An Anniversary That Needs to be Noted. Have We Moved Far Yet?

Just on a year ago the National Health and Hospital Commission (NHHRC) submitted its final report to Health Minister Nicola Roxon. (June 30, 2009)

On E-Health the Executive Summary said the following (Page 8):

Smart use of data, information and communication

Our third lever to support an agile, self improving system is the smart use of data, information and communication.

We are recommending a transforming e-health agenda to drive improved quality, safety and efficiency of health care.

The introduction of a person-controlled electronic health record for each Australian is one of the most important systemic opportunities to improve the quality and safety of health care, reduce waste and inefficiency, and improve continuity and health outcomes for patients. Giving people better access to their own health information through a person-controlled electronic health record is also essential to promoting consumer participation, and supporting self-management and informed decision-making. We want the Commonwealth Government to legislate to ensure the privacy and security of a person’s electronic health data.

Making the patient the locus around which health information flows is critical and will require a major investment in the broader e-health environment. Electronic health information and health care advice will increasingly be delivered over the internet. Broadband and telecommunication networks must be available for all Australians if we are to fulfil the real promise of e-health.

We are also recommending that clinicians and health care providers are supported to ‘get out of paper’ and adopt electronic information storage, exchange and decision support software. The Commonwealth Government must set open technical standards which can be met by the vendor industry while ensuring the confidentiality and security of patient information. Most importantly, we urge governments to expedite agreement on a strengthened national leadership structure for implementing a National Action Plan on E-health, with defined actions to be achieved by specified dates.

Access to good information is also vital to measuring and monitoring the health of our population. We are recommending the development of Healthy Australia Goals 2020 – the first in a rolling series of ten-year goals. We want all Australians to participate in setting these goals and working towards improvements in health outcomes at local, regional and national levels.

We are also keen to promote a culture of continuous improvement through health performance reporting. Our recommendations include:

·         systems to provide comparative clinical performance data back to health services and hospitals, clinical units and clinicians;

·         publicly available information on health services to assist consumers in making informed choices;

·         the Australian Commission on Safety and Quality in Health Care to analyse, report and advocate on safety and quality across all health settings; and

regular reporting on our progress as a nation in tackling health inequity

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 The detailed e-Health Recommendations are found in Section 5.3 of the report.

All the report and associated literature are here (yes, it has all moved from www.nhhrc.org.au)

http://www.health.gov.au/internet/nhhrc/publishing.nsf/Content/nhhrc-report

It is interesting now to see where we are a year on (See Section 16 – Page 229 on for accountabilities – Mostly NEHTA and DoHA).

From earlier (Page 29) here are the recommendations:

Implementing a national e-health system

We recommend that, by 2012, every Australian should be able to:

·         have a personal electronic health record that will at all times be owned and controlled by that person;

·         approve designated health care providers and carers to have authorised access to some or all of their personal electronic health record; and

·         choose their personal electronic health record provider.

We recommend that the Commonwealth Government legislate to ensure the privacy of a person’s electronic health data, while enabling secure access to the data by the person’s authorised health providers.

We recommend that the Commonwealth Government introduce:

·         unique personal identifiers for health care by 1 July 2010; unique health professional identifiers (HPI-I), beginning with all nationally registered health professionals, by
1 July 2010;

·         a system for verifying the authenticity of patients and professionals for this purpose – a national authentication service and directory for health (NASH) – by 1 July 2010; and

·         unique health professional organisation (facility and health service) identifiers (HPI-O)
by 1 July 2010.

We recommend that the Commonwealth Government develop and implement an appropriate national social marketing strategy to inform consumers and health professionals about the significant benefits and safeguards of the proposed e-health approach.

Ensuring access to a national broadband network (or alternative technology, such as satellite) for all Australians, particularly for those living in isolated communities, will be critical to the uptake of person-controlled electronic health records as well as to realise potential access to electronic health information and medical advice.

