Wednesday, February 02, 2011

Now Hear Is Something Else NASH and the HI Service Could Help With! And It Is Actually Also Needed!

The following appeared a day or so ago.

Govt should subsidise prescribing resources

MEDICAL leaders want electronic prescribing resources for doctors to be subsidised and regularly updated as the federal government puts more emphasis on e-health initiatives.

Professor Jon Emery, professor of general practice and head of the school of primary, Aboriginal and rural health care at the University of Western Australia, said quality use of medicines was an important issue and the federal government should look at ways to make the Australian medicines handbook (AMH) freely, or at very least more cheaply, available to all GPs.

The AMH currently costs $160 for an annual online subscription.

Professor Nick Buckley, consultant clinical pharmacologist and chair of the AMH editorial advisory committee, said the cost of the AMH or the Therapeutic guidelines should be subsidised because the community and patients paid a very high price when poor prescribing decisions were made.

Professor Buckley estimated it would cost less than 10 cents per GP prescription to subsidise the AMH or the Therapeutic guidelines.

He said such a subsidy would be cost-effective in improving health and would be likely to generate net savings.

“The total budget for the two organisations providing these resources is less than the average PBS [Pharmaceutical Benefits Scheme] expenditure on just one of the 717 … subsidised medicines,” Professor Buckley said.

The two experts were commenting on a study reported in Family Practice, which looked at GPs’ use of electronic information sources and computerised clinical decision support systems (CDSSs) for prescribing.(1)

More here:

It seems to me that this is really a very un-ambitious proposal. In the National E-Health Strategy in 2008 it was proposed that a modest sum should be spent ensuring all clinical practitioners have access to a service similar to the Clinical Information Access Program (CIAP) offered by NSW Health to public health employees in NSW.

The limitation in providing extended services to other groups is that the information providers retain copyright on some of the material and want to know the number of users so the correct fees can be charged.

With the HI Service and NASH we are promised that we will know who is accessing what and when they are doing that. This would be a great situation to have, with robust professional authentication, when negotiating the relevant licensing conditions with information providers.

We know the CIAP program has been especially useful to the more remote practitioners and a true nationwide extension would be not only be good clinically (CIAP has been evaluated and found to improve care) and better would be something that might bring faster adoption of the HI Service and NASH as there would be a reason for practitioners to adopt using the identifiers and credentials.

Sadly I fear this might just be too sensible to actually happen. Pity!



Paul Fitzgerald said...

wasn't this sort of thing covered in the PIP a few years ago? PKI etc and online references from memory....has that gone away?

Anonymous said...

That malarkey is still the current set of rules.

Not for much longer I'm told, however they don't forewarn folks about what changes are in the pipeline so who knows what's around the corner.

If the RACGP has anything to do with the new criteria, it will be something along the lines of "you must use Telstra, can't ePrescribe via the Guild's system and have to wear RM Williams boots to work".

Anonymous said...

I read your post and 5 minutes later read an article in the Australian about NEHTA getting an additional $38.5 million to spend over a mere 6 month contract to project manage the next bureacratic stage of the fanciful PCEHR white elephant.

I work in the hospital system (and used to work for an Australian health IT vendor that folded about 5 years ago), but also have to visit outpatient services every month for Warfarin management. So I've been affected by the lack of e-health from a few different perspectives and I'm a real believer that simple use of appropriate information technologies can make a big difference in improving safety or helping patients have a better quality experience.

I read your post and then the big-noting, egotistical arrogance of NEHTA's CEO Peter Fleming and I could bearly contain the expletives.

I am disgusted, appalled, incensed, infuriated and incredulous at this waste. Patients in australian hospitals and communities are suffering awful quality of care, unsafe hospitals because of poor morale, bad communication and poor morale of overloaded nurses and doctors, we have shockingly poor mental health treatment options and an indigenous population that dies 10 years before they should. We have a cyclone devastating North Queensland, floods displacing thousands in Queensland and Victoria and bushfires in NSW and Perth.

