We Really Need To Work Out How These Lessons Might Be Used in OZ!

(Note: This was developed just before the 2010 Budget was released.)

The following appeared a few days ago.

Studies: When Doctors Take More Responsibility, Care Becomes Cheaper And Better

By Andrew Villegas

KHN Staff Writer

May 04, 2010

Some health policy experts and clinicians have long maintained that, in the effort to reduce health care costs and improve patient outcomes, there's no place like (a medical) home.

A new study in the May issue of the journal Health Affairs seems to validate that notion.

Medical homes — where primary care doctors are held responsible for coordinating care for individual patients – are seen as a model for lowering costs without sacrificing quality. (Related story: Living In A Medical 'Home’).

Dr. Rob Reid and colleagues from the Group Health Research Institute examined the costs and patient outcomes from a team of medical professionals providing care for 10,000 patients at a Seattle-area Group Health "medical home." The conclusion? The medical home produced significant cost savings.

For example, during the two years studied, the team's patients had 29 percent fewer ER visits and 6 percent fewer hospitalizations compared with other Group Health clinic patients. There were start-up costs — $16 per patient per year — and results took a couple years to provide the bulk of the savings. But, ultimately, Reid said that for every $1 it invested in the system, Group Health saved $1.50 by keeping patients out of the ER and the hospital. And the medical home patients "reported better care experiences" as well.

The strategy is now being expanded to all 26 of Group Health's Washington state medical centers — covering more than 400,000 patients. Reid, in an interview, called primary care "a real team sport where the primary care clinician is the quarterback."

If such plans sound like managed care organizations such as Kaiser Permanente, that's because they have a lot in common, including the primary care doctor at the center. But patients at Group Health can self-refer to certain specialists and the approach rewards doctors, not simply the organization, to improve health outcomes.

There's evidence that the medical home, "works and works very well," said HHS Secretary Kathleen Sebelius, at a Tuesday Health Affairs briefing. She also noted that primary care will be important to transitioning to a lower-cost health care system in America. But historically, it's been difficult to attract the necessary workforce needed to provide that type of care. "The reimbursement system clearly has penalized primary care providers over the last several decades," she said.

More here:

http://www.kaiserhealthnews.org/Stories/2010/May/04/medical-home-shorttake.aspx

It seems that this approach is really working and is cost effective in the US. The parts of the model that are workable in OZ certainly need to be applied as we press forward with the planned Primary Care Reforms.

If the budget leaks we see here are close this may be a much more effective attempt that the earlier Hospital Reforms.

Every doctor's practice to get a nurse

• Sue Dunlevy
• From: The Daily Telegraph
• May 09, 2010 10:13PM

Key Points

• Every practice to get full-time nurse
• Nurses to lead medical revolution
• GPs to concentrate on complex care

EVERY doctor's practice in the country will get its own nurse to help treat patients, make home visits, write prescriptions and co-ordinate follow-up care, under a medical revolution in tomorrow's Federal Budget.

Each GP will be eligible for $25,000, worth up to $75,000 a year to a three-doctor practice, enough to hire a full-time nurse.

The nurses will lead a revolution in healthcare, teaching patients with chronic problems like diabetes and heart disease how to manage their conditions, dressing wounds, and carrying out asthma tests and vaccinations.

They will also carry out pap smears, test blood sugar and cholesterol and co-ordinate follow-up care with specialists and health carers.

The care they provide is expected to come at no cost to the patient and it will free up GPs to carry out the more complex medical care.

Currently, government incentives for employing nurses are capped at $40,000 per practice and only apply in rural areas or those with a workforce shortage. About 40 per cent of practices do not employ a nurse.

More details here:

http://www.news.com.au/business/federal-budget/every-doctors-practice-to-get-a-nurse/story-fn5dkrsb-1225864264442

Let’s hope this has been properly planned and the necessary Health IT support has also been factored in! (Post budget comment – we now know it wasn’t. Personal EHRs were funded to some degree – not provider systems apparently)

David.

University of NSW – Centre for Health Informatics - 10th Anniversary e-Health Research Seminar.

Here is the announcement.

A decade of Australian e-health research

It is with great pleasure that I invite you to join us at Centre for Health Informatics (CHI) 10th Anniversary Symposium. CHI is Australia's largest and longest running academic e-health research group. The Symposium will provide us with an opportunity to reflect on a decade of Australian research in e-health, as well as look to the future. All our guest speaker are nationally recognised leaders in their fields.

