherapists revolve around provision and quality of care, including improving collaboration (33% strongly agree), improving continuity of care (32%) and improving the care delivery process (19%). Efficiency (25%) and patient satisfaction (18%) are also strong.

• Affordability is the leading concern amongst physiotherapists, with 33% strongly agreeing. The potential visibility of practitioner performance data also registers (30%). Several of the top concerns relate to adequate IT systems, for example a preference for established technology (28%), the need to maintain compatibility with existing IT systems (26%), concerns about malfunction or downtime (25%) and access to adequate IT support (23%).

• Three drivers resonate most strongly for physiotherapists – financial incentives (49% strongly agree), the advice of professional bodies (42%) and the expectations of other practitioners (41%).


PodiatristsOverview of size, composition and role

Overview of group

Description of profession The role of the podiatrist is to improve mobility and enhance the independence of individuals by the prevention and management of pathological foot problems and associated morbidity.*

Number 3,439 registered podiatrists**


* Australasian Podiatry Council website 2011.** Australian Health Practitioner Regulation Agency, Registrant Snapshot, media release (19 April 2011).

Distribution by age and location – podiatrists




29

8

12

9

16

38

9

28

40

11

55+

45-54

35-44

25-34

0-24

10

2

3

12

28

0

11

17

27

2

31

0

3

12

14

27NSW

ACT

NT

TAS

SA

WA

QLD

VIC

75

17

6

1

1

6

18

75

Remote

Outer regional

Inner regional

Major city


Exhibit 58

167


Overview of respondent practice attributes for podiatrists% of respondents


60

425+

4

16-2533

6-15

< 6


27

34

Four or more20

Three

19

Two

One


8

9

13

Never 67 Once amonth or less

Monthly1


Daily


4

20

75+

71

50-745

25-49

<25

Exhibit 59


• A four-year undergraduate university degree, with an emphasis on biomedical science is required, this is offered at six Australian universities.15 Postgraduate options at PhD and Masters level are also available.

• In order to be eligible to register with Medicare, Podiatrists must be registered with the Podiatry Board of Australia, which is one of the national boards established under NRAS.


• Eligible Podiatrists can access Medicare on referral from a GP through the individual allied health items for people with a chronic or terminal medical condition and complex care needs (MBS items 10950-10970) and the follow-up allied health items for people of Aboriginal or Torres Strait Islander descent (MBS items 81300-81360).

• Private Health Insurance rebates are also available under the ancillary tables.

15 University of Western Australia, University of South Australia, La Trobe University, University of Western Sydney, Newcastle University, Queensland University of Technology


Peak National Body

Australasian Podiatry Council (APodC) www.apodc.com.au 89 Nicholson Street Brunswick East VIC 3057 T: +61 3 9416 3111 F: +61 3 9416 3188 E: [email protected]

Podiatrists and eHealthExamples of relevant eHealth applications

Some example uses of eHealth that podiatrists could benefit from include:

• Electronic transfer of diagnostic scans

• Education and senior supervision

• Telemedicine




Podiatry is a relatively ‘young’ specialty and for the most part practitioners are very technologically competent. There is increasing use of smartphone devices and iPADs to transfer data and search for information. Most practices have electronic practice management and billing, but electronic health record systems are still few and far between. There is little available in terms of software that is suitable for this purpose in podiatry.

Podiatrists are able to prescribe some medicines and use diagnostic imaging so integrating these functions into the software system is important. Now that national registration has been embraced by the profession, and CPD is compulsory, the Council will be making use of online technologies to deliver CPD.

In terms of any shared medical record there is the strong feeling that the nature of the record should be as complete as possible and include aspects of the social history. The APodC believes that podiatrists should have access to the past medical history ‘our responsibilities do not end at the knee’. This is because many podiatry problems are caused by systemic conditions like diabetes and arthritis.


• 66% of podiatrists reported they worked in more than one practice. 33% work at least occasionally in a rural or remote area.

• Podiatrists have broadly adopted eHealth solutions for educational purposes including online clinical reference materials (65% currently use) and CPD (63%). In both cases, a further 31% of practitioners are not currently using this application, but would like to. Practice administration

169

is similarly ubiquitous, with 75% of podiatrists using computers for patient booking and scheduling, and 67% for billing and rebates.

• Podiatrist show considerable interest in broader eHealth applications including diagnostic imaging (29% view on a computer, a further 49% would like to, 6% order online, a further 66% would like to) and collaboration with other practitioners (31% send and receive referrals online, a further 56% would like to, 20% share health records with other practitioners online, a further 59% would like to).

• Telehealth use for podiatrists is low at 5% of respondents, although 34% indicated they would probably use telehealth solutions in the next 3 years. There was little interest in patient-facing applications though, with training, supervision and collaboration with other practitioners the leading interests.

• 30% of podiatrists rely solely on paper records, yet 30% have entirely computerised records. Of the 70% using some form of computer records, 64% reported they use an EHR. 61% of respondents strongly agreed they would like access to a shared patient record. 57% of practitioners strongly agreed that computer use is expected.

• Podiatrists perceived the core benefits of eHealth adoption as improving firstly the provision and quality of care (46% strongly agreed it would improve collaboration, 35% strongly agreed quality of care would be improved) and secondly business drivers (43% strongly agreed practice efficiency would improve). There was less emphasis on patient relationships and engagement (9% strongly agreed eHealth adoption would improve patient relationships).

• Computer access and connectivity were less prevalent for podiatrists than many other allied health practitioners, most prominently internet access in regional (30% of inner regional practitioner did not have internet access in their practice) and remote areas (42%).

• The two leading barriers to adoption for podiatrists are affordability (35% strongly agree) and the need to maintain compatibility with existing IT systems (31%). Other technology concerns registered strongly including concerns about malfunctions and downtime (23%) and the need for adequate IT support (21%). Privacy issues also resonated, including potential breaches of patient privacy (24%) and the visibility of practitioner performance data (23%). Selection and use of systems did not cause strong concerns (only 7% strongly agreed they found it difficult to select and implement a system).

• Podiatrists indicated they were receptive to most adoption drivers, with financial incentives (61% strongly agreed), the advice of their professional body (51%) and patient expectations (49%) the top three.


PsychologistsOverview of size, composition and role

Overview of group

Description of profession Psychologists are experts in human behaviour, having studied the brain, memory, learning, human development and the processes determining how people think, feel, behave and react. Psychological interventions are widely used to treat individuals and families and can also be applied to groups and organisations.

Clinical psychologists comprise 45% of the psychology workforce. The remainder of the workforce are either general psychologists, academics, specialists working in areas like neuropsychology, or working in a nonclinical area like market research or HR.

