Who Pays the Piper

In the last few weeks I have been reflecting on the rather sad series of outcomes we have seen in the e-health space in Australia and wondering just what can be done to change the present situation for the better.

The first thing that is obvious is that there is no quick and easy fix. Standing back from the day to day fray a little I think most would accept that what the desired end state is clinicians (covering doctors, nurses and others providing patient care) being able to access the information and decision support they need to do their job well and safely.

It is clear that without this end-state being reached clinical error of both commission and omission will continue and patients will be injured or die as a result. It is thus clear that what is needed is a national infrastructure that provides these services to the clinicians. (Note: this analysis leaves aside for now the thorny issue of how to achieve use of the technology once it is available at the point of care delivery for use).

There are thus two issues – the first is who pays, and the second is how to obtain adoption and use of the technology once there is no longer the “elephant in the room” that blocks adoption – viz. that the clinician user is expected to pay personally for benefits to be harvested by others.

The Australian Health Care System has a powerful, built-in, disincentive to the use of technology in the delivery of clinical care – that is that not only do you have to spend your money to obtain the technology but that, because your financial rewards are linked to patient throughput, once you have the technology in place you will see your income drop as you use the technology to do a better but unrewarded better job (at the very least for the first few months of use).

For reasons that totally escape me the Department of Health and Aging are of the view that clinicians (who are essentially small businesses) will adopt technology and pay for it on the basis of warm feelings in their nether regions that they are doing the “right thing”. This is clearly rubbish.

Automation of clinical practice provides the bulk of its benefits to the payers (i.e. the Medicare system) and the patients through less quality poor care and reduced cost of care. It is these sector that need to pay. The policy question for Government is how best to deliver the funding – not to place it’s head firmly in the sand and hope something will happen as if by magic.

Once the issue of the “financial friction” is addressed we can then start to use the appropriate change management approaches to foster uptake. Without the first step we might as well just forget it and look for other windmills at which to tilt.

David.