Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Wednesday, September 09, 2009

The Astonishing Lack of Co-Ordination in Australian E-Health.

Late last week we had the following announcement from Minister Conroy, quite unaided by Minister Roxon.

Clever Networks CDM-Net E-Health Project launch

It is my absolute pleasure to be here today for the launch of a project that demonstrates the digital revolution taking place in healthcare.

Congratulations to Precedence Health Care, Barwon Health and all of the partners in this very impressive project.

This project is at the forefront of a radical change in medical services.

It points to a future when digital technologies enabled by broadband will commonly assist and enhance the provision of patient care.

The Chronic Disease Management Network — or CDM-Net — has received funding under the Government’s Clever Networks program.

You may be aware that the Government recently called for funding proposals under our new $60 million Digital Regions Initiative, which seeks to expand further on the benefits enabled by high‑speed broadband.

CDM‑Net should be viewed as a great example of the type of scalable solutions we are thinking of to support service development in regional, rural and remote Australia.

CDM-Net highlights the very real capacity for emerging technology and broadband to change the way we think about healthcare.

Allowing care teams and patients to develop and track personal care management plans — in real-time — offers great opportunities for more efficient and targeted treatment.

I understand this innovation could slash the time for needed for creating and managing a care plan from more than an hour to a matter of minutes.

These types of projects — simply enabling the better use of information — have significant positive implications for the economics of health care and patient welfare.

Chronic disease accounts for 70 per cent of Australian health care costs and significantly impacts on workforce productivity.

I trust that this solution will be a significant driver of efficiency in the future.

CDM-Net has been successfully trialled in the Barwon South-Western Region of Victoria and the Eastern Goldfields of Western Australia with more than 700 patients.

Those trials have demonstrated a 200 per cent increase in the use of care plans and 300 per cent increase in collaboration between care providers.

In doing so the project has overcome obvious but significant challenges in relation to scalability, reliability, security, and privacy protection.

From today, CDM-Net and its core Chronic Disease Management Service, will begin rolling out nationwide and I wish all the partners the very best as they drive its expansion.

Enabling e-health projects like CDM-Net is a key objective of the Rudd Government’s investment in the National Broadband Network.

I spoke recently at the National E-Health Conference in Canberra where I received a clear message that the health sector is ready and willing to drive forward with these sorts of developments.

It is worth noting the views of iSOFT, the world’s second biggest health software provider, that the NBN could pay for itself ‘twice over’ thanks to the e-health benefits.

Specifically it suggests that integrated patient records could save $8–10 billion a year — equating to a 10 per cent saving in sector spending.

It says the NBN will resolve obstacles to connecting the health care industry, such as large file transfers of CT scans and video conferencing.

As you will be aware, digital health solutions are also the focus of a range of recommendations in the National Health and Hospitals Reform Commission report.

The report makes a strong point about the importance of the National Broadband Network and recommends further action in areas such as:

  • transferable personal electronic records,
  • a national e-health policy, and
  • an open technical standards framework.

As the Health Minister has said, digital technologies should play a key part in our efforts to create a more patient-centric healthcare system.

The Government will be responding to the Reform Commission report in the months to come.

Today, of course, we are here to celebrate some of the great digital, broadband-enabled innovation already delivering improved outcomes for patients.

CDM-Net is a fine example of a collaborative approach to development.

It tackles a key problem in the management and prevention of chronic disease by creatively applying digital technologies enabled by broadband.

It gives us a clear view of the type of services we can expect to be driving greater health care efficiency and better patient services in the future.

Congratulations to the team and may I wish you all the best as CDM-Net is rolled out across the country.

Thank you.

The speech is found here:

http://www.minister.dbcde.gov.au/media/speeches/2009/060

This announcement prompted me to go to the Departmental site and find out just what this Clever Networks Program was.

Here is what I found.

Clever Networks

The $118.6 million Clever Networks program is in its final year and all funding has been allocated. The Clever Networks program is enabling the rollout of broadband infrastructure and services to regional, rural and remote areas of Australia.

It has two distinct roles delivering innovative services and broadband development:

Innovative Services Delivery

This element co-funds 26 projects that deliver improved services in the priority sectors of health, education, government and community services and emergency services. All of these projects are in their final phases of implementation or have been completed.

During 2008-09, four Building on Broadband projects were funded to leverage suitable successful Innovative Services Delivery initiatives by extending their benefits into other jurisdictions and/or service sectors.

Broadband Development Network

This element co-funds broadband project managers for each state and 16 project officers across Australia to assist in improving skills, capabilities and business practices in underserved communities.

Clever Networks genuinely demonstrates Commonwealth and state/territory collaboration in the delivery of essential government services. Total project funding of $275 million includes the Commonwealth's $105 million contribution with the remainder being provided by project partner organisations, including state and territory governments.

The Clever Networks programs ends on 30 June 2010.

For more information, go to Clever Networks program background.

See here:

http://www.dbcde.gov.au/broadband/clever_networks

The projects in the health sector seem to be as follows.

Clever Networks projects are impacting on hospitals and health facilities across regional, rural and remote Australia by improving service delivery and reducing costs.

Broadband applications are improving health services by allowing the transmission of electronic medical records and images, enabling remote diagnosis and treatment and providing professional support and development for health workers.

The following health projects have received Clever Networks funding (Direct Government Funding and then Planned Total Spend):

This list is found here

http://www.dbcde.gov.au/broadband/clever_networks/health_sector

Added up roughly this amounts to about $45 Million in Direct Commonwealth Grants and a little over twice that with the contributions of various departments and companies.

