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Monday, May 19, 2008

Richard Dixon Hughes of DH4 Provides Detailed E-Health Budget Analysis.

Richard Dixon Hughes, Managing Director of DH4 Pty Ltd, (an ICT and e-Health Consulting firm) has kindly agreed to allow general access to his detailed budget analysis.

Australian Government Budget 2008-09
Summary of e‑Health and health information measures


Having discussed the budget measures with a number of friends and colleagues, all of whom were interested in getting more information on the implications and outcomes for e‑health and health information activities in Australia, I committed to put together this consolidated document containing a summary and extracts of what I consider to be the more relevant provisions.

Overview

The measures identified appear in several places in the 2008‑09 Budget Papers, with each measure typically being covered in one or more of the following:

· Aggregated into the Expense Measures in the summary expenditure tables at pages 39-76 the start of Budget Paper No 2 Budget Measures 2008-09;

· Expenditure tables and summary descriptions of expenditure measures for the Health and Ageing (H&A) portfolio at pages 201 to 246 of Budget Paper No 2;

· Expenditure cuts and reallocations under Whole of Government: Responsible Economic Management at pages 201 to 246 of Budget Paper No 2; and

· Information, explanations and justifications set out in the 2008-09 Health and Ageing Portfolio Budget Statements (Budget Related Paper No. 1.10), particularly in relation to Outcome 10 (Health System Capacity and Quality).

Key features of the Budget provisions that were identified as having some relationship to current or proposed e-health activities are:

1. Cuts to the previous e-health implementation program. While these totalled $10.5 million over three years and were part of a basket of cuts, it is not clear what the extent and nature of the specific reductions within the e‑Health Implementation Program have been (see Appendix A below for more detail).

2. The role of e‑health being acknowledged in general terms in relation to improving the capacity and quality of the Australian health services (see Appendix B below).

3. Improvements in safety and quality outcomes and in clinical and administrative decision-making are the goals of Department of Health and Ageing Program 10.2 (e‑Health Implementation) as set out in Appendix C below, including the following cornerstone activities:

· providing Australian Government leadership in e-Health, by:

- demonstrating the health care safety and quality benefits; and

- developing health information privacy measures,

· working with states and territories, professional groups and consumers, to address aspects of e-Health requiring national leadership and coordination - specifically development of a national e-Health strategy;

· overseeing the development of national standards to enable compatibility of e-Health systems and alignment with national e-Health policy;

· working to ensure health systems are interoperable, and can safely and securely exchange electronic health information; and

· consulting with medical groups, the software industry, other professions and the community to take their needs into account in pursuing the above.

4. As stated on page 220 of the H&A Portfolio Budget Statements, Administered funds provided for a specified period and not used in that period are subject to review by the Minister for Finance and Deregulation, and may be moved to a future period.

Of the $70.076 million of Administered funds moved between 2007-08 and later years for the Health and Ageing Portfolio, $7,362 was within the e-Health Implementation program.

5. Previous ICT incentives for General Practice are being abolished and a new incentive payment of $6.50 per patient introduced in their place – however the net result is planned to be a saving of $110.7 million over the next 4 years. More information on this measure is provided at Appendix D below.

6. In other e-health related measures being undertaken by DoHA, the following were noted:

(a) The KidsMatter Initiative under the Mental Health programs (Outcome 11) includes activities to ensure that help is available to families by links to web-based mental health services, information systems and programs such as Kids Helpline;

(b) Web-based mental health therapies and interventions to complement face-to-face services, which are supported through the Mental Health – Telephone Counselling, Self Help and Web-Based Support Program (DoHA Program 11.1); and

(c) A KPI for DoHA Program 2.5 (Palliative Care and Community Assistance) is that the CareSearch website meet the information and resource needs of health professionals, volunteers, patients, families and carers.

7. Investment by AIHW continues to capitalise on the “new information environment” offered by information technology and e‑health, but with a less specific program of activities than was suggested in last year’s budget. More details are provided in Appendix E below.

8. As noted at page 445 of the H&A Portfolio Budget Statements: “The NHMRC is developing an integrated data platform to improve accountability, information management and reporting of the Australian Government’s investment into health and medical research. In 2009, a research investment management system, developed by the NHMRC to support the grants management process, will come online. The system will support the full grants management process from application through to grant acquittal, including peer review, approvals, administration and accountability. It will replace the current grants management system and facilitate the growing reporting and business intelligence needs of the NHMRC.”

9. One of the major cost saving measures was the abolition of the Access Card project (being managed within the Human Services portfolio) leading to an all up reduction of $1.2 billion over 5 years. More details are provided in Appendix F below.

10. As indicated in the Portfolio Budget Statements for the Human Services portfolio Medicare Australia is undertaking a range of activities aimed at:

(a) Maximising take-up of electronic Medicare claiming to enhance access, choice and convenience for the public and for providers;

(b) Designing and developing a Unique Healthcare Identifier (UHI) service under contract to the National E-Health Transition Authority, noting that: This service will generate healthcare identifiers for patients, healthcare providers and healthcare locations, and is aimed at facilitating the development of electronic health records in Australia. [at page 91]; and

(c) Aged Care online claiming and refreshing the technology of aged care payment systems.

