Sunday, March 09, 2014

Does This Sound To You Like A Man With A Plan - It Really Doesn’t to Me!

Mr Dutton gave a major speech last week.

Keynote Address to the General Practice Registrars Australia Conference 2014

Minister for Health Peter Dutton presented the Keynote Address to the General Practice Registrars Australia Conference 2014 on 6 March 2014.

Page last updated: 06 March 2014
6 March 2014
Check Against Delivery
Good morning ladies and gentlemen and thank you for welcoming me here this morning to open the Future of General Practice 2014 (#fgp14) conference.
For the past four years I have spoken at the GPRA’s annual conference while in Opposition, so I’m pleased to have the opportunity to address this event as the Minister for Health.
I would like to acknowledge:
  • GPRA Chair, Dr David Chessor, and Board members,
  • General Practice Students Network (GPSN) Chair, Joseph Monteith,
  • GPRA Patron Professor, John Murtagh,
  • medical students and registrars, and
  • other important members of the medical community.
Firstly thank you to the GPRA for continuing to look for innovative ways to further improve the quality of Australia’s health care through higher standards of education and training.
These conferences play an important role in the future of the health care sector, providing an opportunity for leaders in the field to share ideas and investigate ways we can support the next generation of GPs to provide the standards of care that Australians need and deserve.
Thank you also for your important work representing the nation’s future GPs - and I note the importance of the theme you have chosen for this conference – transforming communities – and your focus on the role of technology in the future of general practice.
New technology and social media have been transformative forces in modern Australia, touching virtually every aspect of our daily lives. I suspect your experience with Twitter is a little different to mine.
The many new young registrars we have coming through today, many of whom will be tomorrow’s GP in communities throughout Australia, are high users of online tech both personally and professionally.
You are part of a new generation of physicians for whom new online technology and social media tools will greatly influence their professional life. This opens up new opportunities – both for GPs as well as the communities and patients they support.
A large part of the challenge we face today is the need to think about how we can better utilise those tools to better support you – to help you do your job more efficiently and effectively, and to achieve better outcomes for patients.
The full speech is here:
There was commentary on the speech here with some e-Health comments at the bottom of the article:

PIP payments for teaching set to double

6th Mar 2014
A DOUBLING in PIP payments for GP teaching promised by the Coalition before the election last year looks likely to be included in the upcoming federal budget.
Health Minister Peter Dutton told the Future of General Practice Conference, held by General Practice Registrars Australia (GPRA) in Canberra today, that the government was “implementing that promise”.
The $119 million commitment would result in existing maximum practice payments for teaching sessions with medical students rise from $100 to $200, with a maximum of two sessions able to be claimed by a practice per calendar day. Eligible sessions must last at least three hours, while the maximum payment of $200 would remain, regardless of whether multiple students are taking part in the session.
----- Lots omitted
And while there remained some “serious flaws” in the personally controlled electronic health record (PCEHR) system, Mr Dutton remained optimistic about its potential.
He told the conference he was considering the findings of a review he commissioned into the billion-dollar system but said problems relating to the availability of reliable medication and allergy information needed to be made a priority.
By improving these areas and allowing greater uploading of patient discharge summaries, GP and hospital clinician engagement could be significantly increased, Mr Dutton said.
Full article here:
What we have here is that the Minister thinks the PCEHR has ‘serious flaws’- unspecified  - but that it has potential. He then goes on the say he is still considering the review. It is interesting that the speech transcript did not mention e-Health that I could see.
On the basis that the report represents Mr Dutton’s views we are forced to conclude that, having had the Review for 2-3 months, really does not know what to do - or he would have done it - or possibly he is wanting to get more input.
What I suspect is going on is that Minister is under lobbying pressure from the vendors supporting the PCHER and NEHTA that this can all be fixed and that if he is patient it will all turn out to be a great success.
My view is that if he falls for this line he will regret it, big time, 2-3 years from now. Anyone who knows anything about e-Health know the PCEHR is a deeply conceptually flawed concept that does not know what its purpose is and who it is meant for.
Doing anything other than essentially starting again with a more workable model or scrubbing the whole thing are the only viable options. I suspect the final outcome will depend on the dollars needed and the quality of the lobbying. Do you reckon it is possible the increased PIP Payments will be funded by a cut to the e-Health PIP incentive? Overall this my not be an ideal way to set public policy and meet health needs.