Number 28,699 registered psychologists*


* AHPRA 2010, Snapshot of registrants.

Distribution by age and location – psychologists




20

28

21

26

4

15

30

24

27

3

55+

45-54

35-44

25-34

0-24

29

12

3

11

1

2

5

18

28

32

3

1

2

6

14

33

ACT

NT

TAS

SA

WA

QLD

VIC

NSW

6

77

1

15

1

5

14

79

Remote

Outer regional

Inner regional

Major city


Exhibit 60

171


Overview of respondent practice attributes for psychologists% of respondents


35

65

25+

0

16-250

6-15

< 6


33

50

Four or more5

Three

12

Two

One


10

58

Never 77

Once amonth or less

Monthly

0

Weekly or fortnightlyDaily


7

14

75+

6950-74

11

25-49

<25

Exhibit 61


• Becoming a psychologist requires at least four years of full-time university study. Common courses are a four-year Bachelor of Psychology or a three-year degree followed by an Honours program in psychology. Graduates must then complete two years of either postgraduate tertiary study in a specialist area or supervised practice. Completing this six-year sequence is a requirement for registering to work as a psychologist in Australia. The Australian Psychology Accreditation Council (APAC) sets the standards for accreditation of Australian psychology programs.

• Clinical psychology requires an additional postgraduate degree – PhD or Masters – as well as 2 years clinical practice under supervision.

• In order to be eligible to register with Medicare, Psychologists must be registered with the Psychology Board of Australia, which is one of the national boards established under NRAS.


• Eligible Psychologists can access Medicare on referral from a GP (and in some instances, a psychiatrist or a paediatrician) through the individual allied health items for people with a chronic or terminal medical condition and complex care needs (MBS items 10950-10970); the follow-up allied health items for people of Aboriginal or Torres Strait Islander descent (MBS items 81300-81360); the Better Access to psychiatrists, psychologists and General Practitioners through the MBS items (MBS items 80000-80170); the Helping Children with Autism or any other Pervasive Developmental Disorder items (MBS items 82000-82025); and the Pregnancy


Support Counselling items for women who are concerned about a current pregnancy, or a pregnancy which occurred in the preceding 12 months (MBS items 81000-81010).

Peak National Body

The Australian Psychological Society is the largest professional group representing psychologists in Australia, although others exist.

Australian Psychological Society www.psychology.org.au Level 11, 257 Collins Street Melbourne VIC

PO Box 38 Flinders Lane VIC 8009 Phone: (03) 8662 3300 Toll free: 1800 333 497 Fax: (03) 9663 6177 Email: [email protected]

Psychologists and eHealthExamples of relevant eHealth applications

• eTherapy, including online cognitive behaviour therapy, for selected patients, particularly in combination with initial assessments in-person. This would greatly improve access for rural and remote patients. There are several centres for the development of online cognitive behavioural therapy programs, including at Swinburne University, Australian National University and Queensland University of Technology.

• Electronic health records, particularly directed at the transfer of information between participants in multidisciplinary care teams and background medication records.

• Continuing professional development (CPD).

• Digital referrals and electronic transactions.


The Australian Psychology Society has already undertaken a brief survey of its members on IT use which showed that only one third use any kind of practice management software, and of those only 10% understand and use secure messaging.

The level of eHealth readiness amongst the members is perceived as being poor with most using paper-based records and index cards to manage information in the practice. The decision to embrace IT solutions is generally seen as a business decision by psychologists and not one that is at all relevant to patient care. Several (up to 10) software systems have been designed with psychologists in mind but this has not improved uptake due to the poor motivation of practitioners associated with poor understanding of the benefits of eHealth solutions. One contributing factor towards the poor uptake is thought to be deep concern about privacy and confidentiality of patient records - even though the situation now is far from ideal with paper records. The Society has a very strong code of ethics in relation to this.

173

The APS considers that incentives to change practitioner behaviour need to be a combination of explicit infrastructure support and potential negative consequences such as the recommendation by the National Health and Hospitals Reform Commission linking the provision of Medicare Benefits to utilisation of secure messaging (Recommendation 120). It was also mentioned that most psychologists are reasonably technologically competent in their personal lives with over 90% using email regularly.

It is possible to automate the care planning process using existing software, but many practitioners see this as a hindrance not a help. The ideal software package would have the following elements: note-taking function which is integral, diary, electronic billing and claiming for allied health, eReferrals, GP letters and the ability to separate clinical notes from the patient details required for Medicare audits to protect patient confidentiality.

The APS believes that the current discussions regarding the new telemedicine items in the Medicare Benefits Schedule should reconsider inclusion of allied health in eTherapy as research demonstrates that online psychological services would make a real contribution to rural access to mental health services.


• Psychologists are typically older practitioners, with 45% over 55 years of age. 65% of psychologists see less than 6 patients per day, and 50% operate from one practice.

• Psychologists have adopted eHealth methods for education purposes (54% use for education and training, 54% for CPD), and for administration (52% use for booking and scheduling, 49% for billing and rebates).

• There is strong interest amongst psychologists for increased use of collaboration applications (23% currently send or receive referrals electronically, although a further 56% would like to, 15% currently share health records with other practitioners electronically, a further 52% would like to) note-taking (31% use a computer to enter notes after a consultation, a further 40% would like to) and patient education (18% use a computer to show patients health-related information, a further 49% would like to).

• 7% of psychologists responded they used telehealth solutions, with a further 25% indicating they probably would in the coming 3 years. Training (17%), consultations with other practitioners (16%) and supervising (15%) all resonated with psychologists, with 12% of respondents also very interested in patient consultations.

• 26% of psychologists rely solely on paper records, and 10% have all patient records on computer. Of the 74% using some form of computer records, 37% reported they use an EHR. 62% strongly agreed most practitioners in their network used computers, 54% strongly agreed computer use was expected. 42% strongly agreed they would like access to a shared patient record.

• Collaboration (41% strongly agree), efficiency (32%) and continuity of care (28%) were the leading benefits expressed by psychologists. 19% strongly agreed eHealth solutions would help improve patient engagement, although the impact on patient relationships was less clear (6% strongly agreed eHealth solutions would improve).


• Psychologists’ leading concerns for the adoption of eHealth solutions are affordability (55% strongly agree) and their concern for the privacy of patient data (48%). The maturity of technology resonates strongly (42% strongly agree they prefer to wait for established technology, 37% don’t believe they have adequate IT support, 36% strongly agree they are concerned about malfunctions or downtime).

