Thursday, October 27, 2011

The Spin From DoHA Just Goes On and On. They Make It Up As They Go Along!

In response to the Royal Australian College of GP suggestion that additional financial incentives would be needed to compensate for the additional costs in time and effort there was an amazing response as far as I am concerned.
I discussed the statement from the College identifying the requirement here:
This prompted a response from the Office of the Minister (among a fair few others):

Spokesperson, Office of the Hon Nicola Roxon MP Minister for Health and Ageing

21 October 2011 at 9:13

The RACGP's media release ignores many of the facts and underlying principles of personally controlled eHealth records. GPs are heavily involved in the development of eHealth records, and we are confident our system will help provide better care, save lives and save money.

On consultation with GPs: Over a third of the health professionals advising the development of eHealth records are GPs. This recognises our commitment to consult extensively with GPs. Significantly, the head of the eHealth Clinical Leaders group is Dr Mukesh Haikerwal, a GP, and past president of the AMA. Joining Dr Haikerwal in the group, is Dr Chris Mitchell, a past President of the RACGP.

On GP additional workload: The Government already has incentives in place to encourage GPs to keep up to date with the latest developments in eHealth. Our eHealth Practice Incentives Program provides up to $50,000 per year to practices and we would expect these funds to assist with their adoption of the PCEHR.

On education and adoption: The Government is well aware of the need to encourage patient uptake of eHealth records and, in particular, older Australians, Aboriginal People and Torres Strait Islanders, and mother and their new-born children. That's why many of our eHealth implementation sites focus on these groups. Further, we are investing almost $30 million to encourage the adoption and uptake of eHealth records by the public and the healthcare sector. See this release for further details:

On personal control: The Government does not apologise for creating a personally controlled ehealth system. Right now, it is completely up to a patient what they tell their doctor and this will continue with eHealth records. Importantly, only clinicians will be able to create or alter eHealth records.

The initial article and this and all the other comments are found here:
While there are potential issues with all these 4 points it is point 2 about the PIP being a source of funds to compensate for the time and effort to maintain the PCEHR that deserves a little scrutiny.
The eHealth Incentive Guidelines - found on the Medicare Web Site - and dated August 2011 explains what the PIP payment is for:
“To be eligible for the PIP eHealth Incentive, practices must:
1. have a secure messaging capability, which is provided by an eligible supplier as listed on the  NEHTA website
2. have (or have applied for) a location/site Public Key Infrastructure (PKI) certificate for the practice and each practice branch, and make sure that each practice GP has (or has applied for) an individual PKI certificate (excluding locums)
3. provide practice GPs with access to a range of key electronic clinical resources.”
Further detail is provided in the short document which is found here:
Note that there is no mention of the PCEHR at all. These payments are for getting a secure messaging capable GP system in place (you don’t seem to have to be using it!)
All you need is to have a system from the list which was last updated 18 months ago!
The list is here:
Equally you need to have - but not necessarily be using PKI certificates (not NASH provided ones).
The electronic resources are easily available and integrated into at least some GP systems.
The payment is approximately $6,500 for a solo General Practice a quarter and capped at a maximum of twice that no matter the size of the practice.
For a 5 man practice (40% of all practices) this amounts to $10,000 per practitioner per annum which, while reasonable is not a huge amount.
Compare this with the impact of spending 2 minutes of each consultation on ensuring PCEHR currency and reliability. The average GP probably sees six patients per working hour or say 40 patients per day. If we assume say a conservative 30 minutes per day on PCEHR related activities (consent, checking, uploading, reviewing) we are looking at a net loss of say 3 patient consultations per day. Doing the math that is say $300 / week in lost income - i.e. approx. $15,000 a year (very conservatively) in lost income.
Thus - unless there are real productivity and workflow benefit from the PCEHR this is a real looser for the GPs.
Be assured it is maths like this the AMA and the RACGP are doing that has them alarmed and resistant. They know this is going to cost them and they are not happy!
What the DoHA spokesperson is saying just makes no economic sense as does a good deal else in the overall PCEHR proposal despite all the claims to the contrary!


Anonymous said...

plus all the risk and liability for getting it right is with the GP too! (From a medico-legal perspective)

B said...

Unstable requirements -> failed project

I'll leave it up to you to decide if the requirements (not just the technical requirements, but the requirements of all stakeholders) are known and settled.

I have my opinion and it's not favourable.

Anonymous said...

From the outset this PCEHR initiative has been run by cowboys.

Commencing with the ad hoc and indiscriminate announcement of Wave 1 sites and the atrocious handling of Wave 2 sites we have seen an absolute butchery of stakeholder relations and goodwill from the providers. This relates directly to the comments from B above.

The deadline has been a farce from the beginning and is more evidence that this Government (and Roxon in particular) is all Spin and no Substance. That statement can probably be construed politically, but the evidence is mounting.

The descoping of the project to online registration function is a sham and was totally expected. Yet more spin doctoring.

The disgraceful sidelining of HCN and Medical Director who hold the lion's share of current information shows complete disrespect for legacy businesses in the private sector and the investments made by private shareholders over many years to establish solid and self-sustaining businesses. This can be seen for what it is, an anti-commercial and anti-business stance from Labor.

It is ironic now that the GP community is going to blackmail the Government into yet another subsidy / fee to make it look like something is being done. The legislation penalising them for breaches of privacy makes it extremely unlikely that they will risk participating anyway.

Additionally, the amateurish team that has been given the steering wheel at NEHTA is going to be exposed as a complete failure and committing the age old mistake of over-promising and under-delivering. That is why we are witnessing the rats jumping off the sinking ship with a 30% staff turnover rate.

Meanwhile, the Management Consultant spivs and shonks at Deloitte and Accenture and others continue to put their hand out to accept the risk-free dollars they have conned their way into receiving along the way.

Thank you David for keeping these bastards honest. You are performing a national service.

As a taxpayer, I think it is a disgrace to allow these people to continue to waste our hard-earned money on fanciful and impractical schemes and then walk away scot-free once the whole thing has fallen over.

It is time to name and shame these frauds.

I would like to see penalties introduced for some of these public servants who are racking up this waste and clawback of the fees from some of these consultant shonks and spivs.

Given the billions that have been splurged on this eHealth fiasco with nothing to show for it that would be justice. Nobody should be unaccountable in the way that NEHTA and it's governance structure has obscured transparency and scrutiny. The ease with which NEHTA have brushed off questions by the Senate Committee indicate that there is not enough attention being paid to this.

It is now time to assess the achievements, and ultimately the damage that has been caused by this mob of incompetents and shut this thing down before more waste and damage is done.

Anonymous said...

Friday, October 28, 2011 11:06:00 AM

This summarizes the situation in ehealth in Australia perfectly. I think it should be distributed to every politician in Canberra and published in the national media.

Anonymous said...


The PIP situation is even worse than you have stated.

1. While SMD (ATS 5822-2010) has been around for a while, it is still not usable. The PIP program has not caused incentives to flow back to the secure messaging providers, which may have promoted some progress. We are still missing infrastructure such as the ELS. There has also been no agreement on how SMD will carry HL7 V2 messages.

2. While encouraging the take up of certificates in good in theory, it is a pointless exercise as they will all be replaced by NASH certificates at some time in the future. I doubt that there will be an automatic reissuance of NASH certificate to all those who have Medicare certificates. I also wonder if we will actually ever see NASH. It has been promised so often that no one in their right mind would believe yet more promises.