Thursday, June 21, 2012

Just A Little Note On The Benefits Claimed By The Pollies For E-Health. They Don’t Know What They Don’t Know.

I have been impressed to see how quickly the politicians have leapt on the $11.5 billion figure for PCEHR benefits over the next 15 years
Here is an example of what we heard in the Senate:
Senator EGGLESTON (Lib) (Western Australia)
“It has been forecast that by 2020 e-health capabilities could save up to $7.6 billion a year in health costs by reducing duplication and errors, by improving productivity and by providing better adherence to best practice principles. The government's own numbers suggest that the benefits of e-health records alone in Australia would be $11.5 billion saved by the year 2025. That is an incredibly large figure which in itself justifies completely the introduction of the system.”
Surely this needs to be followed by something like ‘if you think you can really believe it”!
Now I am as keen as the next person to see all that benefit - but I really think we need to just conduct a small sanity check.
A simple one is to compare today with 15 years ago (the benefits period cited). Back then - say 1997 - we had no Broadband to speak of, no digital radio, DVD’s were utterly new fangle (the format was launched in March 1997), Apple was almost broke and Windows was back at the amazingly unstable Win95 version. The level of change that one sees in 15 years is just amazing!
Frankly, no one can know what world and technology let alone healthcare IT, will look like in 15 years and what value e-health might, or might not, be offering then.
And it you want even more of a giggle a new report from a different team working for the Government refers to benefits and, I quote, ‘disbenefits’. They used to be costs when I was a boy. Additionally, but hardly surprisingly they come up with different numbers.
In the recent draft they say for Benefits out to 2020.

“Theoretical potential value

At a national level, with full adoption, the total gross annual direct benefit potential of eHealth including the PCEHR in Australia estimated to be $8.2 billion in 2012-13 (annual potential assuming full adoption and technical capabilities). Including disbenefits of $5.2 billion, net benefits are expected to be $2.9 billion annually. Note that current net benefit value refers to the monetary value of benefits less the value of disbenefits (including capital investment from the Commonwealth Government, jurisdictions and individual providers as well as time-costed effort).”
I suspect one cost that may not have been really fully addressed is the impact of the 1-2 mins spent looking at and updating an extra system in addition to the usual GP System.
With 4 consults per hour (2 mins of time for each update) over a 6 hour working day that is 48 mins (if always used) per day. That is 4 lost 10 minute consultations per day. Call it 20 per week and you can see the potential productivity impact and cost to GPs.
Each short consultation is paid at about $50. That means the GP loses $1000 per week or $50,000 p.a. doing all this. The Practice Incentive Program is up to $50,000 per practice (not per GP) so you can see why some are a little concerned, if this is really to get used, about the cost and productivity hit.
It is not only me who is pretty sceptical of these figures
Here are the results of a poll on this blog a few weeks ago:
The question was:

Do You Believe The DoHA Estimates Of the Benefits That Will Flow From The PCEHR are Realistic?

-  4 (10%)
- 32 (84%)
I Can't Tell
-  2 (5%)
Votes 38
Here is the link:
The Government issues a revised Budget figure every 6 months (MYEFO) and it does this to keep things credible. Even to get a handle over the next 2-3 years is pushing it a little and beyond that it is just pointing a finger in the air and hoping. It is all perfectly well intentioned but I wonder do such estimates come with enough disclaimers as to the possible level of error?
Let’s be clear - I know Governments need to justify investments (as does the private sector) - but surely they might at least be honest enough to make it clear what is expected and trustworthy and what is little more than wish laden estimates.


P said...

While much of the PCEHR effort is badly misguided, if we were to deride every forward estimate of cost-saving with accusations of inaccuracy, we'd never be able to plan for anything with an expected benefit which took more than 2-3 years to accrue. No snowy mountain scheme. No Harbour Bridge. Probably no bridges! And probably no healthcare funding either? We have start somewhere, and while Deloittes’ economic models are doubtlessly dismal in their scientific rigor, they are likely the best tools we have at present to justify nation-building projects, no matter how pointless they seem.

Dr David More MB PhD FACHI said...

"they are likely the best tools we have at present to justify nation-building projects, no matter how pointless they seem."

I disagree..if all the assumptions and so on are public we can form a view and with some sensitivity analysis make sensible decisions. With no facts, no assumptions and hand waving figures we are in the total dark.

NB. Genuine physical infrastructure can be both costed and assessed more accurately then Health IT.

I am sure there was a credible business case for the SM Scheme and the Bridge. Have you seen one for the PCEHR? If not, why not?


P said...

In an ideal world, I would agree that all material supporting the public procurement of infrastructure be made available, so is the concern that Australian eHealth is operating far away from the ideal?

What do you make of Mr Powick's recently aired comments here?

Dr David More MB PhD FACHI said...

Pretty simple.

I disagree..and I have discussed the topic with him in some detail.

He is entitled to his view as I am to mine.

It is actually possible people can have honest disagreements and this is a case like that.