Spending on healthcare IT is set to surge as governments around the world seek to reduce healthcare costs amidst aging population growth and also driven by a demand for healthcare systems integration, noted a report by research firm Markets and Markets.

The report forecasted that global healthcare IT spending will rise from 2012's US$40.4 billion to US$56.7 billion by 2017.

In Asia there is a major focus among countries like Hong Kong, Singapore and Australia to develop national e-health record (EHR) systems as a basis for transforming healthcare delivery.

The integration of systems and patient data across key institutions and healthcare providers is seen as a key enabler for driving up the quality of healthcare delivery.

Dr William Hersh, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology (DMICE), Oregon Health & Science University, spoke recently in Singapore on the area using operational e-health record (EHR) data.

He noted that there has been substantial investment in the US with up to US$27 billion to adopt EHR systems. "The Health Information Exchange--a system in the US that allows for sharing of patient data across platforms and geographies, similar to the systems in Hong Kong and Singapore--have afforded healthcare authorities a unique bird's-eye view of patients who get their care in different places," said Hersh.

Eyes on the prize

While this rush to implement EHR systems gathers pace, some observers warn against placing too much importance on the concept of a national e-health record at the risk of losing sight of the end goal.

"I don't actually buy the idea that Singapore or Hong Kong is leading the region in strategic e-health delivery," said Matt Hector-Taylor, CEO of health software provider, HSA Global in New Zealand. The focus in New Zealand has been more about building standard interfaces to enable a variety of parties to access, read and update patient information across different systems while enabling a new approach to healthcare that pushes health delivery away from hospitals and out to the wider healthcare community.

Hector-Taylor, who spoke during an interview at the HIMSS Asia Pacific 2013 conference / Greater China eHealth Forum held recently in Hong Kong, is not convinced that the national EHR concept is core to the overall strategy of improving and transforming healthcare. "The fact that these countries will get these EHR systems live within budget and on time is commendable and we want to see it work and generate value, but these systems in themselves are not going to deliver better healthcare," he said. "The question is: are these EHR systems actually changing any practices around healthcare?"

Hector-Taylor noted the technology in these systems is great but if these systems do not actually change the way people receive healthcare, or enable a cheaper and better method of healthcare, then what have they achieved?

He added that there are clear use-cases for a national EHR with scenarios of patients moving from region to region or appearing in a hospital that has no prior record of treatment in that area. "But does that scenario really transform healthcare?"

Health practice rethink

Most observers including Hector-Taylor agree that there will be benefits from implementing EHR systems. But the critical elements are the transactional pieces around a patient receiving better healthcare -- will the patient when dealing with multiple touchpoints actually get better, cheaper care as a result? That is the question that must be answered.

"There needs to be a thorough rethinking of new workflows and practices -- right now I still see a separation of workflow and health practice from the information and systems that are being developed," he said.

Stephen Lieber, President & CEO of HIMSS agreed that starting the journey to better healthcare with a focus on delivering an EHR platform and just "seeing where it takes you" would not deliver the right goal. "By focusing on real healthcare-oriented goals and metrics--such as patient satisfaction, speed of treatments--and working backwards from there, there is a better chance of making real progress," he said.

Without commenting on specific countries, Lieber noted that the risk for some markets is the fear of trailing other parts of the world in developing systems. "A catchup mentality can be adopted rather than a strategic mentality aimed at delivering a more strategic goal around improving healthcare."

HSA Global is working with institutions in New Zealand, Australia and Singapore to rethink healthcare delivery around the idea of continuous and community care. This involves not just standardizing data and systems but also rethinking workflows, the roles of individuals and institutions that interact with patients.

Australia is one market that also has seen lots of attention on leading adoption of EHR systems but Hector-Taylor again casts doubt on the real value. "Rather than upset anyone by not proposing any changes to workflows or healthcare structure, Australia has simply said it will digitize all patient data," he said. "That simply takes a manual mess and turns it into a digital mess and quite possibly not even a comprehensive digital mess."

(By Chee-Sing Chan)