• The two leading influences for psychologists are financial incentives (56%) and the advice of their professional body (46%). Peer and patient expectations are less relevant although still strong (e.g., advice of other practitioners 37%, pressure from patients 35%).

Radiographers and sonographersOverview of size, composition and role

Overview of group

Description of profession A radiographer is responsible for producing high quality medical images that assist medical specialists and practitioners to describe, diagnose, monitor and treat a patient’s injury or illness. Much of the medical equipment used to gain the images is highly technical and involves state of the art computerisation.

A radiotherapist utilises sophisticated imaging equipment and advanced computer systems to create a treatment plan to deliver the optimum dose to the tumour, specific to a particular patient and their diagnosis whilst minimising the dose delivered to healthy tissue. The radiation therapist will deliver the planned treatment with the same accuracy and precision using highly sophisticated computer-controlled equipment.

A sonographer is a highly-skilled professional who uses specialized equipment to create images of structures inside the human body that are used by physicians to make a medical diagnosis.

Number 12,000 radiographers in Australia in total, including 9000 diagnostic radiographers, 2,000 radiation therapy technicians and 900-1,100 nuclear medicine technicians.*

4,500 qualified accredited sonographers**

(2006 Census recorded 9,917)Gender mix 80% female, 20% male (radiographers and radiation therapists)

77% female, 23% male (sonographers)* Australian Institute of Radiography** Australian Sonographers Association

175

Distribution by age and location – radiographers and sonographers




24

10

7

22

30

13

21

29

32

12

55+

45-54

35-44

25-34

0-24

99

2

1

2

8

19

24

35

2

1

2

9

19

24

35

SA

WA

QLD

VIC

NSW

ACT

NT

TAS

6

15

77

1

1

6

17

75

Remote

Outer regional

Inner regional

Major city


Exhibit 62


Overview of respondent practice attributes for radiographers andsonographers% of respondents


3025+

34

16-2534

6-15

< 62


868

Four or more19

Three4

Two

One


6

12

Never 79

Once amonth or less

Monthly

0


3

Daily


29

75+

69 50-743 25-490

<25

Exhibit 63



• Professional entry to diagnostic radiography / medical imaging in Australia may involve:

– Completion of an accredited 3-year undergraduate medical imaging/diagnostic radiography Bachelor degree followed by completion of the Professional Development Year program.

– Completion of an accredited 4-year undergraduate medical imaging/diagnostic radiography Bachelor degree.

– Completion of an accredited 2-year graduate entry medical imaging/diagnostic radiography Master degree followed by completion of the Professional Development Year program.

• It is only possible to study sonography as a postgraduate following a degree in radiography, nuclear medicine, biomedical science or nursing – it requires at least a further two years at university. All sonography training is accredited by the Australasian Sonographer Accredition Registry (ASAR), and continuing education and CPD is provided online by the ASA.

• Registration is required for medical radiation practitioners in Australian Capital Territory, Northern Territory, Queensland, Tasmania, Victoria and Western Australia. Medical radiation practice is expected to be included in NRAS from 1 July 2012.16


• Radiographers, radiation therapists and sonographers work as salaried employees in either public hospitals or in private radiology practices.

Peak National Body

The national peak body for radiographers and radiation therapists is the Australian Institute of Radiography (AIR). Their membership base includes many sonographers.

Australian Institute of Radiography www.air.asn.au 25 King Street, Melbourne 3000

PO Box 16234 Collins Street West VIC 8007 tel: +61 3 9419 3336 fax: +61 3 9416 0783 email: [email protected]

16 Sonographers will not be included

177

The national peak body for sonographers is the Australian Sonographers Association (ASA).

Australian Sonographers Association www.a-s-a.com.au PO Box 709 Moorabbin, Victoria, 3189

4/350 Charman Rd, Cheltenham, Victoria, 3189 phone: 03 9585 2996 fax: 03 9585 2331 email: [email protected]

Radiographers, sonographers and eHealthExamples of relevant eHealth applications

Some example uses of eHealth that radiographers, radiation therapists and sonographers could benefit from include:

• Electronic transfer and storage of diagnostic scans (and associated notes)




Radiographers and radiation therapists are have very high technical competence. Most are adept at using computers and new technology both personally and professionally, and consider themselves early adopters. They have lead the charge for the AIR to adapt to new technology and now all CPD, exams and audits are provided online.

Areas in which radiographers could potentially use more technology are in contributing to the health record which currently does occur through the PACS system and for Radiation therapists through the medical records and electronic treatment sheet systems which are all now online,. To this could be added flagging areas on images to which the radiologist should give particular attention (‘red dots’), and safety initiatives around the ‘minimum dose, maximum quality’ principle. There is an issue that digital imaging makes it more difficult to detect when someone has taken numerous unnecessary films, this should always be monitored as standards are in place.

Training and supervision of rural and regional radiographers also takes place online - this is achieved with Government funding but this is somewhat limited by poor bandwidth and slow systems.

Sharing information in online communities and discussing images in online forums are very important and popular activities among radiographers.

In contrast, although sonographers use cutting edge equipment in their work, this does not always translate into computer literacy in other areas, and this cannot be assumed. Rapid progress in acquisition of computer skills has occurred because of the prevalence of digital imaging and the need to use the associated systems and records electronically. According to the ASA, the participation of sonographers in any universal eHealth system will be essential because they are


often on call, and in some rural areas they are the only health professional that may see the patient before a problem is detected. Teleradiology is often used now so that the reporting radiologist is not on site and may be miles away. They will definitely need to access the past medical history in the PCEHR to ensure the correct process for scanning is followed. They are somewhat concerned about how responsibilities will be allocated with the PCEHR ie who will be responsible for uploading what information.

There is some concern about where sonographers will fit in to the whole eHealth ecosystem as devised by the Government. They have been told that they will not need to use the health identifiers and that the radiologists would own these, however the peak body does not understand how this will work. It is a problem for them as radiologists would have to do enter the identifiers hundreds of times and this could become a bottleneck, also there are no radiologists in rural Australia. Also sonographers work in multiple sites and this should be taken account of in the system.


• As expected, radiographers and sonographers exhibited the highest patient throughput (34% saw more than 25 patients per day) and 68% work in a single practice. 21% practice at least occasionally in a rural or remote region.

• The dominant use of computers for radiographers and sonographers is to support administration (90% use for patient booking and scheduling, 87% for patient billing and rebates). 68% of radiographers and sonographers use a computer to view diagnostic imaging, while a further 13% don’t currently use a computer, but would like to. Education and training are facilitated (58% responded they use online CPD) as is viewing and recording of patient information (49% use a computer to enter patient notes after a consultation, a further 19% would like to). Collaboration for process communications are surprisingly absent (19% use a computer to send or receive referrals, while a further 45% would like to).