This symposium is for everyone with an interest in e-health, and promises to be a stimulating and entertaining day. I do hope you can join us to celebrate the many achievements of e-health researchers across Australia.

Seminar Details Are:

Date:

Tuesday 15th June, 2010

Time:

9.00am - 4.30pm

Location:

Law Theatre, Law Building

University of New South Wales

(Map Reference F8)

Lower Campus

RSVP by Friday 4th June, 2010 to:

Danielle Del Pizzo

Phone: (02) 9385 3165

Email: d.delpizzo@unsw.edu.au

All the speaker details are on the website:

http://www.chi.unsw.edu.au/CHIweb.nsf/page/CHI%2010th%20Anniversary

Please consider attending if you are interested in the work being done!

David.

The Senate Has Apparently Failed to Get to Health Identifier Legislation.

The Senate rises this afternoon / evening and does not seem to be considering the Bill today and didn’t over the last two days.

Here is today’s program.

http://www.aph.gov.au/Senate/DynamicRed/Index.html

The next sitting day is June 15, 2010 so it will be all on hold until then I guess.

See here for sitting days:

http://www.aph.gov.au/Senate/work/sitting/2010/sitting.htm

I wonder what happens next as we have been told not much can happen prior to the legislation passing?

David.

A Few Details From Minister Roxon on the E-Health Plans. Now I am Really Confused!

The ABC’s World Today had an interesting interview with Ms Roxon on the e-Health plans.

Here are a few selected quotes.

Patient records go online

Melinda Howells reported this story on Wednesday, May 12, 2010 12:14:00

ASHLEY HALL: The Budget allocates almost half a billion dollars over two years for a new system of electronic health records.

Patients will be able to read the information online as will doctors, hospitals, pharmacists, and allied health workers.

Privacy is an obvious concern, but the Government says patients will be in control of their own information.

Doctors say what's been announced is still a long way from what's needed.

Melinda Howells reports.

.....

MELINDA HOWELLS: Last night's Budget allocated almost half a billion dollars over two years to develop the new system. It aims to reduce medication mistakes, cut down on duplication, and give patients access to their own health records.

The Health Minister Nicola Roxon says participation is optional.

NICOLA ROXON: The new investment of $466 million allows us to build the system so that patients will importantly be able to access their own health information. The easiest way to think about is like the sort of banking you do online. You can access your statements and your details. The Commonwealth will not be holding the data. We will be building the parts of the system that link a doctor's records with a pharmacist's records, with a hospital discharge and it will be up to the patient to decide who can access that information and when.

.....

MELINDA HOWELLS: The project is still in the planning stages, but Ms Roxon says privacy concerns have been addressed in the design of the system. She says the Government won't be storing the patient information.

NICOLA ROXON: Well, I think that is one of the big issues that is addressed by the Commonwealth not being the data warehouse, if you like, of this information. We'll in fact be holding and funding the links to the system each individual doctor or pharmacist or hospital service provider will retain information about an individual patient. But the convenience and protection this will give to patients is that you won't have to hunt around and make hundreds of calls to find out when you last had a vaccination.

MELINDA HOWELLS: Doctor Andrew Pesce says what's being proposed is only the first step down the road to a comprehensive national system of electronic health records, which is as useful to clinicians as it is to patients.

ANDREW PESCE: We're still only about 10 per cent of the way down that road. I mean, it's gonna take years something as big as this isn't going to happen overnight, there are lots of systems currently in place that have to be matched up. You just think about it, I mean every hospital has its own electronic health database, general practices do, some doctors don't have computers. All of this has to be married up into a seamless electronic health record. It's going to take some time.
.....

MELINDA HOWELLS: Nicola Roxon says half a billion dollars is a big commitment.

NICOLA ROXON: Governments of past have put off making the decision to do this and our focus will be absolutely on these stages and of course there is business plan for the stages that can come after that. This investment, however, will give the momentum to taking electronic health records that step closer to reality in Australia.

ASHLEY HALL: The Health Minister Nicola Roxon ending that report from Melinda Howells.

The full report can be found here.

http://www.abc.net.au/worldtoday/content/2010/s2897298.htm

One question. Does anyone know what they are actually on about and how it is going to work. I sure don’t.

I note the Australian is asking about Google and Microsoft.

http://www.theaustralian.com.au/australian-it/opinion/will-e-health-records-be-outsourced-to-google-microsoft/story-e6frgb0o-1225865572819

Will e-health records be outsourced to Google, Microsoft?

