NEHTA released its second Clinical e-Newsletter a day or so ago – dated 19 May, 2010.
The full document can be obtained from here.
http://www.nehta.gov.au/component/docman/doc_download/1005-nehta-clinical-enewsletter-may-2010
Main Headline is this.
Federal Budget - $467m for personally controlled electronic health records for all Australians
The Government’s investment of $467m into the development of electronic health records announced in the 2010/11 budget on 11 May represents a key building block of the National Health and Hospitals Network.
A secure system of personally controlled electronic health records will provide: summaries of patient health information including medications, immunisations and medical test results; secure access for patients and healthcare providers to their e-health records via the internet; rigorous governance and oversight to maintain privacy; and national standards, planning and core national infrastructure to enable healthcare providers to use the system.
In 2010-11, the Dept of Health and Ageing (DoHA) will consult with stakeholders on the planning, design and development of a personally controlled electronic health record system and will also develop related national governance and legislative requirements.
The second year will focus on building on existing foundation development to increase linkages to other health information elements, such as pathology and specialist reports, for incorporation into the electronic health summary.
The Budget paper also noted that in 2010-11 the Government will continue to provide incentives to general practices to promote the use of e-health tools and systems through the Practice Incentives Program (PIP). It also noted that DoHA will continue to support the development of secure messaging specifications to assist the use of electronic referrals, prescribing and discharge summaries ahead of the personally controlled electronic health record system rollout commencing in 2012-13
The secondary headline is here:
Federal Budget – Pharmacy e-prescription incentives
The Fifth Pharmacy Agreement with the Pharmacy Guild includes $82.6m in e-prescription incentives. From 1 July 2010 the Commonwealth will pay a fee of 15 cents per transaction to approved suppliers dispensing electronic prescriptions. Software vendors will have 24 months to comply with the requirements that include compliance with the Australian Standard specified relevant version of NEHTA’s specifications for ETP.
The Pharmacy Agreement defines an electronic prescription as one electronically generated by a prescriber, authenticated (electronically signed), securely transmitted (either directly or indirectly) for dispensing and supply, seamlessly integrated into dispensing software and, for PBS prescriptions, able to be electronically sent to Medicare Australia for claiming purposes.
----- End Extract.
For a silly bit of trivia it is worth noting that the document dated 19 May asks for consultation responses on e-Referrals and says this consultation closes on the May 21. What?
But to the substantive issues:
On the Personally Controlled Electronic Health Records (PCEHR) we note:
It is DoHA and not NEHTA who is going to consult on the planning, design and development of the PCEHR. This work is to happen 2010-11.
In 2011-12 we will work on messages to fill up the apparently central repository.
And implementation starts after all that.
I will leave it as an exercise for the reader to try and figure out where the skills for this project will come from, how whatever is planned will be procured (surely DoHA would not try to develop something like this?), what the governance will look like, and why clinicians would send information of this sort to a Government repository among a host of other questions about data quality, data priority, legal liability for contents transmitted and so the list goes on.
Remember we went down a similar path with such shared records ages ago. The program was called HealthConnect and was killed when Mr Abbott and Mr Hockey discovered just how much it was going to cost – and turned it into the legendary ‘change management strategy’.
All the details can be found here from December 2004!
This is a presentation of the concepts and how it would work
http://moreassoc.com.au/downloads/bap_dec2004.ppt (400k)
And here are all the details:
http://moreassoc.com.au/downloads/BA%20V1.9i%20final.zip (800k)
On the basis of this we have hardly moved forward in half a decade. Read and weep. Only the names have essentially changed!
If people are interested I have a large archive of this stuff – I can post the key ones. Let me know.
Remember as some wise soul said ‘those who forget the lessons of history are condemned to repeat them!’ (George Satayana or Arnold Toynbee - Google not clear!)
The e-Prescribing announcement is just amazing! Basically it seems to say for 2 years you can use any old un-standardised system to transmit prescriptions for 2 years – and get paid - and then you will have to conform to NEHTA’s specification! How about getting standardised first and then get paid. This is absolute policy rubbish in my view.
Sadly we seem to live in some very stupid and forgetful times!
David.
12 comments:
Yes, “We have been there before in 2004” and we are going there again. Which explains why the excellently named Primary Health Care Organisations (PHCO) have suddenly and unexpectedly been renamed Medicare Locals.
