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New approaches to knowledge management for medical practice have
evolved under the label of ‘evidence based medicine’. This involves
systematic compilations of quality-assured clinical research findings such
as those of the global Cochrane Collaboration (which has an Australian
Centre supported by the National Health and Medical Research Council)
as well as development and dissemination of clinical practice guidelines.
The use of video conferencing facilities for patient consultation is
beginning to be used to provide access to specialist medical practitioners
for those in rural and remote areas. It is often impossible to attract and
retain specialist practitioners outside the major population areas. For
example, these ‘telemedicine’ facilities have been used for child psychiatry
consultations in Victoria and for monitoring of patient progress in renal
dialysis centres in South Australia.
Diagnostic pathology and imaging services
Diagnostic services are a widely used and rapidly growing part of the
health service picture. Although increased testing is a direct requirement
of new health treatments, there are considerable concerns about
increasing costs, unnecessary or inappropriate testing and multiple testing
because of failure to share test information among health practitioners
and agencies.
Pathology and imaging services are rapidly consolidating and many
services are highly automated internally. There are currently several trials
of electronic messaging for ordering of tests and for communicating
results back to referring medical practitioners.
Advances in telecommunications bandwidth, data compression technology
and medical telemetry permit the positioning of imaging, testing or other
monitoring devices remotely from the person interpreting the information
generated from these devices.
This is enabling developments such as:
• a specialist radiologist reviews images in real time without being in the
same location as the patient, with consequent increases in patient and
doctor convenience and reduced cost; and
• pathology testing or patient monitoring equipment can be located in a
patient’s home, with information communicated automatically to a
supervising hospital or medical practitioner, permitting safe home
treatments like intravenous administration of drugs which would
otherwise require hospital admission.
Community health and related community services
Integrated health care for the increasing number of people disabled by a
chronic health condition requires effective collaboration and
communication among many service providers. In the past, this has been
conveniently and cheaply provided in institutional settings but
changing patient demands, social attitudes and cost structures have
meant that the majority of such care is now provided to patients who
live in their own homes. Integrated care in the community is a major
issue for all providers.
A number of ‘coordinated care’ trials have been funded by
Commonwealth and State Government health authorities, and many of
these have involved an element of electronic messaging for transactions
among the different agencies. There are significant opportunities to
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