This was announced earlier today, as part of the response to the COVID-19 virus.
March 29, 2020 11:08 am AEDT
$1.1 billion to support more mental health, Medicare and domestic violence services
More help will be given to millions of Australians battling the devastating impacts of coronavirus with a $1.1 billion package which boosts mental health services, domestic violence support, Medicare assistance for people at home and emergency food relief.
Prime Minister Scott Morrison said more support would be rolling out immediately to deal with the secondary effects of the health and economic crisis caused by coronavirus.
“As we battle coronavirus on both the health and economic fronts with significant support packages in place and more to come, I am very aware many Australians are understandably anxious, stressed and fearful about the impacts of coronavirus and what it brings,” Prime Minister Scott Morrison said.
“We are focused on saving lives and saving livelihoods and this new support package will provide much needed care and help to so many Australians facing hardship at no fault of their own.
“We will get through this crisis by staying together, by supporting each other and ensuring that no Australian, even though we have to be isolated, should have to go through this alone.”
Medicare support at home – whole of population telehealth
To provide continued access to essential primary health services during the coronavirus pandemic, $669 million will be provided to expand Medicare-subsidised telehealth services for all Australians, with extra incentives to GPs and other health practitioners also delivered.
Australians will be able to access support in their own home using their telephone, or video conferencing features like FaceTime to connect with GP services, mental health treatment, chronic disease management, Aboriginal and Torres Strait Islander health assessments, services to people with eating disorders, pregnancy support counselling, services to patients in aged care facilities, children with autism, after-hours consultations and nurse practitioners.
Providing the opportunity to get health services at home is a key weapon in the fight against coronavirus while limiting unnecessary exposure of patients and health professionals to the virus, wherever treatment can be safely delivered by phone or videoconferencing. This will take pressure off hospitals and emergency departments and allow people to access essential health services in their home, while supporting self-isolation and quarantine policies.
The GP bulk billing incentive will be doubled for GPs and an incentive payment will be established to ensure practices stay open to provide face to face services where they are essential for patients with conditions that can’t be treated through telehealth. The new arrangements will be in place until 30 September 2020, when they will be reviewed in light of the need to continue the fight against coronavirus.
Domestic violence support
An initial $150 million will be provided to support Australians experiencing domestic, family and sexual violence due to the fallout from coronavirus.
Google is seeing the highest magnitude of searches for domestic violence help that they have seen in the past five years with an increase of 75 per cent and some services are already reporting an increase in demand.
The funding will boost programs under the National Plan to reduce Violence against Women and their Children including:
- Counselling support for families affected by, or at risk of experiencing, domestic and family violence including men’s behaviour change programs which will provide a short, medium and longer term response to support men.
- 1800RESPECT, the national domestic, family and sexual violence counselling service, which already answers around 160,000 calls a year.
- Mensline Australia, the national counselling service for men that provides support for emotional health and relationship concerns for men affected by or considering using violence.
- Trafficked People Program to support particularly vulnerable cohorts such as victims of human trafficking, forced marriage, slavery and slavery-like practices.
- Support programs for women and children experiencing violence to protect themselves to stay in their homes, or a home of their choice, when it is safe to do so.
A new public communication campaign will roll out to support those experiencing domestic violence over this period and to ensure those affected know where they can seek help.
Minister Payne and Minister Ruston will convene a COAG Women’s Safety Council meeting on Monday to discuss with the states and territories how to best deliver this funding to support local responses to this issue.
Mental health support
An initial $74 million will be provided to support the mental health and wellbeing of all Australians.
The Government’s digital mental health portal, Head to Health (www.headtohealth.gov.au), will be a single source of authoritative information and guidance on how to maintain good mental health during the coronavirus pandemic and in self-isolation, how to support children and loved ones, and how to access further mental health services and care.
Here is a link:
This package runs till the end of September and it seems me that this will result in millions having the opportunity of using remote consultations and many will find it useful and will be keen to not go back to the old ways for suitable contact.For many consultations telehealth is safe, effective and works for both the clinician and patient. There are some useful comments on making telehealth work well here:
http://medicalrepublic.com.au/practical-tips-for-doing-telehealth-well/26261
What would be ideal would be a thorough evaluation after 3-4 months of experience and then use of the evaluation to fine tune the technology and regulations / rules.
