The Numbers Never Lie. The Federal Commitment To E-Health Seems To Be Weakening.

----- The Following is A Draft Article For a Print Magazine - Comments welcome.

In mid May 2012 we had the most recent Federal Budget released. Along with seeing just how the promised surplus was to be achieved, not surprisingly, my main interest was to see what had been done with e-Health Funding over the next financial and the three out years.

To get a full picture of what is being planned there are a couple of ways it is important to view the announcement(s).

first consider, in isolation what has been announced for the next financial year. Here is the specific e-Health funding for 2013/13 from the Ministerial Press Release:

“eHealth spending in the 2012-13 Budget comprises –

• $161.6 million to operate the Personally Controlled Electronic Health Record (PCEHR) system for the next two years, including registration and customer support, adoption support and benefits monitoring and evaluation;
• $4.6 million to maintain safeguards for privacy-related aspects of the PCHER system. This will mean that people can be confident that the privacy of their personal health information is fully protected; and 
• $67.4 million as the Commonwealth’s share of joint funding with the states and territories for the National E-Health Transition Authority (NEHTA) work program for the next two years. This is to operate and maintain critical services and standards for the secure electronic exchange of health information, including healthcare identifiers, authentication services and eHealth standards.”

This $233.6 million follows the $466.7 million over the previous two years. Interestingly, of the new $233.6 million the cash flow is actually spread over three years.

2011/12 (Present year) $ 33.4 million

2012/13 (Next Year) $ 79.2 million

2013/14 (Year After) $121.0 million

As far as can be determined the specific PCEHR spend is an additional $33.4 million for the year to June 30, 2012 and then a total of $166.2 million for the next 2 years after that. The other $67.4 is spent on NEHTA over two years bring its annual budget to approximately that figure allowing that the funds are spread equally over the two forward years (This is well down from the 2 previous years)

A few other points from the Budget Papers and announcements subsequent that are worth making are:

1. That to date the investments in consumer and practitioner education, GP and specialist software, call-centres and so on which will be needed to actually implement the PCEHR have been very small indeed and indeed pretty late coming.

2. A review of the full 4 year e-Health Program as now budgeted shows that about $20 million has been cut from the 4 year program with major cuts in the Telehealth program in the later years.

3. Yet again there has only been two years of funding committed for both NEHTA and the PCEHR program rather than the traditional 4 years window for continuing programs.

4. Oddly two weeks after the 2012/13 Budget was announced we have had another $50 million added to the e-Health domain.

In summary and to quote the release “Health Minister Tanya Plibersek has announced $50 million over two years will be made available to Medicare Locals – networks that support frontline health providers – to assist GPs and other health care providers to adopt and use the Australian Government’s new eHealth records system.”

You really have to wonder why this was not included in the Budget?

5. The operational expenditure for the PCEHR and Health Identifier Service have disappeared into the huge bucket for funds ($4 billion +) supporting Medicare Australia and are not dissected as far as I can see.

6. The targeted adoption of the use of the PCEHR appears to be only 25-30% of the population after five years which seems very low. Only the first two years of the program are supported in a budgetary sense so it is hard to know what will happen after that.

7. Despite the apparently rather low adoption targets the Ministerial Press Release announcing the e-Health Budget claims the Government strongly supports e-Health because it will deliver $11.5 billion of savings over 15 years - but then says the supporting evidence for this claim has been used for Cabinet Discussions and so cannot be revealed. A big call I would suggest!

8. In another part of the Budget (under Outcome 10.5.3) there has been a change to the requirements for Practice Incentive Payments (PIP) related to e-Health which imposes quite a high technical barrier to the continuing receipt of these quite significant payments (up to $50,000 p.a. per practice). The AMA and the RACGP have expressed ‘concern’ about this change in the requirements and are clearly not happy.

For those who have an interest in the topic area there is also a very recently published review of this topic which has been prepared by Dr Rhonda Jolly of the Parliamentary Library. This review may be found here:

http://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/rp/BudgetReview201213/Ehealth

Overall I would describe the Budget as an incoherent and fragmented mess lacking any strategic vision or integrated approach to reaching the goals we all broadly support. e-Health deserves much better leadership and governance than is presently evident.

Enough on the Budget and to follow up on the article from the last quarter’s issue I can now confidently assert that when the PCEHR launches (on July 1, 2012) it will actually be a PC-LES (a Personally Controlled Largely Empty Shell - Jenny O’Neill MSIA.) for which consumers will be able to register and then wait for some useful functionality to be provided at some point in the (distant) future.

All I can suggest at this point is that people keep a watchful eye on the PCEHR Program and consider registering to use it when it is clear there is some value to be had from spending the time to do it. That time may be a good way off.

----- End Draft

David.