Sunday, August 10, 2014

This Is Going To Be The Mother Of Health Related Computer Projects If It Happens. The Risks Are Stratospheric!

This announcement appeared from the Minister For Health last week.

EOI for Medicare-PBS Payment Services

The Australian Government allocated funding in the 2014-15 Budget to go to the commercial market calling for Expressions of Interest from the private sector to provide claims and payment services for Medicare (MBS) and the Pharmaceutical Benefits Scheme (PBS).
Page last updated: 08 August 2014
8 August 2014
The Australian Government allocated funding in the 2014-15 Budget to go to the commercial market calling for Expressions of Interest from the private sector to provide claims and payment services for Medicare (MBS) and the Pharmaceutical Benefits Scheme (PBS).
The Government is committed to cutting red tape in the health system and is seeking to streamline and simplify systems for patients, doctors and other health providers.
The Department of Health currently contracts the Department of Human Services to deliver the collection and payment system which remunerates doctors and other health professionals.
The current IT systems that manage the claims and payments processes are dated and in need of a substantial upgrade. In these circumstances it is good process to review and test existing and alternative systems.
The market test will determine the level of private sector interest and capability in providing those IT services for both the Department of Health and the Department of Veteran’s Affairs.
The EOI does not include the face-to-face services provided by Medicare.
The EOI process will inform the Government whether the commercial sector can deliver greater efficiency, flexibility and agility to the MBS and PBS processes.
The commercial sector may be able to provide a better service to Australians at a lower cost to the taxpayer, if so patients, doctors and the Government will reap the benefits and savings.
Commercial organisations already provide services to government involving large amounts of data and transactions.
The Department of Health is now seeking Expressions of Interest through advertisements in the media which provide information and details of the EOI process.
The EOI will close on August 22.
The release is found here:
There is coverage of this release here:

Department of Human Services set to broken up and privatised

Date August 8, 2014 - 9:15AM

Noel Towell

Reporter for The Canberra Times

The federal government’s biggest department, Human Services, looks set to be broken up and some of its key functions privatised.
The Commonwealth is moving to outsource $29 billion in annual Medicare and Pharmaceutical Benefits Scheme payments, in a decision which would cut the 30,000-strong department in half.
Jobs in the Department of Veterans' Affairs will also be in the firing line as the Health Department looks to outsource nearly $2.5 billion in veterans’ benefits currently administered by DVA.
The moves were recommended in the Abbott Government’s Commission of Audit and raised the prospect of more radical shakeups in the bureaucracy contained in Tony Shepherd’s report being brought into effect by the government.  
More here:
And here:

Medical payments to go private

Joanna Heath
More than $30 billion in Medicare and pharmaceutical benefit payments a year is likely to be outsourced, cutting the Department of Human Services in half and reshaping the delivery of government services.
The decision – a key recommendation of the Commission of Audit – could allow Australia Post or one of the big four banks to step in to calculate and process health payments and absorb Medicare retail outlets.
It aligns with the government’s plans as part of the budget process to reduce the size the public service and make government services more efficient.
In an advertisement in today’s The Australian Financial Review, the Department of Health calls for com­panies to express interest in providing claims and payment services for the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS), the second-biggest responsibility of the Department of Human Services after welfare payments.
It follows the allocation of $500,000 in this year’s budget, largely unnoticed, for market testing.
“We’re determined to put into place a 21st-century payment system that will be more efficient for patients and doctors,” Health Minister Peter Dutton said. “It will reduce red tape for doctors and streamline their administrative processes and, we believe, deliver a ­saving to the taxpayer.”
The contract is likely to be highly complicated. The new provider would have to be capable of processing a ­collective $29 billion of claims from 600 million transactions a year conducted for the Department of Health, and nearly $2.5 billion in claims from 33 million transactions for the Department of Veteran’s Affairs.
More here:
As I said in the title of the article this is going to be an absolutely huge transformation if it happens and the risks are just enormous.
The current systems have been in place for a very long time and you can read all about it here:
Any system that is this old and has been in place for so long will be, by now tweaked and modified to death and it is very unlikely that anyone really fully knows the systems in depth. You can also be sure there is no complete written specification of just what these systems do.
Equally, over time all sorts of systems have been linked and interfaced into the core system and just how all these have been made to work will almost certainly have been lost in the ‘mists of time’!
Additionally is has to be very unlikely that there is anything available commercially that will be more that ½ of the required solution.
Last remember the data held in these two (Medicare and PBS systems) are needed for all sorts of reporting to Government, as well as supporting a range of research which needs to be conducted securely and safely as it involves real patient information.
I would be genuinely amazed if this project does not take 3-4 years, cost a few billion dollars, and have a close to even odds of failing if not worse.
Good luck to anyone to winds up tendering for this, recognising that the project has to succeed or the Government will have to revert to quills and ink at some time in the next few years. This is a classic example of being between a rock and a hard place while at the same time really not being able to find some reasonably safe way of navigating the needed change out from under the falling rock!
Heaven help us with this - given how central these systems are so central to the overall health system.
David.

7 comments:

Anonymous said...

Just add some Orion, Telstra and Howard and anything is possible LOL!

Anonymous said...

Throw some David Bunker and Les Schumer in to ensure design clarity and good system Architecture LOL

Anonymous said...

Who is David Bunker out of interest? Is he Les Schumers solution architect for the PCEHR?

Anonymous said...
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Anonymous said...
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Bernard Robertson-Dunn said...

Re David Bunker.

According to this:
http://www.oecd.org/sti/ieconomy/46978384.pdf

David Bunker is a technologist.

Not only that, but his bio says:
"The Commonwealth, state and territory governments of Australia have tasked NEHTA to identify and foster the design and development of technology to deliver a high quality e-health system for Australia."

As I have been saying, eHealth in Australia and the PCEHR in particular has all been about technology, not about information systems or health information.

IMHO, the fault does not lie with NEHTA or David Bunker. The fault lies with the poeple who set up NEHTA in the first place.

And as David More has pointed out, the root cause is the lack of a proper National eHealth Strategy.

Anonymous said...

"The Commonwealth, state and territory governments of Australia have tasked NEHTA to identify and foster the design and development of technology to deliver a high quality e-health system for Australia."

What exactly is an e-health system?

Is the PCEHR the e-health system that is referred to here? Or do they mean e-health foundation systems like the HI Service and the NASH?