E-Health Funding Requests in Budget Submissions – Are they Reasonable?

Last week the Australian reported on the E-Health wish list of some in the health sector

E-health funding urgent

Karen Dearne | January 22, 2008

FRUSTRATED health IT professionals hope the Rudd Government's first budget will kickstart several low-cost but urgent e-health programs.

The Australian General Practice Network (AGPN) wants $3.6 million for an immediate national rollout of the Argus secure clinical messaging system to link doctors, hospitals, laboratories and pharmacies.

"Work is under way to determine the requirements for an integrated e-health network, but it's still a long way off," network chief executive Kate Carnell said. "The use of secure electronic messaging provides an immediate solution. Argus is a licensed open-source product that is freely available, with intellectual property owned by the Government."

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The Health Informatics Society of Australia (HISA) is seeking less than $1 million for an industry-led program that would fix IT inter-operability problems that hamper communications between existing systems.

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The Australian Healthcare and Hospitals Association is seeking an urgent deployment of a $200 million electronic medication management system in all public hospitals.

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Read the full article here:

http://www.australianit.news.com.au/story/0,24897,23087176-15306,00.html

Before reviewing the other two claims I need to point out that HISA not only suggest some modest spending on Integrating the Healthcare Enterprise (IHE) but also and crucially and first off recommended a Nation E-Health Plan be developed to put all these initiatives in context.

The AGPN has an e-Health request of $28.6 Million for the development of a Universal Secure Electronic Messaging Platform.

The details are as follows

“AGPN recommends that funding is allocated in the 2008-09 Federal Budget to:

1. Establish a small grants program to enable primary care professionals to purchase computers and clinical management software to increase connectivity and better integration within the sector; ($25m) = $1500 for 15,000 health professionals

2. Facilitate the national rollout of secure electronic messaging by providing the Argus open source product to all primary care professionals. The Divisions of General Practice network is well placed to support the national rollout by providing support to connect and integrate local primary health care professionals with the hospital sector at the local level. $3.6m ($30k per division)

3. Extend the existing commitment to rollout individual Personal Key Identifier (PKI) to GP’s, to include the rollout of PKI’s to specialists and allied health professionals.”

Bizarrely there is $3.6 Million for secure messaging and $25.0 Million for computer grants for primary care professionals who – as best I can tell – already have them.

The key point here is that the AGPN is recommending the Federal Government pick a winner with no review or evaluation of the already existing competitors to Argus. (HealthLink, Medical-Objects and e-Clinic to mention just 3). I very strongly agree with the need for secure messaging as the AGPN describes but not this sort of bull at a gate approach. Let’s have the Government do a proper plan for secure clinical messaging in Australia and then work out how it can be best delivered!

The request for $25 Million for computers is to me just a joke and reduces the credibility of the AGPN case about as dramatically as their approach the secure clinical message acquisition.

The details of the Australian Healthcare and Hospitals Association’s Electronic Medication Management proposal are as follows:

“Electronic medication management

The introduction of electronic medication management throughout the health system would reduce some of the most common mistakes in health care and would save lives, as well as dollars (estimated at $4-7,000 per bed per year).

Medication error has been estimated to result in 80,000 hospital admissions in Australia and costs around $350 million per year.

Medication errors often occur in handover situations (when people move from one form of care to another) for example, from hospital to an aged care institution or GP care in the community. A significant benefit of electronic medication records is enhancing continuity of care, enabling care providers with on-line records in real-time advising of any changes in their patients' medications, greatly reducing the risk of errors such as double-dosing or missing important prescriptions.

Major areas of savings are:

· reduced lost bed days due to decrease in adverse events (shorter stays > shorter waiting lists);

· reduced use of expensive drugs;

· increased use of generic drugs;

· increased standardization of treatment regimens/protocols (best practice);

· efficient nursing and other staff time utilisation;

· streamlined pharmacy process and improved supply chain management; and

· reduced medical indemnity costs.

The technology is now available and has been demonstrated to work in Australian public hospitals. Northern Territory is already partway through a Territory-wide rollout of an Australian made product that is also being used at St Vincent’s Hospital in Sydney

NSW and Victoria are already committed to State wide clinical projects but electronic medication management is still a long way off.

As the technology is proven in this case, the much greater challenge is to manage the impact of the change on the existing processes and the people involved. For this reason we would suggest an incremental approach commencing in one or two hospitals in perhaps two states in order to give people and systems time to adapt and minimise the risks. Qld, ACT and WA may be appropriate jurisdictions in which to initiate jointly funded projects in key hospitals.

The AHHA recommends funding to implement electronic medication management systems in hospitals.

Indicative Cost: (for implementation in every public hospital excluding NSW and VIC): $200m over 4 years ($50 million per annum ongoing) plus funding for change management. NB This cost includes hardware which can also be used for many other purposes (such as clinical guideline tools and pathology results (see below)).”

This really is a very sad submission. Yes medication management is a very good thing and yes it should be done – but as a stand-alone project lacking integration to and support from surrounding systems it can never reach anything near its full potential.

It is also not clear why there is discrimination against NSW and VIC.

Yet again trying to run before you can walk and having no roadmap to show where you should be walking will only lead to walking into a river or off a cliff. So sad!

On the other hand this suggestion is a really good one I believe.

“National clinical practice guidelines

The system-wide adoption of known best practice within health care would also significantly improve quality and reduce preventable errors. Clinical Practice Guidelines provide clinicians with the best available evidence on treatment for specific conditions.

Incorporating these guidelines into standard hospital and health service practices and making them available electronically will ensure that consistently high quality care is provided to all patients.

The AHHA recommends funding to establish a taskforce of clinicians, experts and consumers to assess existing electronic clinical practice guideline systems, including the UK’s Map of Medicine, for adaptation to the Australian healthcare environment with the view of implementing a system of localizable electronic clinical practice guidelines, in conjunction with states/territories, throughout the public health system.

Indicative cost:

1. $7m per annum [minimum five year term] for fully serviced Australianised web service; includes initial core service training (train the trainers model);

2. Additional costs to include local hosting and implementation requiring web-access and related hardware (clinical guidelines tools should not require extra hardware or network facilities if hardware has been installed for other clinical functions such as electronic medication management systems).

In summary, the Map of Medicine^®:

• is an evidence-based benchmark for clinical processes that supports the configuration of services, local commissioning and clinical practice across all care settings;
• addresses clinical governance by providing a national benchmark for clinical guidelines while allowing the development and sharing of local guidelines and care pathways;
• provides content which is a distillation of recognised international sources of clinical evidence, designed by clinicians;
• can be integrated with electronic medication management systems and other local healthcare IT applications; and
• includes software tools to facilitate localization of the content at a national and local level promoting usability and adoption.”

The issue of localising the content however is not a trivial one, and needs to be carefully thought through. It can be done and would be helped greatly if Australia had a National Institute for Health and Clinical Excellence (NICE) like entity as exists in the UK.

The great thing about this proposal is that it only needs basic IT infrastructure which is widely available and is able to be implemented essentially stand alone. Would be great to see it properly planned and done!

David.