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.
Wednesday, August 06, 2014
Article Draft : Australian E-Health Finds Itself At A Crossroads. It Is Hard To Know What Comes Next!
In the last few months there have been a number of releases and events that we will look back and see as having been quite seminal for the whole Health IT endeavour in Australia.
First we had the release of the Federal Budget on Tuesday May 13, 2014. This has been one of the most contentious Budgets in recent memory, especially regarding some aspects relating to health (e.g. the proposed $7 Medicare Co-Payment). As far as e-Health is concerned an additional 1 year of funding was provided to give Minister Dutton time to work out what to do with the whole eHealth / PCEHR program.
There is a detailed review of a range of the Budget measures undertaken by the Parliamentary Library and some commentary found here:
Second we had the release of the Royle review of the Personally Controlled Electronic Health Record (PCEHR) which was requested by Health Minister Dutton on taking office after the election. The PCEHR Review was handed to Government in December, 2013 (after having taken just 6-7 weeks) and released just after to the Budget in May 2014.
A summary of the recommendations from the 91 page Report are found on page 16 of the report and - in very broad terms can be summarised as recommending:
1. Much improved governance of the National E-Health Program - including the establishment of a broadly representative Australian Commission for Electronic Health (ACeH) which reports direct to Health Ministers.
2. Dissolution / Absorption of NEHTA into ACeH.
3. Transition of the PCEHR from an ‘Opt-in’ to and ‘Opt-out’ system with every citizen having a record created and populated for them unless the citizen takes active steps to ‘opt-out’.
4. Rename the PCEHR to the MyHR (My Health Record).
5. The undertaking of a range of reviews to eliminate duplication of activities between the ACeH and the Department of Health.
6. Privatisation of a range of current NEHTA / Department of Human Services activities.
7. Reviews of a range of e-Health infrastructure programs to ensure they are working as intended.
8. Improved measurement, reporting and transparency on all aspect of e-Health.
9. A range of steps to attempt to enhance clinical usability and utility of the system.
10. A range of miscellaneous smaller initiatives.
Sadly the review did not drill down sufficiently to ask the really important questions around the purpose and value of the PCEHR and whether the present design and implementation of the system was optimal or needed change. The assumption seems to be that be basics were all correct - a contention with which I disagree strongly.
It needs to be noted that the PCEHR Review was a report to Government and as such was not binding on Government.
Third there was the surprise announcement that former President of the AMA and one of three members of the PCEHR Review Panel, Dr Stephen Hambleton, had been appointed to be chairman of the NEHTA Board. There was a universal view that this appointment was a ‘good thing’, however one is forced to wonder just what impact and control the good doctor is likely to be able to exert on a Board and Organisation he recommend be ‘dissolved’.
At the time of the publication of the PCEHR Review it was announced that there was to be consultation with a range of stakeholders on the Review recommendation to assist the Minister to work out what to do next. This review consultation process began in late July, 2014 and is intended to last just six weeks until September 1, 2014. There is also to be an on-line survey which will be found at http://www.ehealth.gov.au.
The consultation process is being very tightly constrained and apparently when complete and considered to Government will decide what it will do regarding all the recommendations of the Review and move forward to implement its decisions.
It is hard not to reach the conclusion that the Government is struggling to work out just what exactly is should do. It is already clear that some of the recommendations are not possible in the Review recommended timeframes and that budgetary constraints will put a limit on what will be spent to ‘fix’ all the issues identified.
There is also a considerable body of expert opinion that suggests that a fundamental review of future options beyond what is contained in the very should Royle review should be undertaken, especially given the international experience of similar systems which suggests that the present national approach being adopted my not be ideal.
No matter what the consultation process throws up one gets the sense the very short consultation period may go some way towards preventing the best possible outcomes being reached. That said I suspect that by early next year it will be clear where the Government is heading. It is also possible that what is finally decided may be quite radical - such as outsourcing / privatising the entire initiative in order to let this very complex cup be ‘passed’ from Government. It is hard to argue the last 15 years has shown either side of politics as being very good at this sort of technology adventure.
Whether the course the Government is the right one we will just have to wait and see!