Wednesday, March 28, 2012

The Health Minister Decides GPs Need To Be Paid for PCEHR Services, Restricts Ambition Dramatically and Sanity Finally Prevails!

Here is the transcript of the speech given today.


Gold Cost
28 March 2012
I would like to acknowledge the traditional owners of the land on which we meet today, the Bundjalung people and pay my respects to elders past and present.
I am delighted to be here at the Health-e-Nation conference.  eHealth is an exciting area of innovative health practise and of industry collaboration.  I imagine we’re all pretty excited about the health benefits eHealth can deliver.

The Health And eHealth Reform Agenda

But in eHealth, as in our health reforms more broadly, two questions drive my approach to the Health Portfolio -
- is it good for patients? and
- of all the competing demands for the health dollar, is this the best thing we can do with our investment?
The case for eHealth needs to be made with both these questions in mind.
The anecdotal benefits of eHealth are obvious.  I heard from a doctor recently, married to another doctor, whose father-in-law lived with them.
The father-in-law collapsed in a shopping centre from a perfectly preventable negative interaction between medicines after his GP and gerentologist changed his medication without knowing what the other had done.
Each year around Australia there are more than 15,000 hospital admissions because of medication errors due to poor patient information.  eHealth will help to reduce such errors.
eHealth will also mean:
- better co-ordinated care for patients with chronic or complex illnesses;
- reduced duplication of testing;
- less of a need for patients to retell their story every time they see a healthcare professional; and
- a more efficient use of time, staff and funding.
These benefits were recognised by health ministers from across the country back in October 2008 through the National eHealth Strategy.
The Strategy details the shared commitment of all governments to developing electronic medication management, secure electronic messaging between healthcare providers, the use of healthcare identifiers for patients and providers, digital authentication, and a national eHealth records system.

eHealth Achievements So Far

Any change so large and so complex, any infrastructure investment so significant, needs solid foundations.
Our progress on the foundation elements of an eHealth system has been strong.
In 2010 the Healthcare Identifiers Service commenced operation.  And already more than 1.7 million Individual Healthcare Identifiers have been matched and downloaded from the Service.  This is an essential part of the preparation for the roll out of the eHealth records system, as it allows healthcare professionals to accurately identify patients so they can safely exchange their records.
We’re also seeing around 70% of community pharmacies now using ePrescribing.  One prescription exchange service reported 4.2 million prescriptions dispensed in the week before Christmas last year alone.
We’ve also developed specifications for the clinical software that healthcare professionals use that allow them to contribute to and access a patient’s eHealth record, including shared health summaries, event summaries and discharge summaries with their patient’s permission.
And of course we are currently building the foundations of a national eHealth records system.

The National eHealth Records System from 1 July

The national eHealth records system will be a cornerstone of eHealth in Australia…
…and from 1 July this year the Federal Government will start to roll it out.
From 1 July, patients will be able to register for their own eHealth record through Medicare shopfronts and over the phone.  And mums and dads will be able to register for their kids.
When they’re registered, patients will be able to go online to view their record and add a range of basic health information, including emergency contact details, the location of their advanced care directives, any allergies they have or medication they’re on.
Patients will also be able to create their own private ‘diary’ area of the eHealth record, where they can enter their own health-related notes.
Powerful patient privacy controls are a critical part of the eHealth record.
From the start, patients will also be able to set these privacy controls to determine who can access which information.  For extra security, patients will also be able to see an access log that shows them every time their record has been a viewed or edited.

1 July – The First Step Of Many In A Gradual Roll Out

This is a big and exciting project, but I’m determined not to rush it.
This isn’t a matter of ‘flick a switch’ on 1 July and away you go.
We’ve always said the rollout of the national eHealth system would be in gradual, carefully managed phases.  That is the sensible, responsible way to deliver this reform.
The initial step we’ll take on 1 July has always been about two key things…
…firstly, delivering the core national eHealth system – the building blocks…
…and secondly, allowing the first patients to register.
   And both are on track.
Over time, as patients and doctors register, more detailed and sophisticated features will be available as part of an eHealth record.
Eventually things like immunisation records, Medicare and pharmaceutical benefits information, organ donation details, and hospital discharge papers will be able to be added.
And healthcare professionals will start to integrate patient eHealth records with the software they use in their practices…
…so they’ll easily be able to add new information to a patient’s record.
The Northern Territory introduced a form of eHealth records a few years ago.
What that example shows us is that take up tends to be slow in the first couple of years, but that as the system matures take up accelerates.  We expect that to be the case for the national eHealth records system too.
This project has been talked about for a decade, so naturally there is a high degree of interest and excitement now that it’s becoming a reality.
The roll out of eHealth will eventually change the way patients are cared for, starting first with the highest users of health services.
Just as the Snowy Scheme took years to build, and moved, over time, from simply an irrigation project to a renewable energy project that today powers the morning and evening rush hours of Sydney, Brisbane, Canberra, Melbourne and Adelaide.
This didn’t happen overnight, nor was the full potential of the project realised on the day the water started flowing.  The national eHealth records system will grow and evolve in a similar way.
Labor governments are nation building governments.
Labor governments invest in infrastructure.
And we’ve committed to building and investing in an eHealth records system because it’s the 21st Century digital infrastructure that will help revolutionise healthcare in Australia.

