IT consumes billions of dollars each year, causes heated political debate and touches every man, woman and child in the country.
Australia's healthcare industry provides vital services to the nation's 20 million-strong population. A complex mix of public and private facilities, it struggles to meet ever-increasing demands.
Just as information technology has dramatically changed the way the corporate business world operates, so too the healthcare industry has embraced its offerings. Seeking ways to streamline processes and improve care quality, major investments have been made in clinical equipment and support systems.
But while significant advances have been seen, healthcare providers are constantly looking for further ways in which technology can provide assistance. Increasingly, attention is turning to data communications and networking as an area offering considerable potential.
Many healthcare providers recognise the inherent inefficiencies that exist in large areas of their operations. Traditional processes, many of them paper-based, worked well in the past but have the potential for radical overhaul.
When it comes to the movement of information both within and between organisations and healthcare providers, there is significant room for improvement. There is also pressure, both from providers and government, to move to a system of electronic patient records. In New South Wales, for example, a deadline for e-records has been set for 2010.
But while the advantages of electronic records and patient data seem clear, convincing doctors of the case can take time. In the Hunter Valley of New South Wales, one group is working to link doctors via broadband Internet connections to allow ready exchange of information, but getting their buy-in to the project has been a challenge.
The Hunter Urban Division of General Practice (HUDGP) has been working to link general practitioners in the region to a broadband network. HUDGP's IT director Dr Malcolm Ireland says busy doctors don't have a lot of spare time to learn a new system and so take-up of the service has been a little slower than expected.
"It really is a long-term vision for us," he says. "But we can see that a lot of what is currently paper-based work can easily be transferred to an electronic form and sent over the broadband network."
Ireland believes the network will grow from the existing 60 GP users to more than 400 within the next couple of years. The organisation is working with Hunter-based ISP HunterLink to build the necessary infrastructure. The company is also working to ensure GPs have appropriate security software installed on their practice PCs.
The network is based on Cisco routers with in-built security capabilities. Each user site, or practice, has a 512 Kbps ADSL link, which effectively replaces multiple phone lines used for fax machines and dial-up connections.
In another example of co-operative adoption of technology, a group of rural Victorian hospitals has implemented an IP-based network linking 33 sites. Dubbed the South West Alliance of Rural Hospitals (SWARH), the group uses the network for everything from telephone calls to sharing of clinical data.
SWARH's chief information officer Garry Druitt says the original vision for the network was to build a capability to deliver voice, video and data over a single connection.
"We were looking for something that could continue to evolve in the future and so IP was the natural choice," he says. "We started with wanting to simply route phone calls and do some video conferencing. We've achieved that and a whole lot more."
Druitt says the network is now routinely used by doctors to provide remote diagnosis and treatment recommendations for patients. Rather than travelling, patients and doctors can converse via video links.
Based on microwave links, the network has been built by Dimension Data using Cisco routers. Redundant links have also been incorporated using ISDN. The network, called SWARHnet, is operated by telecoms carrier AAPT with Telstra providing last-mile links where required.
Druitt says that, as well as improved efficiencies, the network has resulted in a significant reduction in telecommunications costs. "We are working to remove a number of outdated PABXs from hospitals in the region, reducing the total number from 16 to two," he says. Calls are routed by an IP server, with changes and additions made at will. Support staff costs have also been slashed.
Druitt says the future vision for the network includes implementing a single portable device for clinical staff capable of providing voice, data and video services. There will also be opportunities for video conferences between patients and friends in other locations.
"Other Australian states are looking closely at our trial and we expect some of them to begin implementing a similar system in the not-too-distant future. The benefits that flow from it are simply too impressive to ignore."
As well as groups of hospitals using networks to improve communications and share vital data, many are finding uses internally for the technology. By critically looking at established ways of working, new systems can be designed that bring significant benefits.
At the Sydney Adventist Hospital, a 320-bed private facility, Internet technology has been used to allow doctors to access patient records and clinical data regardless of their location.
Adventist information systems manager Chris Williams says the hospital had been using an ageing extranet facility for some years, but a recent security review had showed areas that needed to be improved.