What do you think?
David.
17 comments:
Sung to the tune of - job and growth, education and hospitals. Been a collective disaster for a long time and time has called in its debts.
The Federal government is busy leading from behind. They are being forced to do things they should have thought about and agreed before this pandemic even happened.
The states and the medical profession are leading the way and the Feds, who only seem to care about the economy don't understand the problem. Everyone it critically dependent on manufacturing and engineering - you know the people who produce venetelators, PPE, and test kits. In the USA, the Corps of Engineers are swinging into action to re-purpose existing buildings and premises in which to keep and treat patients.
The first stimulus package was aimed at getting business to invest in capital expenditure didn't realise that the problem is customers and revenue. The money they threw at welfare recipients was aimed at getting them to go out and spend - then they closed non-essential businesses and told everyone to stay indoors.
IMHO, this pandemic is a catastrophic failure of governments. They were warned years ago by the likes of Bill Gates
https://www.ted.com/talks/bill_gates_the_next_outbreak_we_re_not_ready
and a CDC program called PREDICT was created under President Bush and continued by Obama. Trump (who hates anything Obama was involved with) cancelled the project last year.
http://nautil.us/issue/83/intelligence/the-man-who-saw-the-pandemic-coming
https://www.npr.org/2020/02/28/810268997/u-s-needs-to-lead-coronavirus-coordination-expert-says
PREDICT was a proactive approach to help countries prepare for the emergence of infectious diseases.
Our governments are lucky because of our geography and our medical profession.
The Americans are unlucky because of the lack of leadership and an incompetent president. IMHO, ythey have no ide what is about to hit them. The virus has been brewing for months. The only reason their headcount is so low (but still teh highest in the world) is because of their poor testing rate. The Mardi Gras in New Orleans alone will transmit the virus all over the country, never mind local hot-spots like New York and Florida.
When the USA sneezes Australia will suffer even more.
I'll stop ranting now.
There is a sobering article via LinkedIn - Survive now pay later - the Australian Government to small business owners.
It's high time people started asking on talk-back radio "What vaue is My Health Record?, Why is Government still spending $?400 million on the My Health Record System?, so many questions which should not be avoided any longer.
The mantra of Digital Health evangelists is "the right information in the right place at the right time".
Unfortunately the assumption is that this information resides in health records.
The COVID-19 pandemic shows the flaw with this assumption.
Australia's first virtual hospital rolls out for COVID-19 patients
https://www.smh.com.au/national/australia-s-first-virtual-hospital-rolls-out-for-covid-19-patients-20200329-p54ezj.html
"Hundreds of coronavirus patients who present at the Armidale Hospital emergency department in the far north of NSW - and who otherwise would have needed a hospital bed - will soon be allowed to go home with sophisticated machines to monitor their vital signs."
Similarly
World-first tool to help medicos detect COVID-19 could save 'thousands of lives'
https://www.smh.com.au/national/world-first-tool-to-help-medicos-detect-covid-19-could-save-thousands-of-lives-20200329-p54f1w.html
The right information is that which is acquired and used at the place and time of treatment, not historical data in real EHRs and especially in pretend EHRs like myhr. The data also needs to be suitable for putting straight into monitoring and diagnostic systems.
EHRs have a part to play in keeping a record of some historical data but not as a primary clinical tool.
Progress in Digital Health will only be achieved when technologists understand these simple facts.
> Unfortunately the assumption is that this information resides in health records.
That's not the assumption for me, or of most of the digital health evangelists I know. Our focus is on health records for operational reasons. And because actually building a framework that changes that game is expensive and you can't demonstrate it's value until after it's built.
"You can't demonstrate its value until after it's built"! even though "... building a framework that changes that game is expensive."
This sounds like blind faith to me. Surely there must be a more pragmatic way forward.
Right now we are witnessing the collapse of many companies which took to borrowing hugely at low interest and expanding rapidly based on excessive hubris and little attention to building capital reserves to carry them through market downturns.
I repeat, surely there must be a more pragmatic way forward,containing risk, whilst neutralising the downsides off "blind faith".