Support For Healthcare Professionals

For healthcare professionals, eHealth records will mean easier and faster access to more patient information. This is good news for all clinicians — perhaps for GPs more than most, because they see such a large number, and wide variety, of patients.
We know clinicians will be central to the smooth and effective operation of the national eHeath records system.
That’s why the Government has supported GPs to prepare for eHealth through Practice Incentive Payments.
In 2010-11 the Government invested around $85 million in the Practice Incentives Program eHealth incentive, with around 4200 general practices receiving up to $50,000 each.
These Practice Incentive Payments have ensured that over 95% of GP are using computers and the Internet.   Australian GPs are, in fact, the fifth most computerised general practice workforce in the world.
And today I’m in a position to detail additional support for GPs.
I am pleased to confirm MBS consultation items will be available to GPs as part of providing continuity of care to a patient, and if they are creating or adding to a shared health summary on an eHealth record which involves taking a patient’s medical history as part of a consultation.
The Level B, $35.60 benefit will be available for consultations that involve taking a medical history for less than 20 minutes.
The Level C, $69 benefit will be available for consultations that involve taking a detailed medical history for more than 20 minutes.
And the Level D, $101.55 benefit will be available for consultations that involve taking a more extensive medical history for more than 40 minutes.
I want to confirm that the use of the longer consultation items will be seen as appropriate by the Medicare Australia Practitioner Review Process and the Professional Services Review in circumstances where there is clear evidence of patient complexity and there is documentation of a substantial patient history.
I understand that issues surrounding the use of MBS items have caused some uncertainty in the profession, so I am happy to offer these clarifications today.

A Genuine Partnership

I am committed to a genuine partnership between our Government, patients, healthcare professionals and the IT sector to deliver this important reform.
Our 12 eHealth pilot sites are an example of this collaboration in action.  I visited one of these pilot sites in Brisbane a couple of weeks ago – Metro North Brisbane Medicare Local.
I saw for myself the innovative new technologies being trialed and the strong partnerships being forged between healthcare and IT professionals for the good of patients.  These pilot sites are breeding grounds of best practice that we can learn from and weave into the roll out of the national system.

Conclusion - Making a real difference for patients

But it’s not just the pilot sites that are adopting these new opportunities with vigour.
Earlier this year I was impressed by Professor John Wilson’s telehealth project and the potential for expanding in-home services for patients in remote areas or those who find travel difficult.
A few weeks ago I visited Shell Cove Family Practice – one of our GP Super Clinics – and saw their ability to integrate patient data – to look for smokers or diabetics or young mums to proactively offer better services or interventions.
A growing number of Australians will come to see and enjoy the value of a national eHealth records system as functionality increases and access improves.
They will see the benefits in managing their own health care and that of their family, and in creating a safer, more efficient and effective healthcare system.
Take the case of Vietnam veteran Peter Ryan, who was rushed to hospital on a Sunday afternoon with what turned out to be renal failure.  Before he was diagnosed, the emergency medics were forced to waste valuable time trying to contact his GP to find out what medication he was taking.  ‘I could have died while the hospital staff were chasing my medical history,’ Peter says.
With a national eHealth records system, a frightening situation like that could eventually be a thing of the past.
Technology has long been a driver of significant advances in health care in Australia — of our ability to detect and treat injury, illness and disease, and of our ability to protect and preserve life.
The great majority of our healthcare professionals — GPs, specialists, pharmacists, and allied professionals such as physiotherapists and psychologists — use computers regularly in their daily practice.  And most of us have internet access at home.
The problem has been that up to now, all these computers have not been talking to each other.
But the Government’s national eHealth records system will enable secure and consistent information sharing.
Government has worked with the health profession and the IT industry to develop the common language and secure information transfer needed to make a real difference where it matters most - for patients in clinics, hospitals and homes across our nation.
All I can say is that this is the most sensible speech on e-Health I have heard for a good while. It recognises it is long and hard, sets way more sensible objectives for July 1, and makes it clear this will be years in the making.
Recognition of the e-prescribing services and so on that are already operating is a welcome change indeed.
Minister Plibersek gets high marks indeed in my view for this resetting, recalibration and recognition she needs the GPs to have e-Health work.
Good on her.
Is my job done here?


Anonymous said...


Your critics need to take note that you are not only disposed to the negative, when good things happen. Your support of the minister's comments is spot on.

I agree completely that this is a breath of fresh air. I await with trembling expectation, the much needed top (and I manly mean top) to bottom purging of NEHTA, and its transformation into something that is value for money, and not an ivory tower for self-styled experts who never have had to have their expertise tested in industry or academia, and who could not survive in either sector, where poor performance gets you the cut pretty quickly.

Anonymous said...

A sensible speech indeed but ......
what has changed? Anything?

Two fundamental questions are:
- will NEHTA continue doing what NEHTA has been doing in the way NEHTA has been doing it?

- will DOHA continue doing what DOHA has been doing in the way DOHA has been doing it?

Sure the Health Minister has changed. That is a good first step. But what else has or will be changing?

Anonymous said...

The name - not PCEHR anymore but National eHealth Records System. Mentioned countless times - was that to brainwash us all in to forgetting that PCEHR ever was?

Not much else will change at all, including throwing more taxpayers money down the drain it seems.

Dr David More MB PhD FACHI said...

As I mentioned about 3 weeks ago!



Anonymous said...

> PCEHR anymore but National eHealth Records System. Mentioned countless times
> - was that to brainwash us all in to forgetting that PCEHR ever was

Nah - that's your change and adoption strategy at work

Anonymous said...

NeHRS? Is that meant to rhyme with nurse? Or with nerds?

Anonymous said...


The Minister's most-worthy speech, finally, after a decade or longer, marks the starting line of the long journey ahead.

So unfortunately for you, it means that you're going nowhere.

Thank you for your tireless and tenacious pursuit of accountability, transparency and proper management of eHealth in Australia - it's definitely had a positive impact...