Sunday, February 21, 2016

The Financial Review Has A Collection Of Articles On E-Health On Their Saturday Front Page. Not Good Advice Offered I Believe!

The two main articles were these. First we had:

Former Vic health minister calls for 'carrot and stick' incentives for e-health

Feb 19 2016 at 7:09 PM
There must be a "carrot and stick" approach to drive GPs and other healthcare providers to use electronic health records and online consultations to reach more patients at lower cost, says a former Victorian health minister.
New figures released by the Federal Department of Health show only 2.59 million Australians – just over 10 per cent of the population – and 7836 healthcare providers have signed up to the government's struggling My Health Record e-health system.
The number of patients is double the 1.3 million signed up in December 2013, just after the Coalition won government in Canberra, but the numbers are still well below the critical mass needed for healthcare providers to have a strong interest in signing up.
The call comes as tight budgets and a swarm of reviews into the rapidly growing $155 billion healthcare sector have put the big players on edge, with pathology companies and GPs threatening to launch an election year campaign against budget cuts from their waiting rooms. 
The use of electronic patient management systems is mainly at trial stage and lags behind similar moves in other consumer industries, such as banking and aviation, by a decade.  
"I think the government should be exploring all options – carrot and stick," said Bronwyn Pike, chairman of Western Health – a large public hospital network based in Melbourne's west – and until recently head of Telstra Health, which offers health IT services including a tablet-based portal for online consultations and conferences. 
Experts such as Ms Pike, and health insurance bosses such as Australian Unity's Rohan Mead, say e-health records are urgently needed to reduce waste and duplication of the kind experienced by John Dalziel, a retired Melbourne advertising executive and Australian Unity health fund member.

Four specialists, four sets of tests

Mr Dalziel, 76, went into the Epworth Hospital at the end of 2014 for surgery to remove a cancerous bowel section, but contracted septicaemia and had to stay for a month. 
He was seriously ill, and said he received excellent care from four different specialists. But when he came out of intensive care, he wondered why they each still called on him so regularly and ordered their own tests, even though they shared the results, instead of co-ordinating their visits. 
"It just seemed amazing to me that I had those four eminent specialists waiting on me. I don't mean to sound ungrateful. [But] each one of them was a very good specialist and could easily have recognised the symptoms the others were looking for and called them in if it was necessary," Mr Dalziel said. 
"When I read about the bad budget situation I think they could have saved a fair bit of money without reducing the care I received." 
Lots more here:
Here is the second article

'Heart-sink' patients: tech pioneers battle healthcare inertia

In economic terms we have got a system that's entirely captured by producer interests.

Feb 20 2016 at 12:15 AM
  • "In an attempt to arrive at the truth, I have applied everywhere for information but in scarcely an instance have I been able to obtain hospital records fit for any purpose of comparison. If they could be obtained, they would enable us to answer many questions. They would show subscribers how their money was being spent, what amount of good was really being done with it or whether the money was not doing mischief rather than good." - Florence Nightingale, 1863, quoted by Rohan Mead, Australian Unity's chief executive, September 2015
Shelley Kleinhans, chief operations officer of Brisbane North PHN, wants the 1000 GPs in the area to bring their "heart-sink patients" to her organisation.
"We describe them to the GPs as: 'These are your heart-sink patients – when they come into your consult room, your heart sinks,'" she says.
"You think 'what is she going to present with today?' and 'how am I going to solve her problems in the 15 or 20 minutes that I have to treat her?'"
These patients have chronic diseases such as cancer, heart disease, diabetes and smoking-related shortness of breath – often compounded by social problems such as isolation, frailty and poor access to transport.
Brisbane North PHN was a pioneer of Team Care Co-ordination, a multidisciplinary team approach to treating such patients. Many are hospital "frequent flyers", consuming an outsized share of the $105 billion spent annually on health by state and federal governments.
Government health budgets, and the additional $50 billion spent directly by patients and their private insurers, are a fiercely contested battleground in an era of flagging tax revenues and soaring healthcare costs.
Health Minister Sussan Ley has launched an armada of reviews aimed at trimming spending. Initial budget cuts to pathology rebates have already drawn threats by pathology companies and doctors to carpet-bomb waiting rooms with election year anti-government leaflets.
Brisbane North PNH, one of 31 federally funded primary health networks, had its own electronic health records system built a decade ago. It aimed to support co-ordinated care and keep more patients out of hospital by enabling GPs, hospital doctors and other clinicians to instantly share case notes.
The 2000 participating patients in a trial from 2005 to 2007 were 26 per cent less likely to be admitted to hospital than a control group of 1000, a study found.
Co-ordinated care is one way health experts reckon the health budget could be trimmed or better spent. Brisbane North PHN also uses a localised version of Map of Medicine, a British software system that maps optimal "clinical pathways" for the treatment of different ailments.
When a GP in Brisbane North PHN's area encounters a chronically ill patient, she contacts a care co-ordinator at the organisation – a registered nurse – who checks in on the patient at home.
The care co-ordinator then arranges support. This could be as simple as helping the patient to take the right medicines at the right time, engaging local services to take her shopping once a week or take out the wheelie bins to prevent falls. The co-ordinator can also help to buy walking aids or pay for exercise classes or physiotherapy.
"Their role is to understand what a person needs and work with them to keep them out of hospital – and delay admission to a nursing home," Kleinhan says.
Hospital and nursing homes are the costliest ways to provide services, so reducing admissions can save a lot of money.
Lots more here:
Leaving aside the obvious comment regarding the frequent mention of Telstra’s offerings the issue that concerns me here is the failure to acknowledge that just waving the term ‘e-health’ will not suddenly see a cure to all that ails the health system.
Interestingly, with a comment like this “The use of electronic patient management systems is mainly at trial stage and lags behind similar moves in other consumer industries, such as banking and aviation, by a decade.” there is denial of all the technology presently used by GPs, hospitals, labs abd so on. What is missing is not ‘e-health’ (whatever that is) but the leadership and governance mechanisms to have all this technology actually sharing information to improve co-ordination and information flows.
If the PCEHR was a workable solution, and properly designed, it would have been adopted with alacrity. Sadly this was not the case and so we are now where we are.
Unless the new planned Australian Digital Health Agency and its Board and CEO can turn things around and leverage what exists with some sensible well planned initiatives we are all in strife.
I am not sure the advice from a former State Health Minister to stick with an implementation that has failed rather than move to a new direction deserves to be taken at all seriously - despite the fact that the problems she identifies are important. It is here plan for the future which is deeply flawed and probably should be ignored.


