Wednesday, May 13, 2015

Here Are The Main Details Of The E-Health Area Of The Budget For 2015-16. Very, Very Interesting!

This is the detail.
Programme 7.1: eHealth
Programme Objectives

Redevelop and operate a national shared eHealth record system

The report from the Review of the Personally Controlled Electronic Health Record, released in May 2014, made recommendations aimed at improving the operation of the system and increasing use by healthcare providers and individuals. In 2015-16, the Government will work with stakeholders to implement key recommendations from the review including: usability improvements; renaming the system as My Health Record; revised incentives; and education and training for healthcare providers. The Government will also commence trials of new participation arrangements, including an opt-out system recommended by the review, to inform future strategies for increasing uptake and meaningful use of the My Health Record.

Provide national eHealth leadership

The Australian Government will continue to lead the national roll out of eHealth technology and services, and work with the States and Territories to support eHealth foundations, and finalise a national eHealth strategy. This strategy will identify the priorities for future Commonwealth and jurisdictional investment in eHealth.
In 2015-16, an Implementation Taskforce will be established to oversee and manage the transition of governance arrangements and eHealth operations from the National eHealth Transition Authority and the Department of Health to the Australian Commission for eHealth. This Commission will assume responsibility for the governance, operation and ongoing delivery of all eHealth across Australia, including the My Health Record from 1 July 2016.

In 2015-16, the Practice Incentives Programme (PIP) eHealth Incentive will be reviewed with the aim of encouraging general practices to contribute to and use the My Health Record system to improve clinical decision-making and the continuity of care for their patients.

Programme 7.1 is linked as follows:
·           This Programme includes National Partnership payments for:
-    Tasmanian electronic patient information sharing.
National Partnership payments are paid to State and Territory Governments by the Treasury as part of the Federal Financial Relations Framework. For Budget estimates relating to the National Partnership component of the programme, refer to Budget Paper No. 3 or Programme 1.9 of the Treasury’s Portfolio Budget Statements.
·           The Department of Human Services (Services to the Community – Health Programme 1.2) to support operation of the My Health Record.
·           The Department of Industry and Science (Business and Market Development – Programme 3.2) to expedite clinical trial reform in Australia.
Programme 7.1: Expenses

Table 7.2: Programme Expenses

2014-15 Estimated actual
$'000
2015-16 Budget

$'000
2016-17 Forward Year 1
$'000
2017-18 Forward Year 2
$'000
2018-19 Forward Year 3
$'000
Annual administered expenses





Ordinary annual services
135,221
135,981
129,963
120,944
5,062
Non cash expenses1
18,309
18,309
18,308
-
-
Programme support
23,127
20,829
10,515
10,577
10,830
Total Programme 7.1 expenses
176,657
175,119
158,786
131,521
15,892
1    “Non cash expenses” relates to the depreciation of computer software.

Programme 7.1: Deliverables

Qualitative Deliverables for Programme 7.1
Redevelop and operate a national shared eHealth record system
Qualitative Deliverables
2015-16 Reference Point or Target
Good practice principles and methods are applied to the operation and support of the My Health Record system.
The My Health Record system operations and practices are regularly reviewed to improve performance and usability.
Trials of new participation arrangements are undertaken, including for an opt-out system.
Trials to commence in 2016.
Provide national eHealth leadership
Qualitative Deliverable
2015-16 Reference Point or Target
New eHealth governance arrangements are implemented, including establishment of the Australian Commission for eHealth.
The Commission is operational from 1 July 2016.
Programme 7.1: Key Performance Indicators
Qualitative Key Performance Indicators for Programme 7.1
Redevelop and operate a national shared eHealth record system
Qualitative Indicator
2015-16 Reference Point or Target

Participation trial findings inform future planning to increase participation in, and meaningful use of, the My Health Record.
Trials to commence in 2016.



Quantitative Key Performance Indicators for Programme 7.1
Redevelop and operate a national shared eHealth record system
Quantitative
Indicator
2014-15 Revised Budget
2015-16 Budget
Target
2016-17 Forward
Year 1
2017-18 Forward
Year 2
2018-19 Forward
Year 3
System availability
99% of the time (excluding planned outages)
99% of the time (excluding planned outages)
99% of the time (excluding planned outages)
99% of the time (excluding planned outages)
N/A

The amazing details are as follows:

1. They don’t actually have a National -Health Strategy at present.

2. They will establish the usual task force in 2015-16 to implement the changes - presumably after some planning!

3. They will begin trial of Opt-Out in 2016 - so hardly likely to see much actually until 2017.

4. ePIP will be fiddled with again to increase pressure to use the system.

5. The funding allocated is hardly more than was already planned - if at all!

6. And in the notes we see this:  The Government has agreed to continue and improve the operation of eHealth records for three years, ending 30 June 2018. The funding largely stops at that date.

