Sunday, March 01, 2015

The Secrecy And Obfuscation By The Department Of Health Regarding The PCEHR Just Rolls On.

We had Senate Estimates last week - Wednesday Evening there were a few questions asked by Senator Di Natale on e-Health.
The session began just before 8pm.
Here is the transcript. I have made the important bits bold and italic.
Go to the link below to see the details of the cast that was assembled. As best I can see NEHTA was a no show!
----- Begin Extract
Senator DI NATALE: Regarding eHealth, where are we up to following the May 2014 review? What progress are we making on the implementation of those recommendations?
Mr Bowles : It is a decision before government again. It is in that process.
Mr Bowles : Yes.
Mr Bowles : Yes.
Senator DI NATALE: You still have not decided?
Mr Bowles : That is correct.
Senator DI NATALE: What was Mr Dutton doing, for all the time he was health minister? It seems like he was sitting on a bunch of reports.
CHAIR: Senator Di Natale, I think you know that a public servant is not going to be answering the question, so perhaps you should move on to questions that can be answered.
Senator DI NATALE: I know, but you have got to wonder. Of the $140 million that was available in 2014-15, have all those funds been spent? And what have they been spent on?
Ms Powell : To go to the second part of your question about how it is allocated: of the $140 million, $103.9 million is set aside for, primarily, the health department, but some goes to The Department of Human Services and some goes to DVA to operate the PCEHR. I will give you those splits: $82 million of that goes to Health; $21.8 million goes to the Department of Human Services; $0.1 million goes to DVA; $2.3 million goes to the Office of the Australian Information Commissioner; $34.4 million goes to NEHTA as part of our COAG contributions to pay for the eHealth foundation work that is done by NEHTA—and that adds up to 140. Sorry, you also asked about expenditure. We would expect that that would be close to spent.
Senator DI NATALE: Fully expended.
Ms Powell : Yes.
Senator DI NATALE: In terms of progress, the last I heard—it might have been mid-last year or so—there were 260-odd hospitals that were connected. How many have been connected since then? What are we at?
Ms Powell : We have hospitals in every state that are connected at the moment. We recently had all five hospitals in the Northern Territory come online.
Senator DI NATALE: The total number of public hospitals?
Ms Powell : The total number of public hospitals—and some are major health centres—is 274.
Senator DI NATALE: So, in seven or eight months we have had nine more hospitals connected?
Ms Powell : I am not sure what the figures were last time, but the way hospitals have been coming on board has been as part of natural rollouts of software and IT related activities.
Senator DI NATALE: How many healthcare providers are currently registered to use it? I think in June there were 6,500 or so, out of a total of 57,000 who were eligible.
Ms Powell : As of 19 February, there are 7,645 providers—that is, healthcare provider organisations.
Senator DI NATALE: Healthcare provider—
Ms Powell : Organisations. That is, general practices; it might also be a hospital, and it might also be a lot of hospitals.
Senator DI NATALE: So we are still a long way short of the total number of 57,000 healthcare provider organisations. Is there any reason—
Ms Powell : I am sorry, I do not understand.
Senator DI NATALE: I am advised that there are 57,000 healthcare provider organisations that are eligible to register.
Mr Bowles : Providers, maybe.
Mr Madden : Not organisations.
Ms Powell : That does not sound right to me.
Senator DI NATALE: The advice I have is 6,500 out of a total of 57,000.
Mr Madden : Regarding the numbers and the way that we break them up: an organisation, as Linda Powell said, could be a hospital. It could be an area health network. It could be a series of hospitals. It could be a GP Super Clinic, or it could be just a sole practice. It means all of the providers within those organisations can have access to the system.
Senator DI NATALE: Okay. But it is counted as one healthcare organisation?
Mr Madden : That is right.
Senator DI NATALE: Can you tell me how many in total would be eligible? Can you take that on notice?
Mr Madden : Sure.
Senator DI NATALE: If you have—you are saying it is 7,400 or so?
Mr Madden : It is 7,400 organisations.
Senator DI NATALE: Organisations, okay. And that is out of a total of how many that might be eligible?
Mr Madden : We will take that on notice.
Senator DI NATALE: Great, thank you. What about the number of clinicians? The sense I get is that momentum is completely stalled on this: GPs have gone cold on it and there has not been much progress. I am asking because I think it is important; it is a really important reform. Is that consistent with what you are seeing? Has the number of clinicians who are accessing the PCEHR plateaued?
Ms Powell : We currently have 10,721 individual practitioners—who are not necessarily GPs; they are a variety of practitioners—registered to use the system. In terms of your question about use of the system, we are finding that the number of documents that are loaded into the system continues on a slow but steadily upward trend.
Senator DI NATALE: Is there any money allocated to this beyond the end of this financial year?
Ms Powell : There is some money that has been set aside to continue the operation of the PCEHR.
Senator DI NATALE: How much has been set aside, beyond this financial year?
Mr Madden : The funding beyond 30 June is still subject to that decision by government, that Mr Bowles mentioned earlier.
Senator DI NATALE: How much has actually been committed so far?
Ms Powell : In the next financial year, approximately $28 million.
Senator DI NATALE: In the next financial year?
Ms Powell : That is for the costs of continuing to operate the system—just the technical work.
Senator DI NATALE: Just to basically operate it?
Ms Powell : Yes.
Senator DI NATALE: How much have we invested in it so far?
Ms Powell : It depends on what you count and when you want to count it from.
Mr Madden : I think total spend so far is a complicated issue. There was the investment in the Personally Controlled eHealth Record System to establish it, and there is the operation for the 2012 through to the 2014 period, now the 2014-15 period.
Senator DI NATALE: Those figure would be good.
Mr Madden : Can we pull those figures on notice?
Senator DI NATALE: Yes. Tell me what you have in front of you at the moment, just as it is..
Ms Powell : I can tell you that the budget in 2012-13 was $233 million. From 2012-13 to 2015-16, total eHealth program funding was $538 million—that is the four-year total.
Senator DI NATALE: And that does include all—
Ms Powell : That is all of eHealth, not just the PCEHR. That is all of eHealth activities.
Senator DI NATALE: What I am getting at is that we have committed hundreds of millions of dollars into this and we seem to have consistent support, and now we have committed—what?—$20 million to keep it going?
Mr Bowles : There is a decision of government to come forward for the future, so we cannot pre-empt what that might be.
Senator DI NATALE: We had an announcement in 2013 that there would be a review. We spent six months hanging around for the outcome of that review. We got the review not even half way through the year. We are now coming into March. We are a few months away. This is supposed to be the thing that is going to take healthcare into the 21st century and beyond, and we still do not know what we are doing with it. I just cannot believe it.
Mr Bowles : It is before government.
Mr Madden : In the midst of 2014 we did go out to consultation with the broad community on the key recommendations in the report, just to make sure that we had the right views. The outcomes of that consultation have been provided as input to the government for the decision which they need to decide on at the moment.
Senator DI NATALE: Is there any indication that NEHTA will be closed come the end of June?
Mr Bowles : Again, it would be a decision for government. But I think it would be a pretty tall order to close NEHTA between now and then—the end of the financial year.
Senator DI NATALE: No, by the end of June.
Mr Bowles : Yes, by the end of the financial year.
Ms Powell : NEHTA is also funded by other jurisdictions as well.
----- End Extract.

