This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.
Sunday, September 08, 2013
Well The Election Is Done - What Now For E-Health?
Well we seem to have got a clear result in the House Of Representatives and I have to say what rather looks like an unpredictable set of results in the Senate and the inevitability of some really odd legislated outcomes.
With a high probability that Mr Peter Dutton will be the next senior Health Minister and Dr Andrew Southcott (Opposition Primary Care Spokesperson) looking like a certainty in his seat their comments are both important.
Before the period immediately prior to the election we have had the following
From 2010 - the previous election period:
Coalition e-health black hole worries AMA
Summary: Australia's peak medical body, the Australian Medical Association (AMA), has expressed concern over the Coalition's seeming lack of e-health policy.
update Australia's peak medical body, the Australian Medical Association (AMA), has expressed concern over the Coalition's seeming lack of e-health policy.
In a statement, Shadow Health Minister Peter Dutton said that the Coalition was "absolutely" committed to e-health.
"We are committed to e-health into the future. We do strongly support a roll-out of e-health and the funding is there until 2012."
"We don't trust Labor with money; we don't trust them because they have wasted it in every other area," he said. "We will review why Labor has gone nowhere on e-health in three years and whether or not the money is being most efficiently spent."
Updated at 3:00pm, 6 August 2010: comment included from Peter Dutton.
We then had the debate on the PCEHR in 2012 when it was legislated for. Dr Southcott gave a long speech where the Opposition supported the legislation but were not sounding all that convinced.
We then had a pretty clear set of comments in the heat of the recent campaign.
Labor’s $1 billion E-Health debacle
Date: Mon, 19/08/2013
Spokesperson: Shadow Minister for Health and Ageing, Federal Member for Dickson, The Hon Peter Dutton MP
Labor’s implementation of an e-health patient record is a $1 billion disappointment. With nearly $1 billion spent on the program, it has failed to deliver anywhere near what the Labor Government promised.
The e-health program has been shown to be more about politics than about policy and more about spin than about outcomes for patients.
“Australian Doctor has reported that there are only 4,000 e-health records in existence. At a cost of $1 billion that works out at $250,000 per record,” said Peter Dutton.
“This latest development proves this government is incapable of delivering on e-health. It speaks volumes about Labor’s incompetence,” he added.
Apart from the very low take up rate, the system itself is deeply flawed. The Government has been throwing good money after bad, spending money getting Medicare Locals to sign people up to a program that does not yet have basic clinical protocols in place, let alone support from clinicians.
“The Coalition continues to provide in-principle support for e-health, but shares the concern of many in the sector about Labor’s incompetence in managing the process,” said Mr Dutton.
The previous Coalition Government achieved significant improvements in the computerisation of general practice, from 17 per cent to over 94 per cent, by working with the profession and implementing effective policy.
“If elected, the Coalition will assess the true status of the PCEHR implementation and again work with health professionals and the broader sector to provide real results on this important reform for patient care,” Mr Dutton said.
TONY Abbott has vowed to work with health professionals to review the troubled $700 million personally controlled e-health record system should the Coalition win on September 7.
One GP called for the PCEHR to be governed by an independent council comprising medical experts. The proposed review does not come as a surprise as the opposition called for a "pause" to the system's rollout more than two years ago...
Both Queensland Liberal senator Sue Boyce and opposition e-health spokesman Andrew Southcott have repeatedly criticised the PCEHR implementation over the years.
While the future of the National E-health Transition Authority - Mr Abbott's baby while he was health minister during the Howard years - under a Coalition government is uncertain, doctors say an e-health overhaul is timely. The opposition's health policy, released last week, says "if elected, the Coalition will undertake a comprehensive assessment of the true status of the PCEHR implementation".
"In government, the Coalition implemented successful incentives to computerise general practice and will continue to provide strong in-principle support for a shared electronic health record for patients.
"The Coalition will again work with health professions and industry to prioritise implementation following a full assessment of the current situation," the policy says.
“If elected, the Coalition will undertake a comprehensive assessment of the true status of the PCEHR implementation. … The Coalition will again work with health professions and industry to prioritise implementation following a full assessment of the current situation”
Oh goodie. They will assess the status of the PCEHR implementation and then prioritise implementation.
What the heck does that mean?
For a moment let’s pretend the PCEHR is a car. It stops working. It won’t start reliably, when it does it lacks power and doesn’t brake well. You call the NRMA. The service man gives the car a once over and says – “my assessment is that it’s not working”. That’s a lot of help. So you get it towed to a service station for a second opinion. The report says “our assessment is that the engine has blown a gasket, the transmission is stuffed and the brakes are worn out. It will cost twice as much as the car is worth to repair.”
So what do you do? Sell it for scrap and buy a replacement?
You head off to your local car dealer and ask them for advice. You tell them you have a Mazada 1 which is beyond repair and want to price a replacement. The dealer, being a good dealer ask the question “what do you want the car for?” Your reply leaves the dealer stunned. You need the car to tow your four berth caravan when on holiday and your two-horse float every weekend.
The reason your car has worn out is because you have the wrong car. The NRMA man and the service station couldn’t tell you that because they only saw the car. You didn’t tell them what you wanted it to do.
The issue is not the car, it’s your choice of car.
Getting back to the PCEHR, it’s the same situation. They can assess the PCEHR as much as they like, but without a description of what it is supposed to do – in terms of health outcomes, not registrations and health summaries – any assessment is useless. The only question it answers is “we must do something, what can we do?” Unfortunately, doing something is not the same as doing something useful.
This is a really important point Bernard raises as it is really clear and has really never been well answered - namely what is the PCEHR for and what is it actually intended to do - and of course will it actually do as intended.
It would seem ‘courageous’ for the Coalition to press on without being clear what is hoped for in terms of benefits and outcomes and also an assessment of just how likely these benefits and outcomes are.
What I expect is silence for a number of months - followed by an announcement that the PCEHR will continue - but with no expansion or extension - and that it will be quietly allowed to disappear. Any spare funds will probably diverted to support of more evidenced based and proven to be useful initiatives.