Wednesday, May 23, 2012

Here Are Two Speeches You Really Must Read and Think About. Shows You Where The Battlelines Are.

The Committee for the Economic Development of Australia had a ½ day session recently (May 16, 2012). Here are the speakers:

PROGRAM OUTLINE

Keynote address:
The Hon Tanya Plibersek
Federal Minister for Health
Session 1 - Policy and progress: the road to health reform
  • Dr Steve Hambleton
    President, Australian Medical Association
  • Elizabeth Savage
    Professor of Health Economics, University of Technology Sydney
  • Pam Williams
    Director - Policy Coordination and Projects, Department of Health (Victoria)
Session 2 - Health and Productivity: Gains for the workplace and society
  • Allan Fels AO
    Chairman, National Mental Health Commission
  • Emma Hossack
    Chief Executive Officer, Extensia
  • Wayne Kayler-Thompson
    Ambassador, Workhealth
Here is the link:
As it was there was a lot of discussion of e-Health.
Here is the full transcript of what the Health Minister said (important in the light of the benefit claims):

THE HON TANYA PLIBERSEK MP

Minister for Health

SPEECH

Committee For Economic Development of Australia

16 May 2012

E&OE
Thank you for inviting me to be with you this morning.
I acknowledge the traditional owners of this land, the people of the Kulin nation and pay my respects to their elders past and present.
I’d also like to acknowledge the CEO of CEDA, The Honourable Professor Stephen Martin, and all CEDA members who’ve joined us here today.
CEDA plays an important part in advancing the national conversation on economic and social policy. Having a strong contest of policy ideas is central to my approach to the health portfolio, and I thank CEDA for its role in promoting informed, thoughtful debate.
I was very pleased to have been asked to speak with you today about eHealth. It’s a priority for me as Health Minister, and for the Government.
Australia’s health challenge
Like many developed nations, Australia is ageing.
Forty years ago, about 8 per cent of Australians were aged 65 and over. Today, it stands at about 14 per cent (Australian Government Department of the Treasury. Australia's Demographic Challenges. Appendix – the economic implications of an ageing population. Accessed 14.5.12. http://demographics.treasury.gov.au/content/_download/australias_demographic_challenges/html/adc-04.asp).
By 2040, this is projected to double to around a quarter of our entire population.
Of course, this is good news. More Australians are living longer. It means our medical treatments are better and we’re making healthier lifestyle choices.
But the trend is putting ever-increasing pressure on the public purse.
This is compounded by an increase in chronic and complex conditions like dementia, cancer, and diabetes – as well as the rising cost of new treatments.
If we don’t act to help ease this pressure, over time the cost of healthcare will become too much for taxpayers. If we don’t move to a more sustainable model, some estimate that within 30 years healthcare spending will outstrip the total revenue collected by all state and local governments (Australian Government Department of Health and Ageing. National Health Reform progress and delivery (p.1) DoHA. Canberra, September 2011).
Making the most of the health dollar
This means more than ever before, we have to make the most of every precious health dollar.
We must be guided by the evidence and invest wisely.
We must find efficiencies and return the benefits to patients.
And that’s what we’ve done in this Budget.
Where the evidence said things weren’t working, the Government’s done things differently.
We’ve made sensible saves to fund smart policy.
It’s how, in the face of tough economic circumstances, we’ve been able to deliver both a surplus and a reforming health Budget…
- a Budget that’s delivered dental care to those Australians who need it most…
- that’s delivered bowel screening to help detect cancer early…
- and that’s delivered $233 million for the next instalment of the Government’s eHealth program.
The case for eHealth
The case for the Government’s eHealth program is a strong one. That’s why we’re continuing our investment.
eHealth has helped computerise our paper based medical records system.
It has helped healthcare professionals, clinics, hospitals to communicate electronically with their patients, and with each other.
And now the Government’s national eHealth records system is drawing all those threads together.
It will be the cornerstone of the eHealth system in Australia.