• Telehealth adoption amongst radiographers and sonographers is advanced, with 27% already using telehealth in some form. Of the 73% who do not currently use telehealth, 15% expect they will be using these solutions within 3 years. Interest in telehealth amongst radiographers and sonographers is entirely in training (8% very interested), supervision (5%) and collaboration (4%), with no interest in patient applications, as expected given their reliance on specialist equipment.

• Computer use for record storage is prevalent amongst radiographers and sonographers. 13% of psychologists rely solely on paper records, and 23% have all patient records on computer. Of the 87% using some form of computer records, 69% reported they use an EHR. While 85% strongly agreed most practitioners in their network use computers, just 41% strongly agreed they would like access to a shared patient record.

• The three leading benefits perceived amongst radiographers and sonographers are improving practice efficiency (40% strongly agree), collaboration (38%), and continuity of care (37%).

• The top barriers to eHealth adoption for radiographers and sonographers are technological – 44% strongly agree the need to maintain compatibility with existing IT systems is a barrier, 29% that they prefer to wait for established technology, 28% that the need to connect with external systems is a barrier.

179

• The two leading influences for radiographers and sonographers are financial incentives (43%) and the advice of their professional body (39%).

Social workersOverview of size, composition and role

Overview of group

Description of profession Social work is the professional activity of helping individuals, groups, or communities enhance or restore their capacity for social functioning and creating societal conditions favourable to this goal.

Number There are approximately 18,000 social workers in Australia. About 6000 are members of the Australian Association of Social Workers (AASW) and of these 17% work in the health sector. The 2006 census indicated 12,444 social workers, and industry coding data shows 30% of social workers are working in health.

Gender mix 81% female, 19% male

Distribution by age and location – social workers




24

28

16

28

26

6

30

11

26

6

55+

45-54

35-44

25-34

0-24

33

9

30

2

2

1

3

12

15

25

10

2

1

13

15

27

ACT

NT

TAS

SA

WA

QLD

VIC

NSW

17

7

1

73

1

7

16

74

Remote

Outer regional

Inner regional

Major city


Exhibit 64



Overview of respondent practice attributes for social workers% of respondents


35

64

25+

0

16-251

6-15

< 6


35

51

Four or more6

Three

8

Two

One


9

9

25

Never54

Once a month or less

Monthly3


Daily


8

15

75+

7150-74

6

25-49

<25

Exhibit 65


• An AASW accredited Bachelor of Social Work (BSW) degree or AASW accredited Master of Social Work (Qualifying) (MSW) degree is required to meet the minimum eligibility requirements for AASW membership. However, the AASW is the standard-setting body for social work and many jobs require eligibility for membership of the AASW.

• In order to be eligible to register with Medicare, Social Workers must be registered as a ‘Member’ of the AASW and be certified as meeting the standards for mental health set out in the document published by AASW titled ‘Practice Standards for Mental Health Social Workers’ as in force on 8 November 2008.


• Eligible Social Workers can access Medicare on referral from a GP (and in some instances, a psychiatrist or a paediatrician) through the individual allied health items for people with a chronic or terminal medical condition and complex care needs (MBS items 10950-10970); the follow-up allied health items for people of Aboriginal or Torres Strait Islander descent (MBS items 81300-81360); the Better Access to psychiatrists, psychologists and General Practitioners through the MBS items (MBS items 80000-80170); and the Pregnancy Support Counselling items for women who are concerned about a current pregnancy, or a pregnancy which occurred in the preceding 12 months (MBS items 81000-81010).

181

• Accredited Mental Health Social Workers (AMHSW) who have Medicare provider numbers mainly deliver services under the Better Access items, with a small amount providing services under the individual allied health items.

• Accredited Mental Health Social Workers are automatically registered with DVA to claim benefits for services provided to entitled veterans when they register with Medicare Australia. Therefore, providing services to veterans is available to all AMHSW with a Medicare provider number.

• The remainder of social workers in the health sector are largely in salaried positions in public hospitals or the community sector.

Peak National Body

Australian Association of Social Workers www.aasw.asn.au Level 4, 33-35 Ainslie Place Canberra City ACT 2601

PO Box 4956, Kingston ACT 2604 Tel: (02) 6232 3900 Fax: (02) 6230 4399 [email protected]

Social workers and eHealthExamples of relevant eHealth applications

Some example uses of eHealth that social workers could benefit from include:

• Online or telephone-based counselling services

• Remote supervision of junior social workers

• Online education and Continuing professional development (CPD)



The technical capabilities of social workers are generally rated as being low, but seem to be improving, particularly over the last decade (5% used computers 10 years ago, compared with 50% today). The AASW moved to introduce online membership renewal in 2009 and many members struggled with this, and older members in particular have struggled to adapt.

They AASW offers an online newsletter which about one third of members access regularly, and discussion forums online.

The commonest uses of computers are for email and data entry for the case management required by Government agencies. Use tends to lag a bit in the private sector where lots of invoices are still handwritten or typed out. About 50% of social workers regularly access the internet to get professional information, and those in the public sector are often required to enter information into an electronic medical record.


Several schools of social work offer distance education online, and there is some limited use of telehealth and tele-supervision programs for rural and remote health. There are also some private practitioners who use online tools, email and SMS to communicate with patients – mostly in the mental health area.

The uptake and rollout of eHealth in the social work profession will mostly depend on endorsement and support from employers. In areas where this has occurred like Centrelink which offers web-based client management systems – social workers skills have increased considerably. Very few social workers seek out the equipment and training they need on their own as the financial barriers are considerable.

The culture of social work really encourages at least one detailed face-to-face consultation with the patient, but continuation of management using eHealth tools is acceptable. Overseas much multidisciplinary care takes place using web-based tools but this is only just starting in Australia.

Many software products for social workers have been developed in the USA but are not available in Australia.

Social workers will find it difficult to accept the PCEHR due to their strong commitment to privacy and confidentiality of clients – this will be a major barrier to participation, particularly where patients have experienced traumatic events, such as sexual assaults.

The AASW is hopeful that the Government will encourage uptake by offering education and training in eHealth tools. It wants private practitioners to be offered financial incentives to upgrade their systems to the appropriate standards to use eHealth.


• Social workers are an older profession, with 41% of respondents over 55 years of age. 64% reported they saw less than 6 patients per day, and 49% work in more than one practice location. 46% work at least occasionally in a rural or remote area.