• Karen Dearne and Fran Foo
• From: Australian IT
• May 12, 2010 2:46PM

opinion | OVER the past few months, federal Health Minister Nicola Roxon has kept mum on who exactly will run the proposed electronic health records system.

Will it be the private sector, Medicare, or some other government body? Will it be handed over to health insurers to manage? The crystal ball is still blurry, but we're hopeful Ms Roxon's office will clear the air once and for all today (if she responds to our query).

There have been murmurs in the industry for some time that the government was primed to "outsource" the administration of e-health records to commercial providers, although Ms Roxon has refused to confirm or deny the speculation.

Yesterday's federal budget added more fuel to the fire; look no further than Treasurer Wayne Swan's carefully selected delivery of the new funding regime for e-health records

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Make of all this what you will!

David.

The Government’s E-Health Announcement is Really Bizarre and Very Incomplete.

So we are to have $460+Million to be spent over 2 years, with the possibility of some more if success is seen as coming, to develop Personally Controlled Electronic Health Records (or maybe Individual Electronic Health Records (IEHR) or maybe something in between).

As with all such announcements the only thing that is missing is any detail. Until that becomes clear this is so much hot air.

Worryingly, the lack of information on the following issues leave one wondering just how seriously all this has been planned and developed.

1. How on earth can a program of this size be kicked off and undertake useful work starting in only seven weeks?

2. What will happen after two years and who would bother if there is no confidence of some reasonable follow-on?

3. Who is going to deliver this national system? Public sector, private sector, a PPP or what?

4. Where is the information that is to apparently populate these records come from?

5. What will be the governance framework for these records?

6. What is the evidence for the actual value of these records to health outcomes – as opposed to provider EMRs?

7. What is NEHTA’s role and what is DoHA’s role to be?

8. What will be the management and organisational framework for delivery of these plans?

I anticipate the Department will make the answers to these questions available over the next week or so. They must know or how else can they say the spend – over 2 years – will be exactly $466.7 Million.

If this information is not forthcoming promptly we will all be able to draw our own conclusions about all this.

David.

Full Press Release on Personally Controlled Electronic Health Records.

Personally Controlled Electronic Health Records for All Australians

Australians will be able to check their medical history online through the introduction of personally controlled electronic health records, which will boost patient safety, improve health care delivery, and cut waste and duplication.

PDF printable version of Personally Controlled Electronic Health Records for All Australians (PDF 24 KB)

11 May 2010

Australians will be able to check their medical history online through the introduction of personally controlled electronic health records, which will boost patient safety, improve health care delivery, and cut waste and duplication.

The $466.7 million investment over the next two years will revolutionise the delivery of healthcare in Australia.

The national e-Health records system will be a key building block of the National Health and Hospitals Network.

This funding will establish a secure system of personally controlled electronic health records that will provide:

• Summaries of patients’ health information – including medications and immunisations and medical test results;
• Secure access for patients and health care providers to their e-Health records via the internet regardless of their physical location;
• Rigorous governance and oversight to maintain privacy; and
• Health care providers with the national standards, planning and core national infrastructure required to use the national e-Health records system.

Benefits for patients

Patients for the first time will be empowered with easy-to-access information about their medical history - including medications, test results and allergies - allowing them to make informed choices about their healthcare.

They will be able to present for treatment anywhere in the country, and give permission for health professionals to access their relevant history at the touch of a button.

Patients will no longer have to remember every detail of their care history and retell it to every care provider they see. Parents will not have to remember the vaccinations their child has had, and doctors and nurses won’t have to thumb through paper records.

Patients will control what is stored on their medical records and will decide which medical professionals can view or add to their files, meaning privacy will be strengthened.

A personally controlled electronic heath record will have two key elements:

• a health summary view including conditions, medications, allergies, and vaccinations; and
• an indexed summary of specific healthcare events.

Benefits for health providers and the health system

Poor availability of health information across care settings can be frustrating and time consuming for patients and health professionals alike.

It can also have damaging effects on a patient’s health outcomes through avoidable adverse drug events and lack of communication between health care providers.

About 2-3 per cent of hospital admissions in Australia are linked medication errors. It equates to 190,000 admissions each year and costs the health system $660 million.

About 8 per cent of medical errors are because of inadequate patient information.

Clear, quickly available information will reduce such incidents, avoid unnecessary tests and save scarce health resources.