It will mean a patient’s medical information is available in one place. Available online, wherever and whenever it’s needed - which is a particular benefit given how mobile we Australians are. We spent 262 million nights away from home in the year ending September 2011 (Travel by Australians ¡V September 2011 Quarterly results of the National Visitor Survey, Tourism Research Australia, Canberra. 2011.)
The national eHealth records system will mean better, more efficient, more convenient healthcare. And the benefits will flow to patients, healthcare professionals, and to government.
You may be surprised that in any one week, one in three Australian GPs see a patient for whom they have no current information. More than one in five GPs face this situation every day (Australian Government Department of Health and Ageing. The readiness of Australian general practitioners for the eHealth record. Unpublished. 2011.).
We know that about two to three per cent of all Australian hospital admissions are medication-related. This represents about 190,000 hospital admissions each year, costing $660 million of which about 15,000 are due to inadequate patient information (Roughead, EE & Semple, SJ. Medication safety in acute care in Australia: where are we now? Part 1 : a review of the extent and causes of medication problems 2002-2008. Australia and New Zealand Health Policy 6:18, 11 August 2009.)
For patients over 75, up to 30 per cent of admissions are known to be medication-related, with up to three quarters of these potentially preventable (Runciman, WB, Roughead, EE, Semple, SJ & Adams, RJ. Adverse drug events and medication errors in Australia. International Journal for Quality in Health Care;15(1):i49-i59. International Society for Quality in Health Care & Oxford University Press. Boston, Mass., December 2003)..
For example, I recently heard the story of an elderly man who collapsed in a shopping centre. He collapsed from a perfectly preventable interaction between medicines. The incident occurred after the man’s GP, and his specialist, changed his medication independently of each other ¡X without knowing what the other had done.
With eHealth, stories like these should be a thing of the past. Doctors will have access to a patient’s medical information at the click of a button, including medication.
eHealth will also spell the end for the duplication of things like blood tests. One study I’ve seen showed more than 7% of all tests ordered in a hospital’s immunology lab were unnecessary duplicates (Huissoon, AP & Carlton, SA. Unnecessary repeat requesting of tests in a university teaching hospital immunology laboratory: an audit [letter]. Journal of Clinical Pathology 2002;55:78. 2002).
In our diabetes pilot in Queensland, the Hope Island Medical Centre showed me how GPs using eHealth will keep track of, and prompt, visits to allied health professionals like podiatrists and dieticians for their diabetic patients.
eHealth will also mean:
 - better co-ordinated care for patients with chronic or complex illnesses; and
- less of a need for patients to retell their story every time they see a healthcare professional.
And eventually eHealth also will work together with telehealth technology.
For people with diabetes this could one day mean blood sugar levels read from home, sent to the doctor, and uploaded straight to an eHealth record.
As benefits like these are realised over time, we estimate eHealth will save the federal government around $11 billion over 15 years (Deloitte, The national PCEHR system: relationship to the 2010 national IEHR business case, unpublished, Version 0.19, 22 June 2011)
That’s a long-term return of $11 billion for a government investment which includes around $465 million over the last two years, and another $233 million in the next two.
However you look at it, that’s pretty good bang for your buck.
eHealth: a journey
But the eHealth journey isn’t one that’ll be complete overnight. It’s not just a matter of ‘flick a switch’ and away you go.
During the last two years, the Government’s been building the foundations for the national eHealth records system. And progress has been strong.
We’ve been working hard to build the essential digital infrastructure – the virtual poles and wires for the national eHealth records system.
It will ‘join the dots’ — connecting up our medical records, and connecting the computers of our hospitals, GPs, specialists and allied health professionals to each other.
And the foundations for this will be ready on 1 July this year.
