As He Leaves, Dr Ian Reinecke Finally Seems to Get it!

This will be my last comment on the now departed NEHTA CEO. So it seems good to be able to make it a positive one!

Dr Ian Reinecke gave a speech a few days ago. It is well worth a read. The following is the publicly available text.

“Chronic Disease Management Conference 2008

Presentation by Dr Ian Reinecke, Chief Executive Officer, NEHTA

Wednesday, April 2, 2007

I am this morning going to outline how e-health effectively implemented has the potential to fundamentally improve healthcare, and in particular the management of chronic disease.

In the process, I will outline the initiatives towards national health reform, which is so badly needed in Australia today.

It is needed because chronic disease is on the rise in Australia:

Over 3 million Australians, or nearly one in seven, suffer from chronic disease.

As the population ages, so does the rate of chronic disease rise.

The seven chronic diseases, identified as National Health Priority Areas, together account for almost 80 per cent of the total burden of disease and injury in Australia.

It’s expensive: the 2007-08 Budget contains additional funding of $236 million for measures to help Australians to avoid preventable chronic illnesses. (DoHA).

And it is often preventable,

However, our health system is much better equipped to respond to acute health crises than preventing it in the first place.

To quote the Prime Minister, “Put simply, we are better at providing a hospital bed when you have had your heart attack than providing the advice and lifestyle supports to prevent it occurring in the first place.”

A new approach to healthcare in Australia is needed, and e-health provides us with a great opportunity to implement reforms that make a difference

So what needs reforming?

• We have poor information sharing, especially between primary, secondary and community care;

• There is a lack of alignment of Australian health funding and policy with service delivery, IT adoption and health outcomes;

• The system is currently not delivering for many Australians and is not improving.

Here are six e-health initiatives that will support the national reform agenda:

1. Referring - more appropriate ‘upstream’ referral to enable earlier intervention in chronic illness which has the effect of reducing hospitalisation

2. Prescribing- improved prescribing of the most effective or least expensive drugs using e-prescribing decision support that reduces adverse drug incidents

3. Enabling - better health outcomes through enabling consumers to take a stronger role in managing their chronic diseases.

4. Managing - better monitoring patients with complex medical conditions through shared care using a common information platform and decision support tools.

5. Embedding - ensuring consistent use of more reliable clinical processes to reduce duplication, waste, errors and omissions creating the basis of a reliable source of health system knowledge.

6. Measuring- by putting government in a better position to measure the effectiveness of health spending

All six of these initiatives require consistency of approach and national coordination of their implementation

It is necessary to put the e-health co-ordinates in place to enable health care reform:

• Implementing these initiatives requires a national approach to e-health standards, and infrastructure to enable health information to be shared.

• Enabling a coordinated approach to implementing health reform using a common information base - so that we are no longer shooting in the dark.

• Providing a roadmap for consistently targeted investment in ICT over the next 10 years in public and private hospitals, by GPs and specialists and pathology, radiology service providers and community and hospital pharmacies.

• Discouraging unilateral e-health investment strategies that run counter to the objective of national e-health reform by inhibiting information sharing.

In Australia, there is a growing realization that e-health has a significant role to play in enabling the reform of the health system;

• Bringing to fruition the promise of both the national broadband and e-health initiatives will require coordination at federal level

• For the first time in many years, the Commonwealth Government has signaled fundamental health reform and improvements in state and federal relations as major policy objectives.

• When the Prime Minister’s Australia 2020 summit is convened in April, the use of technology to improve safety and quality in healthcare is on the agenda.

• I am pleased to have been nominated to participate in the summit and very much look forward to contributing to its work.

• The announcement of members of the Health and Hospital Reform commission also marks a significant step forward.

• Their contribution to shaping the reform agenda for health between now and June next year will be crucial

• And the negotiation of a new Australian Healthcare Agreement will inevitably guide IT investments across all jurisdictions.

• These are all opportunities for e-health to be seen as a key means of enabling reform and innovation.

• They are not however by themselves enough to achieve change

• The key enabling infrastructure for health, as it is for education and the economy as a whole, is the availability of broadband communications that are highly reliable and affordable

• The Commonwealth government’s broadband strategy deserves wide support and its implications for health are profound

• These are anchor investments necessary to address market failure in communications and health

• In short, these are promising times for developing a wider understanding of the relationship between the national reform agenda and a nationally consistent approach to e-health

NEHTA was established out of recognition that only a national approach will work. NEHTA has been tasked by the governments of Australia to identify and foster the development of the national approach necessary to deliver the best e-health system for Australia.

• We are well advanced in developing the technical platform that will underpin the implementation of shared electronic health records.

• Consumer choice and the right to privacy are two of the principles underpinning the development of e-health. They are an integral part of all NEHTA’s work.

• However, many States, Territories and the Commonwealth have initiated localised e-health projects that enjoy varying degrees of success

• NEHTA was formed because it was considered that the greatest benefits in safety and quality and efficiency would be achieved by an approach based on national standardisation.