Implementation of personally controlled electronic health records

Personally controlled electronic health records will build on the foundation laid by the introduction of the Individual Health Care Identifiers later this year. Under this, every Australian will be given a 16-digit electronic health number, which will only store a patient’s name, address and date-of-birth. No clinical information will be stored on the number, which is separate to an electronic health record.

Implementation will initially target key groups in the community likely to receive the most immediate benefit, including those suffering from chronic and complex conditions, older Australians, Indigenous Australians and mothers and newborn children.

This investment includes funding for the first two years of the individual electronic health record business case developed in consultation with all states and territories and the National Electronic Health Transition Authority (NEHTA).

Subject to progress in rolling out the core e-Health infrastructure, the Government may consider future investments, as necessary, to expand on the range of functions delivered under an electronic health record system.

Reforms to take health system into 21st century

A national e-Health records system was identified as a national priority by the National Health and Hospitals Reform Commission and the draft National Primary Health Care Strategy. It was also supported by the National Preventative Health Strategy.

The Government’s reform plans in primary, acute, aged and community care also require a modern e-Health infrastructure. It is a key foundation stone in building a health system for the 21st century.

A personally controlled electronic health record will not be mandatory to receive health care. For those Australians who do choose to opt in, they will be able to register online to establish a personally controlled e-Health record from 2012-13.

The release is here:

http://www.health.gov.au/internet/budget/publishing.nsf/Content/budget2010-hmedia09.htm

Comment later – but I do note there is no mention of leadership, governance or technologies to be used.

David.

Government Proposes Some Vague e-Health Ideas, or is There a Plan? Who Knows!

This is what is in the Budget for e-Health.

National Health and Hospitals Network — eHealth — personally controlled electronic health records

Expense ($m)

2010‑11 185.6 Million

2011‑12 281.2 Million

The Government will provide $466.7 million over two years to establish the key components of the personally controlled electronic health record system for Australia. This secure online system will enable improved access to health care information, commencing in 2012‑13.

This funding will provide the capability to produce nationally consistent patient health summaries from existing and compliant information sources. Patients who choose to participate will be able to securely access, and permit their healthcare providers to access, their health information. Personally controlled health records will over time be capable of incorporating a range of health information, such as a patient's general health history, pathology and radiology summaries and prescription information. This will support more informed clinical assessments and decision making, improve continuity of care for patients and introduce efficiencies in health care service delivery.

The measure builds on the Healthcare Identifiers Service, which is being developed as a foundation service for eHealth initiatives in Australia. Healthcare identifiers will allow for accurate identification of patients and health care providers and provider organisations. Subject to the passage of legislation, $0.5 million per annum in existing funding will be provided to the Office of the Privacy Commissioner for regulatory support in relation to health care identifiers in 2010‑11 and 2011‑12.

In order to fully realise the significant benefits of this Commonwealth investment, State and Territory governments will also need to continue their planned or expected investments in core health information systems. The States and Territories will also need to provide the complementary investments to build their capacity in readiness for connection to this national system.

Sounds fine – I wonder what the business case for this vagueness it. Maybe it is there is a lot more detail somewhere else, and we will see it in due course!

There is also an item for the Pharmacists:

The measure will also provide funding of $375.3 million over six years (including $91.8 million in 2014‑15) to implement new initiatives under the agreement. These include:

• a range of new patient‑focused pharmacy programs including patient medication monitoring (at a cost of $285.5 million);
• a 15 cent payment to pharmacists for every prescription processed electronically with a National E‑Health Transition Authority specifications (at a cost of $82.6 million); and
• collection of data on pharmaceuticals that are priced below the Pharmaceutical Benefits Scheme general co‑payment (currently $33.30) including patient, prescriber and dispenser demographic data (at a cost of $7.2 million).

Does anyone know if that specification actually exists and has been tested etc?

I guess we will have to wait for more detail, but note how there is no mention of the Private Sector, just the States and Territories!

I wonder who is going to manage all this money. Not clear right now!

Can they possibly start spending all this money in less than 2 months? That may be a real prescription (forgive the pun) for waste and mismanagement!

You can read the detailed press release here:

http://www.health.gov.au/internet/budget/publishing.nsf/Content/budget2010-hmedia09.htm

David.

This Is Not Good News! If True This Will Really Sour Any Budget e-Health Announcement!

The title was.

Healthy gains for pharmacists

Author: Edmund Barton

The article discussed the Fifth Community Pharmacy Agreement which was recently agreed with the Commonwealth Government and which will be revealed in detail on Budget night we are told.

The relevant paragraphs for the e-Health Community are as follows:

“She said the agreement also encouraged pharmacies to use electronic prescriptions.