I would be happy to invest up to $5 million on that basis.
Call me ;-).
The obvious way forward is small localised clinical trials of different information flows with clinical leadership ready to make the treatment and administrative changes to make it worth while. I've been looking for some one to fund something like for a while now
but in the absence of an open national infrastructure for authenticating people, and managing engagement and consent, and the kind of APIs we should have, trying to get something like this off the ground is way more expensive than it should be (way more than 5 million :-( ), and it's also like moving through molasses (https://en.wikipedia.org/wiki/Great_Molasses_Flood)
Grahame, you speak as a technologist.
To address your core concern, namely, cost, I suggest that it doesn't cost a huge amount. The investment required addresses two key issues: a) investment to support collaboration and cooperation across the health system; and b) investment to support clinicians to take the lead and support them in the resolution of confounding issues and the removal of barriers. The returns on investment are in the form of improved safety, improved quality and increased efficiency which play out over time and over scale of adoption.
Further, the language of 'trials' is filled with many bad experiences of health clinicians investing time and passion in the design, development and initial operation of some innovation only to find later that there was no support for on-going operations. This approach has to stop; it is neither the right language and certainly not the right approach.
This brings us to the issue of Leadership. The challenge is to identify those clinical leaders who know where qualitative improvements to information flows would make a real difference. Only they can work through the necessary clinical changes deriving from, for example, the embrace of digital pathway, and provide the 'business case' for change.
Clinicians have to define the information flows in their terms, not the terms of technology. It is only within the context of clinically-oriented information flows that the norms governing the information flows can be surfaced and addressed.
Technology specifications follows on and are largely a translation issue. Technology has to be the servant of clinicians and health service delivery, not the other way around.
Finally, the strategic challenge for the design of clinical systems resides in a paradigm shift. Dr Jerome Carter, in an article entitled: Looking Ahead: Projects and Themes, made the following comment: "Record/Archive concepts have been the guiding design paradigm for most of the history of clinical software; it is time to shift to a new paradigm; why not try clinical productivity as a design goal? Why not indeed!
hi John
I might be primarily a technologist but I mostly agree with what you wrote, especially with regard to this being a clinical information management problem, not a technology problem. But I have one big proviso. You wrote:
> a) investment to support collaboration and cooperation across the health system; and b) investment to support clinicians to take the lead and support them in the resolution of confounding issues and the removal of barriers
Amen, exactly. Only... I've sat in on plenty of these discussions... we have great ideas for how we could do amazing stuff like that. If only the information systems being used were not closed gardens so we can't get support to access the data. And changing that requires investment beyond what is possible in the context of the project. That's where the cost comes from. If you have some miraculous way to change that, I'm all ears.
The US government, for all it's obvious flaws, made a strategic commitment to force the healthcare information system to adopt open standard APIs a few years ago. They're sustaining that for the long haul, knowing that it will change the game over time, though it has not yet done so (by and large).
That's the only way I've seen this picture change. But we here have no strategy to do that, and it's mostly not happening. And so we can't have the projects you and I envision.
Hi Grahame, I appreciate your comments and your focus on the so-called 'closed gardens'to provide a point of understanding for those not fully engaged in this conversation.
Equally, your comments on the US scene reflect two things which I think are worthy of closer examination. The first is the presumption that the solution lies in technology, namely, open standard APIs. The second, which is not referred to lies in the background. This is the resonance of the CHOICE narrative that runs through American society. Patients and families have to have the ability to make a choice and in healthcare at the moment they don't have the information upon which to make such choices. This CHOICE narrative resonates widely and opens the door to other powerful players, such as Apple, Microsoft, etc.
You made no mention of the UK NHS initiative under the banner of the Apperta Foundation. Their argument is a call an Open Platform. They make some interesting observations about the need for a Platform-based approach and raise but do not address the question of Who Owns the Platform. The critical limitation I see in the Apperta Foundation's approach is that it remains anchored in technology. It does not make the connection to health service delivery, the ability of clinicians to obtain the information that they need at the point of care, nor how clinicians will be able to engage in the design of new models of care and the enabling information flows to support the service delivery workflows.
