Sunday, June 03, 2012

This Is An Astonishing and Just Unsupportable Piece Of Nonsense. A Fraud On The Populace Is My View.

This astonishing document appeared a few days ago.

Expected benefits of the national PCEHR system

Printable version of Expected benefits of the National PCEHR System (PDF 71 KB)

Based on economic modelling work undertaken in 2010-2011

Overview of the national PCEHR system

The national PCEHR system will comprise a secure network of systems enabling access to consolidated and summarised health information drawn from multiple sources across the Australian health sector.

Summary of expected benefits

The net direct benefits of the national PCEHR system estimated by Deloitte are expected to be approximately $11.5 billion over the 2010 to 2025 period. This comprises approximately $9.5 billion in net direct benefits to Australian governments and $2.0 billion in net direct benefits to the private sector, where the private sector includes households, GPs, specialists, allied health clinics, private hospitals and private health insurance providers.
Economic modelling was undertaken from the commencement of investment in the PCEHR in 2010 and considered benefits that would be accrued over the 15-year period to 2015. The economic modelling considered both the benefits that accrue from the direct investment in the national PCEHR system as well as the benefits that accrue from investment by the broader health sector that is catalysed by the Commonwealth Government’s investment in the national PCEHR system.

Expected net benefits

Deloitte has categorised the expected benefits and costs of the national PCEHR system as follows:
  • Public – The benefits and costs of the national PCEHR system to the public sector, which consists of the Commonwealth and State and Territory Governments
  • Private – The benefits and costs of the national PCEHR system to the private sector, which consists of households, GPs, specialists, allied health clinics, private hospitals and private health insurance providers.
  • Community – The combined benefits and costs across both the public and private sectors.
Table 1 below shows the sum of future net benefits of the national PCEHR system over the 2010-2025 period.

Table 1 – Expected total net benefits of the funded national PCEHR system (2010-2025)

Benefit

Expected total net benefits
(2010-2025) ($M)

Public benefits
$13,121
Public costs
$3,614
Net public benefit
$9,507
Private benefits
$7,594
Private costs
$5,555
Net private benefit
$2,038
Total community benefits
$20,715
Total community costs
$9,170
Net community benefits
$11,545

Benefit contribution to priority health activities

The benefits of the national PCEHR system accrue from two key areas:
Reduced avoidable hospital admissions and GP visits due to more effective medication management
With more complete information about a patient at the time of prescribing — independent of location or time constraints — prescribing errors and adverse drug events (ADEs) in both acute care settings and in the community can be reduced. The national PCEHR system will enable this outcome through giving health providers access to clinical documents that contain concise medication information for a patient, such as Shared Health Summary, Discharge Summary and Event Summary documents.
Improved continuity of care
Reducing the time consumers and care providers spend repeating and sharing information across the health sector will improve the effectiveness and efficiency of healthcare delivery. The national PCEHR system will enable this outcome through enabling health providers to contribute patient health information to their PCEHR in the form of PCEHR-conformant clinical documents. Other health providers can then access and view this information for the same patient thereby reducing the need for consumers and the original care provider to repeat the same information. For example, a Shared Health Summary document will summarise the current health status of a patient so that this can be accessed by other health providers involved in their care, such as outpatient clinics and allied health professionals.

Table 2 below shows the benefits for priority health activities which the national PCEHR system is expected to deliver over the 2010-2025 period based on available global research.

Table 2– Benefits of the national PCEHR system for priority health activities

Priority health activities

Benefits of national PCEHR system
(2010-2025) ($M)*

Reduced avoidable hospital admissions and GP visits due to more effective medication management
$10,237
Improved continuity of care
$1,308
Total net community benefits (as per figure stated in Table 1)
$11,545
* The allocation of benefits across the priority health activities is an estimate based on their proportional contribution to overall benefits modelled for the period 2010-2015.
Table 3 below provides a break-down of the above benefits for the national PCEHR system by care setting.
Table 3– Breakdown of PCEHR benefits by care setting
Priority health activities
Care setting
Benefits of national PCEHR system (2010-2025) ($M)*
Reduced avoidable hospital admissions and GP visits due to the more effective medication management
Community setting
$9,228
Aged care setting
$603
Acute care setting
$405
Subtotal
$10,237
Improved continuity of care
Community setting
$1,254
Acute care setting
$55
Subtotal
$1,308
Total
$11,545
* The allocation of benefits across the priority health activities is an estimate based on their proportional contribution to overall benefits modelled for the period 2010-2015.