The suggestion that this is all just a holding action to keep things ticking over while actually doing a new Strategy and working out what to do is looking better and better!

More comments later.

David.

12 comments:

Bernard Robertson-Dunn said...

"The Government will also commence trials of new participation arrangements, including an opt-out system recommended by the review, to inform future strategies for increasing uptake and meaningful use of the My Health Record."

I read this as saying that they have not yet decided to change to opt-out. The trial is to "inform future strategies".

Which means that I agree with David's observation: "The suggestion that this is all just a holding action to keep things ticking over while actually doing a new Strategy and working out what to do is looking better and better!".

It also makes sense in terms of the small amount of money that's been allocated to the PCEHR.

I suspect that they are really testing the water to see if opt-out will be accepted by the population at large. I don't fancy their chances.

Anonymous said...

When did ~$500M become a "small amount of money"?

Symptomatic of the mental contemptuous disease in Canberra when this magnitude of Taxpayers' funds are characterised as such...

Karen Dearne said...

Hi Bernard, the PCEHR Act says:

11 (2) This Act does not make the Crown liable to be prosecuted for an offence or liable to a pecuniary penalty.

Note: Subsection (2) does not limit other rights and remedies.

Whereas,substantial civil penalties apply to the "unauthorised collection, use and disclosure of health information" in a consumer's PCEHR, and even criminal proceedings may follow.

See Act here:

http://www.comlaw.gov.au/Details/C2015C00075/Download

Karen Dearne said...

Story from the time gives context

http://www.theaustralian.com.au/business/technology/personally-controlled-electronic-health-record-system-coming/story-fn4htb9o-1226203867730

Karen Dearne said...

Story from time gives context

http://www.theaustralian.com.au/business/technology/personally-controlled-electronic-health-record-system-coming/story-fn4htb9o-1226203867730

Karen Dearne said...

And another

http://www.couriermail.com.au/news/govt-agencies-escape-e-health-penalties/story-e6freon6-1226159750748

I am posting because all of these issues will need to be revisited when it comes to opt-out

Bernard Robertson-Dunn said...

Thanks Karen.

So in rough terms, the government's role is "all care, but no responsibility"?

With an opt-in model, a citizen can choose to accept this and all the other risks because they believe there is some value in having this sort of health record, along with all the other health records that exist over which they have no control whatsoever.

With an opt-out model there will be no choice. And unless the legislation is changed, the government has no legal liability if they make errors creating or maintaining health records.

Or if incorrect data leads to bad medical decisions and bad outcomes.

Or if health professionals have to spend time cleaning up bad records.

Dr Ian Colclough said...

Bernard said "I suspect that they are really testing the water .... "

When you look closely at the evidence Bernard is correct .... they are at the beginning of a whole new strategy to close NEHTA and shift to a new 'entity', tragically they are working it out as they go without clarity of thought or any depth of understanding as to what needs to be done, why, how and by whom. It's a bit like watching a squash ball flying from wall to wall.

Bernard Robertson-Dunn said...

"... tragically they are working it out as they go without clarity of thought or any depth of understanding as to what needs to be done, why, how and by whom."

Unfortunately, with things this complex, it is essential to make the right decisions in the right order. And by that I don't mean that you make decisions one by one. Quite often there are groups of decisions that should be taken together and there are some decisions that need to be made before others.

Proper decision making requires the understanding that Ian observes is missing. Otherwise it's rather like throwing mud at a brick wall and seeing what sticks. It's a laborious process, you don't get a very good result and there is a lot of waste.

There is also a good chance that many bad decisions have already been made, decisions that will be expensive and time consuming to put right.

Karen Dearne said...

Exactly, Bernard. "With an opt-out model there will be no choice"

This is crux of issue, and why Labor took the "personally controlled, opt-in" approach.

A switch to opt-out means everything is back up for negotiation. Provided people understand what's at stake.

Karen Dearne said...

People should be aware that the legal groundwork has already been put in place. The issue of a switch to opt-out is specified in the Act thus:

Section 108 Review of operation of Act

(1) The Minister must cause a review of the operation of the Act (two years after commencement and completed within 6 months.

Royle Review, tick!

(4A0 Without limiting the matters to be covered, the review must consider the following matters:

(a) the identity of the System Operator

(b) alternative governance structures

(c) the opt-in nature of the PCEHR system, including the feasibility and appropriateness of a transition to an opt-out system.

Tick

Oh and the Rules state:

109 (1) The Minister may, by legislative instrument, make rules ... about matters required or permitted by this Act

(3) The PCEHR rules may specify the following:

(c) conditions on the registration of participation in the PCEHR system

(d) other requirements relating to the PCEHR system that apply to consumers or participants

So, the Minister can act without taking any changes back to the Parliament, an issue that caused some consternation at the time

Anonymous said...

and we trust this government not to resort to a quiet bit of scope creep, don't we?

Like heck we do.