Australian E-Health Descends into Utter Confusion. The Saga So Far.

As those readers who have followed the story so far we have the following:

Courier Mail reports on June 8, 2009 that the planned Individual Health Identifier would utilise a smartcard as a healthcard. The card was intended to be able to voluntarily store your health information which could be shared with your healthcare providers.

This is found here:

http://www.news.com.au/couriermail/story/0,23739,25601319-952,00.html

The details about providing override access to the card for paramedics seems to make it clear a smartcard (which may or not be a Medicare Card) is what is being discussed.

Next, later in the day, we have an apparently separate set of comments reported by SkyNews which are found here:

http://www.skynews.com.au/business/article.aspx?id=339989

Here it is also clear a smartcard is being talked about. It is to be apparently voluntarily loaded with information selected by the patient who will be then able to decide who has access to the information.

Since then there have also been reports in The Age (picking up on the SkyNews Report):

http://www.theage.com.au/national/health-card-plan-sparks-privacy-concerns-20090608-c0uk.html

Also similar material has appeared in the Financial Review, The Brisbane Times and a brief note in the Australian which is found here:

http://www.theaustralian.news.com.au/story/0,25197,25608007-23289,00.html

So what are we to conclude from all this. All I think we can safely conclude is that the Heath Minister has been getting many strands of different advice from different interest groups that have different positions to sponsor.

NEHTA is still wedded to the establishment of its Individual Electronic Health Record (EHR) service. Remember this used to be called the Shared EHR and was at the core of the HealthConnect project which NEHTA was intended to progress.

See this presentation from May 29,2009.

http://www.nehta.gov.au/component/docman/doc_download/729-physicians-week-michelle-bramley

The National Health and Hospitals Reform Commission seems to be keen on what it describes as a Person-controlled EHR

Read about this here:

http://www.nhhrc.org.au/internet/nhhrc/publishing.nsf/Content/BA7D3EF4EC7A1F2BCA25755B001817EC/$File/Person-controlled%20Electronic%20Health%20Records.pdf

The Deloittes National E-Health Strategy (endorsed by all Health Ministers including Ms Roxon) supports an incremental approach to e-Health addressing provider systems, secure clinical messaging and health information flows, support for adoption and use and appropriate strategic governance of the whole initiative.

The summary of the Deloittes approach is found here:

http://www.ahmac.gov.au/cms_documents/National%20E-Health%20Strategy.pdf

Medicare would presumably be keen on progressing work on the NEHTA sponsored identifiers to the stage where other activities such as e-prescribing could occur.

DoHA is apparently working on Identifier Legislation, the fiasco we know as ePIP and various consultancies but they keep their cards close to their chest and may indeed be dusting of card based plans.

Phew – what a mess!

More than all this the quoted comments from Ms Roxon seem extend smartcard deployment from just healthcare providers (as envisaged by the NEHTA NASH initiative) to the entire population (voluntarily of course!) and to envisage a third and different type of EHR system (card based).

I suspect the only reason this has all come up is because of this NHHRC discussion paper:

http://www.nhhrc.org.au/internet/nhhrc/publishing.nsf/Content/16F7A93D8F578DB4CA2574D7001830E9/$File/E-Health%20-%20Enabler%20for%20Australia%27s%20Health%20Reform,%20Booz%20&%20Company,%20November%202008.pdf

In this there is a lot of discussion of work that is happening in Germany and Lombardy.

The German effort is behind time and seems to be fairly expensive:

http://www.ehealtheurope.net/news/3580/german_government_unveils_smartcard_costs

“In total, costs of the smartcard project are expected to reach €1.4 billion. Additionally, about €150m of annual running costs are forecast once rollout is complete.

The €1.4 billion quoted covers the smartcard rollout and the establishment of a core online infrastructure. In particular, the number does not include costs for electronic medical records (EMR), and does not include costs for applications including online booking services and the like.”

Note this is just to cost for the card roll out!

I was going to go on from here to expand on why the Health Smartcard with clinical information was a very bad and very expensive idea – but my readers have done it for me. See here:

http://aushealthit.blogspot.com/2009/06/e-health-policy-confusion-just-rolls-on.html#comments

and here:

http://aushealthit.blogspot.com/2009/06/update-on-ms-roxon-plan-this-is-really.html#comments

(It is great to have such smart readers!)

I also covered similar points in yesterday’s post here:

http://aushealthit.blogspot.com/2009/06/e-health-policy-confusion-just-rolls-on.html

Really the only point now to be made is that the time is well and truly past for the Minister to come out and say what she is actually planning. We all need to be put out of our misery! We also need to make sure with the rush to complete the NHHRC report by June 30 nothing too silly gets initiated!

I do also need to say, with all these apparent options – which I believe are mostly fantasy – I still am firmly convinced we should implement the plan developed by Deloittes and that is should be made fully public ASAP.

I really am on the edge of my seat to see what happens next! We do really live in interesting e-health times!

David.