Approach to modelling

The economic impact assessment undertaken by Deloitte focused on identifying the incremental health and economic benefits that could be realised from the implementation of a national PCEHR system as distinct from the benefits of other eHealth investments occurring in the Australian landscape, such as:
  • The core standards and eHealth foundational infrastructure being developed by the National E-Health Transition Authority
  • Investments that have already been proposed or implemented by Australian governments, such as the implementation of Electronic Medical Records, ePrescribing, eDiagnostics and Care Plan capabilities
  • Investments that have already been proposed or implemented by commercial providers, such as commercially available ePrescribing solutions.
To identify the incremental costs and benefits associated with the national PCEHR system as compared with other eHealth investments that would be expected to be made independent of the national PCEHR system, two scenarios were developed:
  • The Base Case investment scenario In this scenario, where no national PCEHR system is developed, a cost-benefit model was developed that identified the range of eHealth capabilities that would be expected to come online regardless of whether a national PCEHR system was developed. The assumptions underpinning the expected costs and the timing of new capabilities coming on-line was estimated based information gathered from the broader health sector.
  • The PCEHR investment scenario In this scenario, where a national PCEHR system is developed, a cost-benefit model was developed that identified the additional eHealth capabilities that would be expected to be either specifically delivered or brought forward as a direct result of the implementation of a national PCEHR system. As in the Base Case, the assumptions underpinning the expected costs and the timing of new capabilities coming on-line was estimated based on information gathered from the broader health sector. The benefits estimates were based on a literature review of the likely improvements in safety, quality or efficiency of care associated with each capability, with the PCEHR cost benefit model identifying the additional benefits that would be unlocked as a result of the national PCEHR system being developed.
By comparing the benefits that would be realised for different technologies in the PCEHR scenario with the Base Case scenario the analysis is able to identify the benefits associated with the national PCEHR system.

Base assumptions

In modelling the scenarios for the national PCEHR system, five key assumptions about the operating environment of both scenarios were made:
  • Privacy legislation and all necessary regulation is expected to be implemented
  • Available bandwidth exists to support the information sharing across patients, care providers and governments
  • Basic carer provider infrastructure, such as computers and access to internet where relevant, is available
  • Technology change is steady
  • Current health sector funding and governance remains unchanged.
To calculate the benefits of the national PCEHR system over time, Deloitte made assumptions regarding the take-up of the system among consumers and the health sector. An overview of these assumptions is provided below.

Provider take-up assumptions

With the scope of the change and adoption strategy focused towards eHealth, a nationally uniform rate of technology take-up is not expected. It is expected that there will be a faster rate of adoption and take-up within eHealth Site regions, and a slower rate of take-up in the rest of the country. It has also been assumed that there will be comparatively higher rates of take-up by GPs, hospitals, pharmacies and aged care providers, with lower rates among specialists and allied health providers.

Consumer take-up assumptions

The national PCEHR system will be based on an opt-in participation model. This means that the extent to which benefits are generated as a result of the PCEHR will be dependent on the rate of participation by consumers. The consumer participation rate was based on two key assumptions:
  • A percentage of consumers will, for a variety of reasons, never choose to register for a PCEHR
  • The rate of participation by consumers will lag the aggregate participation rate for healthcare providers.
You can find the page here:
Just as a small sanity check:
From this reference found here we hear the Adverse Drug Events cost the Community $660 million per year.  So the cost over 15 years is $9.9 billion.
See here:
The reference cited is:
6. Easton K, Morgan T, Williamson M.  Medication safety in the community: A review of the literature. National Prescribing Service. Sydney, June 2009.
You can grab the paper from here:
So what we are being told is that introduction of the PCEHR will save essentially every cent of cost incurred in the community with no help from e-prescribing, GP and Pharmacist automation and the like.
Also this must assume 100% adoption from day one etc, etc. And I just love how they can estimate to five significant figures 15 years out. This is NASA like futurology!
The utter lack of supporting detail and references is, of course, an insult to anyone interested in the area. The arrogance here is really spectacular. DoHA are saying 'We will make it up as we go along, put it on a government web site and you will believe it" Sorry, it just does not work like that.
Whatever these people are smoking I want some. It must make reality a very distant concept.
It is this sort of rubbish that gives economists credibility in getting their predictions right!
David.
Addendum June 5, 2012: Please Note: I have no real criticism of what Deloittes have done - which I am sure is has been undertaken competently and properly. My criticism is of DoHA who simply don't release enough information to allow any one to form a view, on the evidence provided, on the actual conclusions reached! They are just too secretive and un-transparent.
D.

10 comments:

Anonymous said...

Just because you build it does not mean that they will come.

The fundamental assumption behind what is summarised here is that if information is available, it will also be looked at, understood, and then it will alter decisions. However repeated evaluations of health IT show there is a substantial 'loss' at each of these steps.