• The dominant use of computers amongst social workers is education and clinical reference (57% access online clinical reference material, 53% complete CPD online). Patient notes (34% use a computer to enter patient notes after a consultation) and completing event summaries (30%) are common applications. In many areas, social workers show strong interest in using computers more widely than they do currently, including collaboration (22% send or receive referrals electronically, while a further 44% would like to, 19% share health records with other practitioners electronically, while a further 34% would like to).

• 9% of respondents indicated they used telehealth applications, with 31% indicating they were likely to within the next 3 years. Interest in telehealth amongst social workers is largely for training (22% very interested), supervision (21%) and collaboration (15%).

• 34% of social workers store patient records entirely on paper, although 9% only use computers. Of the 66% who use computerised records in some form, 28% use an EHR. The expectation of computer use is high (for example 60% strongly agree they are expected to use computers) in comparison to the emphasis placed on shared patient records (28% strongly agreed they would like access to a shared patient record).

183

• Improving collaboration (30% strongly agree) and continuity of care (24%) are the leading perceived benefits of eHealth for social workers. Social workers also emphasised the potential to broaden their scope of services (23%), increase practice efficiency (22%) and increase number of referrals (20%).

• Infrastructure for social workers is less prominent than for many other allied health professions. In rural and remote areas, 53% of respondents indicated they did not have access to a computer, and 47% that they did not have internet connectivity.

• Affordability emerged as the largest barrier for social workers (47% strongly agree), while concerns about patient privacy were also strong (31%). A group of concerns about technology were also prominent (access to adequate IT support 38%, preference for established technology 27%, need to maintain compatibility 26%, concerns about malfunction or downtime 23%)

• The two leading influences for social workers are financial incentives (54%) and the advice of their professional body (44%).

Speech pathologistsOverview of size, composition and role

Overview of group

Description of profession Speech pathology, (previously called speech therapy), is the assessment, diagnosis, management and treatment of individuals who are have disorders of communication (speech, language, voice, fluency, social skills and behaviours, literacy and numeracy, problem solving and general learning) and/or swallowing and who are unable to communicate effectively or manage their nutritional status. Speech pathologists treat communication and swallowing impairments throughout a person’s life span. Speech pathology is a health service that is delivered across many jurisdictions including disability, education, aged care and the private sector.

Number Speech pathology is not a registered profession in any State except Queensland which makes it difficult to collect reasonable and accurate demographic data on the profession. It is estimated that there are approximately 6,500 practising speech pathologists in Australia. The 2006 census recorded 3,865 practising speech pathologists.

Speech Pathology Australia (SPA) has 4,000 fully-qualified practising members.Gender mix 97% female, 3% male


Distribution by age and location – speech pathologists




16

42

5

25

13

14

4

28

40

15

55+

45-54

35-44

25-34

0-24

28

1

1

2

8

11

20

29

1

1

3

9

11

19

27

30

ACT

NT

TAS

SA

WA

QLD

VIC

NSW

7

74

1

17

1

8

18

71

Remote

Outer regional

Inner regional

Major city


Exhibit 66


Overview of respondent practice attributes for speech pathologists% of respondents


5347

6-15

< 6


10

55

Four or more26

Three 9

Two

One


6

5

19

Never 67 Once a month or less

Monthly2


Daily


38

75+

57

50-74

225-49

2

<25

Exhibit 67

185


• To become a member of Speech Pathology Australia (SPA), completion of a SPA-accredited university course is required. The training course can be undertaken as a four year undergraduate Bachelor’s degree or a two year postgraduate Masters degree.

• In order to be eligible to register with Medicare, Speech Pathologists practising in Queensland must be registered with the Speech Pathologist Board of Queensland. In all other states, the Australian Capital Territory and the Northern Territory, they must be a ‘Practising Member’ of SPA.


• Eligible Speech Pathologists can access Medicare on referral from a GP (and in some instances, a psychiatrist or a paediatrician) through the individual allied health items for people with a chronic or terminal medical condition and complex care needs (MBS items 10950-10970); the follow-up allied health items for people of Aboriginal or Torres Strait Islander descent (MBS items 81300-81360); and the Helping Children with Autism or any other Pervasive Developmental Disorder items (MBS items 82000-82025).

• A range of bodies conduct specific programs which may pay for speech pathology services where eligibility is met and an appropriate referral from a medical practitioner has been provided to the speech pathologist. These include the Department of Veterans Affairs, WorkCover, vocational rehabilitation and motor accident authorities.

• Speech Pathology services can be rebated under certain ancillary tables of private health funds.

Peak National Body

Speech Pathology Australia www.speechpathologyaustralia.org.au Level 2 / 11-19 Bank Place Melbourne 3000 +61 3 9642 4899 +61 3 9642 4922

Speech pathologists and eHealthExamples of relevant eHealth applications

Some example of uses of eHealth that speech pathology clients could benefit from include:

• Computer-based speech training and therapy programs (always need supervision – either by therapist or parent/carer trained by therapist)

• Assessment, diagnosis and some treatment using telehealth (particularly in rural and remote areas)

• Online education and Continuing Professional Development (CPD) for professional self-regulation and contribution towards Certified Practising Speech Pathologist status

• Speech generating devices for people with complex communication needs

• Digital referrals and electronic health records



In the health sector, speech pathology adoption of technology is variable due largely to insufficient infrastructure investment to purchase hardware in the first instance, and secondly appropriate software programs. The profession uses a great deal of technology in different settings, such as the assessment of swallowing which uses computerised diagnostic imaging equipment. There is little use of electronic health records except where an individual agency has implemented a partial electronic health record. Speech Pathology Australia has always expressed commitment to and support in developing the PCEHR as part of the effort to improve overall health outcomes including allied health outcomes for clients. There is a general concern that many projects have been initiated but there is little tangible evidence at a practical level of success with an integrated electronic health record (other than individual arrangements in facilities) and often allied health is not part of project scope.

Most speech pathologists undertake some of their training at public hospitals where access to necessary infrastructure for eHealth applications can be limited. Where this is the case, it can limit the opportunity to develop skills.

Speech pathology services are largely provided by face-to-face contact. In the health sector, agencies are paid for ambulatory allied health services. Community health centres generally have low levels of staffing to manage a diverse range of clients and often have to rely on attracting funding for specific programs. Availability of technology in public and community health settings is restricted. In the private sector about 30% of practices use electronic practice management and this has largely been driven by the use of electronic billing through HICAPS and Medicare.

Some electronically enabled therapy programs are coming into use but they do require supervision by someone who has been trained to deliver, monitor and evaluate the program with the client. A greater evidence-base is needed to support some of these therapies. In some areas of practice eg. fluency treatment, there has been extensive use of the evidence base to inform the development of online fluency programs.

