ACT Health Announces A Large e-Health Investment - Is It Credible?

The ACT Budget came down last week. Among a range of initiatives was the following announcement.

ACT budget injects $90m into e-health

Renai LeMay, ZDNet.com.au

The Australian Capital Territory has allocated $90 million as what it described as an "unprecedented level of investment" to electronic health initiatives in its annual budget, including an e-health record for all residents of the territory.

Territory treasurer Katy Gallagher said the investment would fund a suite of initiatives that would put the ACT "at the forefront of e-health technology in Australia" and would give all Canberrans an opportunity for an electronic health record. The funding would help improve safety and quality of care in hospitals, she added, with a focus on improving efficiency across the board.

The news comes as the e-health agenda appears to be gaining speed in Australia, with many states having recently flagged projects to finally dump paper records in favour of e-health systems to store and make patient records available between facilities.

NSW Health Minister John Della Bosca said over the weekend that the state had initiated a $100 million project to digitise no less than 250 hospitals, following on recommendations made in the Garling review of the state health sector in 2008.

More here:

http://www.zdnet.com.au/news/software/soa/ACT-budget-injects-90m-into-e-health/0,130061733,339296293,00.htm

The full press release is found here:

http://www.treasury.act.gov.au/budget/budget_2009/files/press/08_press.pdf

$90 million investment in an e-healthy future

A $90 million investment in e-health capacity and infrastructure will take Canberra’s health care system into the future, ACT Health Minister, Katy Gallagher, said today.

Announcing the funding allocation in the 2009-10 Budget, Ms Gallagher said initiatives like this would ensure our health system was better positioned to meet the needs of the ACT community now and into the next decade.

“We will continue to prioritise health and invest in services to meet growing demand and keep pace with new and innovative ways of delivering health care.”

“Despite the challenging economic times, this Government will not withdraw from our obligations to the community and will continue to invest in health,” Ms Gallagher said.

The benefits of e-health are increased efficiencies, quality, timeliness, safety and productivity of the system overall.

“New information and communication technologies are recognised as being key components in addressing and managing the increase in demand for health services and these initiatives are a significant commitment to meeting these challenges,” Ms Gallagher said.

The Minister said the E-Healthy Future package delivered on a key 2008 election commitment and had four main elements:

Personal electronic health records

“Personal Electronic Health Records (PEHR) will ensure that accurate and trusted personal health information is made available to the right person, at the right time to enable informed care and treatment decisions, which is better for patients and consumers, as well as health professionals and providers.

Digital hospital and healthcare infrastructure

“The ACT Government’s commitment to a $1 billion rebuild of our health system requires next generation digital infrastructure.

“This will require a medical grade secure network to enable safe, timely and reliable exchange of sensitive clinical information by health professionals and provider organisations.

“Remote diagnostic and treatment services to enable care to move seamlessly outside the hospital and clinic environment and into patients’ homes will be achieved through common clinical applications and high availability ICT infrastructure.

Decision support

“Decision support will guide the highly skilled work undertaken by our front line health workers – doctors, nurses and allied health professionals,” Ms Gallagher said.

“This will include electronic medication management (EMM) to ensure safe, accurate and timely prescribing and administration of medication, and online access to clinical protocols, guidelines and new medical research.

Support services

“Support services are the essential infrastructure components of e-health that make decision support, personal electronic health records and the digital environment possible,” Ms Gallagher said.

The Minister said an E-Healthy Future would enable patients to be put at the very centre of the health care system and support General Practitioners through the electronic sharing of patient clinical information between the hospital and the GP to improve patient safety.

“This considerable investment in e-health capacity will also provide patients with a much greater say in how their personal health information can be used to improve access to health care, reduce wasted time associated with current multiple disconnected paper-based and other systems, and above all improve the safety and quality of health care,” she said.

“It will also ensure that our service delivery is safer, more timely and efficient.”

In the capital spend announcement we see the following:

enhancing e-health capacity with An E-Healthy Future $90.2 million

The Budget provides a package of measures designed to build the necessary e‑health capacity and infrastructure, as part of the Government’s $1 billion Your Health Our Priority program to rebuild the public health system.

An E-Healthy Future has four key elements.

1. Personal Electronic Health Records (PEHR) - to ensure that accurate and trusted personal health information is available to enable informed care and treatment decisions.

2. Digital hospital and healthcare infrastructure - to provide the required next generation digital infrastructure, including a medical grade secure network, to enable safe, timely and reliable exchange of sensitive clinical information.

3. Decision support - to guide the highly skilled work undertaken by our front line health workers, including electronic medication management (EMM) to ensure safe, accurate and timely prescribing and dispensing of medications; and instantaneous online access to clinical protocols and research.

4. Support services - to deliver essential infrastructure components of E-Health, including expansion of the ACT Health patient administration system (ACTPAS) to include the Calvary hospital, adoption of an ACT wide staff rostering service, and implementation of a state of the art diet and food management system.

All well and good – although it would be nice to see a few clinical hospital applications and some messaging to and from practitioners included.

But we then look at the recurrent health budget and we find the following:

Program - An E-Healthy Future

2009/10 $350,000

2010/11 $1,381,000

2011/12 $1,061,000

2012/13 $11,050,000.

So no serious expenditure until 2012/13.

Looking back there is also none of the usual $xx Million over x Years.

Looking at the ACT Health Web Site one finds there is an Information Services Branch but no Information Services Plan and no e-Health Plan that can be found (there is a policy on acceptable computer use for staff).

No mention of the branch in the Budget but we do find this:

“Depreciation and Amortisation:

.the decrease of $1.312 million in the 2008-09 estimated outcome from the original budget relates to delayed implementation of major information technology and other capital works projects; and

.the increase of $2.573 million in the 2009-10 Budget from the 2008-09 estimated outcome relates mainly to the completion of major information technology projects. (Page 39 of 44)

Balance Sheet

- cash and cash equivalents: the increase of $16.272 million in the 2008-09 estimated outcome from the original budget relates to a reduction in receivables, receipt of Commonwealth project funds and unspent information technology project funding.

And this

- property, plant and equipment: the decrease of $69.404 million in the 2008-09 estimated outcome from the original budget relates to delays in the Capital Asset Development Plan (CADP).

- intangibles: the increases of $9.380 million in the 2009-10 Budget from the estimated outcome relates to major information technology projects, including those associated with the CADP. (Page 40 of 44)”

We also have to think about the scale of this alleged investment. The ACT population is about 340,000 and that of Australia is 21.7Million.

If you do the proportional arithmetic this is a national capital investment of approximately $5.7Billion!

If you believe this is real you are a keen fan of the tooth fairy! Oh would it were true!

I look forward to the detailed forward plan, investment details etc.

I suspect I will be waiting a long time!

Note: Yet again we seem to have so little understanding of e-Health that one cannot even work out if this notional plan is to fund EHRs, PHRs or both!

David.