"It was also rather complex to manage as doctors needed to have special client software installed on their PCs and configured to dial into the hospital system," says Williams. Once linked into the central computer, users had complete access, which was also of concern to the hospital.
Williams says the new system, which is web browser-based, can be configured to allow users access only to the parts of the system they require for their particular task. Certain records also can be limited to read-only status.
So, from any Internet-connected PC in the world, doctors armed with a log-on name and password can view patient lists and records, make theatre bookings and view pathology and radiology results.
"We've come to realise that providing top-quality patient care means having access to the right information at the right time in the right place. This network helps to make that happen."
Taking the Internet-based network model even further, the Victoria-based Mercy Health group is using it as a platform for virtually all IT support services, from administrative applications to patient record access.
The group has implemented a Citrix-based system for more than 1000 users across 10 hospitals and aged care facilities. Mercy infrastructure manager Simon Richardson says the system replaced an ageing client-server network that was becoming increasingly difficult to maintain.
"Users were also limited by slow dial-up links in regional areas, which limited how much benefit they could derive," says Richardson.
The Citrix system, based on MetaFrame Secure Access Manager, allows high-speed access to everything from Microsoft Office and other administrative applications to patient x-ray and pathology reports.
"Some 95 per cent of all our applications are now available to users," says Richardson. "The staff love it and wonder how they ever worked without it."
As well as the ability to access and share centrally held information, the Citrix-based system has also improved the use of email within the hospitals, bringing further improvements in efficiency through better communication. It has also enabled the hospital to use older PCs for access, rather than being forced into an expensive upgrade program.
As well as wired networks, many health institutions are turning to wireless technologies in the constant search for productivity improvements. Rather than writing patient details on bedside clipboards, doctors and nurses are using handheld computers to enter data which is transferred wirelessly to a central computer.
Matthew Jones, strategic relations manager with Intel, says Brisbane's Mater Private Hospital is one of the first in the country to trial wireless technologies based on the chip giant's Centrino technology.
Portable computers are being used to update patient details, order drugs from the hospital pharmacy and view medical test results. The trial uses two Wi-Fi hubs and five tablet PCs.
"It is making their lives a whole lot easier," says Jones. "We expect them to be more widely used after the trial."
However, the Adventist's Williams remains unconvinced about the benefits of wireless technology in wards. His hospital has instead opted to increase the number of PCs on each floor to allow staff immediate access to information. "For us this is more cost effective and seems to work well," he says.
Others point to increased security pressures that accompany the implementation of wireless technologies into hospitals. RSA Security vice president Richard Turner says wireless poses unique challenges that have to be carefully addressed.
"Wireless is very easy to set up and so sometimes it happens without proper thought about improper access," he says. "Once data is no longer contained within the four walls of a hospital problems can occur."
For many healthcare providers, the holy grail of technological progress is the implementation of completely electronic patient records. A concept that has been discussed and debated for more than five years, electronic records have the ability to streamline healthcare and improve efficiencies.
While the concept is relatively simple, implementing it across multiple regions and organisations is very complex. Standards have to be agreed, security protocols implemented and sharing agreements ratified.
Mercy's Richardson says there is still a long way to go before any hospitals will have a totally electronic patient record system, but that should not stop the progress towards it. Others agree, saying the full potential of high-speed networks will not be realised until the records are in common use.
Director of government, education and health at software giant Oracle, Mike McLaren says electronic records have been held back because different organisations have opted to implement different systems for their creation and storage. This makes the secure sharing of information extremely complex.
"Electronic records are the future but you can't have disparate systems or the advantages are lost," says McLaren. Oracle has developed a centralised storage system that can extract records from different systems and provide a single view, allowing cross-organisations sharing. Pilot trials of the system are taking place in Australia and Williams expects them to be rolled out during the next 12 months.
Communications technology has done much to improve the efficiency of Australian healthcare providers, but all recognise there is still much more to be done. However, if the pace of progress during the past couple of years is maintained, the goal of a seamless, cross organisational information system could be achieved.