Another possibility is that they have a plan and that it has real Budget impact and so is under review by Finance etc before being agreed. It is worth remembering the PCEHR funding ends Jume 30.

Maybe the Health IT industry could develop a recovery plan?

Look forward to other insights!


Anonymous said...

After stumbling across "Lysenkoism" (See wikipedia) of late I think we have a healthy dose of Lysenkoism somewhere deep in the health department and no amount of science, logic or common sense is going to stop them from pursuing the "Holy Grail" that the PCEHR has become to them. Lets hope the minister is smart enough to see the truth and stop throwing good money after bad!

Marko said...

Dr More confuses his opinionated stance with the ideas behind the PCEHR vision and/or (if you negate it had a clear vision) the major dilemmas facing our healthcare system. "The PCEHR is a deeply conceptually flawed concept" ignores what the PCEHR is aspiring to achieve. More importantly, this line of one-sided barracking does not address the exponentially rising financial challenges our society faces, if it does not increase the agency of its healthcare consumers and promote a much more 'open source' approach to the patient journey.

1. Public Healthcare desperately requires some means of sharing health records across the vast array of providers. This is a given. Any review of adverse drug events, medication errors, avoidable hospitalisations and repeated assessment procedures reinforce this conclusion. If nothing else, the current government recognises the value of shared health records, even if it is just to 'save money', as Dr More has previously highlighted.

2. Public Healthcare desperately requires some means of engaging consumers in caring for their own health in an active, rather than passive way. Why is the smart phone and tablet Health App industry exploding? Because those consumers actively engaged in health and fitness see the value of tracking and improving their health.

If we actually apply concepts and theories to understand consumer behaviour, such Lean and Agile thinking, some key questions coming begging: what is the 'engine of growth' for engaging consumers in their own health record? Although an almost non-existent national awareness campaign has a massive role to play, slow take-up and usage of the PCEHR speaks volumes for the public's lack of understanding about the value of taking control of their healthcare. Online and smart-phone banking has completely transformed the sector. We have socially accepted the concept and activity. Within weeks of the NSW Transport Opal card becoming available the take-up is clearly visible. It is a no-brainer that people would rather have a perpetual $20 minimum in the NSW coffers than constantly queue 20 minutes at Sydney Central for their travel cards and tickets. The engine of growth, public messaging and concept is clear and primed.

The PCEHR not only challenges health providers into a Copernican shift away from their own self-serving and sustaining worlds but also consumers.

Lastly, what is the alternative? Interoperability of Secure Messaging technologies are clearly needed to increase the levels of security, privacy and efficiency of clinical hand-over and document exchange between providers. But they are not a centralised means of sharing health records (health summaries, medications, pathology results, etc.). The USA is staking its healthcare reform and ehealth claim on the meaningful use of EHRs. The UK blew billions of dollars on its decommissioned project and is now 'hoping' to redeem itself by 2015. Dr More needs to track, pursue or promote alternatives, rather than barracking from his ring-fenced back garden. That, or come clean and out in the open with his other possible drivers, such as dropping the whole idea of a universal public health system, a public-private marketplace where the insurance sector is welcomed, but with clear regulations to ensure they do not follow the path of the USA and create a monstrously divided and divisive society, where only the insurance companies win (and win big).

And if Dr More's underlying (if not undeconstructed) assumptions lie in the free-market economy of survival of the richest, he needs to review the dilemmas both John Howard and even Tony Abbot worked through in recent years - both attenuating their privateer, wild-west mindset and accepting some form of collaborative partnership between all stakeholders.