Anonymous said...

These people speak as though they are competent to manage health and the Medical Profession is not. I would like to see some evidence for this because since generic management was forced into public hospitals costs have spiraled out of control and hospitals have lost many specialists because of frustration with clueless management. Similarly in eHealth the non corporate pathology labs managed to establish electronic pathology without government intervention (and it continues to this day) while the government eHealth programs have spent billions with no return and we have probably gone backwards. Similarly we have seen multiple "Divisions of General Practice" or equivalents that have been started, killed and restarted at great expense and no one can really define what the actually do. How many billions have been spent here.

Its time we saw some evidence that the generic managers (who are sprouting this lie that the PCEHR is fit for use) have actually contributed anything to the delivery of health care in Australia. They are rent seekers who add no value. Its time for evidence based management.

Anonymous said...

Bronwyn Pike is the ex Health Minister who gave us HealthSmart (castigated by Victoria's Auditor General) and delivered by her then Health Department Secretary Shane Solomon now CEO of Telstra Health! As you said "These people speak as though they are (insert the missing word) .......... "

Anonymous said...

As a catalyst and incentive to achieve change in the primary care domain the carrot & stick is a rather crude simplistic concept but the best the bureaucrats can come up with as they only have a very superficial understanding of the health system and inadequate strategic thinking skills to come up with better ways to achieve change.

Anonymous said...

Critical mass is fallacious thinking by the bureaucrats. Critical mass will not give providers a strong interest irrespective of how many providers and their patients are signed up. Signing people up also achieves nothing under the circumstances now prevailing around PCEHR / MHR.

Think about it this way - people (and providers) sign up thinking it might be good, then they have a look at what it offers and when they see it provides no useful value they don't use it and they forget about it. 2 million or 24 million signed up will make not one jot of difference; the outcome will still be the same and the politicians and bureaucrats will remain mystified as to why it is not being used. The answer is well known and should not need to be restated. Chronic Disease Management, integrated with fail safe medication management will catalyse and drive change.

Anonymous said...

Critical mass is fallacious thinking by the bureaucrats. Spot on. The tipping point will come when we can see real value in using the system. Artificially creating an appearance of usage with smoke and mirror incentives will not do anything other than provide a basis for the Department to make false claims about usage.

Anonymous said...

"generic managers"! Sounds like the contemporary equivalent of the old-fashioned communist bureaucrats were we taught to despise in decades gone past. I wonder when we will have our own 'Perestroika' to rid ourselves of these Bachelor of Commerice/MBA types, 'Consultants' and their Public Relations mates, replaced with a more participatory form of planning and decision making among a broader group of stakeholders (not just another 'Board', or 'Committee' of an elite)?

Bernard Robertson-Dunn said...

"Critical Mass" and "Carrot and Stick" are useful only when the aim is useful or has some benefit.

I'm reminded of the old strategy:
"Floggings will continue until moral improves"

Anonymous said...

In today's Pulse IT ..... The revised eligibility criteria for the eHealth Practice Incentives Program (ePIP) payments will begin on May 1, with general practices to be formally notified in writing from next month.

In other words the two year MYHR trials in NQPHN and NBMPHN is a complete con trick. The RACGP and their members will now experience the thrusting up of the big stick. Complain by all means and blubber away, but do as your told because you have no say.