Quote Of The Year

Quote Of The Year - Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

Saturday, September 02, 2006

The e-Health Fiasco in Australia Is Now Recognised – What Should be Done?

Finally at least one side of politics has recognised there is a major problem with the Australian e-health strategy (or lack of it) and has pointed out the “waste and mismanagement” that has been bedevilling the area for years.

The following is the Sydney Morning Herald’s report of the Opposition Spokeswoman for Health.

http://www.smh.com.au/news/National/National-health-record-system-stalled/2006/08/29/1156816880858.html

National health record system 'stalled'
August 29, 2006 - 1:29PM
The government has wasted hundreds of millions of dollars in stalled and failed attempts to introduce a national electronic health record system, Labor says.

Opposition health spokeswoman Julia Gillard said on Tuesday it was widely considered that using information technology to integrate patients health records could help prevent over-referrals, over-prescribing and minimise medical mistakes.

But the government had scrapped the Medicare Smart Card and its new proposed $1.1 billion Smartcard would not provide access to patient medical records, Ms Gillard said.

The much-lauded e-health records system HealthConnect no longer existed as a program and had all but disappeared, she said.

"Recent developments suggest that our national e-health strategy has not only stalled, but is dangerously close to being considered an expensive failure," Ms Gillard said in a speech to the Australian College of Health Services Executives in Adelaide.

HealthConnect - a national health information network designed to integrate patient records from hospitals, doctor surgeries, nursing homes, medical laboratories and pharmacies - was launched in 2000 with claims it could reduce accidental mishaps in treatment by as much as 30 per cent.

But Ms Gillard said "just a handful" of small HealthConnect initiatives were currently running in some states.

"And there do not appear to be any reports about what we have learned from those projects, how they might be further extended or why they succeeded or failed," she said.

"In terms of a coordinated national initiative, we are not much further advanced in this area than we were back in April 1999.

"The problem is that hundreds of millions of dollars have been spent on programs launched with much fanfare and then allowed to die."

Ms Gillard said changing the health care management and delivery system was not an easy task, but the government had missed some opportunities and made some obvious mistakes.

She said states and territories have started their own e-health efforts, raising fears of a fragmented and disconnected system.

Australia now had to face the reality that a national e-health system was at least a decade off, Ms Gillard said.

"To fix the problem we will need a national, collaborative approach and strong national leadership," she said.

Health Minister Tony Abbott in 2003 said the health system would be in "systemic paralysis" if a smart card carrying an individual's medical history was not available within five years.

But the federal government said the HealthConnect project was on track and a major agreement had been made at the most recent Council of Australian Governments (COAG) meeting.”

Ms Gillard made a number of points which were, in my view, absolutely spot on.

These key ones were:

1. “To fix the problem we will need a national, collaborative approach and strong national leadership.”

2. “In terms of a coordinated national initiative, we are not much further advanced in this area than we were back in April 1999.”

3. “The government has wasted hundreds of millions of dollars in stalled and failed attempts to introduce a national electronic health record system.”

The Government’s response to this considered and utterly accurate assessment of the current e-health state of play was that the most recent COAG meeting “had agreed to have a work schedule in place by 2009, a "considerable" step involving consensus about protocols and terminology had been taken with the provision of “an additional $130 million to be invested in the National E-Health Transition Authority, the body responsible for developing the electronic records”.

It also made the utterly ludicrous claim that “HealthConnect is still operational and on track and we are learning some very valuable lessons from the trials that have been going on in Tasmania and the Northern Territory”. This is a barefaced untruth as has been widely reported and thoroughly documented, if in no other place, in this blog. The development of HealthConnect has been totally downscaled and essentially defunded.

The sole element of the minister’s comments I can agree with is that “the minister has expressed his frustration with how slow things are moving, but it is very complicated, and it's moving ahead”.

I would suggest that it is time to say that the HealthConnect centralised model for e-health service delivery has failed in Australia and that what is needed is a radical re-think of approach.

This is implicitly recognised in the timeframes now being talked of by NEHTA for delivery of the Shared EHR Concept of Operations and Version 2.0 of the Interoperability Framework (Both now apparently due some time in 2007).

Evidence would seem to be emerging globally that centralised approaches bring with them high cost, high risk and excessive complexity. Witness the problems being experienced in the UK NHS Connecting for Health Program.

Equally it is now becoming clear that there are models for regional health information sharing that are becoming both technically as well as financially viable. Witness the successes seen in Scandinavia and in some of the nascent Regional Health Information Organisations in the USA.

As I have argued previously there are e-health projects that can make a difference, are affordable and which offer considerable benefit for both clinicians and their patients that could be undertaken in Australia. These include provision of effective General Practice and Specialist Practitioner computerisation, the automation of Acute and Long Term Hospitals, the computerised support of pharmacy, radiology and laboratory practice and the introduction of a common interoperable form of secure health messaging.

That would be a major two to three year agenda that could be sponsored and delivered by either side of national politics with enough will, understanding and determination. One can only hope that both Ms Gillard and Mr Abbott can recognise the value of such an approach – as well as the lower political risk to themselves personally, and move towards having NEHTA adopt such an approach, while possibly continuing some of the important long term infrastructure work they have in their work plan. To just do the latter, without the former, delays benefits to all Australians and carries a high risk of virtually total failure with the associated need to start again in 2010 or so. A quite unacceptable outcome.

David.

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