• The best results for Australia will be achieved when all health systems implement the same specifications, standards and electronic infrastructure for healthcare communications.

• At the heart of a reform strategy sits a national system of electronic health records – this strategic national investment provides the compass settings to guide Australia’s e-health investments

• The principal purpose of a shared electronic health record is to provide high quality health status and healthcare information concerning an individual health consumer, in order to inform and enable high quality healthcare decision-making

• A necessary pre-condition is that this happens within a structured privacy framework. Each phase of technical development has privacy safeguards in-built.

• The privacy blueprint for shared electronic health records developed in consultation with a wide range of stakeholders will soon be released for public consultation.

The benefits of this national approach to shared electronic health records in the context of a major reform program are demonstrable and they include:

• Giving access to a trusted record on which consumers can rely to manage their own health, and help prevent chronic disease in the first place

• Supporting better referral, prescribing, medications management

• Enabling clinical information to be quickly and accurately exchanged between care providers

• Fostering innovation that improves health workforce productivity, for example, e-consultation

• Enabling shared care of complex medical conditions

• Assisting in reducing hospital demand stemming from chronic disease complications

• Providing a comprehensive and accurate repository of health system knowledge

• Aggregating relevant clinical information drawn from a variety of sources – information that can be used for public health and policy planning, safety initiatives, disease detection, research and education.

• Supporting a more mobile population while saving clinicians time in seeking information and repeating tests

In summary, e-health has a central place on the agenda of national healthcare reform by enabling:

• The adoption of common standards, identity services and terminologies that paves the way for better quality care

• A standards-based approach that encourages health IT vendors to increase interoperability between systems

• Successful implementation of significant workflow change in health

• Contributing directly to reducing adverse events and improving safety and quality in healthcare

• Better value for money from current levels of health expenditure

These are all matters with a global dimension, as many countries struggle to address similar issues in different environments

• Healthcare across the globe today increasingly promises benefits at prices we cannot afford.

• The staggering cost of providing clinical services is billions of dollars every year in developed countries yet hospital and healthcare systems are strained beyond capacity.

• An indication of the significance of these events is currently being played out in the US presidential race for the Democratic Party nomination, where healthcare has emerged as a potent issue.

• Barack Obama has pledged to invest $10 billion a year for the next five years to adopt an e-health system including shared electronic health records

• His Plan for a Healthy America promises to phase in requirements for the full implementation of Health IT and the federal resources to make it happen.

• He quotes a Rand Corporation study that says if most hospitals and doctors adopted electronic health records, up to $77billion of savings would be realized each year through -

o Reduced hospital stays

o Less duplication and unnecessary testing

o Better drug use and other efficiencies.

• Hillary Clinton also wants a paperless health IT system that she says will reduce waste and redundancy while improving safety and quality by reducing medical errors.

• She has proposed a $3billion a year investment fund to help the adoption of Health IT.

The rationale for these commitments is that when implemented they can constrain the national growth of costs of healthcare costs through investment in e-health.

• And if the US does outlay that kind of funding, backed by a Federal directive, we will rapidly see some major changes on the health care landscape globally.

• These are all reasons to look forward to the next few as a time in which e-health’s contribution to health reform will mature and we will start to see some tangible returns on the investments now being made.

Ends”

The original presentation is found here:

http://www.nehta.gov.au/index.php?option=com_docman&task=doc_download&gid=461&Itemid=139

It seems to me there are a few points that can be drawn from this speech.

First there is the recognition, I think for the first time, that to do e-health properly will cost serious dollars and that this expenditure can almost certainly be fully justified.

Second I see a clear understanding that ‘business as usual’ for the health sector – both here and in other developed countries is simply not sustainable.

Third it is clear there has been a lot of work done by NEHTA in thinking about all the aspects of their brief.

Fourth it seems clear the change of government has led to a much more patient centric rather than academic view of the place of e-Health and its potential impact.

Fifth there is at least some mention of the actors in the health sector beyond those seen as NEHTA’s responsibility (ambulatory care and community care for example).

Sixth there is recognition of the random “Brownian motion” style of small uncoordinated micro implementations is to be discouraged

Seventh there is clear understanding of the need for a co-ordinated plan for steady progress to be made.

Eighth the need to co-ordinate the e-Health and the Health Reform agendas is made explicit. They have to support and grow together.

What is sad is that the products of this all work were not more widely shared for comment, review and education.

A few vital things are missing from this vision to me. First a recognition of the scale of the change management task involved with the adoption and implementation of e-Health. Second the issue of benefits distribution on e-Health adoption (which is fundamental) is not squarely addressed. Last there does not seem to be comprehension of the place of effective governance in having progress made.

All in all this is, despite the odd issue, not a bad springboard for the next CEO to begin to develop an improved agenda which, if it can be adopted, might make NEHTA actually reach its potential.

The key to success will be a cultural change to more openness, transparency and real consultation with the whole health sector. I hope we start to see that soon!

Not a bad effort at all.

David.