Over the last two years, the Government has also provided more than $160 million to general practices across Australia (up to $50,000 per practice) to upgrade their computer systems for eHealth.
Government support has helped more than 96% of Australian practices to get the IT they need for eHealth – more than two times better than practices in the United States. That makes our GP workforce the fifth most computerised in the world The Commonwealth Fund. Why not the best? The Commonwealth Fund Commission on a high performance health sector. October 2011. p.50..
Now many practices have most of the IT in place, we want to make sure government focuses its investment on the roll-out and take up of the eHealth record.
We've supported GPs to develop their IT systems. And from next year, by raising the bar for incentive payments, we'll encourage them to offer eHealth to their patients through the eHealth record.
Already we’re seeing around 70% of community pharmacies now using ePrescribing. One prescription exchange service reported 4.2 million prescriptions dispensed in the week before last Christmas alone.
Once the digital infrastructure is in place 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 their basic health information. This will include things like emergency contact details, the location of advanced care directives, allergies, and medication.
Patients will also be able to create their own private ‘diary’ area of the eHealth record, where they can enter their own notes.
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 the reform.
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. That way they’ll easily be able to add new information to a patient’s record.
As many of you would know, 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, as the system matures, take up starts to grow exponentially. We would expect that to be the case for the national eHealth records system too.
Looking to the future – the role for government in eHealth
As we move forward with our eHealth agenda it makes sense that we regularly reassess the appropriate role for government.
Back in 2008, the National eHealth Strategy suggested the best role for government was to stimulate investment in high priority computer systems and tools.
In a general sense, I think that holds true still. But what that means in practice is beginning to shift as eHealth in Australia evolves.
Since day one, we have called on expertise from the private sector to build the foundations for eHealth, to develop a common electronic language, and new software for GPs.
To date, this is work that’s largely been driven by government. And so it should have been. Investing in foundations, building infrastructure for the benefit of the whole nation – that’s the kind of work government is uniquely placed to lead.
But as we bed down the core infrastructure, I believe we need to turn our minds to how government can help unleash the creativity and inventiveness of the private and not-for-profit sectors.
As long as the strict security and privacy regime is maintained, we should work to make it easy for private providers and NGOs to offer eHealth related services to health professionals and patients.
I am particularly excited about the potential for some seriously interesting innovation in the consumer applications space.
As I’m sure you all know the recent growth in the number and functionality of apps has been staggering.
Google has reported 300% growth in the number of apps available in its online store in just one year – from 150,000 to 450,000 (ComputerWorld UK, March 2012).
And several different sources show that healthcare apps already make up approximately 4% of the overall active apps market Mobilewalla.com, May 2012 (Active apps are those that have been recently downloaded).
A few years ago we couldn’t have even imagined some of the incredible apps we enjoy today – apps that turn phones into metal detectors, apps that can tell you the name of a song just by listening…and the list goes on!
If we can partner with industry to create the right environment, eHealth has the potential to act as an innovation hub for app designers.
And I trust if we get it right, that many talented designers out there will create new, revolutionary eHealth apps.
These tools, working together with the Government’s national eHealth records system, will allow patients to keep track of their own health better than ever before.
Conclusion
eHealth is a great example of how the Government is working to get the best value from each health dollar.
We’re investing in eHealth because the evidence stack ups.
---- End Speech
Here is the link:
Also speaking was the AMA President:

Dr Hambleton speech to CEDA on health reform

Speech: AMA President, Dr Steve Hambleton

TO THE COMMITTEE FOR ECONOMIC DEVELOPMENT OF AUSTRALIA (CEDA), MELBOURNE, WEDNESDAY 16 MAY 2012

Health reform – from ‘big bang to a whimper’

Just a few short years ago, we were in the middle of what was being called the biggest reform of the Australian health system since Medicare.
There was excitement in the air.
And, of course, there was caution and concern and consultation … lots and lots of consultation.
There was a mood for change, but change to ‘what’ and ‘how’?
Like most groups in the health sector, the AMA was supportive of ‘big bang’ reform, just as long as it was the right ‘big bang’ reform.
A lot of the plans – many of which had been recommended by the National Health and Hospitals Reform Commission – had the conditional support of the AMA.
We were firmly engaged in the reform process.
We supported the idea of a single funder, the end of the blame game, greater responsibility and accountability, enhanced safety and quality, less waste, and a guarantee of clinical input to decision making.
Then political circumstances changed and political courage fell away.
The unique ‘once in a generation opportunity’ for genuine health reform fell away.
State Governments changed complexion and COAG became a battleground once again.
The Government changed leaders and faced a tough election with the polls working against it.
And then we had minority Government … and chaos.
The ‘big bang’ became a ‘small bang’ and then all we had left was a sparkler.
To be fair, the Government has pushed through some pieces of the original health reform big picture.
There are Medicare Locals and Local Hospital Networks, a Pricing Authority, a Performance Authority, a Safety and Quality body, and a national funding pool.
The AMA likes some bits, dislikes other bits, and is seeking changes where there is insufficient input or management from doctors.
It will be some time before these changes are fully bedded down, and even longer before we know the impact on patients and communities.
But, in a difficult and dramatically altered political environment, we must be thankful for some change.
So where does that leave us?
Realistically, the biggest element of health reform now confronting us is electronic health, with the biggest headline item being the Personally Controlled Electronic Health Record – the PCEHR.
I want to concentrate on e-health today.  It is the health reform ‘news’.
As a busy general practitioner, I am personally always interested in improving productivity in health care. 
A key productivity tool in health is the electronic health record.  While it will take longer in general practice, it should save both time and lives in the rest of the health system.
The PCEHR – due to commence implementation from 1 July this year - holds the promise of reducing adverse events and reducing duplication of treatment.
Most AMA members are enthusiastic about the shared electronic health record vision.  They know that, with the right system, they can improve the patient healthcare experience. 
And hopefully save themselves some time in quickly and accurately understanding the nature of the patient’s problem based on ready access to reliable health information.
The right sort of shared record system will help doctors deliver better care. 
They will have important information about their patients to help them make good clinical decisions.
We know that if we just share an accurate medication list, lives will be saved.  Some of my elderly patients can only tell me the colour and size of their tablets. 
These days it is very important to know whether those little blue pills they take at night are round or diamond shaped.  One makes the heart stronger, the other might wear the heart out.
With new patients to the practice it often takes quite a while to work out that medication list.  Often there is no choice but to phone the last pharmacy to piece the information together.
With a properly constructed e-health record, I could confirm my assumptions by reading the medication prescribed by the last doctor.  Or even see what has been dispensed by the last pharmacy.
This would be an improvement over the current situation, and would save time.
A good system will save extra costs for duplicate tests when the originals can't be found or retrieving them would take too long.  Treatment can happen more quickly and better decisions can be made.
The proposed system could be improved to make it much more useful to treating doctors.  A past AMA President, Dr Mukesh Haikerwal, has tried to facilitate this through NEHTA by engaging Clinical Leads.  They need to be listened to.
The introduction for this forum today notes the importance of getting the technological landscape right for e-health. I agree.
But today I also want to point out that introducing technology reform needs the right policy setting.
It needs an e-health policy environment that recognises that health care providers are keen to implement e-health for their patients – but only in a ‘light touch’ regulatory environment.
If the burden looks too great in time, cost and resources needed for the task, very few will adopt the new system.
The reality of patients having to opt-in means that, when doctors look for a patient’s record, they will often find there isn’t one. 
The PCEHR has been designed from an ideological point of view. 
Patients will decide if they want one. But there is no information about what the opt-in rate will be.  We might have fast take-up by patients, or it might be very slow.
In the meantime, in clinical practice there are only so many times that doctors are going to stop and look to see if their patient has opted in and given them access to their PCEHR.
If doctors were to find that most of their patients had a PCEHR, they would be more likely to keep using the system.  We hope that the opt-in feature proves successful. 
We know that, from 1 July, patients will be able to register for their PCEHR.