What seems to be being delivered is PACS/RIS systems, video-conferencing, web sites of various types and a few e-Health applications.

This is all described as being innovative but it is really nothing of the sort. All this is plain health delivery systems which should, in my view, be funded from the usual health budgets.

With this much money we could do things like actually set up proper governance co-ordination and management for e-Health in Australia and fund a clinical information portal that would provide in-depth clinical information to all practitioners to assist in the emergence of really evidence based care.

What this also raises is also why it is the Department of Broadband doing all this stuff with no apparent co-ordination with DoHA or NEHTA etc?

Additionally if anyone can locate evaluations of any of this I would be very interested. A search does not seem to turn up much.

Surely we can do better than this, and surely we can also avoid the nonsense of patenting of systems to support the most basic and common of clinical processes as has been revealed today here:

Medical manager goes global

Karen Dearne | September 08, 2009

A LOCALLY developed chronic disease management system with potential to keep patients out of hospital emergency departments has an international patent pending on the core technology.

The Chronic Disease Management Network (CDM-Net) -- which uses a web platform to support team care of people with complex medical needs -- was launched by Communications Minister Stephen Conroy on Friday in Geelong, where the concept has been trialled with diabetes patients.

"CDM-Net highlights the very real capacity for emerging technology and broadband to change the way we think about healthcare," he said. "Allowing care teams and patients to develop and track personal management plans in real time offers great opportunities for more efficient and targeted treatment."

Senator Conroy said the Victorian trial and an earlier pilot in Western Australia's Eastern Goldfields region had demonstrated a 200 per cent increase in the use of care plans, and a 300per cent increase in collaboration between GPs and allied providers.

Developed by Precedence Health Care and a consortium of local healthcare services, universities and IT suppliers with the aid of a $2.2million Clever Networks grant, Precedence now plans a staged rollout.

Details of patent claim here:

http://www.australianit.news.com.au/story/0,24897,26039829-15306,00.html

Fuller details here:

http://smtp1.patent.gov.uk/p-find-publication-getPDF.pdf?PatentNo=GB2456708&DocType=A&JournalNumber=6271

Sometimes I wonder about people who think it is a good idea to patent totally obvious clinical process support – but that is just me I guess.

As was said as the Health-e-Nation Conference a week or so ago by Adam Powick who developed the National E-Health Strategy.

“Conclusion –the need to work together

We are poised for significant progress but still could easily fragment the national agenda into 1000 moving parts

What is needed is:-

Clarity, Focus, Pragmatism, Leverage, Collaboration”

What we are seeing at present doesn’t come close!

David.

5 comments:

Anonymous said...

You don’t think those who have taken the commercial risk have a right to be able to patent their invention?

CDM-net is addressing “the most basic and common of clinical processes” as you say but surely that is not the point of the patent. It is the way those processes are addressed that’s important and which distinguishes the originality of thought and invention behind the patent. Michael has the support of some of the worlds largest IT companies like IBM and Cisco which must be running their commercial ruler over the patent to assess it commercial value.

Look at how much money has been spent trying to develop similar solutions like CDM-NET, squillions and squillions, all to no avail. Do you know of any better alternative solutions? Sometimes all it takes is a new fresh approach and intellect to make the breakthrough that everyone has been looking for.

Anonymous said...

I think you are being a bit optimistic to expect “evaluations” when the project(s) are just reaching the end of their initial funding phase. Perhaps in a few more months some evaluations might filter through. The Barwon Health CDM-net evaluation would be very interesting. You should ask Precedence Health Care when it is due to be published.

Dr David G More MB PhD said...

On comment 1 what is being done here is, in my view just not novel. Care planning is a basic process and there are already well developed standards (CCR and the CDA V2 template) which facilitate such processes using computers etc.

On Comment 2 we have been having these broadband initiatives for years and as an example the Eastern Goldfields Project was finished at least 18 months ago - and still no public evaluation. That is why we keep doing the same thing over and over.

David.

Anonymous said...

I agree with you David, there does seem to be a preference for doing the same thing over and over again. I have often wondered why that is so. New enthusiasts on the scene could be one reason, wanting to have a go, perhaps even critical of past attempts. Technology moving forward at a great rate of knots suggesting new ways of approaching the problem could be another. Past projects, set up with plenty of good intent, becoming buried in a quagmire of problems making it too difficult to salvage the project is yet another reason. Thus leaving no alternative but to go back to square one and start again from basic principles.

Another reason could be impatience by (external 3rd parties and) stakeholders or disillusionment with the project’s direction combined with the slow pace of the project’s progress and a reluctance by entrenched stakeholders (for many reasons) to change or modify their approach. This would leave those keen to move forward with no alternative but to start all over again. There are plenty of other reasons too as I’m sure you would agree but that is a good start.
I’m not sure that much can be done about it. Perhaps one has to accept it as part of the life cycle of complex projects; stop, start; two steps forward one step back; premature announcements followed by unrealized expectations, burn out and disillusionment, closing down of the project and starting again elsewhere with new players. It has always been my firm belief that one must admire, respect and genuinely acknowledge those who choose to start from scratch developing a complex solution, build the business, entrench the product in the local market and export it overseas, whilst all the while surviving in the rough and tumble world of commerce along the way. History provides us with some very good examples here in Australia - BHP, Cochlear, ResMed, ProMedicus, Sonic, to name but a few. Food for thought I hope.

Jim Cocks said...

FYI I have a copy of the Eastern Goldfields Evaluation Report - unsure of its provenance as it's now 18 months since I had a look - but it is not a pretty read, as I recall.