Wednesday, May 11, 2011

The Federal Budget Has Some Interesting Revelations in E-Health. As Always the Devil is in the Detail!

There is really quite a large amount regarding e-Health in the detailed papers.

The full Commonwealth Health Budget for 2011/12 is found here.

http://www.health.gov.au/internet/budget/publishing.nsf/Content/2011-2012_Health_PBS

Of main interest is this section.

Outcome 10:

Health System Capacity and Quality (PDF 332 KB)
Health System Capacity and Quality (Word 533 KB)

Here is the text summary of the key section

Program 10.2: e-Health implementation

Program Objectives

Through Program 10.2, the Australian Government aims to:

· provide national leadership in electronic health (eHealth) to improve health system standards and infrastructure;

· promote the use of Healthcare Identifiers and Authentication Services to improve safety and quality outcomes for patients and support improved management of health information by health care providers; and

· support the design and development of a personally controlled electronic health record system to increase the availability of health care information for consumers and health care providers when and where it is needed across the health care system.

Major Activities

National eHealth leadership

The Australian Government will demonstrate the benefits of eHealth to the community in terms of improved health care safety, quality and efficiency. The importance of eHealth is recognised around the world as an opportunity to fundamentally reshape and improve health service delivery. eHealth has the capacity to change the way practitioners interact with each other and with patients, leading to more efficient and effective patient-centred health care.

The department, in partnership with state and territory governments, will continue to fund the National E-Health Transition Authority (NEHTA) to develop the specifications, infrastructure, software and systems required to support electronic health systems nationally.

NEHTA is responsible for the delivery of key eHealth components, including the Healthcare Identifiers (HI) service, the National Authentication Service for Health (NASH), standard clinical terminologies and secure messaging to support the safe and secure electronic exchange of patient information. NEHTA, along with Standards Australia, plays a crucial role in the development of the eHealth standards necessary to guide the implementation and take-up of the Government’s eHealth initiative nationally.

Standards Australia is an independent, not for profit organisation, recognised by the Government as the peak non-government body in Australia for the development of rigorous, internationally aligned standards. In 2011-12, the department will actively participate in stakeholder discussions, led by NEHTA and Standards Australia, to inform the development of national eHealth standards. The development of national standards is critical to ensure an information technology system which will allow for the sharing of health care information.

The department will promote the use of eHealth standards, particularly the foundation standards for clinical terminology and secure messaging, to ensure efficient, effective and consistent implementation of eHealth nationally. In addition, the department will lead discussions with states and territories to develop funding options for national eHealth work for 2012-13 onwards.

The department will fund early implementation of standard clinical terminology into emergency departments during 2011-12 and collaborate with Therapeutic Goods Administration, pathology companies, community pharmacies and diagnostic imaging companies to adopt the Australian Medicines Terminology.

In 2011-12, the department will continue to provide incentives to general practices, through the Practice Incentives Program, to promote the use of eHealth tools and systems. The department, through the Fifth Community Pharmacy Agreement, will also provide funding to pharmacies for dispensing prescriptions that are generated electronically by prescribers. Through these activities, general practitioners and pharmacists will able to send and receive crucial information faster and more securely.

The department will also continue to lead nationally focussed stakeholder engagement, consultation and associated communication to ensure that national eHealth programs are deployed and implemented effectively. The department will continue to consult with various stakeholder groups, including the community, clinicians and the information and communications technology vendor industry, to promote collaboration across the health sectors around the national eHealth agenda. With privacy being a key consideration for consumers, the department’s eHealth leadership includes working collaboratively with states and territories on the national health information regulatory framework.

Promote the use of Healthcare Identifiers and Authentication Services

In 2011-12, the department will continue to promote the use of Healthcare Identifiers (HI). HIs are unique reference numbers allocated to individuals receiving health care, individual health care providers and health care provider organisations involved in providing patient care. HIs ensure that individuals and providers can have confidence that health information accessed through eHealth technologies is linked with the correct individual at the point of care.

The department will work with NEHTA and Medicare Australia, as the HI service operator, to support the adoption of HIs in health care provider information management systems.

The Healthcare Identifiers Act 2010 and the Healthcare Identifiers (Consequential Amendments) Act 2010 set out the governance arrangements as well as permitted uses and privacy safeguards related to HIs. The department, through Medicare Australia, NEHTA and the Office of the Australian Information Commissioner, will provide consumers and health care providers with information and assistance about the benefits of HIs, legal compliance and how the HI service works. Further information is available from Medicare Australia website.

A key challenge for the department is building the public’s confidence in the use of the HIs. In 2011-12, the department will continue to support the development and implementation of HI adoption plans focussed on specific health care sectors, including primary care, aged care and private hospitals. The department will fund the development of lead implementation sites in two waves to demonstrate the benefits of HIs, the National Authentication Service for Health (NASH), secure electronic communication and the personally controlled electronic health records (PCEHRs). Wave One lead sites are targeted around general practice and Wave Two sites will expand upon existing work to cover a broader range of settings including pharmacies, hospitals, aged-care homes and Indigenous health care providers. The lead sites will implement eHealth infrastructure and standards in real world settings. These sites will provide a foundation for secure electronic communications such as referrals and sharing of summary health information to support continuity of care between health care providers.