Telehealth techniques are also increasingly being used by speech pathologists in rural and regional Australia. Assessment, diagnosis and some interventions can be provided using telehealth programs. Limitations include lack of familiarity/acceptance by Indigenous people, and the lack of funding through Medicare for telehealth and case management for allied health practitioners.

Much of speech pathology work is undertaken as part of a multidisciplinary team, and electronic records and referrals can make it easier to manage patient care across the multiple health professionals involved in their care and across multiple settings when patients are transferred. At present this occurs in settings like rehabilitation where a multidisciplinary approach to patient care is the standard.

Key barriers to eHealth adoption are the lack of appropriate funding structures under Medicare for allied health services, and poor access to services. Software vendors are not motivated by the allied health market which is too small and too fragmented, and the products available are much too medical-centric and lack relevance for allied health practitioners. There is also the issue that the professions which do not yet have national registration but are self-regulated are likely to need to undertake more steps to be able to access the health identifier system.

187

Drivers for uptake of ehealth will include education and the availability of products that make jobs easier and introduce efficiencies into practice. A standard toolkit for practice which includes a standardised eReferral system for speech pathology would be a great help according to Speech Pathology Australia.


• 47% of respondents saw fewer than 6 patients per day. 45% worked at more than one practice location. 33% worked at least occasionally in a rural or remote region.

• Education was the leading application of computers for speech pathologists (56% access clinical reference materials online, 48% complete CPD online). However, for many applications, speech pathologists show significant interest in making greater use of computers although current adoption is low. Collaboration (20% send or receive referrals online, while a further 66% would like to, 20% share health records with other practitioners online, while a further 63% would like to), note-taking (31% use a computer to enter patient notes after a consultation, a further 55% would like to) and patient education (20% use a computer to show patients health-related information, a further 55% would like to) are the leading examples.

• 18% of respondents indicated they used telehealth applications, with 28% indicating they were likely to within the next 3 years. Interest in telehealth amongst speech pathologists is split between training (11% very interested), monitoring patients remotely (11%) and consultations with other practitioners (11%).

• 32% of respondents used only paper records, and just 1% only used computerised records. Of the 68% using some form of computerised records, 27% use an EHR. Expectations of computer use amongst speech pathologists are high (82% believe the majority of their colleagues use computers), although access to a shared patient summary was not universally desired (45% strongly agreed they would like access).

• Affordability was the dominant barrier to further eHealth adoption suggested by speech pathologists (51% strongly agree), followed by the availability of adequate IT support (31%) and concerns about patient privacy (25%). Other technology concerns registered strongly (e.g., maintaining compatibility internally 25% and externally 24%) as did the effect on productivity (24%).

• Two dominant adoption drivers emerged for speech pathologists – the advice of their professional body (50% strongly agreed) and financial incentives (48% strongly agreed).


Appendix 4 – eHealth readiness survey questionnaire Welcome to the National Technology in Healthcare Survey of Allied Health Practitioners• This survey has been commissioned by the Federal Department of Health and Ageing, and is

endorsed by Allied Health Professions Australia

• It is designed to measure the use of technology by allied health practitioners in the provision of healthcare in Australia

• This survey has been approved by the Australian Government Statistical Clearing House. The approval number is 02171-01. You may phone the Statistical Clearing House on (02) 6252 5285 to verify the approval number

• The survey is an on-line, self-completion survey which should take approximately 15 minutes to complete

• To minimise the time required for completion, this survey’s content is focused on specific priorities. The findings will be supplemented by further separate research activities.

• The survey is hosted by Action Market Research, an independent market research company

• Your participation in the survey is greatly appreciated, and will help to provide representative results for your particular allied health Profession

• All of your responses will be kept strictly anonymous, confidential and only reported in an aggregate for your profession

• Please complete the survey as soon as practicable, but before April 21st, 2011

• Please follow all instructions on-screen during the survey

FIRST, SOME INITIAL QUESTIONS ABOUT YOU AND YOUR MAIN PRACTICE.....

S1 Your main specialty or category of allied health profession [CLICK ON ONE] Aboriginal Health Worker m

Audiologist m

Chiropractor m

Dentist m

Dietitian m

Exercise physiologist m

Occupational therapist m

Optometrist m

Osteopath m

Physiotherapist m

Podiatrist m

Psychologist m

Radiographer / Ultra-sonologist m

Social worker m

Speech pathologist m

189

S2 What is the postcode where your main practice is located? [TYPE IN]

If you do not know the postcode, click here m

[IF POSTCODE IS TYPES IN, SKIP TO I1. IF POSTCODE IS NOT TYPED IN, GO TO QUESTIONS BELOW.] [THIS IS AN AUTO-CUE NOT SEEN BY RESPONDENT]Click on your State / Territory below:NSW m

VIC m

QLD m

WA m

SA m

TAS m

NT m

ACT m

Type in the city or town where your main practice is located

L1 At how many different practice locations do you normally see patients? One location m

Two locations m

Three locations m

Four or more locations m

L2 Approximately what percentage of your income is derived from each of the following sources? [TOTAL SHOULD EQUAL 100%]

a) A salaried position in the public sector ___%b) A salaried position in the private sector ___%c) Fee-for-service income in the private sector ___%


L3 [IF I2(a) < OR = 50%] [OTHERWISE SKIP TO I4] [THIS IS AN AUTO-CUE NOT SEEN BY THE RESPONDENT] PLEASE ANSWER ALL REMAINING QUESTIONS IN RELATION TO THE MAIN PRACTICE LOCATION USED FOR YOUR PRIVATE SECTOR WORK.

What is the primary setting of your main practice in the private sector? [CHOOSE ONE]Private hospital m

Private rooms or clinic, not attached to a hospital m

Laboratory or radiology facility m

Community health centre m

Patient home or premises m

Other m

If “Other”, please describe the primary setting in your own words:

L4 [IF I3(a) > 50%] [OTHERWISE SKIP TO I5] [THIS IS AN AUTO-CUE NOT SEEN BY THE RESPONDENT] PLEASE ANSWER ALL REMAINING QUESTIONS IN RELATION TO YOUR MAIN PRACTICE LOCATION.

