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Friday, 28 October 2011 17:13

Seeking the e-health elixir


150-haikerwalWhen the discussion turns to e-health Mukesh Haikerwal locks eyes - he rarely glances away but examines your reaction with diagnostic concentration. It's no doubt a skill honed as a GP, but it is still slightly unnerving.

Government, its agencies, health departments and the IT sector may all on occasion try to stare him down but Haikerwal won't blink in terms of what he wants from a national e-health programme. As the national clinical lead for Australia's National E-health Transition Authority (Nehta) Haikerwal is determined that technology can completely reform Australia's health sector and deliver improved, more sustainable services to Australians.

He has for years fought unsustainable status quos, ever since he was an uppity junior doctor in the UK railing against the long hours forced on young doctors. Today he's 50 and a highly visible member of the establishment, a former president of the Australian Medical Association, an Officer of the Order of Australia, and was appointed chair of the World Medical Association in April.

That he remains such an engaged and driven professional is particularly remarkable given the fact that in 2008 he was the victim of a senseless attack in Melbourne by a group of thugs which left him literally at death's door. Haikerwal made a remarkable recovery and is now seemingly more passionate and engaged than ever.

300-haikerwalHe's had 40 years to hone both his skills and views having decided at the age of 10 to become a doctor - and specifically a GP.

 'I was born in India of Indian heritage in a place called Lucknow which was what the British would call the place of the Indian mutiny and the Indians would call the birth of the independence movement,' says the characteristically forthright Haikerwal.  The eldest of three sons (all of whom are married to doctors) born to a an electrical engineer  father and biochemist pioneer mother, Haikerwal spent his earliest years in West Africa before moving to boarding school, followed by university, in England.

The youngest medical student of the year at the University of Leicester, Haikerwal immediately plunged into the political fray, becoming the president of the medical student society and later appointed by the British Medical Association as a 'card holding union rep' where he was 'active in the junior doctor's movement around hours of work and terms and conditions.'

Haikerwal's family moved to Australia when he was still in medical school in the UK, and he and his doctor wife followed in 1990 and started a practice in Melbourne's western suburbs in 1991 which now has a team of seven doctors. He and his wife have also raised three of their own sons, two at school still and one at university.

Today Haikerwal bristles with technology. During the brief moments when his eyes dart away it's to glance at one of two mobile phones, an iPad or his laptop. 'When I worked as the Australian Medical Association president, my life was crucified by access to nonstop communications - mobile, email, fax - apart from Dover on the east coast of Tasmania where there's nothing I was completely ruled by that. It's good from a business point of view, good from a get the message point of view but certainly killed downtime apart from that one place.'

He wasn't always such a technophile.

'I was very antagonistic toward a movement around computerisation when I was at school - I was the traditional Luddite because I saw IT destroying career aspirations.

'All that changed going through training and seeing how much time was chewed up in an already very intense working month by doing rubbish. You could spend an entire night before a ward round finding X-rays or filing blood results and I actually streamlined the admission system in my hospital as a junior doctor by saying to the 'why the hell are we admitting patients to 33 wards?' On a good night I'd be walking 33 wards. '

He eventually convinced the hospital to admit patients initially to a ward next to the admissions office.

Technological and process reform have been high on Haikerwal's agenda for years. 'The changes to the (UK) National Health Service under (PM Margaret) Thatcher came in and we had Kenneth Clark as health secretary. I had a stand-up argument with him in his home constituency on TV in front of a national audience as a junior doctor which was quite interesting. '

The Thatcher reforms meant doctors had to prove what they were doing in order to get paid. 'I had two nurses two days a week to go through files, pull files and prove that all the women had smears, all the children had vaccinations, all the 75 year olds had had their checks - what a waste of resources.'

By the time he set up his own practice in Altona, west of Melbourne, Haikerwal was a confirmed technophile and developed his own billing system and database in the early days. He then bought a commercial computer system which proved a complete disaster and cost $50,000 to buy, install and then uninstall. Eventually a comprehensive billing and medical records management system was developed for the practice.

'I live in the western suburbs of Victoria - it's one of the most ethnically diverse places, so you have a large number of people from the whole united nations, but often not the ability to read or write and if they do it's not in English anyway. The multiple illnesses we treat because of age and predisposition and you find that the care they had was extraordinarily fragmented and multiple tests were repeated and repeated again,' he says.

Having access to a comprehensive, centrally available record remains critical.

Today the nation is battling similar issues albeit writ on a much larger scale. Australia has an ageing population, a ballooning health bill, and rising expectations from the population regarding access to efficient and effective healthcare.

Enter e-health. The Government has so far earmarked $467 million to get a national e-health system underway, introduced health identifier numbers for every Australian, and embraced the concept of a PCEHR, or personally controlled electronic health record, which will be at the centre of the e-health reforms -  providing a single central record of care for every Australian who wants one.

Ultimately Haikerwal believes that the PCEHR will prove the catalyst to move e-health forward in order to; 'Enhance the patient journey and professional access to information to make better decisions in a timely manner.'

Nehta is one of the core drivers of change - but in its early days the organisation had scant interaction with the clinicians who would be using the e-health systems it was conceiving, an approach roundly criticised at the time by Haikerwal.  To attempt to fix the problem he was invited into Nehta as clinical lead and today is a regular feature of e-health conferences and debates and also a lightning rod for discussion about how health professionals can and should make use of e-health systems.

'I'm an insider - but I'm not captured. If there's an issue I'm honour bound to express it and some people don't like that and that's too bad. I'm doing this because it's right for the patients I look after and it's right for my colleagues and it's going to lead to sustainability of Australian health care into the future. '

While describing investment in e-health as a 'no brainer' Haikerwal keenly understands that in a political climate which tends to focus healthcare debate around beds and nurses, e-health can be sidelined. 'In the political cycle it's always an afterthought or the one thing you drop off your ledger first to cut costs, rather than seeing it as an investment that will cut costs in the future

'My role as head of clinical leadership and engagement includes relationship building with all the communities - vendors, consumers, clinicians, governments, and making sure we are aligned. We're not - but there is good will and it's to really leverage that and it's across the political divide. The health identifier number got through parliament last year on 24 June - and the way that happened across both houses and both parties was because the background work had been done.'

300-haikerwalHe may in the future have a lot more background work to do. While Haikerwal believes that the personal computer remains the foundation platform for e-health in terms of providing access to records, that will be supplemented by portable or tablet computers. The real revolution though comes through access to ubiquitous high speed communications networks which can overcome the tyranny of distance and provide access to health professionals regardless of a patient's location.

'Absolutely the NBN is irreplaceable in the build - it's a major component. Like the railways of the past - it's something you can't move away from.'

And doctors and healthcare professionals can benefit significantly by embracing ICT he argues. 'In terms of technology,  what I didn't see initially is that yes, new technology is scary to start off with- but it increases your own productivity and your lifestyle and delivers the tools to do it more effectively, efficiently in a timely manner - and it doesn't knock off your profession, it enhances your profession.'


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