Review of State Health IT Budgets – A Mixed Bag to Say the Least.

We have now seen pretty much all the State Budgets that matter.

First we have NSW.

NSW Health gets $63m IT injection

Karen Dearne | June 16, 2009

NSW Health Minister John Della Bosca has committed more than $603 million to building better health infrastructure this year, with around 10 per cent going to IT projects.

The IT funding falls far short of the $700 million urgently needed to upgrade IT systems across the state's public hospitals before July 2011, as ordered by Special Commissioner Peter Garling in his searing review of the acute care sector.

Mr Della Bosca said the delivery of major IT initiatives to enhance patient services was "also a Government priority over the next four years".

For the moment, however, he allocated $63.1 million in 2009-10 "to upgrade business information technology, including medical imaging and clinical systems across the state".

"The Government is boosting health funding right across NSW to ensure local communities continue to have access to high quality services closer to home now and into the future," he said.

Most of the $603 million will be spent on rebuilding hospitals and regional health centres.

A further $485 million has been allocated to "Caring Together" initiatives, previously announced in March, when the NSW Government made its formal response to the Garling Report.

Rather than spending money on new IT systems to reduce the administrative and planning burden on frontline doctors and nurses, the Government plans to employ 500 clinical support officers, at a cost of $44 million per year, to take over the paperwork.

It will also employ 64 new clinical pharmacists, at a cost of $8.6 million, to improve patient safety by monitoring the use of medications.

More here:

http://www.australianit.news.com.au/story/0,24897,25646141-15306,00.html

This seems to me to be a relatively poor effort from the Health IT perspective. The deployment of more staff rather than enabling technologies shows how little the present NSW government understands about making the system sustainable in the longer term.

The papers refer to “the introduction of state of the art information systems such as the First Net Emergency Department software program” in 2008/09 so this can only be a good thing. (Page 13-6).

Sadly as mentioned in the article the “Caring Together” programme does not seem to really have the Health IT Mr Garling was suggesting.

We also see the following as the only e-Health nominated funding:

E-Health

“As part of its continued commitment to e-Health, the Government will invest $35.7 million over the next three years to continue its support of the National E-Health Transition Authority. This investment will commence with the allocation of $9.4 million in 2009-10.” (Page 13-12)

Oddly there is also this which is not tagged as e-Health (Capital):

“commencement of new Information and Communication Technology programs including the implementation of a new Community Health and Outpatients Information System, the upgrade of infrastructure, and further development of the department’s corporate information systems. These projects will enhance clinical and corporate information management and deliver improved service” (Page 13-15)

All sounds a bit like a refresh rather than new capital!

What I can’t find is what the recurrent expenditure for Health IT is. I suspect that is buried in the Shared Services Area to maximise how opaque it is. Anyone who can provide the figures I would be grateful for a comment!

Next report we have was here:

Health IT gets mixed funding in state budgets

Karen Dearne | June 17, 2009

QUEENSLAND has dug deep to add $270 million to its Health IT spending in this year's budget, while South Australia has performed a surprise U-turn, ripping $42 million from its planned e-health infrastructure program over the next four years.

In the SA Budget, only $8.3 million has been committed to new health ICT projects in 2009-10, down from $12 million in 2008-09, although a further $8 million has been allocated to continue work on a new clinical nursing and midwifery system.

"Savings initiatives" have rubbed out planned expenditure of $9.2 million next year, and $10.9 million, $11.3 million and $10.6 million in the years to 2012-13.

SA Health portfolio details show the foundation IT program has been stripped to just $890,000 next year, from $7 million this year.

No money has been allocated for "minor" technology projects, compared with $890,000 last year; there is also no money for a SA ambulance IT project, compared with $410,000 last year.

Lots more here:

http://www.australianit.news.com.au/story/0,25197,25650119-15306,00.html

I have already commented on South Australia. See here:

http://aushealthit.blogspot.com/2009/06/south-australia-works-hard-to-be.html

The ACT Budget was pretty early and is covered here:

http://aushealthit.blogspot.com/2009/05/aus-health-it-gets-some-facts-wrong-on.html

So we can push on to Queensland.

The key capital parts are here (Budget Paper 3 – Page 83) :

“In 2009-10, $84.5 million will fund provision of health technology equipment that supports the efficient delivery of safe, quality health services.”

And here

“A total of $87.1 million will be invested in 2009-10 in projects across e-Health Clinical Systems and other health systems. These are a series of interlinked projects that will contribute to the objectives of the e-Health strategy in delivering an electronic medical record to support a patient-centric, networked model of care to ensure location-independent delivery of health services. Key highlights of this investment include:

- ongoing statewide rollout of a new Radiology Information System enabling a significant reduction in the time taken for radiologists to view, assess and diagnose medical problems;

- implementation of digital technology for breast screening that will enable faster communication of the results to patients and the potential for improved detection of breast cancer;

- ongoing implementation of an Enterprise Discharge Summary to provide a more accurate care record to consumers and improve communication to General Practitioners; and

- Information and Communication Technology projects to enable secured system access, integration of existing systems and manage reference datasets.

$86.2 million for information and communication technology equipment to replace, upgrade and provide future capacity/capability to support the e-Health strategy and clinical information solutions. This investment incorporates telephone system replacements, network and server upgrades.”

This is all encouraging but again there is a theme of refresh of systems rather than newer ones – allowing that there are a few new ones – The RIS for example.

At least, other than the RIS, most of the planned expenditure is for ongoing programs previously announced. In total there seems to be about $55M for ongoing actual clinical e-Health expenditure. (Page 87)

This level of investment, given the false starts in the past, is really not all that impressive.

For Victoria we had a rather disappointing e-Health outcome.

This was even noticed by the AMA.

