The NEHTA CEO is wandering around popping up a slide extolling the benefits that flow from e-Health as prepared by Booz and Company.
The presentation can be downloaded from here:
His slide is headed as follows
Economic value of e-health in 2020
TOTAL ANNUAL BENEFIT $7.6bn
Optimal use of pharmaceuticals (including generics) 2.3% ($200m)
Eliminating duplication of effort 8.1% ($600m)
Improved use of infrastructure 8.2% ($600m)
Enhanced workforce productivity 14.7% ($1.1bn)
Reduction of errors 36% ($2.8bn)
Enhanced adherence to best practices 30.6% ($2.3bn)
Source: Booze & Company Global E-Health Investment Model
The details of where this information can from the presentation referenced here:
On the next slide we have the following:
E-health will improve records management
18% of medical errors occur from inadequate patient information
50% of unnecessary acute episodes from lack of knowledge of patient condition
10% of all GP consults are with a patient the doctor has never seen before
25% of doctors’ time spent collecting data
Does anyone else notice the incoherence in all this? Is the NEHTA work plan really going to deliver the benefits cited above? Just where is the explanation of (and evidence for) how much of these 'so-called' will be altered by NEHTA's efforts and the PCEHRs proposed by Government?
The core issue I see in all this is the use of the term ‘e-health’ without really being clear just what is being talked about.
This list from the Booz Report (Page 12) provides some useful clues as to what is the core of e-health
Core E-Health Applications and Capabilities Defined
Connected care enables the electronic transfer of referral information from one provider to another and supports shared care plans where multiple providers are involved with the case treatment of a patient over time.
Decision support provides clinicians with access to guidelines, reminders, and best practices to improve patient outcomes by helping them to make more informed and cost-effective decisions.
Electronic medical records extend a clinical information system with comprehensive patient records, imaging, specialised clinical tools, and interfaces to the local administrative systems within a healthcare organisation.
Identity and access control provides the security infrastructure needed to maintain patient privacy, effectively identify and authenticate providers and patients, and control access to facilities and health information.
Medication management provides clinicians, patients, and dispensing pharmacies with information regarding a patient’s current and past medications, allergies, and basic medication-related decision support in the quest to eliminate medication errors.
Patient self-management provides patients with a portal view for managing their health records and researching health topics. In addition, the capability can provide secure, private patient communications with clinicians, enabling more effective participation in disease management programs and avoiding unnecessary visits to a clinic.
Quality and performance management provides a comprehensive database supporting intelligent performance reporting, monitoring, and the revision and improvement of care guidelines and best practices. It can also support clinical trials and academic research.
Shared summary care records (also referred to as EHRs) provide clinicians with summarized descriptions of the medical events in a patient’s history that may pertain to the current treatment, along with electronic access to detailed procedure, laboratory, and radiology reports.
----- End Extract.
What is obvious, when you take the suggested list of benefits and the core capabilities, is that the strategic and implementation emphasis has to be on provision of ICT support to providers if the majority of the benefits are to be genuinely harvested.
The big ticket benefits come from helping providers do their job better and more safely and all this discussion on Personally Controlled EHR (PCEHR) should be given much less emphasis until we really have nailed provider and hospital support and the communications between these health sector components.
The NEHTA focus on facilitation of messaging applications is correct as far as it goes, but improved GP and Hospital systems are probably even more (and certainly equally) important. These are where the main paydirt (read benefits) exists.
The issue is, of course, that to do this will actually cost some real money and needs to be properly planned, managed and executed. This is something we have not seen all that often recently!
The PCEHR, and its alleged benefits, is a smokescreen and needs to be named as such by those who should know better.
On a slightly different tack is it good to see how the Booz Study points out just how unbalanced the benefits flows and costs are between each of the different elements of the Health Sector (Providers, Consumers, Payers and Government).