More fundamentally, there are questions of health system sustainability and fiscal sustainability to be addressed. This tension can be hard to see in the American system whereas it is front and centre in health systems which are fully or largely publicly funded. Your reference to the 'closed garden' is really a metaphor for the tension between health systems and governments and the business models of the technology sector.
My personal sense is that we first have to recognise the strategic reality of this tension and then find a new narrative and enabling solution framework for moving forward. These are surmountable challenges provided we are clear about what might be called the 'hostage situation' health systems find themselves in with the business models of the technology sector.
Hi Grahame,
I appreciate your comments especially your focus on the so-called 'closed gardens' to provide a point of understanding for those not fully engaged in this conversation.
Equally, your comments on the US scene reflect two things which I think are worthy of closer examination. The first is the presumption that the solution lays in technology, namely, open standard APIs. The deficit I see here is the absence of a solution framework placing these within a wider social and technical networking framework and methodology.
The second, which is not referred to, lays in the background. This is the resonance of the CHOICE narrative that runs through American society. Patients and families have to have the ability to make a choice and in healthcare at the moment they don't have the information upon which to make such choices. This CHOICE narrative resonates widely and opens the door to other powerful players, such as Apple, Microsoft, etc.
You made no mention of the UK NHS initiative under the banner of the Apperta Foundation. Their argument is a call an Open Platform. They make some interesting observations about the need for a Platform-based approach and raise but do not address the question of Who Owns the Platform. The critical limitation I see in the Apperta Foundation's approach is that it remains anchored in technology. It does not make the connection to health service delivery, the ability of clinicians to obtain the information that they need at the point of care, nor how clinicians will be able to engage in the design of new models of care and the enabling information flows to support the service delivery workflows.
More fundamentally, there are questions of health system sustainability and fiscal sustainability to be addressed. This tension can be hard to see in the American system whereas it is front and centre in health systems which are fully or largely publicly funded. Your reference to the 'closed garden' is really a metaphor for the tension between health systems and governments and the business models of the technology sector.
My personal sense is that we first have to recognise the strategic reality of this tension and then find a new narrative and enabling solution framework for moving forward. These are surmountable challenges provided we are clear about what might be called the 'hostage situation' health systems find themselves in with the business models of the technology sector.
> The deficit I see here is the absence of a solution framework placing these within a wider social and technical networking framework and methodology
hmm. I took for granted that you would need something like that. And in fact, that is our problem here: the technology for APIs exists; that's not the problem. What is the problem is choosing to adopt them which is all about those things. I think that you are pigeon-holing me too much here.
I chose not to comment on the UK because they are doing things that make sense but still designing what is (or looks to me, anyway) a top down strictly controlled information eco-system that will prove costly to maintain and very non-resilient, in as much as it is still based on centralised design. You're certainly right that this a reflection of cultural reality.
Grahame, I am well aware that you think in bigger pictures than just the technology. In honesty, I was provoking you a bit to see if you would show this side of your appreciation. I am glad that you rose to the occasion.
My starting point is that we need a new Narrative; certainly in this country.
Further, the narrative should stand outside any particular decisions about centralised repositories of electronic health records.
When I first started, we choose the narrative of 'Moving Information to Care'. We recognised that clinicians, patients and carers would immediately warm to it as they could quickly cite examples where the information they needed just wasn't where it was needed, when it was needed. Further, health executives as well as funding bureaucrats could see merit in the idea. Importantly, COAG's Health Ministers' Council endorsed the idea as the basis for strategy and policy development and investment to back the good ideas clinicians had for qualitative improvements to information flows.
We need a different Narrative now and that is something I and a few colleagues have been giving serious attention to, particularly as it needs to connect with the delivery of 'apparent value'. That is, the difference between the old and the new is tangible and if done right measurable.
One of the things you soon notice when you try to cross boundaries (jurisdictional, geographic, public/private and professional) is the value of a Collaboration Mechanism able to take those really hard issues off your plate and resolve them properly. Privacy in an electronic environment is but one example, along with various medico-legal issues. The real threat here is capture of the Collaboration Mechanism by one or a few vested interests, including government.