There was little detail provided about the specifics of how these aspirations would be realised or the investments required.

11. A large number of H&A portfolio programs involve the maintenance of data collections, to assess national health status, program effectiveness and for other purposes. The following are among those specifically mentioned in the H&A Portfolio Budget Statement.

· National Postnatal Depression Initiative – data collection to be developed collaboratively with the states and territories and BeyondBlue to support evaluation and management of the program and for research.

· National Cervical Screening Program - overall coordination of national data collection, quality control, monitoring and evaluation.

· A National HPV Register is being developed on behalf of DoHA by Victorian Cytology Services to provide ongoing monitoring of coverage rates and vaccine effectiveness. Data collection will begin June 2008, with uploading to the electronic system to commence in November 2008 for access by girls and health professionals from January 2009 onward.

· Improving national data on the effectiveness of programs to prevent and treat illicit drug use (including collecting data on the cost and social burden of drug use) [under DoHA program 1.3].

· Medicare Services Program [DoHA Program 3.1] supports access to a range of medical services listed in the MBS and maintains and analyses comprehensive data on services, benefits and costs to patients.

· National Respite for Carers Program – data on carers provided with respite assistance.

· Within Outcome 8 (Indigenous Health):

- participating in the National Advisory Group for Aboriginal and Torres Strait Islander Health Information and Data;

- improving the quality and availability of important statistics relating to the health of Indigenous people;

- funding new work on estimating Indigenous mortality rates;

- developing guidelines for improving Indigenous identification in key health datasets;

- developing social and emotional well-being data; and

- producing the 2008 Aboriginal and Torres Strait Islander Health Performance Framework Report.

· Monitoring the uptake of insurance products and use of services covered health insurance and their impact on private health insurance costs and risk equalisation arrangements - through quantitative assessment of Hospitals Casemix Protocol data, data collected by the PHIAC and consultation with the private health insurance industry.

· Better Arthritis and Osteoporosis Care Initiative - data collection related to funded programs focused on primary and secondary prevention, and best practice management of arthritis and osteoporosis.

· Commonwealth Dental Health Program – collaborative development with states and territories of performance indicators and health data reporting to support more consistent national access to services and provide nationally comparable health data to plan future improvements to dental services.

· Australian Health Care Classification Systems - develop and refine nationally consistent patient health care classification systems and patient level data for emergency departments and outpatient services to support COAG commitment to a more nationally consistent approach to activity based funding for services provided in public hospitals.

On page 191, it is noted that: “The Australian Government is committed to a consistent Australian health care classification system that goes beyond counting activity to measuring outcomes and the success of the health sector in delivering appropriate services to Australians who need them. Funding for this major activity is sourced from Program 13.3 – Public Hospitals and Information.”

· The Hospital Information and Performance Information Program under Program 13.3], including:

- funding the development of national classification systems for patients, their treatment and associated costs to provide a basis for measuring and paying for hospital services under the AHCA;

- National Hospital Cost Data Collection (round 11); and

- Release of Australian Refined Diagnosis Related Groups v6.0.

· Outcome 14 (Biosecurity and Emergency Response) - Strengthening communicable disease surveillance systems to detect, assess and respond to communicable disease threats in Australia and overseas, through the national communicable disease surveillance system, OzFoodNet and the Foodborne Disease Surveillance Program.

· AIHW – working closely with peak bodies responsible for cancer control and state cancer registries to provide data on cancer prevalence and survival rates, and to monitor cancer screening programs.

· ARPANSA - Data collection and analysis of patient dose in CT scanned patients.

· Cancer Australia – improvements to collection and use of cancer data in collaboration with state, territory and professional groups.

· National Centre for Gynaecological Cancers - the development of minimum datasets for gynaecological cancers (to complement the existing national cancer clinical minimum dataset); and consulting on research priorities.

· National Blood Authority:

- Completing development and implementation of the NBA’s new integrated data management system aimed at improving operational data and performance reporting for the sector and to address the challenge of providing nationally relevant information from a disparate set of systems and processes in each jurisdiction (additional funding provided);

- Implementing Australian Bleeding Disorder Registry by June 2009; and

- Completing plans for a National IVIg management system by June 2009.

Concluding observations

It is reasonable for e-health expenditure to be strongly controlled at this time while the nation takes stock of the e‑health environment, develops its next e‑health strategy and identifies the resources, organisational measures and policies needed to achieve it.

An effective e‑health strategy requires effective communication, involvement and collaboration across all aspects of the health system – including specialists, diagnostic services, aged and long-term care, mental health, indigenous health, public and private sector acute care facilities as well as those in the primary and ambulatory care sector, who have been much of the focus to date. All in the health informatics community hope that the e‑health strategy to be produced in 2008-09 will facilitate an effective outcome and ensure that the core policy and infrastructure components needed to achieve e‑health are successfully put in place.

At DH4, we trust you find this synopsis a useful guide.

J. Richard Dixon Hughes,
Managing Director, DH4 Pty Limited

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Those who are interested in the detailed appendices (an additional 12 pages of analysis) are invited to contact Richard by e-mail (richard at dh4.com.au).

Thanks Richard for the work.

David.

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