Thursday, September 09, 2010

Where to For E-Health in Australia Now We Have a New Government?

Now the election has been decided (for now at least) it is probably time to try and assess where we might go over the next few years with e-Health.

One good thing that seems to have emerged is that there does seem to be a considerable political consensus (from each of Labor, the Coalition and the Greens) that introduction of reasonable levels of computerisation and electronic messaging within the health sector can have a significant positive impact on the quality, safety and efficiency within the health sector while recognising there are issues of information security and privacy that do need to be addressed. This is a least a basic starting point for ‘moving forward’!

A reasonable point to start this brief review is from the most recent budget in May, 2010 as this was the first occasion we had a budgetary commitment from the previous Rudd Government outside support for the half funding of the National E-Health Transition Authority (NEHTA) in a Council of Australian Governments (COAG) meeting in November 2008. The shared funds ($218million) were to run NEHTA from July 2009 to June 2012.

There have been four significant announcements including the Budget announcement.

First, in the 2010 Federal Budget the Government announced an investment of $466.7 million that was claimed would revolutionise the delivery of healthcare in Australia. It was said that for those Australians who choose to opt in, they would be able to register online to establish a personally controlled e-Health record (PCEHR) from 2012-13. It was later made clear that the service would be provided by a centralised portal and that the patient would control who would be able to access the information held within the portal. The source of the information to populate the portal has never been clarified to my knowledge.

What details that are available from the source are found here:

and here:

The second e-Health related announcement was that of a package of measures that were announced at the Labor Party policy launch on August 16, 2010.

The announcement was costed at $392 million and was intended to modernise the health system, including allowing patients to access Medicare rebates for online consultations. At the launch Ms Gillard also said a re-elected Labor Government would use the internet to modernise the health system by funding online consultations and videoconferencing.

The package was made up as follows:

1. $250 million for online consultations, providing about 495,000 services over four years for rural, remote and outer metropolitan areas.

2. Financial incentives for GPs and specialists to deliver the online services at a cost of $56.8 million and an expansion of the GP after-hours helpline at a cost of $50 million.

3. $35 million to support training for health professionals using online technologies.

Read about this here:

Third we had an announcement from the Health Minister (Nicola Roxon) that some of the budget money ($12.5 million) would be spent on three e-health pilots. She noted that “each of the e-health sites announced today – GPpartners (QLD), GP Access (NSW) and Melbourne East GP Network (Victoria) – was chosen because they already have strong e-health capability and support within their communities.” Each site was to receive $100,000 to be involved and NEHTA was to receive $300,000 to co-ordinate and manage what are technically very different pilots in terms of architectures and applications.

You can read all about this here:

Fourth we had a very late joint announcement with the Australian Institute of Health and Welfare (AIHW) of a MyHospitals web site where people could locate comparative information on the performance of the nation’s public hospitals. (As of today this is still not operational – despite having been due last month – ‘coming soon’ as they say)

Check here:

Note it is odd going here gives you a different page:

What is that about I wonder?

What was missing from all these announcements was, among other things:

First any revamp of the national leadership and governance of e-Health in Australia or reform of the way NEHTA supports the whole health sector and not just jurisdictional interests. It has been an ongoing problem that NEHTA has failed to really address the needs of the whole health sector rather than the focus of its directors.

Second any clarity about just what the PCEHRs would deliver, what the business case for their implementation was and what information would be used to populate the patient’s record. With the new apparent ‘rainbow coalition’ this really needs to change and fast

Third it was hard to see how these announcements fitted into the priorities which were established in the National E-Health Strategy that had been endorsed and supported by the Department of Health and Health Ministers as recently as December, 2008. Neither was there any commitment to actually proceed with the implementation and funding of this Strategy. This is a really serious problem I believe. If we are not implementing that strategy just what are we doing?

Fourth any coherent explanation of how all these initiatives were developed and what the organising concept behind these apparently random announcements was. It all seems pretty ad-hoc and non-strategic to me but I could have missed something.

Fifth there was really no explanation of how this was to be implemented and what impact these proposals might have on clinical workflows, liability insurance and so on.

On the basis of the last four months and this set of election campaign announcements I fear we are in for more of the glacial, non-strategic, money wasting progress we have seen over the last decade. Time will tell I guess.


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