And some idiot believes that a good investment of tax-payer money is to spend $38.5 million for a bunch of bungling bureaucrats to decide how to spend the next $400million on eHealth projects that promise the world and deliver nothing. Then we have the audacity of the chief bungling bafoon, Peter Fleming to say "With the work on the other components, the benefits realisation, change management and so on, we’re going to see a lot of activity focused on communities this year.”

Not my bloody community!!!!

So with a rising blood pressure, I scanned the last five years of NEHTA's annual reports and only got more irate. Here's what NEHTA spent apparently and is likely to spend in 2010/11 (assuming this extra $38.5 million builds on last years base):

2006: $8.5 million
2007: $17.3 million
2008: $31.2 million
2009: $66.7 million
2010: $89.5 million
2011: $133.6 million

Total: $347 million

They've almost doubled their spending every single year. At this rate, they're doing better than Google or Facebook and could be a $4 billion business in just another 5 years!!

But I want to know the answer to this question: Having spent more than five years and a treasure chest of almost $350 million dollars, show me one single patient who has had a better experience, one single area of safety improvement or one single doctor or nurse who has been able to provide better care. I don't believe there is one and I can see no evidence from NEHTA of having achieved anything expect line their own pockets, justify their own existence and decimate a forest with paper documents.

I dowloaded a presentation from Leonie Katakar -Nehta's Director of Clinical Leadership (whatever that means) and found the last slide in her presentation said it all:
- Nehta is funded to provide the national infrastructure required to meet the needs of a clinically computerised and electronically connected health sector
-Computerisation and uptake of nehta products are the responsibility of the health sector

Wow - what a clinical leader you are. All care, no responsibility

When will there be some inquiry into this disgraceful waste - when will some auditor or politician hold these people to account? I find it deeply, deeply offensive.

Anonymous said...

Thank you for this enlightening link

The RACGP has included $1,241 of freebies bundled up into its annual membership !!!!!.

Oxygen – is free - valued at $1000 per annual subscription

PCS Clinical Audit Tool™ (CAT) - valued at $200 per annual subscription discounted by $40 to $160

The PrimaryCare Sidebar® - valued at $670 per annual subscription discounted by $201 to $469

All of which is summed up by the RACGP as “paving the way to, a robust electronic health (e-health) system for Australia. The college will be developing some comprehensive tools to help you implement e-health initiatives in your practice.”

How can you - Wednesday, February 02, 2011 6:34:00 PM - describe that as malarkey?

What is ‘malarkey’? The answers can be found here:

Anonymous said...

I too find it deeply offensive. But the fact remains numerous well informed people have said as much in one way way or another over many years all to no effect. Only when the people who cast the votes realize what an obscene amount of money is being frittered away like this will the politicians take any notice.

Paul Fitzgerald said...

What's wrong with RM Williams boots? :-)

Anonymous said...

The appropriately named "Oxygen" is vaporware. If you can find me one person that has paid $1000 for this, then I guess this person has set the market price and the RACGP isn't engaging in misleading marketing after all.

Same applies for the other products listed...imagining an arbitrary value that has never been tested in the market and then discounting it is slight of hand at best. GPs don't pay for such things...if they did, the RACGP wouldn't have to bankroll such services on behalf of their membership.

But I do love RM Williams boots...if I get some PCEHR funding I'll pick up a custom made pair in ostrich leather to celebrate to recouping of some of my wasted taxes.

Anonymous said...

I am afraid that many of the Nehta Clinical leads are the rough equivalent of the Drug Company "Key Opinion Leaders"

They are made to feel important, are fed the company line and "treated well" They are really just acting as an extension of the marketing department, but that is one depeartment of Nehta that actually works. Shame they have no products that work. It's just such a waste of resources and delays real advances.

We may need to wait until Gillard needs to clean up the smelly waste in the lead up to the next election before they reach for the broom. I doubt the PR department can paint over these cracks well enough to go to an election with.