Aim of this QUM program: Medicines are paramount in both the treatment and prevention of disease and overall enhancing one’s health outcome. The necessity for QUM however stems from the fact that medicines are not without risk and in stating so, highlighting the concern for medicine management; quality, safety, efficacy and the degree of its accessibility to all Australians. A focus on hospital to community transition is critical in reducing public health issues. The period following discharge from hospital is a vulnerable phase for many patients. Patients that experience a lack of service coordination and assistance between health service transitions can result in poor continuity of care, consequently causing potentially avoidable outcomes such as re-hospitalisation (Kripalani et al, 2007). The QUM proposal involves a revolution in communication between health professionals. The government initiative, ‘ CommuHealth,’ will be a revolutionary secure online data base exclusively for the purpose of linking health professionals through email. Each health professional possesses a provider number, which in turn will be linked to a private CommuHealth email. Health professionals can instantly exchange information on a patient to one another and clarify anything that may not be clear. Reasons for developing this program: Medication misadventure resulting in morbidity and mortality is well documented within Australia, with evidence suggesting that patient transition between health settings and health care providers often result in sub-optimal use of medication and significant patient harm. Medication related errors can arise at any point. This is clear as 10% of all hospital adverse events are due to medication. Secondly, 12% of patients have an error in their discharge prescription. Also, 9% of patients were discharged from hospital with insufficient medicine supplies, 78% of general practitioners (GPs) were not directly informed that their patient had been admitted to hospital and 73% of GPs did not directly receive discharge summary information. Lastly, hospital re-admission or medicine related adverse event were at an increased risk of occurrence due to the exclusion of a drug from the discharge summary list received by community health care professionals (PGA, 2012). A gap in our country’s medicine management is well expressed in these statistics and demonstrates the necessity for a thorough revision of our current QUM program. Communication issues between health professionals were the most common source of preventable disability or death according to an Australian survey, and were almost twice as common then those due to insufficient medical skills (Zinn, 1995). Despite patients and their families experiencing considerable physical and emotional damage, these events are also financially disadvantaging. In current times, healthcare is becoming increasingly complex; therefore improving healthcare communication will encourage the safe delivery of patient care. Consequences of poor communication within the healthcare system is evident as reported by the NSW Special Commission of Inquiry. Inadequate communication and miscommunication between hospital staff and inadequate clinical handover was stated to be a major risk to patient safety. It was also reported that 20% of sentinel events (ranked as second most contributing factor) experienced within the public health system of Victoria were due to communication problems between staff, and staff and patient. Lastly, Queensland reported that during 2005-2006, 20% of sentinel events were due to communication failures (The Victorian Quality Council, 2010). Improving communication through various structural tools and strategies will optimise patient outcome including access to adequate and timely information that is required to perform roles efficiently. Launching CommuHealth will facilitate good communication. Email has been found to be the most effective route in delivering discharge reports to patient GPs, providing an efficient and secure means of communication (Chen, Brennan and Magrabi, 2010). It will be a mandatory requirement that all Australian health professionals register their provider number to CommuHealth (monitored via the Department of Health and Aging). Contacting a specific health professional will require a name search on the database followed by their provider number. A single health professional may have multiple sites of practice, each with their own provider number. Each provider number will be linked to a single email address. This will ensure that health professionals such as pharmacists, GPs and hospitals are linked, working in conjunction with one another, hence aware of what input each has had in the wellbeing of the patient. For example upon patient discharge, the hospital doctor in charge can forward the patient discharge information and prescription to the patient’s regular GP (via the addition of their provider number). Filling this void will aid in reducing the stretch on the already strained resources of the Australian health care system and decrease the burden of disease and disability on the population. This will have indirect positive results on the economy, as a healthier population means a more effective economy.
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Resources required: Funding is required. The development of CommuHealth will require a team of IT and security specialists as well as database administrators to design the application database and security system. A level of ongoing IT support will be required as well as training most probably online.
Innovation: As of July 2012, the Australian Government introduced electronic health (eHealth), an online record system of patient health information, allowing health care professionals to view this electronically (DHA, 2012). Despite being a commonly used method of communication, email is not used routinely in healthcare (Pappas et al, 2012). In fact, a secure means of email communication amongst health professionals does not currently exist. Enhancing communication will be greatly beneficial for both patient and health professional. CommuHealth will also facilitate secure communication between health professionals and pharmaceutical companies. For example, in the case of a product recall, GPs and pharmacists will be informed directly from the pharmaceutical company regarding the product concerns, eliminating any chance of miscommunication the media may otherwise influence. This will be beneficial across the spectrum, aiming to provide effective and sustainable education, promoting the quality use of medicines whilst developing a supportive environment.
Technical factors: Technology is available to facilitate both the hardware infrastructure and development of this software. Security: Optimal security to protect both the patient and health professionals will be achieved through the use of Secure ID token plus pin and encrypted data base content. Economic factors: There will be initial development and ongoing support costs, however in the long term; the benefits will outweigh the costs due to the reduction of medical misadventure and hospital re-administration expenses.
Phased roll out of CommuHealth commencing with large rural areas and expanding to smaller states. Once success is verified it will be further implemented across the country. Improving Health System Welfare: CommuHealth will provide increased communication between health professionals via a secure manner. Environmentally friendly: The future use of paper documentation may become obsolete, requiring an online system to transfer information, which can be fast tracked with CommuHealth.