Ms Nicola Roxon - An E-Health Report Card.

Yesterday we carried Ms Roxon’s (The Australian Commonwealth Health Minister for those outside Australia) first major foray into the E-Health space.

It can be reviewed here if you missed it.

http://aushealthit.blogspot.com/2009/08/nicola-roxon-speech-health-e-nation-19.html

I think some comments are needed on some of the things that were said. (Ms Roxon’s comments are in italics)

“The report describes the system as at a “tipping point”, and says the time for ‘business as usual’ has passed. The time to act is now.

We simply won’t have the resources to keep doing things the way we are doing them in the future. Our health and aged care costs will grow from around 9 per cent now to 12.4 per cent of GDP – or $246 billion – a little over two decades from now if we don’t change.”

If it remains that low – she, and all of us will be lucky! There are a lot of pressures pushing quite hard to exceed that figure!

On the NHHRC Report and e-Health she says.

“A key theme that emerges from the Report, that is of particular interest to this audience, is the revolutionary potential of e-Health to drive many of the transformative changes needed to meet these goals.

Fast forward 50 years.

Can you imagine our health system without instant access to our medical records? Where you have to carry your x-rays to each appointment, or have test results posted to you, or more commonly your doctor? Where a simple click could deliver so much information – but doesn’t, because we didn’t take action when we should have?

It’s unthinkable.

I want our future health system to be connected, secure and efficient.”

This is what we would have to call a very ‘soft’ objective indeed – it needs to be done in 10 years or the inefficiencies in our system will have us reach unaffordable levels of expenditure well before 50 years.

Remember we have been messing about for over a decade so far trying to work to do.

One wonders why it is it takes almost 2 years to hear the first few serious words on e-Health.

“The NHHRC Report recommends:

- a person-controlled electronic health record for all Australians by 1 July 2012, with unique personal, professional and organization identifiers by 1 July 2010;

- legislative and policy controls to protect patient privacy; and

- encouraging the take up of e-health by making payments to public and private health professionals dependent on e-health compatibility by 2013, starting with hospitals and pathology and diagnostic imaging providers by 1 July 2012.”

Note no “I agree or disagree” with that direction. Would have been nice if she expressed a view.

“We are already moving to implement a new, unique healthcare identifier number, which I shall return to shortly.

The UHI number is important as once they are in place, we can get on with building the vault of information – the medical records – for our health professionals to access, via that unique key.

We are building an e-health system now, because a future without it is unthinkable.”

Giving citizens and providers a number each is far from building an ‘e-health system’! We have been doing that since 2006 or so. Not much in the way of news here!

It is examples such as this which highlight why this debate is so important.

“The decisions we take now on e-health will be felt for generations. We want to get it right. “

That is why it has taken me so long to say anything. I have been thinking about it!

“We want babies born in the next decade to have an electronic health record that stays with them for their whole lives.

An Electronic Health Record would mean patients will be able to present for health service treatment anywhere in the country, and with patient approval, the treating health professional will be able to access a summary of the patient’s treatment and medication history at the touch of a button.

For health professionals, this will mean that less valuable time is lost, expensive tests are not being re-ordered or duplicated at a cost to the taxpayer, and knowledge is shared.”

Here is where we see some possibility Ms Roxon does not quite grasp what system for providers do and what systems the patients store their information within can do.

“In fact, it has been estimated that up to 18 per cent of medical errors are attributed to inadequate availability of patient information, and between 9 and 17 per cent of pathology and diagnostic tests are unnecessary duplicates. When we spend $14.8 billion a year on the MBS, there are clearly some major savings to be made.”

To do this you need detailed information in the hands of providers and to have them properly computerised and connected – hardly with the summary of what the NHHRC said provided above make clear.

“The Reform Commission has put the price tag of an Individual Electronic Health Record at between $1.1 and 1.8 billion. That’s serious money, and it will require serious consideration on how it could be funded.

Coincidently, you may have noticed that this week in the Senate that the Government is attempting to pass its changes to the private health insurance rebate.

We are trying to change the rebate provided to high income earners with private health insurance – for example couples who earn over a quarter of a million dollars – which is estimated to save the Government $1.9 billion.

So as you can see, the E- health reforms are an example of what we could pay for if the private health insurance measure is passed

You might consider placing a call to your local Coalition or Independent Senator to point this out.

E-health does however also have the potential to deliver significant savings. The AIHW supplementary report to the Reform Commission, puts them in the order of $430 million in 2022/23 and $627 million in 2032/33.

The government has committed to a series of public consultations on the Report.”

Here we find a link made between two totally unrelated policy issues for blatant political reasons – of course it is also true this legislation is not going to pass, so she is pushing – but it is just opportunistic in the extreme and pretty disingenuous.

Also with recurring benefits of this scale over decades it seems to me the up-front billion or two is merely the price of admission to a more efficient and safer health system.

“In December last year, Health Ministers endorsed the National e-Health Strategy, which will help drive future e-Health activity for the next decade. The Rudd Government is determined that the Commonwealth has a major role to play in driving the roll-out of e-Health.

With the states and territories, we have already committed to funding of $218 million over the next three years to fund the work of the National e-Health Transition Authority.

Since being established, NEHTA has developed and commenced the roll-out of the Australian Medicines Terminology and the National Product Catalogue, two initiatives which introduce common standards for how medicines and health products are defined in this country. The fact that this situation did not exist before demonstrates the scale of the task ahead as we try to build common foundations for e-Health in Australia.

Mr Peter Fleming, the Chief Executive of NEHTA, will be discussing NEHTA’s work a little later today. My department continues to work with NEHTA on implementation packages for e-Prescribing, e-Pathology, e-Referral and e-Discharge.”

Here is where it becomes clear Ms Roxon does not get it. The NHHRC report recommends implementation of this National Strategy – as well as the other things she mentioned first. You need both!

As for the AMT and NPC after 5 years they are still works very much in progress – incredibly – and the implementation packages are – at this point – simply unproven documentation that is yet to be implemented even on a trial basis.

“By the middle of next year, all Australians will have been allocated a 16 digit Unique Healthcare Identifier.

This 16 digit unique number is the first step in building a secure e-Health system. It will not replace your Medicare card – it will be a totally new, unique number. It will be the key that unlocks the information on your medical record – an e-Health record.

You will be the owner of the key, and you will decide who gets access to your records.

So whilst progress may seem slow at times, there is still a lot of work being done outside the arena of the reform process, but complementary to it.”

Coming ready or not! – well maybe. The glacial progress on the AMT and NPC would make any sane observer pretty sceptical!

Finally we have:

“We stand at the cusp of an era of significant changes in health in this country. The decisions the government makes over the coming months will help build a health system to meet the needs of the current, and future generations. E-health is a clear symbol and practical example of this.

The Prime Minister and I are absolutely determined to get the reform of our health system right. We have blueprint for the most significant reform of the health system since the introduction of Medicare 25 years ago.”

Given that e-Health has essentially been strategically paralysed for a decade, with all the progress and innovation having come at largely local levels, it seems to me we still do not have the savvy leadership we are going to need to make any serious progress.

Sadly, on this effort, all I see is words strung together with little real understanding of what is needed.

What it is not clear from her comments is that she understands that the National E-Strategy must be funded and implemented and I find this deeply disappointing. Without this plan and all it recommends she will surely fail.

David.