Here is the direct link to the page:
It is really hard to know what all this means - but it is clear as of late Wednesday last week the fate of e-Health is before  our presently rather chaotic Government with no decisions made as far as the bureaucrats were prepared to admit.
Interestingly  it seems there is some money set aside - outside the budget process to keep the PCEHR ticking over in 2015-16.
My view is that it is hard to disagree with the good senator on the competence that has been applied to the whole area!


Anonymous said...

You have to keep feeding a white elephant.

Anonymous said...

Dr Brian Owler said "we’ve spent too much money on the e-health record for it to fail".

It is that kind of mentality that perpetuates the continual spending of hundreds of millions of dollars on a flawed system that cannot be fixed.

It is far more costly to try to fix the unfixable than to go back to the drawing boards and start again - small, incremental steps, engaging with experts from the coalface and so on.

Dr Owler's lack of experience in health IT is reflected in his lack of insight into the PCEHR problems.

Anonymous said...

The PCEHR is not failing because of lack of money or political will. It is failing because it never had a credible purpose, other than to create centralised monolithic systems that benefit large IT companies and make bureaucrats look powerful. When designs for record sharing were suggested that were distributed, cheap, and evidence-based they were ignored.

No, Dr Owler, you should delete the "For it to fail" bit i.e. "we’ve spent too much money on the e-health record". It is a failure of government, specifically of DOHA/NEHTA, in doing the wrong thing for the wrong reasons. Unfortunately e-health will get the blame, when it is blameless.

Anonymous said...

When you are deep in a hole, you can't dig your way out; all you will do is get in deeper.

The best thing to do is to stop digging.

But that would look like you are doing nothing, and doing nothing is not a good look, politically.

Anonymous said...

You can always use it as a migration step towards a more mature and purposeful set or capabilities, harvest the good, establish what was good but lost in transit, repair old friendships and get rid of all the merchant bankers

Anonymous said...

Seems more like the PCEHR is too big save? Just like is parent, the banking system...

Anonymous said...

March 03 2015 8:00pm not sure what merchant bankers have to do with this unless younare using a joveal form or ryming slang.

It does beg the question, are those running the show either so use to failure that success is measure by how much or how little a failure outcomes are.

I hope I am wrong but there are workplace charctaristics that are proven to show when people are addicted to failures and in fact revel in being the one to be seen as fixing them, there are studies specifically in IT that highlight inderviduals actually engineer these situations formtheir own need to be the hero, or simply as a form of bulling