What is the primary setting of your main practice? [CHOOSE ONE]Public hospital m

Private rooms or clinic, not attached to a hospital m

Laboratory or radiology facility m

Community health centre m

Patient home or premises m

Private hospital m

Other [SPECIFY] m

If “Other”, please describe the primary setting in your own words:

L5 [ASK ALL – AUTO-CUE] How many days per week in an average week do you see patients at your main practice location? [CHOOSE THE ANSWER THAT BEST FITS]1 day per week m

2 days per week m

3 days per week m

4 days per week m

5 or more days per week m

191

L6 How many patients do you see in an average day, at your main practice location? [CHOOSE THE ANSWER THAT BEST FITS]5 or fewer patients per day on average m

6-15 patients per day on average m

16-25 patients per day on average m

More than 25 patients per day on average m

L7 How frequently do you practice in a rural or remote area in Australia? Daily m

Weekly or fortnightly m

Monthly m

Less than once a month m

Never m

L8 [IF I7 = 2 OR 3 OR 4] [OTHERWISE SKIP TO I10]

When you practice in a rural or remote area, do you typically have computer access in the practice setting? Yes m

No m

L9 [IF I7 = 2 OR 3 OR 4] [OTHERWISE SKIP TO I10]

When you practice in a rural or remote area, do you typically have internet access in the practice setting? Yes m

No m

L10 [IF S1 DOES NOT EQUAL “ABORIGINAL AND TORRES STRAIT ISLAND HEALTH WORKER”] What proportion of your patients are aged 65 or over?0-25% m

26-50% m

51-75% m

76-100% m

NOW, SOME QUESTIONS ABOUT YOUR USE OF TECHNOLOGY IN YOUR MAIN PRACTICE.


Q1 Which of the following do you have access to in your main practice, that is, accessible to you in your own room or office, not just in a secretary’s office or receptionist area? [CLICK “YES” OR “NO” FOR EACH ITEM BELOW]

Yes Noa) A desktop computer m m

b) A laptop or notebook or tablet m m

c) A dictation device m m

d) Videoconference facilities m m

e) Internet access m m

f) A mobile phone m m

Q2 [IF Q1(a) = 1 OR Q1 (b)=1] [OTHERWISE SKIP TO Q3] [THIS IS AN AUTO-CUE NOT SEEN BY THE RESPONDENT]

Is the primary computer in your own room or office less than 3 years old? Yes m

No m

Don’t know m

Q3 [IF Q1(c) = 1] [OTHERWISE SKIP TO Q4] [THIS IS AN AUTO-CUE NOT SEEN BY THE RESPONDENT]

Is your dictation device a digital or analogue recorder?Digital m

Analogue m

Don’t know m

Q4 [IF Q1(e) = 1] [OTHERWISE SKIP TO Q5] [THIS IS AN AUTO-CUE NOT SEEN BY THE RESPONDENT]

Is your internet access broadband? Broadband m

Not broadband m

Don’t know m

Q5 [IF Q1(f) = 1] [OTHERWISE SKIP TO Q6] [THIS IS AN AUTO-CUE NOT SEEN BY THE RESPONDENT]

Is your mobile phone a Smartphone, which means you can use it for web browsing?Yes m

No m

193

Q6 [ASK ALL] [AUTO-CUE] Are patient histories and records at your main practice location stored entirely as paper files, or entirely on computers, or as a combination of paper-based and computerised files?

a) Entirely as paper files m

b) Entirely on computers m

c) A combination of paper-based and computerised files m

Q7 [IF Q6 = 2 OR 3] [OTHERWISE SKIP TO Q9] [THIS IS AN AUTO-CUE NOT SEEN BY THE RESPONDENT]

In your main practice, do you currently use an electronic health record? In other words, do you maintain information about your patients’ health status and health care in a computer-readable format?Yes m

No m

Q8 [IF Q7 = 1] [OTHERWISE SKIP TO Q9] [THIS IS AN AUTO-CUE NOT SEEN BY THE RESPONDENT] What is the name of your electronic health record system that you currently use? Allscripts Ambulatory EHR m

BOSSnet DMR (Core Medical Solutions) m

CareView m

Cerner Acute Care EMR m

Cerner Ambulatory EMR/EHR m

CHI-Datum (Charmhealth) m

GE Healthcare Centricity® Clinical Information Systems m

InterSystems TrakCare m

iSoft Clinical Management m

Medical Director (Health Communication Network) m

Meditech Enterprise Medical Record m

Mitrais MMS Suite m

Oacis EMR (Telus Health Solutions) m

OceanEHR (Ocean Informatics) m

OrionHealth EHR m

QualSoft EHR Software m

TotalCare Clinicals m

Other m

Don’t know m

[IF OTHER] [AUTO-CUE] Type in the name of the system you use:


Q9 [IF Q1(a) = 1 OR Q1(b) = 1] [OTHERWISE SKIP TO Q10] [THIS IS AN AUTO-CUE NOT SEEN BY THE RESPONDENT]

Does your main practice use any of the following security techniques? [CLICK “YES” OR “NO” FOR EACH ITEM BELOW]

Yes No Don’t knowa) Password protected access to computers m m m

b) Password protection or encryption of sent or received files

m m m

c) A practice IT security policy, which might include requirements for changing passwords, the use of firewalls, anti-virus software, and system updates

m m m

d) A disaster recovery plan, which might include regular back-ups of data and offsite storage for data back-ups

m m m

[Q10 was omitted from survey]

Q11 For each of the following statements about the use of computers and technology in healthcare, please indicate if you strongly agree, somewhat agree, somewhat disagree, or strongly disagree.....

[CLICK YOUR LEVEL OF AGREEMENT OR DISAGREEMENT WITH EACH STATEMENT]Strongly disagree

Somewhat disagree

Somewhat agree

Strongly agree

a) It is important that I use the most up-to-date computer systems in my practice

m m m m

b) In my sector, it is expected that I use computers as part of my daily work

m m m m

c) Most practitioners in my professional network use computers regularly within their practice

m m m m

d) Using computers helps reduce the risk of error in my sector

m m m m

e) I would like computerised access to a shared patient summary that includes basic health records

m m m m

f) I like to be an early adopter of new computer systems and software for my practice

m m m m

195

Q12 For each of the following activities in your main practice, please indicate if you use a computerised system, or do not use but would like to have a computerised system, or do not use a computerised system and do not think you need one. [CLICK ON AN ANSWER FOR EACH STATEMENT]

Use a computerised system

Don’t use but would like

Don’t use and don’t need

a) For sending referrals to or receiving referrals from other practitioners

m m m

b) For transferring prescriptions to the pharmacy

m m m

c) To provide interactive decision-making support for prescription ordering or medication management

m m m

d) For ordering pathology tests m m m

e) For viewing pathology results m m m

f) To provide interactive decision-making support for ordering diagnostic tests

m m m

g) For ordering diagnostic imaging m m m

h) For viewing diagnostic imaging results m m m

i) For completing event summaries such as a hospital discharge summary or specialist report

m m m

j) For sharing health records with my patients

m m m

k) For sharing health records with other practitioners

m m m

l) For patient booking and scheduling m m m

m) For billing and patient rebates m m m

n) To view and/ or record patient information during consultations

m m m

o) To show patients health-related information during a consultation

m m m

p) To enter patient notes after a consultation m m m

q) To communicate with patients before or after consultations about health-related issues

m m m

r) To access online clinical reference tools m m m

s) To complete continuing education and training courses

m m m


Q13 This is a question about “telehealth” which is the use of broadband-enabled information and communication technology to deliver health services, expertise and information remotely. It includes both clinical elements of the health care system such as remote consultations with patients, and non-clinical elements such as remote training.