This is a nice little earner, indeed, for the PGA Those e-prescriptions will be handled by the its eRx system, not the Medisecure system endorsed by the College of GPs.

They will attract a taxpayer subsidy of 15c per prescription with another 10c charged by the PGA. Within five years, this could be costing the Government about $18million a year and earning the PGA about $12million.

More than 3700 pharmacies, doctors and medical specialists are reported to be eRxready, although it was launched only a year ago.”

I have to say that this is a totally pathetic outcome in my view. The only way e-prescribing should be sponsored by the Government is via a Vendor Independent Standards Based approach operated as a public good by an agency like Medicare or my proposed ‘e-Health Australia’.

See here:

http://aushealthit.blogspot.com/2010/05/2010-budget-and-e-health-what-must-be.html

We can only hope there is a confused journalist out there!

To hand the Pharmacy Guild a monopoly of this sort is just dreadful public policy in my view.

Can anyone, who has the details, confirm / deny this report?

David.

Not the Appointment We Need for e-Health in Australia – What About A Few Recognised E-Health Experts?

The following just turned up.

Independent Director appointed to NEHTA Board

10 May 2010. NEHTA announces Lynda O’Grady has been appointed an Independent Director to the NEHTA Board of Directors.

Ms O’Grady joins NEHTA at a time when e-health is playing a pivotal role in Australia’s health reform agenda.

Board Chairman David Gonski said Ms O’Grady’s appointment was decided at a recent Board meeting and is effective immediately. The appointment is for a three year term.

“We are delighted to welcome Lynda O’Grady as a new Independent Director. Lynda brings with her a wealth of experience having held senior executive roles in IT, telecommunications and media organisations including Telstra Corporation, PBL and Alcatel.”

Lynda is Principal of the management consultancy firm, Advanced Management Services, which provides consultancy and business advisory services on strategic and organisational issues for clients across a wide range of industries and sectors. In addition, she is a Fellow of the Australian Institute of Company Directors and is currently a member of the Council of Bond University; a member of the Board of Advisors of Questacon, the National Science and Technology Centre; and director of Screen Queensland and Auscript Group Pty Limited. She also served on the Board of TAB Queensland for five years prior to its listing and on the IT&T Board of Advisors to the New South Wales Treasurer.

Ms O’Grady has been working with the NEHTA Board of Directors as an Independent Advisor since April 2009.

ENDS

The release is here:

http://www.nehta.gov.au/media-centre/nehta-news/637-ind-dir

I am sure Lynda is a smart and competent person but she is not an e-Health expert and she does not come from that sector.

The NEHTA Board is stacked by Public Sector Health Executives and has not a single Director who has any real depth in e-Health.

Until that is fixed the Board will continue to be a joke in my view.

I wonder if all this about a pay-out related to NEHTA being wrapped up real soon now?

David.

Weekly Australian Health IT Links - 10-05-2010.

Here are a few I have come across this week.

Note: Each link is followed by a title and a paragraph or two. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or payment.

General Comment:

Well it looks like it will be a very interesting Budget that Mr Swan is describing as ‘boring’!

I only hope for readers here that is not the case!

On other fronts we seem still to have all sorts of issues continuing to grumble along. It is really getting to be long enough to get the Qld Health Payroll fixed!

We will all wait and watch on Tuesday at 7:30pm. I published my wish list yesterday!

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http://www.theaustralian.com.au/australian-it/eligibility-rules-threaten-e-health-regime/story-e6frgakx-1225861743076

Eligibility rules threaten e-health regime

• Karen Dearne
• From: The Australian
• May 04, 2010 12:00AM

FLAWED regulations for the Healthcare Identifiers regime may force the closure of existing e-health programs and force software and IT service providers to employ a registered practitioner "to sit in the corner" in order to meet eligibility requirements.

Under the proposed rules, programs such as shared care for patients with chronic diseases, clinical trials, secure messaging services and e-prescribing may be shut down because software-makers and third-party service providers will not be treated as "eligible organisations" because they are not directly delivering healthcare.

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http://www.theaustralian.com.au/australian-it/emergency-e-health-meeting-called/story-e6frgakx-1225863753171

Emergency e-health meeting called

• Karen Dearne
• From: Australian IT
• May 07, 2010 4:51PM

LEADING medical software-makers are meeting on Monday to hammer out policy and technical concerns over the Rudd government's Healthcare Identifiers project in a worsening crisis as the proposed July 1 launch date looms.