AMA Victoria underwhelmed by Budget

5 May 2009.

AMA Victoria has labelled the Victorian Budget “underwhelming”, saying it misses an opportunity for real action.

....

AMA Victoria was particularly disappointed that the Budget fails again to invest in information technology. HealthSMART has been very disappointing, and doctors are still lacking the basic IT tools needed to provide best possible care to patients.

“What’s missing from this Budget is a plan for health. There is no vision of how to care for a growing state’s health needs now and into the future. We need to invest more in training, in capacity, in IT and the drivers of reform.”

.....

“This Budget will see the Victorian health system continue to limp along rather than make great strides in caring for our sick.”

Full commentary here:

http://www.amavic.com.au/page/Media/News/AMA_Victoria_underwhelmed_by_Budget/

I must say the word ‘HealthSMART’ does not seem to appear in the budget papers at all – which I find very odd indeed! Seems like there is a plan to have it just ‘fade away’!

We do however find this:

The 2009-10 Budget also provides:

• $27 million over three years for Victoria's contribution to the National E-health Transition Authority to enable it to continue its existing work program (Paper 3 – Page 27)

(7.1M, 9.1M and 10.1M over the next 3 years) Page 315

On Page 323 we find.

National E-Health Transition Authority’s Core Operations

Funding is provided to support Victoria’s contribution to the National E-Health Transition Authority (NEHTA) for foundation work agreed to by the Council of Australian Governments. Funding will support identifier and authentication services to allow the development of a National Individual Electronic Health Record (IEHR) system.

This initiative contributes to the Department of Human Services’ Acute Health Services outputs.

This compares with this from 2007/08

“The hospital sector is an information intense sector increasingly dependent on reliable and up-to-date Information and Communications Technology (ICT) to support delivery of high quality, efficient and patient focused care. The government is investing $77 million over four years and $27 million TEI for new and upgraded ICT equipment to support the HealthSMART system.”

There appears to be about $26M pa for 4 years here but odd it is not mentioned this year.

Now we also have to move on to Western Australia and their eHealthWA programme:

Health Information

“• In 2006, WA Health commenced a 10 year program to implement eHealthWA, a major reform initiative designed to provide a modern, integrated platform to facilitate the delivery of world-class health services. The program aligns with the national eHealth program which aims to provide a national approach and framework for the delivery of information and the way it is used to deliver health services across Australia. In 2009-10, work will be progressed on the implementation of the pharmacy module, the planning and early implementation of a replacement Patient Administration System, and hardware and software technology to support eHealth.

• Currently, health information in Western Australia consists of many discrete ‘islands of Information’. eHealthWA will allow health information to flow regardless of where you interact with the system. It will provide access to information and clinical evidence at the point of care to support effective decision-making. That is, having the right information available to the right person at the right time in the right place. It will also allow information to be collected and analysed to guide management, funding and policy decision-making. Consumers, care providers and health care managers will all benefit from the introduction of eHealthWA.”

What is a bit of a worry is that this section does not mention any figures!

There is also some funds to keep NEHTA going.

It seems last year’s budget had some specific funds:

“This is 4yrs too late, and perhaps longer for many Western Australians. Why not ask the Minister and the IT Executive why the eHealthWA Program penned for 600m over 10yrs some 4 years ago has only just been kicked off? and at that with no more than 5% of the original allocation! This program addresses systems that are some 20yrs old, multiple point systems across hospitals with no way of seeing a holistic summary of service utilisation, no shared health records, no single patient ID, no effective medication management cycle management, a die'ing PC fleet, multiple information portals, some of the worst IT management practices in Australia, the list goes on. Health is very much Information Centric, beds are critical, emergency department spend is important, but we are some 10 to 15yrs behind any modern Hospital environment from an ICT perspective, and this is a significant contributor to enhance health delivery across the state.

Posted by: Bobby of Perth 7:55pm December 29, 2008”

http://www.news.com.au/perthnow/comments/0,21590,24852391-948,00.html

There is a recent presentation from the CIO here:

http://www.aiia.com.au/docs/states/wa/Richard%20McFadden%20Presentation.pdf

Sadly no dollars mentioned!

The whole things gets very high points for vagueness in my view.

Second last we have Tasmania.

From the health budget commentary we find:

“$12.9M over the next three years – including $5.3M in 2009-10 – for information technology advancements to support reform of service delivery. Funded projects include new patient/client administration systems for hospitals and mental health services.”

See here:

http://www.budget.tas.gov.au/ministers-on-the-budget/lara-giddings

This is the detail.

Health Information Technology

Funding of $18.5 million has been allocated over four years from the Infrastructure Tasmania Fund to support the development of integrated health information systems and related infrastructure in the Department to enable and support reform in health service delivery. Funding of $5.5 million is allocated in 2009-10 for the implementation of information technology projects including: a patient administration system ($1.5 million); messaging and identifier systems ($500 000); Mental Health Services Electronic Client Management and Reporting System ($750 000); LAN and Infrastructure Upgrade ($1.0 million); Enterprise Storage Solution ($500 000); Child Protection Information Systems Phase Two ($200 000); and Medical Imaging Project ($1.0 million).

Better than nothing I guess and at least some detail provided.

Interestingly no special mention of NEHTA I could spot.

Last we have the Northern Territory.

Here we find and under the Health and Families Department Budget Highlights.

-> Additional funding of $2 million for continued implementation of eHealthNT initiatives.

Not much really given the budget for the Department was just over $1 Billion.

All in all not a great set of figures for e-Health. Sadly it is virtually impossible to understand what level of recurrent investment is being made. This really would be useful for Governments to provide.

Maybe when we actually start to implement a national E-Health Strategy we can get proper information and co-ordination.

David.