Dr David More MB PhD FACHI said...


Thanks for the comments. Sadly the PCEHR won't, in my view, deliver on the objectives you identify.

My weekly reviews (of overseas Health IT) and much other here explores all sorts of alternatives. Just read back and you will find heaps.


Anonymous said...

Is this some good news at last or is it not?

From PulseIT today .... Tasmania's four major public hospitals are now connected to the PCEHR and are uploading discharge summaries, with Western Australia shortly to go live as well.

Bernard Robertson-Dunn said...

IMHO, Marko is conflating objectives with proposed actions.

There is a huge difference between "what the PCEHR is aspiring to achieve" and what it actually achieves, or even could achieve.

Re point 1. Public health care needs more than sharing health records. Sharing health records is an interoperability problem. Sharing existing health records is likely to bring limited returns. What is really needed is the creation of better health information that is used in better ways. The PCEHR does not do this and I have seen no suggestion that it would enable either in the future.

Re Point 2. The statement "Public Healthcare desperately requires some means of engaging consumers in caring for their own health in an active, rather than passive way" needs justifying.

There are many people actively attempting to engage in managing their own health through the use of complementary and alternative medicine and via faith based beliefs. It is arguable that these people do more harm to themselves and their families than good. What is needed is not consumers doing their own thing, its a better engagement between healthcare professionals and society in general. Better health comes from avoiding sickness and bad practices, not from curing sick and unhealthy people. I have seen no suggestion that the PCEHR is expected to play any part in the promotion of better health practices, as opposed to care management.

My reading of Dr More's comments suggests to me that he doubts that NEHTA and the PCEHR will achieve the goals that governments have been trying to achieve. He comes to this conclusion as a medical professional. I have come to the same conclusion based upon my professional background in Information and Dynamic Systems.

It's not the objectives we disagree with, it's how they are trying to achieve those objectives we have a problem with.

I'm sure David will correct me if I have misrepresented his views.

Dr David More MB PhD FACHI said...


Spot on!


K said...

Agree with most of what Bernard wrote, except for this: "Better health comes from avoiding sickness and bad practices, not from curing sick and unhealthy people".

No. There's a degree to which avoiding sickness through healthy living will lead to better health, but it's strictly limited in the end - people get sick because they live, and nothing will stop that. In the end, better health must come from curing people.

Only - it's a self-limiting task - see for a polemical and depressing take on the situation

Bernard Robertson-Dunn said...

@K, Good point. I'll amend my statement to:

"Better health comes from avoiding sickness and bad practices as well as from curing sick and unhealthy people. The former usually reduces the need for the latter.

Unfortunately, the health industry doesn't like the former (conflict of interest) and government prefers the more immediate nature of the latter (the electoral cycle)".

K said...

I've spent almost my entire life doing healthcare in one form or another, and I've never really thought that working on health as opposed to sickness is actually a conflict of interest for the system generally. Obviously a few people are locked into sickness, and working on health will disenfranchise them, but for most people it's really very much simpler: investing in health is a long term solution, and takes money away from today's problem, which is sick people now! Most of the system is just overwhelmed by immediate needs. Perhaps it would be better to say that working on health instead of sickness is a conflict of interest for sick people

Anonymous said...

“Is this some good news at last or is it not?
From PulseIT today .... Tasmania's four major public hospitals are now connected to the PCEHR and are uploading discharge summaries, with Western Australia shortly to go live as well.”
I think it may be the best good news for the uptake and use of the PCEHR. GPs have wanted better access to discharge summaries for a long time, and hospitals have wanted a better way to enable this. Personally, I would find it useful for me and my family too. Also, it may be a good place to get patients registered for the PCEHR – as they are admitted to hospital (not out on the street with a free balloon).
Now we need to measure how many GPs are accessing the discharge summaries. That might tell us if the PCEHR is being useful.