Sunday, May 15, 2011

Funny How Even NEHTA’s Experts Know There is A Huge Financial Hole in the PCEHR Plans!

It seems Dr Haikerwal (NEHTA Clinical Lead) as really belled the cat this time!

COAG warned of need for e-health incentives

The Federal Government and States have been warned that doctors and other health professionals will require financial incentives to encourage them to fully participate in the Government’s e-health plans and prepare for the introduction of the Personally Controlled Electronic Health Record (PCEHR) according to the e-health transition authority Nehta.

According to Dr Mukesh Haikerwal, a general practitioner and national clinical lead for Nehta; “The need for incentivisation is a given and was in the business case for COAG”. While this week’s Federal Budget did not allocate additional funds to pay doctors to update their IT systems, it didn’t strip money away from the e-health programme either, which has already been funded to the tune of $467 million.

Asked where the financial incentives could come from Dr Haikerwal told iTWire; “Some can come from the $467 million or from other appropriations.” Nehta will have to move quick smart to get an incentive programme up, as the $467 million allocated thus far is supposed to be used by June 2012.

Speaking at an Australian Information Industry Association healthcare briefing in Sydney today, Dr Haikerwal was part of a panel discussion examining the PCEHR, and the preparedness both of the health sector and ICT industry to implement and use the records.


But Adam Powick, managing partner at Deloitte warned that there was still a long road ahead and that; “There is no industry with a greater need for new IT than health which is 20-30 years behind other sectors.” He said that to date; “Providers have found it easier to spend money on everything but IT.”


Mr Powick noted that “If we fail…it will drive cynicism and lead to the continued fragmentation of the health system.”

Hanging like a sword of Damocles over Australia’s adventures in e-health is the UK experience. There a £13 billion project to install the iSoft developed Lorenzo system is by some estimates running five years behind schedule and has yet failed to deliver the benefits and savings anticipated.

Full article here:

As I have argued for a while now making changes that are going to slow clinicians down (and therefore cost them financial income) are not going to be at all well received unless the whole model of ‘fee for service’ timed charging is changed - and that is not going to happen any time soon I would suggest.

See here:

Think of this from the perspective of a GP:

At present a consultation of less than 20 mins attracts a fee of about $35.00 and more than 20 mins but less than 40 mins attracts a fee of about $70.00.

If we make the not unreasonable assumption that in a 7-8 hour working day seeing say 25 patients just 2 minutes is spent on issues with updating PCEHR Health Summaries, confirming consents, obtaining IHI’s and so on for each patient we are talking -at best - a cost of around $50 per day or $250 / week.

Basic maths has this costing each GP about $12,000 per annum (48 week work year) in time or income!

According to Australia’s Health 2010 from the AIHW there are 42,000 GP and 24,700 Specialists working in the health system.

If was assume say 50,000 practitioners are impacted then the potential impact in terms of work time lost might be as high as $600 Million !

Anyone who imagines this level of impact can be just swept under the carpet is having themselves on. Try having lawyers or accountants absorb a potential cost of that scale and you would hear the yelps on Mars!

The bottom line is that Australian e-Health has an unfunded ‘black hole’ of some considerable size. We need to hear NEHTA and DoHA on this and soon. You can be sure the issue will not go away and no amount of ‘Government Pressure’ will have the docs just accept this sort of change un-remunerated - nice people though they are!

You can bet we are going to hear all sorts of things about re-designed Practice Incentive Programs (PIP) and the like but I suspect the fiscal hole will be just too big to have that sort of re-allocation come close to working. Additionally it really needed to be announced a year or so ago to have any real impact by June 2012.


1 comment:

Anonymous said...

There are no doubt going to be a couple of big winners in this feeding frenzy - the usual suspects: IBM (of QLD Health Payroll fame), CSC (of NHS botch-up fame) and Accenture (See NHS screw up) and a number of dubious outcomes, goal post shifts and all of a sudden we're staring at another Victorian HealthSMART where nothing has been delivered, we've burnt through the budget and then they've got their hands out for more dollars.

The docs of course are never going to participate until somebody stumps up with a transaction fee and the 81 healthcare providers who submitted unsuccessful Wave 2 waste of everybody's time submissions are hardly going to lift a finger or upgrade their systems to be compliant with this joke of a PCEHR system.

All the while, the roadshows and the free lunches in the 5 star hotels will continue to roll on as we get closer and closer to 30 June 2012 D-Day.

But then everybody knows this was never going to be delivered by that date, let alone ever.

What a complete fiasco!