Sunday, February 02, 2014

The Productivity Commission Seems To Have Totally Missed The Point With Their New Report On The Health Sector. Amazingly Visionless and Useless Stuff That Adds Nothing To What The AIHW Already Does!

This appeared a day or so ago.

Health Minister Peter Dutton pushes overhaul to cut 'waste'

Date January 30, 2014

Dan Harrison

Health and Indigenous Affairs Correspondent

Health Minister Peter Dutton says new figures showing an escalation in health spending demonstrate why the government must cut ''waste'' in health.
Figures to be published by the Productivity Commission on Thursday show that between 2002-03 and 2011-12, federal government spending on health grew at an average of 4.9 per cent a year, while state government spending grew at 6.8 per cent a year, and non-government spending - by individuals and insurers - grew by 5 per cent a year. Health spending per head by all governments rose 37 per cent over the period in real terms, from $4474 to $6230. Adjusting for inflation, non-government health spending per person rose from $1259 to $1802 over the same period.
Mr Dutton said the figures demonstrated the challenge the government faced in placing the health system on a stable financial footing. ''It is the reason we have to cut waste in health and invest in areas that provide the greatest benefits to patients.''
Earlier this month, Mr Dutton flagged an overhaul of Medicare, warning spiralling costs would make the system ''unmanageable'' without change.
''In the end, we want to strengthen Medicare and we want to strengthen our health system, but we can't do that if we leave change to the 11th hour,'' he said.
The government's Commission of Audit is considering a proposal by a former adviser to Tony Abbott, Terry Barnes, for a $6 fee to visit the doctor to discourage avoidable GP visits.
Mr Dutton has also left open the possibility of regulatory change, which would allow private insurers to pay for GP visits, prompting warnings from consumer advocates that such a change would undermine universal healthcare.
More here:
Here is the report referred to:

Report on Government Services 2014

Volume E: Health

This volume was released on 30 January 2014.

Download the volume

Here is the direct link to the .pdf file.
Here is the link to the page:
When you download the huge file you will notice it has over 1600 pages!
So I wanted to see just how much discussion there was on technology, NEHTA, eHealth and the PCEHR.
1. PCEHR References = 0
2. NEHTA Reference = 0
3. eHealth - References = 2 (lots of eHealth PIP in tables etc.)
First we have (page 89):
“Investment continued in major eHealth initiatives. The largest, the Enterprise Patient Administration System (EPAS), continued to progress during 2012-13. EPAS will provide the foundations for the delivery of an SA Health wide electronic health record and will help improve care by enabling clinicians to spend less time on paperwork and more time with patients at the bedside.”
And we also had this (page 869)
“Electronic health information systems
‘Electronic health information systems’ is an indicator of governments’ objective to improve patient safety through enhanced access to patient health information at the point of care and the more efficient coordination of care across multiple providers and services (box 11.15).
-----
Box 11.15
Electronic health information systems
‘Electronic health information systems’ is defined as the proportion of general practices enrolled in the Practice Incentives Program (PIP) that are registered for the PIP eHealth incentive.
A high or increasing proportion can indicate that patient health information at the point of care and coordination of care across multiple providers and services are desirable or are improved, minimising the likelihood of patient harm due to information gaps.
The PIP does not include all practices in Australia. PIP practices provided around 83.0 per cent of general practice patient care in Australia (measured as standardised whole patient equivalents) in 2010-11 (Department of Health unpublished; table 11A.51).
Data reported against this indicator are:
  • comparable (subject to caveats) across jurisdictions and over time
  • complete (subject to caveats) for the current reporting period. All required 2012-13 data are available for all jurisdictions.
Data quality information for this indicator is under development.
-----
The use of electronic health information systems can, for example, facilitate best practice chronic disease management as well as minimise errors of prescribing and dispensing that can cause adverse drug reactions (Hofmarcher, Oxley and Rusticelli 2007).
The PIP provides financial incentives to general practices to support quality care, and improve access and health outcomes. The PIP promotes activities such as:
  • use of electronic health information systems
  • teaching medical students
  •  improving management for patients with diabetes and/or asthma.
The PIP eHealth Incentive aims to encourage general practices to keep up to date with the latest developments in electronic health information systems. Accordingly, new eligibility requirements were introduced from 1 February 2013, requiring practices to:
  • integrate healthcare identifiers into electronic practice records
  • have a secure messaging capability
  • use data records and clinical coding of diagnoses
  • send prescriptions electronically to a prescription exchange service
  • participate in the eHealth record system and be capable of creating and uploading Shared Health Summaries and Event Summaries using compliant software.
Nationally, the increase in the proportion of PIP practices using electronic health systems from 78.5 per cent in 2010 to 88.3 per cent in 2012 was followed by a decrease to 72.2 per cent in 2013, as implementation of the new requirements was not yet completed in a number of practices (figure 11.34).”
---- End Extract.
Two things struck me with all this.
1. Read this carefully:
‘Electronic health information systems’ is defined as the proportion of general practices enrolled in the Practice Incentives Program (PIP) that are registered for the PIP eHealth incentive.
One comment on this definition. WTF!
2.  This is very interesting:
“Nationally, the increase in the proportion of PIP practices using electronic health systems from 78.5 per cent in 2010 to 88.3 per cent in 2012 was followed by a decrease to 72.2 per cent in 2013, as implementation of the new requirements was not yet completed in a number of practices (figure 11.34).”
So it seems NEHTA have over-reached, clinician disconnected nitwits that they are, and made it so hard to get the incentive people have just given up! Just what Government wanted - to save money - I am sure but hardly advancing ehealth!
4. Technology References = 2 (neither on IT)
Here is a summary of the top few Terms of Reference (p29).

The Report on Government Services

1. The Steering Committee will measure and publish annually data on the equity, efficiency and cost effectiveness of government services through the Report on Government Services (ROGS).
2. The ROGS facilitates improved service delivery, efficiency and performance, and accountability to governments and the public by providing a repository of meaningful, balanced, credible, comparative information on the provision of government services, capturing qualitative as well as quantitative change. The Steering Committee will seek to ensure that the performance indicators are administratively simple and cost effective.
3. The ROGS should include a robust set of performance indicators, consistent with the principles set out in the Intergovernmental Agreement on Federal Financial Relations; and an emphasis on longitudinal reporting, subject to a program of continual improvement in reporting.
4. To encourage improvements in service delivery and effectiveness, ROGS should also highlight improvements and innovation.
----- End Extract.
As the Steering Committee for all this is all from PM and Cabinet, Treasury and Finance and State Governments it looks like e-Health and its possible or actual impacts are simply unknown to this lot of mandarins. Surely the use of Health IT is deeply in scope as far as an improvement agenda is concerned. So why so little comment?
Seems progress in eHealth in primary care, hospitals and so on is so low a priority to support quality, efficiency etc. that we might as well just give it away. Pity they are so narrow minded and ignorant - I wonder what a 1600+ page waste of space like this cost us all?
David.

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