Are you already using any Telehealth services?Yes m

No m

Q14 [IF Q13 = 1] [OTHERWISE SKIP TO Q15] [THIS IS AN AUTO-CUE NOT SEEN BY THE RESPONDENT] Please indicate whether you use each of the following Telehealth services: [CLICK “YES” OR “NO” FOR EACH SERVICE]

Yes Noa) Monitoring patients remotely m m

b) Holding consultations with patients m m

c) Holding consultations with other healthcare practitioners m m

d) Training m m

e) Supervising m m

Q15 [IF Q13 = 2] [OTHERWISE SKIP TO Q17] [THIS IS AN AUTO-CUE NOT SEEN BY THE RESPONDENT] Within the next 3 years, what is the likelihood that you will start using any telehealth services? Will you....Definitely start using telehealth services m

Probably start using telehealth services m

Probably not start using telehealth services m

Definitely not start using telehealth services m

Q16 [IF Q15 = 1 OR 2] [OTHERWISE SKIP TO Q17] [THIS IS AN AUTO-CUE NOT SEEN BY THE RESPONDENT] In the next 3 years, would you be very interested, somewhat interested, or not interested in using telehealth services for each of the following applications? [CLICK ON AN ANSWER FOR EACH APPLICATION]

Very interested

Somewhat interested

Not interested

a) Monitoring patients remotely m m m

b) Holding consultations with patients m m m

c) Holding consultations with other healthcare practitioners

m m m

d) Training m m m

e) Supervising m m m

197

Q17 This question is about eHealth, which we broadly define as the combined use of electronic communication and technology in healthcare. Some examples of eHealth solutions include sharable electronic medical records, e-discharge summaries, e-prescribing, e-pathology and e-referrals.

Please indicate if you strongly agree, somewhat agree, somewhat disagree, or strongly disagree that eHealth will deliver the following benefits: [CLICK ON AN ANSWER FOR EACH STATEMENT]

Strongly disagree

Somewhat disagree

Somewhat agree

Strongly agree

Don’t know

a) Improve my practice’s efficiency

m m m m m

b) Improve my ability to collaborate with other care providers

m m m m m

c) Increase patient safety at my practice

m m m m m

d) Increase my patients’ engagement in managing their health

m m m m m

e) Improve continuity of care for my patients

m m m m m

f) Increase my patients’ satisfaction level

m m m m m

g) Increase the number of referrals to my practice

m m m m m

h) Broaden the scope of services offered by my practice

m m m m m

i) Reduce my exposure to legal risk

m m m m m

j) Improve relationships with my patients

m m m m m

k) Improve my care delivery process

m m m m m

l) Increase access to care in my specialty

m m m m m

m) Improve the quality of care in my specialty

m m m m m


Q18 Which of the following factors might influence or encourage you to adopt eHealth solutions more rapidly or more extensively? Please indicate if you strongly agree, somewhat agree, somewhat disagree, or strongly disagree that each factor will have an influence on your eHealth usage? [CLICK ON AN ANSWER FOR EACH STATEMENT]

Strongly disagree

Somewhat disagree

Somewhat agree

Strongly agree

a) If other practitioners in your network requested that you adopt eHealth solutions

m m m m

b) If you faced demand from your patients m m m m

c) If you were asked to use the solutions by your support staff

m m m m

d) If you were advised to use eHealth solutions by professional bodies

m m m m

e) If you were offered financial incentives to adopt eHealth solutions

m m m m

f) If you gained respect and recognition from the medical community for being an early adopter of eHealth solutions

m m m m

199

Q19 Which of the following factors might act or did act as barriers to you adopting and using eHealth technology in your main practice? Please indicate if you strongly agree, somewhat agree, somewhat disagree, or strongly disagree that each is a barrier: [CLICK ON AN ANSWER FOR EACH STATEMENT]

Strongly disagree

Somewhat disagree

Somewhat agree

Strongly agree

a) Your practice can’t afford the initial and continued technology investment

m m m m

b) You are concerned about a drop in productivity during the transition

m m m m

c) It takes too long to access and use the technologies

m m m m

d) You can’t find a solution that meets your needs

m m m m

e) Your practice needs to maintain compatibility with your existing IT systems

m m m m

f) Your practice needs to connect your IT systems with those used externally

m m m m

g) You are concerned about system malfunctions or downtime

m m m m

h) You are concerned about breaches of patient privacy

m m m m

i) You don’t think that practitioner performance data should be made public

m m m m

j) It is too difficult to select and implement a new system

m m m m

k) You don’t have access to adequate IT support

m m m m

l) Others in your practice are resistant m m m m

m) There aren’t enough people using these systems for them to provide a real benefit to you

m m m m

n) You prefer to wait until technology-based systems are proven and well-established before adopting them

m m m m


Q20 What single factor would most persuade you to increase your adoption of eHealth solutions? [TYPE YOUR ANSWER IN YOUR OWN WORDS]

Q21 Are you a member of any Australian health-related professional body or association? Yes m

No m

Q22 [IF Q21 = 1] [OTHERWISE SKIP TO Q23] [THIS IS AN AUTO-CUE NOT SEEN BY THE RESPONDENT] Which Australian body or association are you most closely aligned with? [TYPE IN THE NAME OF THE BODY OR ASSOCIATION]

Q23 In which year were you born? [Optional question]1 9

Q24 [ALLIED HEALTH PRACTITIONERS] [THIS IS AN AUTO-CUE NOT SEEN BY THE RESPONDENT] In approximately what year did you first start practicing?1 9 or,2 0

Q25 Outside of work, how many hours do you spend on the internet each week for personal reasons? Do not include time you spend on e-mail or instant messaging or work-related internet activities [CHOOSE ONE]None m

Less than 3 hours per week m

3 to 10 hours per week m

More than 10 hours per week m

Q26 And finally, is English your first language?Yes m

No m

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