It's understood more than 70 members have agreed at short notice to attend a full-day industry roundtable in Sydney, as Health Minister Nicola Roxon's departmental chiefs and Medicare officials hustle to fix key regulatory matters threatening to derail enabling legisation for the HI service in the Senate.

The Medical Software Industry Association has requested a briefing from senior Health and Medicare staff on flaws in the regulations that threaten to shut down existing e-health programs and force IT service providers to employ a health professional in order to meet eligibility requirements.

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http://www.smh.com.au/nsw/go-figure-silence-of-2mayear-bureau-20100508-uktz.html

Go figure: silence of $2m-a-year bureau

MATTHEW BENNS AND JULIE ROBOTHAM

May 9, 2010

IT IS costing the NSW taxpayers $2 million a year and was supposed to be operational last year but the Bureau of Health Information has so far failed to file a single report.

In March last year former health minister John Della Bosca announced the bureau would be up and running by July 2009, providing more transparent data to improve patient care.

The government's promise was in response to Peter Garling's special commission of inquiry into NSW public hospitals that called for an independent source of health information. But calls to the bureau last week were being transferred automatically to Health Support Services while its website promised it would ''be issuing the first of its releases shortly''.

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http://www.theaustralian.com.au/politics/effective-health-it-can-save-5000-lives/story-e6frgczf-1225863378188

Effective health IT can 'save 5000 lives'

• Adam Cresswell, Health editor
• From: The Australian
• May 07, 2010 12:00AM

AN estimated 5000 deaths, two million GP and outpatient visits and 310,000 hospital admissions could be prevented every year if an effective IT system were rolled out - saving up to $7.6 billion in health costs annually, according to an analysis for release today.

The biggest share of the savings, worth $2.6bn each year, would come from reducing medication errors, while a further $2.3bn would come from improved care and prevention, according to the analysis of how greater computerisation could benefit Australia's health system.

Drug errors occur for various reasons, such as prescriptions being misread, wrong doses given, or because doctors do not spot the drug they are about to supply may interact with others the patient is already taking.

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http://www.theaustralian.com.au/australian-it/doubts-cast-on-telehealth-projects/story-e6frgakx-1225861770418

Doubts cast on telehealth projects

• Karen Dearne
• From: The Australian
• May 04, 2010 12:00AM

THE future of a number of telehealth pilot projects is in doubt as the original funding runs out at the end of the financial year and no new payment models have emerged.

Under the former $120 million Clever Networks program to roll out broadband infrastructure and services in rural and remote areas, telehealth projects have proven successful.

But with no progress on revamping arrangements for Medicare benefits so doctors and other clinicians can be paid for services provided, it is unclear how some services will remain financially viable.

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http://www.medicalobserver.com.au/news/gp-ehealth-network-forecast-to-save-health-system-billions

GP e-health network forecast to save health system billions

7th May 2010

David Brill

CONNECTING general practices in an e-health network could shave nearly $5 billion off Australia’s healthcare costs, and avoid more than two million GP and outpatient visits each year.

According to a new analysis by international management consultants Booz & Company, practices that make a $3000 investment in e-health could yield a potential annual saving of $668,000 for the healthcare system.

These savings would accrue by reducing medication errors, improving adherence to best practices and reducing unnecessary hospital visits.

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http://www.computerworld.com.au/article/345795/primary_role_e-health_low-spending_budget/

Primary role for e-health in low-spending budget

NBN, IT skills likely to be sidelined in next Federal Budget, but Henry Tax recommendations will play some part

• James Hutchinson (Computerworld)
• 07 May, 2010 16:40

Speculation on what the Federal Government may introduce in its annual Budget on 11 May has centred on e-health.

As part of the Budget, it is believed the Government will introduce $2 billion in funding for the health sector, following the announcement of a National Health and Hospitals Network and ongoing national health reform initiatives. While e-health measures were not included in recent health reform announcements, industry bodies have speculated that electronic health initiatives are still on the agenda and may be introduced as part of the budget.

"We think there's going to be something there and we think it's going to be pretty specific on e-health, maybe patient records," Australian Computer Society (ACS) chief executive officer, Bruce Lakin, told Computerworld Australia.

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http://www.nehta.gov.au/media-centre/feature-story/634-smd

NEHTA at the IHE Australia SMD Connectathon

Australia’s first Secure Message Delivery (SMD) Connectathon was held in Canberra from 19 to 23 April 2010.