“The Pharmacy Agreement defines an electronic prescription as one electronically generated by a prescriber, authenticated (electronically signed), securely transmitted (either directly or indirectly) for dispensing and supply, seamlessly integrated into dispensing software and, for PBS prescriptions, able to be electronically sent to Medicare Australia for claiming purposes.”
This definition tightly nails what is an electronic prescription. Medicare Australia will be very pleased the Guild agreed to have this definition included in the 5th CPA which is now signed. But will the Guild be pleased?
“From 1 July 2010 the Commonwealth will pay a fee of 15 cents per transaction to approved suppliers dispensing electronic prescriptions.” What is an approved supplier?
Under the definition do the Guild’s eRx exchange and the RACGP’s MediSecure system comply with the definition as “approved suppliers”?
“Software vendors will have 24 months to comply with the requirements that include compliance with the Australian Standard specified relevant version of NEHTA’s specifications for ETP.”
Which of these software vendors comply with the requirements today?
Under the definition and compliance requirements at what point will the 15 cents per transaction be paid “to approved suppliers dispensing electronic prescriptions”?
When they are seamlessly integrated into dispensing software?
When “PBS prescriptions, able to be electronically sent to Medicare Australia for claiming purposes.” ?
Is there another script exchange about to be launched in the market?
If so it raises the intriguing question as to who might be developing it and could this be in collaboration with Medicare Australia?
I think you will find that the same little group of public servants is there in the middle. They jockey for position and change chairs but they are still the same old faces - using up the taxpayer-funded perks.
Will the loss of frequent-flyer points apply to the public servants as well as the pollies?
Of course you know why I always post annoymous?
I remember being at an 'Industry' meeting where they said $39 million when this Health Conntect thing was posted. A rapid back of the envelope calculation came up with $780 million - we will be there ($780M) in 5 more years with nothing done!
At 15 cents per transaction $82.6 million will pay for 550 million PBS eprescription transactions.
So 200 million PBS scripts per annum that equates to over two years. But given that the market has yet to be established and take up escripts if this $82.6 million is expended over 5 years at 15 cents per script what will the market penetration be at the end of 5 years?
And will the 15 cents / script continue thereafter!!! or be cut back? or be terminated leaving market forces to prevail?
Originally the two script exchange vendors said they were going to charge 25 cents per script downloaded from pharmacy. Ooops. Today eRx announced that it “will lower its transaction fee from 25c to match the 15c incentive payment under the Fifth Community Pharmacy Agreement and will process all e-scripts not currently funded by the incentive scheme (private and pharmacy initiated originals and repeats) at no cost.”
Should we be expecting a similar announcement from MediSecure?
40% of the 25 cent asking price!! And the 15 cent subsidy doesn't even start until 1 July if they can meet the 'criteria' referred to by Monday, May 24, 2010 6:37:00 AM. Do I detect an air of desperation?
Looks like the Winter Sales have already started.
Monday, May 24, 2010 8:16:00 AM said "They jockey for position and change chairs but they are still the same old faces". A lot of those faces have gone by the wayside. A new group is being built as we speak and they are not interested in developing internally. They want a product built that they can own and maintain.
Are you referring to Medicare’s PBS eScriptXchange. Nothing to do with the Pharmacy Guild's eRx system?
Now you see it, now you don’t.
"So 200 million PBS scripts per annum that equates to over two years."
"But given that the market has yet to be established and take up escripts if this $82.6 million is expended over 5 years at 15 cents per script what will the market penetration be at the end of 5 years?"
Good question.
If the market take-up in years 1 to 5 was:
5%
10%
25%
30%
30% respectively then the number of escripts process each year respectively would be:
27,533,000
55,066,000
137,666,000
165,200,000
165,200,000 and the amount paid out in each of thise years respectively would be:
$4,130,000
8,260,000
20,650,000
24,780,000
24,780,000
It's a sobering though to think that at any time the government could move the goal posts or at the end of 5 years discontinue the 15 cents subsidy and leave it for the doctors and pharmacists to pay of their own accord.
Scary thought. Anyone want to disagree?
You’ve got a miscalculation there because you should have used a lesser number of total scripts based on an annual script volume. In one year total scripts of 185,000,000 is the more appropriate figure.
If you use that figure of 185,000,000 and $0.15 per script, together with an incremental year on year increase of market takeup at 10%, 40%, 70%, 80% and 100% you will have expended $82,600,000.
Is it not a bit optimistic to expect 40% uptake in year 2? Let alone 70% in year 3?
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