So, not only should there be discounting in the model for the rate of adoption, there should be discounting for record availability at a given prescribing encounter (web accessible), completeness of the record with respect to the encounter's needs (data gaps), rate of record access per percent encounters (failure to consult record), and a discount for the information translating into an altered behaviour (fail to perceive, believe or change viewpoint).

I challenge these modellers to get their model published in any peer reviewed international informatics journal.

But I'm sure the consultants gave exactly the answer they were asked to do.

Anonymous said...

I think it is interesting that they have started accumulating benefits before it starts...2010?

Dr Ian Colclough said...

The expected total net community benefits are 11,545 million dollars [2010 to 2025; 770 million dollars per annum].

Amazingly, 9,228 million dollars [80 percent] will be contributed by a reduction in avoidable hospital admissions and GP visits due to more effective medication management.

That being so the Government should be doing everything possible to ensure Electronic Transfer of Prescriptions [ETP] is seamlessly embedded as part of the fabric of every medical practice and community pharmacy in Australia without delay.

Anonymous said...

@Anon of 7:53 3une... why not accumulate benefits before it starts? Abbott et al are proclaiming the destructive costs of the carbon tax before it kicks off.... best to get ahead of the game, right :-)?

Anonymous said...

6/04/2012 12:00:00 AM Ian Colclough said ...... That being so the Government should be doing everything possible to ensure Electronic Transfer of Prescriptions [ETP] is seamlessly embedded as part of the fabric of every medical practice and community pharmacy in Australia without delay.

I think everyone would agree wholeheartedly when one considers that:
(a) the acute care setting only accounts for 4 percent of the subtotal 10,237 million of benefits compared with community and aged care contributing 96%
and

(b) ETP is the essential precursor to establishing feeders to enable the eMMR (Electronic Medication Management Record)and control doctor (prescription) shopping.

ETP with approved electronic signatures is needed now. Pretending it cannot be achieved without the PCEHR is rubbish and NEHTA knows it.

Andrew McIntyre said...

This is a joke considering that AMT is almost totally useless for decision support and they know it. We need building blocks and a solid foundation to build anything that is going to make a difference and they don't even get that.

Terry Hannan said...

David, I do agree these are "mind boggling" numbers that seem more theoretical than realistic. Also who will remember this government in 5 years let alone 15 years? To make matters worse there is no "voice" from the opposition on e-Health and who will be in government in less than 2-5 years.
It is unlikley they will 'accept' a labour government supported funding model. Terry Hannan

Anonymous said...

I do worry when I read …. “The national PCEHR system will ….. give health providers access to clinical documents that contain concise medication information for a patient, such as Shared Health Summary, Discharge Summary and Event Summary documents”

THINK ABOUT THIS
- access to multiple clinical documents containing concise medication information for a patient.

Is this not perpetuating the old way of doing things and thereby perpetuating the inadequacies of the current system?

Why do we need to talk about access to multiple clinical documents containing concise medication information?

Surely ALL medication information should be held in ONE location, in ONE document, in ONE electronic Medication Record (eMR) so that all medication ordered and dispensed can be accessed via the eMR and NOT as is being suggested above by Deloitte in MULTIPLE clinical documents such as Shared Health Summary, Discharge Summary and Event Summary documents.

Have I misunderstood what Deloitte is saying?

Anonymous said...

Medication information is very contextual, and it is very hard to get it all into one place, e.g. medication is prescribed, held in a prescription, dispensed (at various times, and with repeats), claim via the PBS, administered (taken), and ceased because of reactions. Sometimes people take over the counter medications, or even whatever is in the cupboard that was prescribed for them years ago, or for another member of the family. There are other records used to record intolerance or adverse events. Nurses can record doses as they are administered, and also the fact that they came up again! The PCEHR provides the opportunity to bring some of those documents together (presuming there are systems that can provide the data), and the more standardised it is across the feeder systems and interfaces, the more meaningful it will be for clinicians and their patients. It's a hard nut to crack for sure, but well worth it it seems. So important then to have standardised coding and specifications, so that we don't just repeat the mess we have in the paper world into the PCEHR.

Anonymous said...

6/04/2012 04:58:00 PM said Medication information is very contextual, and it is very hard to get it all into one place.

Indeed, but if we try to get perfection before we start we will go nowhere. The last decade has proven that. It makes most sense to capture first and foremost every script written by GPs, including repeats, and dispensed by pharmacists, create the eMedication Record with the prescribe/dispense information and progressively build upon the functionality and the infrastructural to achieve incremental improvements going forward. Any problems with that please let us all know.