Over 45 participants from industry, government and GP Divisions visited the collaborative event which was organised by IHE Australia, an open not-for-profit organisation supporting the interoperability needs of e-health Standards users in Australia. The Connectathon was funded by DOHA, and supported by the Medical Software Industry Association and Standards Australia.

Thirteen software companies took part in the event, developing code and testing the interconnectivity between their commercial software applications, using new specifications published by Standards Australia in March, and testing procedures developed and monitored by the NATA-accredited Australian Healthcare Messaging Laboratory (AHML).

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http://www.theaustralian.com.au/australian-it/qld-health-payroll-system-in-chaos-asu/story-e6frgakx-1225862575314

Qld Health payroll system in chaos: ASU

• Kym Agius in Brisbane
• From: AAP
• May 05, 2010 1:44PM

QUEENSLAND Health's payroll system is in "chaos" with 35,000 wage anomalies to resolve and more banking up with each pay cycle, the Australian Services Union says.

Tens of thousands of Queensland Health staff have been underpaid, overpaid, or not paid at all after new payroll technology was installed in March.

More workers have been incorrectly paid in the latest pay cycle on Wednesday.

The ASU, which represents Queensland Health's 650 payroll staff, says technical issues with the new software are yet to be fixed.

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http://www.medicalobserver.com.au/news/software-glitch-hampers-child-flu-vaccine-records

Software glitch hampers child flu vaccine records

7th May 2010

Rada Rouse

SEVERE reactions to this year’s seasonal flu vaccination appear to occur in children naïve to flu vaccine and in those younger than three, rather than the entire under-five cohort as initially suspected.

But establishing a precise denominator for this year’s vaccinated cohort has been fraught with difficulty because a software glitch has prevented optimum recording of doses on the Australian Childhood Immunisation Register (ACIR).

Perth paediatric immunologist Associate Professor Peter Richmond said the affected children were mostly younger than three years. “It seems to have affected more children who are getting vaccine for the first time – the data we’ve got from Princess Margaret Hospital would suggest that,” he said.

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http://www.australiandoctor.com.au/articles/70/0c068f70.asp

Computer says yes

3-May-2010

By Dr Craig Lilienthal

AS a GP with a long interest in risk management, I was disappointed to read the Australian Doctor article that computers don’t improve the quality of patient care (‘Computers dont improve care quality’, 16 April).

I know there is a difference between risk management and quality assurance, but these two activities are closely related. Dr Paul Nisselle, Avant’s former general manager of clinical risk management, used to say they were the flipside of each other, while I refer to them as being at the opposite ends of a spectrum, but overlapping in the middle.

I have worked in computerised practices for more than a decade and I shudder to think of the poor quality of my medical records when, in the bad old days, I wrote everything by hand — medical notes, prescriptions, referrals and certificates. My handwriting was so bad that I used to print important things rather than use my excuse for cursive script. While on most occasions I could read my own notes, none of my colleagues could read them and I always felt sorry for the local pharmacists.

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http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr10-nr-nr079.htm

Better Pharmacy Services

Source: Government of Australia Posted on: 3rd May 2010

The Government and Pharmacy Guild of Australia have finalised the Fifth Community Pharmacy Agreement, which will provide better pharmacy services for consumers and a stronger role for pharmacy at the front line of health care.

The Pharmacy Agreement will ensure all Australians continue to have easy access to essential medicines under the Pharmaceutical Benefits Scheme, by providing security and certainty for Australia’s network of 5000 community pharmacies.

Key features and reforms under the Fifth Community Pharmacy Agreement will include:

• Medication-management programs, under which pharmacists provide education and support to patients on how to best use their medications and avoid medication errors. This will include medication reviews for consumers, including at home and in residential aged care, and specific support for patients with chronic conditions, such as Type 2 diabetes and asthma.

• Support for pharmacists to provide dose administration aids to patients who experience difficulty remembering to use their medicines – preventing unnecessary adverse medication events.

• Safer prescriptions, through encouraging pharmacies to use electronic prescriptions.

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http://www.cio.com.au/article/345598/vic_govt_cools_off_large_it_projects/

Vic govt cools off large IT projects

Smaller government 2.0 ventures on the rise

• Rodney Gedda (CIO)
• 06 May, 2010 11:13

The Victorian state government has become "gun shy" on big IT projects, prompting questions about whether overall IT spending is set to decline, according to an analyst firm.

Some $650 million of funding for IT projects over four years was allocated in the 2005-06 budget. It compares with $525 million in 2006-07, $120 million in 2007-08, $460 million in 2008-09 and $400 million in 2009-10.