In regards to a new Methodology, our starting point is that the EHR is static. It cannot address the dynamics of healthcare. We need a new approach that supports clinicians in articulating their workflows with appropriate flows of information, including updates to EMRs and EHRs. Further, the conditions under which these information flows operate need to be addressed by clinicians, because the resolution of proper digital information flows intimately involves optimising a way of delivering a service or meeting a previously unobtainable goal.
Finally, the development of an ecosystem is necessarily a critical component of a Solution Framework. It becomes clearer how this fits in as the higher levels of the Solution Framework are articulated.
I look forward to continuing our discussion.
John said:
"In regards to a new Methodology, our starting point is that the EHR is static. It cannot address the dynamics of healthcare."
Yes, but IMHO, the problem with any EHR is not the technology or the information flows but the information itself.
The most critical question should be - Is the information the right information? This is a highly complex question because it goes to the heart of clinical medicine. It involves the way physicians practice medicine and the knowledge base(s) they use.
That's why I keep going on about data acquired at the time and place of care. When it comes to diagnosis and treatment that is what really matters.
EHRs have a place but they need to contain the right data for their place, which is more often than not, an analysis and use well after the treatment has been prescribed and given.
If you look at articles like this:
Why Don’t We Know Who the Coronavirus Victims Are?
https://www.theatlantic.com/ideas/archive/2020/04/stop-looking-away-race-covid-19-victims/609250/
and
'You need both stories': WHO adviser calls for national coronavirus recovery tally
https://www.smh.com.au/national/you-need-both-stories-who-adviser-calls-for-national-coronavirus-recovery-tally-20200402-p54ght.html
It is obvious that the right data is not being recorded and it most certainly is not in most EHRs, let alone myhr.
One of the most important objectives of any EHR infrastructure should be to support the individual patient/physician interaction as well as be a source of data to support population health and medical research.
IMHO, the starting point for any attempt to improve the practice of medicine should start with the way clinical medicine is practiced and the data that is required to support that practice. Only when that is understood can proposals to improve the practice be developed.
In my view the biggest single problem with Digital Health is the assumption that the data that washes around in the healthcare eco-system is the right data and that all we have to do is capture it and communicate it.
If you delve into the practice of clinical medicine it is very apparent that this is not a valid assumption.
Bernard,
I would suggest that we remove the EHR from the conversation, at least for the moment.
IMHO you cannot separate the information from the information flow because it is the intended clinical action which must dictate both the information required and where and in what form that information is provided.
Yes, the focus should be predominantly about data acquired at the time and place of care.
Perhaps the right data is not being recorded because physicians and other clinicians are constrained by the digital health solutions imposed upon them.
We need to enable clinicians to start with the way clinical medicine is practised and collaboratively design and re-design for an environment with digital pathways.
Grahame,
Further to our conversation there is some good news. My colleagues and I have a Solution Framework, a Methodology, and a Narrative.
Most importantly the methodology has already been successfully deployed here in Australia across a whole clinical service providing necessary evidence that the approach is effective and can be scaled-up.
The Renal Service Network covers the ACT and Southern NSW Local Health District serving a population just under 1 million people. The Renal Network was purposefully built under a collaboration agreement between the two jurisdictions. There are nine dialysis centres spread across the Network of which two are privately managed and included in the Network.
Doctors and nurses were at the centre of the reform and their efforts have resulted in lower cost, no waiting lists, better work habits and improved clinical satisfaction.
More strategically, taking a system-wide perspective, the indications are that overall savings in the short term are of the order of 12-15%. These savings derive from a variety of improvements. These financial implications are even greater given they do not take account of savings from harm prevention, which is a feature of current service delivery.
Moreover, there are savings and improvements in the longer-term, although they are harder to quantify. These will come from:
1. Improved quality control of information, whereby the right information is available at the right time and in the right place;
2. A more agile system that evolves to meet new needs, obviating the need for expensive and frequently counter-productive, 'change programs'.
3. Improvement in intangibles such as, for example, lowering doctor and nurse stress, leading to improvements in patient-clinician outcomes.
The overarching aim, to use an economics analogy, is to establish a 'virtuous cycle' of information use. If that is achieved, the cost savings and improvements in health provision, will inexorably follow.
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