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The primary e-commerce tools for improved clinical practice are
information management tools which provide practitioners with real-time
access to information needed in clinical decision-making:
• information from the patient’s health record including previous
history, investigation results and treatment; and
• information on clinical best practice and evidence about intervention
which is customised to the particular situation (for example contextdependent
information on drug interactions which is shown as an alert
when prescriptions are being written).
A necessary precondition for these benefits to arise is a system of
electronic health records. It is suggested that the first step (with the
greatest potential pay-off) comes from having an online medication
history available to treating doctors and pharmacists, along the lines of
the Pharmacy Intranet project of the Pharmacy Guild of Australia.
Efficiencies in logistics and administration
There are significant benefits to health care providers and patients from
electronic scheduling and practice management information systems
which permit something more like ‘just-in-time’ best practices in
scheduling and waiting for medical services. For example, it is possible to
reduce length of stay in hospital by more efficient scheduling of tests
required before hospital procedures in gastroenterology. Families of
children with major disabilities can benefit greatly from integrated
appointments systems which would reduce the need for multiple visits to
hospital by scheduling all related appointments on one convenient day.
There are pilot projects which demonstrate these benefits but as yet little
application of these tools to Australian health care.
There are significant efficiencies to be had by implementation of
e-commerce systems among health providers, the health insurance funds,
the Health Insurance Commission (HIC), financial institutions and
consumers. There are several significant trials of claiming systems in
Australia but there is as yet no widespread system which is interoperable
among all the participants in the healthcare payments network. Major
benefits driving HIC is the reduced transaction costs of electronic
claiming and the cost reductions available from closing inefficient
branches. It has been estimated that paper-based claims cost insurers
$3–$5 and that electronic processing would cost $0.70.
6.4 New costs
The benefits of e-commerce in the health sector will only be achieved if
new e-commerce systems are implemented, and these will involve some
new intermediaries. The major issue for the Australian health system, with
its mix of public and private provision, is who will pay for new facilities
and who will control potentially powerful gateways.
Control and financing of information management facilities
The information management applications discussed above presuppose
powerful new information systems:
• Patient information systems which have interoperable electronic health
records which permit information transactions among health providers
and with patients with appropriate security, data protection and
authentication services to meet the complex legal and ethical
requirements of the health system. These systems will require extensive
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