Just last week the Government launched the e-health.gov.au website.  Through that website, the Government is encouraging patients to register an interest in having a PCEHR.
But there is still much work to be done to roll the system out to hospitals and general practices.
There is still uncertainty about when and how well the system will be connected to health care providers.  There is a lot of technical work being done behind the scenes. 
And there is still a long way to go until we have appropriate, interoperable, tested, and affordable practice software to connect doctors and nurses to the system.  Every practice will need an upgrade.
At this stage, the Government strategy appears to be a ‘build it and they will come’ approach to supporting healthcare providers like me to tool up to use the PCEHR.
As announced in last week’s Budget, the Government will require general practices like mine to participate in the PCEHR in order to attract e-health practice incentive payments.
The Government is going to force us to make an investment in terms of redesigning our practices’ processes to integrate a system that, at this stage, we have relatively little information about.  This is a ‘stick’ to encourage us to do more for the same reward.
There is plenty of commentary recognising that general practice will have to make the most investment in the PCEHR both in time and money and will realise the least amount of benefit from it – and that is a real concern for us.
It will be interesting to see how non-GP specialist medical practices warm to the PCEHR without any incentives at all.
The legislation underpinning the PCEHR carries a lot of new obligations for medical practices, hospitals and other organisations providing health care. 
There is a large administrative impact on medical practices.
Medical practitioners who decide to use the system will have to adapt their clinical workflows and train their staff to work within the requirements of the legislation.
Doctors will have to consider the impact of this additional workload, and the changes to clinical workflow, on the fees they charge their patients.
As I said, the biggest impact will be on GPs.
GPs will take on the role of “nominated healthcare providers” and create and maintain the “shared health summary”.  This is a key feature of the PCEHR.
But without specific MBS items for this work, it will have to be absorbed into the standards consultations.
As things stand, GPs are being asked to provide a new service for free.
Providing a shared health summary is a very specific task requiring clinical skills.
GPs will work with their patients to ensure that a complete and accurate summary is available to be used by other health care providers in their clinical decisions. 
It is only reasonable that patients should receive an additional Medicare rebate for this very important additional service.
There needs to be some investment by Government to support medical practices that are private businesses – to invest in the infrastructure that is needed to make the PCEHR work.  There needs to be a business case.
Doctors need greater support than that what is on offer if the PCEHR is going to truly work to improve patient care and reduce waste and risk in health care.
The AMA is a great supporter of, and advocate for, accurate electronic communication.  It is the future.
We support the introduction of the PCEHR – but it has to be the right PCEHR.
At the moment, we do not think the proposed PCEHR is the right PCEHR.  And the Minister knows our view.
The implementation process may start on 1 July but the completion of the implementation will be some time off, unless there is genuine consultation and agreement on the final product.
----- End Speech.
Here is the link.
On the Health Minister’s speech there are two things that leap out at me - other than the obvious slowdown and increasing care with roll out.
First there is a secret (apparently) report with this title that explains where the benefits will come from.
(Deloitte, The national PCEHR system: relationship to the 2010 national IEHR business case, unpublished, Version 0.19, 22 June 2011)
Second we have a range of statistics offered as to the scale of problems in the Health System but no idea just what proportion can be fixed by e-Health. It is more likely to be 10% rather than 100% using the PCEHR! (see yesterday’s blog)
On Steve Hambleton’s speech it seems clear the AMA is just not on board with what is being done. That is a pretty serious issue I would suggest.
We still lack the leadership and governance to get all this to come together!
David.

1 comment:

B said...

And then there's this report

http://www.itnews.com.au/News/301890,gp-security-vital-to-e-health-success-nehta.aspx

...
The Royal Australian College of General Practitioners warned this week that the $161.6 million in additional funding given under the 2012-2013 budget to spur on e-health for the next four years is not enough.

"The international experience is clear that for general practice, the implementation is often costly and takes time, training and infrastructure investment," RACGP president Claire Jackson said.

"'Go live' is now very close and adequate support for implementation across the thousands of Australian practices, despite heavy lobbying, has not been forthcoming."

Jackson pointed to clinical support, data safety and the ongoing drafts of terms and conditions vital to participation in the program as key remaining unknowns in the project, with just 38 days to go.


Sound like critical, not just vital.

As I've said before changing and unstable requirements are the most consistent indicator of a failing project. And there's more than a few in this project.

All the political grandstanding and gloss mean nothing. Testing and usage are the only real tests that count. Especially to those who won't listen to good advice and, to be fair, to the doomsayers.

I wonder if NEHTA and/or DoHA will be publishing take-up statistics.