Wednesday, May 30, 2012

Random Notes On The Senate Estimates Hearing on E-Health - May 30 - 2012.

Notes typed on fly. Accuracy not guaranteed. Did my best. Corrections welcome!
Session ran from 7.20pm to 8.20pm. Key responders were Ms Jane Halton, Mr Peter Fleming and Ms R. Huxtable.
Notes taken as questions were responded to.

Senator Sinodinos

1. Legislation is still out there and not yet passed - timing not discussed - think some things can still happen without passage if it comes to that.
2. Mr Fleming is looking pretty nervous as of 7:30.
3. GP Software is being worked on but not ready, it might be a while yet before we see some progress on this.
4. Training for CPs and so on is not in any way ready for June 30. Coverage for training is only those caring for the about 1.6 million people at Wave Sites.
5. People will be only be able to register - but only that - essentially zero else as of July 1.(Ms Huxtable).
6. Provider registration is rather behind time - maybe September.
7. Senator Sinodinos seems to be pretty focussed and getting DoHA pinned down.
8. Engagement with GP seems to really be very vague. Not clear on how this is moving this forward.
9. Ms Halton admits the benefits will be pretty slow to come. Mainly from connecting various information sources.
10. $110 on the PCEHR for the 2 years has been spent - $218 on NEHTA Functions.
11. $75 million spent so far on Pilot sites - also building infrastructure, evaluation etc...lots of the rest.
12. Pilot sites costs taken on notice - DoHA can’t remember.
13. Cost Benefits. More information is on Commonwealth Health Web Site. Headlines are better shared care and handover improvements.
14. Legal Liability - can affect adoption rates. Guidelines do not exist as yet publicly. Terms and conditions of use are also not resolved.
15. PIP is trying to set expectations on GPs and rules and plans are still being negotiated.
16. Identifiers are still not being used by GP Software, Aged Care and Pharmacy in any large way and is hoped to happen at some point.
17. Long term funding and governance is not settled after the next 2 years.
18. Operating Costs are apparently not going to rise after the next 2 years. The variable cost of adding people is not known.
19. Difference between variable and establishment cost not defined.
20. Clinical Safety Document - is summary - and has been consulted carefully.
21. Ms Halton suggests this is a new way - fixing the systematising of safety.
22. Dr Mitchell - Clinical Safety is a journey. Transparent information to patients will help.
23. NEHTA takes the responsibility for record safety formally - but they hope patient ownership will help this issue.
24. All this will only work if there is a reasonable level adoption.

Senator Di-Natale

25. Answer to where to complain: Complaint handling process is very bureaucratic it seems.
26. Consent to System Evolution as System Changes: They don’t know how this will be handled. DoHA thinks it is legal.
27. Once signed up you are in until you want out is essentially the message from DoHA.
28 Day One - Focus is on Consumer Registration - On-Line Later - Consumer Portal will enable patient entered notes. Provider Uploads will be September or later. All the Medicare Data (Immunisations etc. also later.)
29. Data Upload will be a bit later - end of September or so.
More commentary after we have transcript.


Anonymous said...

The standout impression I came away with was confirmed after watching another the send hour of the Senate Estimates which followed the eHealth-NEHTA performance.

Ms Halton was quite comfortable answering questions in the 8.30 to 9.30 segment around what has DOHA done overseas and the Health & Hospitals Fund Rural and regional $475 M selection process announced in the May budget. She clearly showed she knew what she was talking about as did her departmental support staff.

Not so in the eHealth Nehta one hour exchange. She, her staff, Peter Flemming and Dr Chris Mitchell conveyed a high level of discomfort, lack of detailed knowledge of their subject matter, and random confusing verbosity. This all served to confirm they have no idea where they are going or how they will ever get there.

Unfortunately, and not surprisingly, the Senators seemed to be rather lost in their attempts to zero in on their complex subject matter to elicit much information of any value.

Anonymous said...

I thought it instructive to listen to Jane Halton and Chris Mitchell explaining at length to the Senators the benefits of having an accurate medication record (current and past)...... and I couldn't help wondering how much longer will we all have to wait.

Anonymous said...

Very simple really, it's the rail-gauge problem.

Why do the stakeholders reading this Blog not get this?

Please move along, nothing of interest, value or substance to see here.

Cris Kerr said...

I was amongst those who raised their voices in alarm and disbelief that the National Health and Hospital Reform Commission had not included ehealth in our nation's future... and then came the 'afterthought' that... though the commission recognized within the report the inefficiency of disparate 'health information silos';

' ... Current health information systems are disjointed, which often results in health care professionals operating with incomplete or incorrect patient information. It is estimated that up to 18 per cent of medical errors are a result of inadequate availability of patient information. ... ';

they did not take the next logical step of recommending taking advantage of this once in a lifetime opportunity to create a single, comprehensive population/public health dataset, and instead left the gate open for even more health information silos in respect of ehealth (disparate public/population health data sets are a big part of the reason we needed health reform).

Long before the commission, Deloite's Qld Health ehealth strategy (way back in 2006), recognized;

(1) page 8 - Chronic care patients (e.g. patients with diabetes) can provide regular health-related updates online

(2) page 26 - Patients empowered to play an active role in managing their health


Unfortunately, the federal health minister's last public statement about additional 'applications' infers these will be offered up to 'market forces' where different providers (private and non-govt) will be able to set up, collect, and manage their own health data sets... to create even more health data silos. Think private health insurers, non-profits, etc.

You don't need to be an Einstein to understand the compounded value of centrally collecting population health data and ensuring and protecting that data's integrity, for all our Australian health futures - to improve privacy, to improve transparency, to improve health outcomes, to facilitate research priorities, to make our public health system more productive and sustainable (same $ but better value from them), and hence; ensure our public health system is still affordable and there in the future for all those who may need it.

Those who don't see this as a problem have never considered that their big paying job and great superannuation today could easily turn to no job and global financial collapse the next.

Make no mistake this is in every Australian's best interest.

Because when you give someone an opportunity to collect data, you give them control over it and everything associated with it.

They control the data, they control what's communicated and what's not communicated, they can alert to clinical trials or favourably review medications, they can ask the right or wrong questions, they can choose/decide what they will or will not record, choose who they will share all that information with, or part of it (or not), etc, etc.

And as a result, all those jigsaw pieces of health information will be devalued in terms of potential to improve population health and data will be subject to 'conflict of interest' creep.

Divesting govt public/population health responsibilities is a trend and the easier path to take... one taken long ago in the USA, where market-based approaches are favoured for everything, yes even public health... where people without jobs and employer-funded health insurance could not afford any healthcare... where they are forced to mortgage or sell their homes to pay for the care they need.

The market will like this though.

Labor and Liberal are looking more the same every day.

Anonymous said...

Halton, Flemming and Mitchell quite clearly didn't have a grasp of the facts so they kept passing the ball along the line dumping the other in it and confusing the Senators along the way. Filibustering or B--ls--t. Take your pick.

Anonymous said...

5/30/2012 10:40:00 PM said... having an accurate medication record (current and past)...... I couldn't help wondering how much longer will we all have to wait.

A few weeks ago Health Minister Plibersek said that high on her priority list was a commitment to see interoperability developed between the two script exchanges. So far nothing has happened. We can only hope she will follow through on that because if she does we will see the e-medication record in very short measure of time just.

Anonymous said...

such a shame the Senators didn't ask questions about the website hack that computerworld are providing:

If this is true, then this should be enough to halt the system right now. If NEHTA and DoHA cannot even keep this public site safe from hackers, what hope do we have that they will be able to protect the pcehr system safe.

Anonymous said...

Hansard transcripts now available for this session at