In 2011-12, the department, through NEHTA will continue to develop the NASH. The NASH will support secure electronic communication of health information between health care providers and the adoption of PCEHR by issuing digital certificates to health care providers across the Australian health system. In combination with frameworks for their management and use, these digital certificates will provide assurance about the identity of health care providers when they send electronic communications or access electronic health information systems. From 30 June 2012, health care providers will be able to obtain a digital certificate on a range of tokens, such as a smartcard, that they can then use to authenticate who they are when accessing eHealth systems or communicating electronically with other health care providers. The NASH will enable secure access control and audit logging mechanisms in readiness for when the PCEHR system is put in place. This will allow patients to have greater certainty over which health care providers have access to their information. During 2011-12, the department will progressively update information about the PCEHR on the yourhealth website. The website will also provide an access channel for the community to provide their comment on the design and implementation of the PCEHR system.

Support the design and development of a personally controlled electronic health record system

The Australian Government is committed to strengthening Australia’s ability to share health care information. Through the development of a PCEHR system, the Government will encourage greater participation by individuals in their own health care, improve the efficiency of the health care system by reducing the time taken to locate relevant information, reduce duplication of services and provision of inappropriate treatments.

The department will continue to provide governance and oversight for the rollout of PCEHR system.

This includes establishing the infrastructure, standards and tools needed to enable an individual’s key health information to be secure and available when and where it is required across the health and hospital system. These system components will be delivered by a National Infrastructure Solutions Partner and NEHTA through a tripartite agreement with the department. All Australians who wish to participate in the system will be able to register for their own PCEHR, which will provide a summary of the individual’s health information drawn from information systems distributed across the health system. The PCEHR system which is now being established will enable patients to access their PCEHR regardless of where it is physically located, and will enable Australians and authorised health care providers to securely access patient’s PCEHRs via the internet. The PCEHR system will be complemented by the introduction of the national HIs for individuals, health care providers and health care organisations, as well as authentication services and standard clinical terminologies.

In 2011-12, the department will work with National Infrastructure Solutions Partners and the information and communications technology vendor industry to design and develop the IT architecture and national infrastructure components to enable patients and clinicians to register for use of the PCEHR system commencing from 1 July 2012. This will include sourcing of information from existing health care systems ready to connect to the PCEHR system to provide high priority health information, such as GP health summaries, hospital discharge summaries, referrals and medications. eHealth lead implementation sites will be used to implement national eHealth infrastructure and standards in health care settings, and be able to demonstrate outcomes and benefits.

In 2011-12, the department will evaluate the benefits and capabilities of the system. In addition, the department will develop a national change management framework providing communication, training and support services to health care providers, tailored to meet local community needs. These national communication and management programs aim to ensure the PHECR system is established and adopted effectively. Strategic engagement across consumers, clinicians, industry, and state and territory governments will be ongoing to encourage Australians to register for a PCEHR from July 2012.

Program 10.2 is linked as follows:

· The Department of Human Services (Medicare Australia) to administer the Healthcare Identifiers service and promote the use of Healthcare Identifiers, under its Delivery of other Benefits and Services (Program 1.3).

----- End Extract.

The figures then follow and it seems that it is planned to spend $432,667,000 in 2011-12 after spending $137,678,000 in the current year.

At present it all stops after that with all if $34,675,000 coming in 2012-13.

Seems like a lot of money to spend with no plan to continue on!

The major deliverable targets seem to be:

E-Health Leadership.

  • National eHealth standards for electronic transfer of prescriptions completed by June 2012
  • Fund early implementation of standard clinical terminology into emergency departments during 2011-12 and work with the various organisations on implementation projects to adopt the Australian Medicines Terminology in the health sector during 2011‑12

Health Identifier Service

  • HIs and implementation guidance available to providers, software developers and patients in a timely manner
  • Implementation plans for up to 12 lead implementation sites which will focus on the adoption of HIs as a first step completed in a timely manner

PCEHR Implementation.

  • Undertake awareness-raising campaigns to inform the Australian public of their ability to register for a personally controlled electronic health record from 1 July 2012
  • Implementation plans for up to 12 lead implementation sites which will focus on the adoption of PCEHRs as a first step completed in a timely manner
  • 500,000 Australians registered for a PCEHR before the national launch of eHealth records in 2012-13

The last bullet is interesting as it suggest the PCEHR launch will not be by June 30, 2012 but in the following year! Overall the papers make it pretty clear progress is going to be a good deal more stately than might otherwise be suggested.

Note all the comments on NASH - but the lack of any consumer authentication plans.

The documents are worth a close read! At least e-Health gets a few pages!

By the way, if you want to read about the telehealth program it is found under Outcome 3.

David.

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