We recommend that the Commonwealth Government mandate that the payment of public and private benefits for all health and aged care services depend upon the ability to accept and provide data to patients, their authorised carers, and their authorised health providers, in a format that can be integrated into a personal electronic health record, such that:

·         hospitals must be able to accept and send key data, such as referral and discharge information (‘clinical information transfer’), by 1 July 2012;

·         pathology providers and diagnostic imaging providers must be able to provide key data, such as reports of investigations and supplementary information, by 1 July 2012;

·         other health service providers – including general practitioners, medical and non-medical specialists, pharmacists and other health and aged care providers – must be able to transmit key data, such as referral and discharge information (‘clinical information transfer’), prescribed and dispensed medications and synopses of diagnosis and treatment, by 1 January 2013; and

·         all health care providers must be able to accept and send data from other health care providers by 2013.

We recommend that the Commonwealth Government takes responsibility for, and accelerates the development of a national policy and open technical standards framework for e-health, and that they secure national agreement to this framework for e-health by 2011-12. These standards should include key requirements such as interoperability, compliance and security. The standards should be developed with the participation and commitment of state governments, the IT vendor industry, health professionals, and consumers, and should guide the long-term convergence of local systems into an integrated but evolving national health information system.

We recommend that significant funding and resources be made available to extend e-health teaching, training, change management and support to health care practitioners and managers. In addition, initiatives to establish and encourage increased enrolment in nationally recognised tertiary qualifications in health informatics will be critical to successful implementation of the national e-health work program. The commitment to, and adoption of, standards-compliant e-health solutions by health care organisations and providers is key to the emergence of a national health information system and the success of person-controlled electronic health records.

With respect to the broader e-health agenda in Australia, we concur with and endorse the directions of the National E-Health Strategy Summary (December 2008), and would add that:

·         there is a critical need to strengthen the leadership, governance and level of resources committed by governments to giving effect to the planned National E-Health Action Plan;

·         this Action Plan must include provision of support to public health organisations and incentives to private providers to augment uptake and successful implementation of compliant e-health systems. It should not require government involvement with designing, buying or operating IT systems;

·         in accordance with the outcome of the 2020 Summit and our direction to encourage greater patient involvement in their own health care, that governments collaborate to resource a national health knowledge web portal (comprising e-tools for self-help) for the public as well as for providers. The National Health Call Centre Network (healthdirect) may provide the logical platform for delivery of this initiative; and

·         electronic prescribing and medication management capability should be prioritised and coordinated nationally, perhaps by development of existing applications (such as PBS online), to reduce medication incidents and facilitate consumer amenity.

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A year on it is clear this is going to be a much longer process that the NHHRC envisaged!

We have given people their identifiers but the implementation of their use is now reckoned to take a couple of years.

NASH was meant to be ready for use but has not been seen as far as I know.

The national professional registration systems are just now creaking into life so it will be a while before provider identifiers are ready for use.

Fortunately the very silly idea of linking messaging capabilities to payments of standard Medicare benefits has gone quiet and work is still underway on getting the Standards in place – let alone fully proven and implemented nationwide. It would be hard to tie payments to messaging without a proven, working, nationally accessible system where all software providers had appropriate modifications in place and the data content rules etc were fully evolved. Not next week then!

The  professional and patient portals are also still well off into the future as far as we can all tell.

Lastly and critically – we now have some of the implementation funds without the leadership and governance as recommended in the NHHRC Report.

All in all rather a mixed and patchy implementation effort with most of the ‘hard stuff’ not addressed.

I find it interesting the NHHRC suggested choice of Person Controlled EHRs for patients. According to Ms Roxon that idea is out the window for now – with Medicare Australia to be doing it.

See here:

http://aushealthit.blogspot.com/2010/06/spend-five-minutes-with-nicola-roxon-to.html

For other comments on the PCEHR proposal see here:

http://www.health.gov.au/internet/nhhrc/publishing.nsf/Content/309-interim

It is difficult to see a passing grade on all this just yet!

David.