Sunday, October 27, 2013
You Really Have To Wonder What The Evidence Is For All This Optimism. I Am Not Sure I Can Find It.
This appeared in the Financial Review a few days ago.
With approximately 9.3 per cent of Australia’s gross domestic product spent on healthcare, there is significant scope for improvement in productivity to drive better health outcomes and better care per dollar spent.
One of the biggest challenges facing the health system in Australia is its highly fragmented nature. Funding is decoupled from the provision of care, and outcomes are not always matched with healthcare inputs, notes David Dembo, general manager for GE’s healthcare business.
“The issue is that the left hand does not know what the right hand is doing. In providing care, the GP, the pharmacist and the specialist are only partially informed, and this is why errors are made,” he says.
“We spend an incredible amount of money on healthcare, and for that money you could have an incredible healthcare system, but we don’t yet because we execute it badly.”
According to Dembo, along with Australian Medical Association president Steve Hambleton, the key to extracting better productivity within the healthcare sector is through digitisation.
The introduction of the $447 million PCEHR (personally controlled electronic healthcare record) in 2012 under the previous Labor government was supposed to go some way towards breaking down the silos that exist in healthcare data, and provide a transparent way for patients and clinicians to interact.
The promise of the PCEHR has only been partially realised, however, with some insiders indicating the new Coalition government is going to take a significant look at the system. “The answer to increased productivity is digitisation, which means turning clinical information into information that can be shared,” says Dembo. “At the moment data is still locked up in silos, and the key is to create efficiency through transparency.”
Unlike some players, Dembo is optimistic about the impact the PCEHR can have, because it put in place systems, data standards and signifiers needed to begin breaking down the data silos that exist.
“It created a language where we can share information and enable data sharing,” he says. “It is giving people the incentive to share information.”
Sally Glass, founder of e-health consulting company CHIK Services, agrees with Dembo about the need for data sharing in order to promote productivity in the sector.
“We’ve been talking about the value of information flows in terms of increasing productivity and improving patient outcomes for years,” notes Glass. “But it’s only in the last couple of years that the technology has caught up with the concepts that were being floated around.”
Glass, along with Dembo and Hambleton, is also optimistic about the potential for big data to improve productivity and outcomes in the sector. “The reality is we have to use it,” she says.
Lots more here:
As I read through the full article what keeps striking me is the absence of evidence that what is presently happening with the PCEHR is actually making a difference in any positive sense. Given the scale of the investment made - which is probably over a $A1 Billion in the last three years- there really should be clear cut signs that some return is being achieved on this investment.
Instead what we keep hearing is that everyone is optimistic and enthusiastic - except for those who have looked a little harder and wondered if the emperor is wandering around without his clothes.
Everywhere else in the world there has also been optimism about improvements in the cost of health care and impacts on quality and safety. To my mind we see the level of inflation in healthcare costs march ever upward pretty much everywhere and we see any actual impact on quality and being still being pretty hard to demonstrate.
This report on the UK’s efforts makes really interesting reading in this regard.
All I can say is that in Australia in the last decade huge amounts have been spent with incentives and direct investment but I find a dearth of evidence of impact. If ever we needed a few serious studies to sort out what is working and what is not the time is now! Bland assertions from so-called experts really won’t cut it for too much longer.
Who wants to volunteer?
Posted by Dr David More MB PhD FACHI at Sunday, October 27, 2013