The Last Chance Saloon for E-Health in Australia.

Well the budget has been delivered, the press has discussed and as far as e-Health is concerned it has been a pretty miserable outcome. Overall the Budget Washup 2009 has been a really bad trip. The obvious question is where to next?

Both the serious national dailies had considerable (disappointed and negative) commentary

First we had (just pre budget):

Leaked details show modest costs for e-health

Karen Dearne | May 12, 2009

NATIONWIDE electronic health infrastructure will cost a modest $1.5 billion over five years, or $2.6 billion over a 10-year rollout, according to leaked funding details.

Federal and state ministers have kept tight wraps on costings and timetables since agreeing last December to adopt the National E-Health Strategy, prepared by Deloitte.

The $1 billion to $2 billion range "represents a relatively modest investment" when compared with the total annual health spend of $90 billion, with $60 billion coming from all levels of government.

Deloitte found that "tangible benefits" from implementing the e-health strategy "are in the order of $5.7 billion in net present value terms over 10 years".

Annual savings from a fully integrated system "are estimated to be about $2.6 billion in 2008-09 dollar terms".

The leaking of financial information and costed work programs on David More's AushealthIT blogger website appears to reflect growing frustration with the lack of progress on e-health.

Last month, medical and consumer groups told the National Health and Hospitals Reform Commission they were astonished it had failed to put information technologies at the heart of reform plans.

More here:

http://www.australianit.news.com.au/story/0,24897,25464236-5013040,00.html

And then we had after the event these two articles.

Budget 09: Patients slugged with e-health bill?

Karen Dearne | May 13, 2009

FEARS that patients will have to fund and maintain their own electronic health records have strengthened with the federal Government refusing to put money into a nationwide information-sharing infrastructure in the budget.

Instead, the Health Department is to "develop a legislative and regulatory framework" that would open the field to businesses like Microsoft and Google wanting to cash-in on demand for personal health records.

Concerns that plans for a secure national health information system had been scrapped emerged two weeks ago, when the key healthcare reform body, the National Health and Hospitals Reform Commission, rushed out an unexpected paper suggesting "commercial IT developers" were best placed to deliver personal e-health records to patients "in an open, competitive market".

Health Minister Nicola Roxon has now directed her department to deliver new laws that permit doctors, public health providers and government authorities to use unique healthcare identifiers in support of sharing sensitive patient details, and to overcome privacy and consent concerns that have restricted secondary use of medical data to date.

"Appropriate levels of protection of an individual's health information will help provide consumers with confidence that their information is managed in a secure environment," according to 2009 budget papers.

"The department will also support secure messaging services to assist the widespread take-up of electronic referrals, prescribing and (hospital) discharge summaries, and develop policy parameters for a long-term approach to individual e-health records."

Just this week, leaked details of the federal and state governments' agreed National E-Health Strategy revealed that an Australia-wide e-health infrastructure would cost $1.5 billion over five years - vastly improving patient care and healthcare safety - and delivering financial savings of around $2.6 billion annually.

The budget notes that "since the completion of (the long-abandoned) HealthConnect and Managed Health Network Grants in 2008-09, the e-health program has been refocused to support activities that align with the National E-Health Strategy".

Lots more here:

http://www.australianit.news.com.au/story/0,24897,25474380-15319,00.html

and this one (again just before the budget):

Electronic records could dictate health funding

Julian Bajkowski

The Australian Financial Review | 12 May 2009 | Page: 31 | Information.

States and private health providers have been put on notice that federal health funding may become contingent on the adoption of a nationally compatible electronic health records scheme.

The controversial move to tie funding to the adoption of EHRs is expected to be formally recommended by June 30. That is the date when the National Health and Hospitals Reform Commission (a body of experts assigned by Prime Minister Kevin Rudd and Health Minister Nicola Roxon to modernise health care) hands down its final report.

The distinctly harder line on technology-driven improvements comes as the federal government struggles to find between $1 billion and $3 billion to create a national electronic health scheme against a background of shrinking revenues.

It remains unclear which, if any, electronic health measures will be given money in today's budget.

But the government's options include financing some of the project's outlays from the $5 billion Health Infrastructure Fund and the $43 billion national broadband network project.

More here (subscription required):

http://www.afr.com/applications/Stock_mxml.html?pid=A&one=EDP://20090512000031134287

After the event the AFR went with the headline:

E-Health Scheme in Limbo!

In this article Ben Woodhead points out (Page 26 on Thursday) that there was no good news and that the last hope was that the business case for the National Broadband Network – if such exists – would have to have a substantial e-Health component and that there may be some funds from that source.

So the sole hope we seem to have is the straw in the wind with the ACT planning to make a disproportionately large investment in the area – as discussed last week.

I don’t think that is true. There is one source of hope and that is the National Health and Hospital Reform Commission (NHHRC) will point out the need to seriously fund e-Health as part of the reform agenda and that this will open some funding from the National Health Infrastructure Fund.

Details of that fund are here:

http://aushealthit.blogspot.com/2008/12/health-and-hospitals-fund-announcement.html

As I understand it this fund started with $10Billion and was to be topped up to with another equal amount in the 2008/9 fiscal year. Needless to say with the GFC this is not happening!

Now about $3B was allocated in the present budget from the fund on non e-Health items.

So we now need to wait until the NHHRC final report and see if the response has some serious funding – presumably from this source. If not – forget it – the forces of darkness and ignorance have won!

The real worry is that the NHHRC does not seem, as a group, to understand e-Health very well so we could really wind up with a ‘pig in a poke’ which the Minister chooses to fund – without serious expert advice from the e-Health domain. The horror scenario with more waste etc!

David.