Steve Hodgkinson, research director at Ovum, said past budgets have accumulated a rolling four-year funding portfolio that peaked with a total of about $500 million in the 2008-09 year for new IT-enabled transformation programs such as public transport ticketing, train and bus systems, Healthsmart, the Ultranet, VicSmart fibre to schools and systems development projects in the Justice and Police departments.

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http://www.cio.com.au/article/345623/privacy_commissioner_warns_dangers_scanning_ids_pubs_clubs/

Privacy Commissioner warns of dangers in scanning IDs in pubs and clubs

Scanning policies must adhere to privacy laws

• Lisa Banks (CIO)
• 06 May, 2010 15:52

Privacy Commissioner, Karen Curtis, is warning CIOs of pubs and clubs around Australia to be aware of privacy obligations to their patrons.

It is commonplace for pubs and clubs to request identification of patrons as they enter a venue, however Curtis has warned that patrons’ information could be divulged to a third party if proper security procedures are not adhered to.

“ID scanning, fingerprinting and iris scans are becoming increasingly common at pubs and clubs, and I am not convinced that all venues understand what their privacy obligations are when using these technologies,” she said in a statement.

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http://rfpconnect.com/news/2010/5/4/isoft-business-solutions-partners-with-real-asset-management-to-deliver-a-complete-financial-and-asset-management-solution

iSOFT Business Solutions Partners With Real Asset Management to Deliver a Complete Financial and Asset Management Solution

Published on May 04, 2010

iSOFT Business Solutions, the financial software, procurement and bespoke solutions provider, announces a partnership with Real Asset Management (RAM), a provider of fixed asset management software and services. The new partnership sees the integration of RAM's complete asset management solution with iSOFT's Integra Open Enterprise suite, providing users with fixed asset management functionality to complement iSOFT's existing accounting module.

iSOFT Business Solutions delivers financial solutions and services across its strong commercial base as well as the public sector, working with the NHS, Central Government, Local Authorities, Housing Associations, Police Authorities and Not for Profit organisations to help improve performance and drive financial efficiency.

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http://www.theaustralian.com.au/business/rivals-put-pressure-on-telstra-to-make-up-its-mind-on-nbn/story-e6frg8zx-1225863327518

Rivals put pressure on Telstra to make up its mind on NBN

• Mitchell Bingemann
• From: The Australian
• May 07, 2010 12:00AM

PRESSURE is mounting on Telstra to agree on a deal to participate in the national broadband network after the release of a $25 million report that declared the $43 billion NBN project could be built without the telecommunications giant.

Telstra's rivals heaped praise on the findings of the KPMG and McKinsey-led implementation study, which found that the government's ambitious plan to connect 90 per cent of the nation to a fibre-to-the-home network capable of 100Mbps internet speeds was financially viable, with or without Telstra's participation.

Macquarie Telecom described the findings as a long-sought-for win for equal access in the telco sector, while Telstra's closest rival, Optus, said it would open up true broadband competition for consumers and carriers alike.

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http://www.computerworld.com.au/article/345775/analysts_greet_nbn_study_ask_business_case/?eid=-6787

Analysts greet NBN Study but ask for business case

Four analysts provide the low down on the study, with some doubt over customer uptake rate assumptions

• Tim Lohman (Computerworld)
• 07 May, 2010 12:26

Analysts have broadly welcomed the findings of the NBN Implementation Study, but expressed some doubt around the state of a business case for the national infrastructure project.

Ovum’s David Kennedy said the Study’s cost estimate of $26 billion for coverage of 93 per cent of the population was realistic and in the range the analyst house had expected – between $25 and $30 billion.

However, there was much less detail in the Study on the revenue side, Kennedy said, particularly around the assumptions on the rate of fibre take up.

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http://www.computerworld.com.au/article/345621/nbn_implementation_study_numbers/?eid=-255

The NBN Implementation Study numbers

And a few others that relate to the rollout of the National Broadband Network rollout

• Trevor Clarke (Computerworld)
• 06 May, 2010 15:41

The NBN is a numbers game. Despite all the commentary around socio-economic benefits, innovation levels and other effects the fibre-to-the-premises (FTTP) network promises, most discussions remain focussed on the figures. So here are a few in the wake of the NBN Implementation Study’s release:

• 84 - The McKinsey & Company and KPMG prepared report, The NBN Implementation Study, includes 84 recommendations for Government
• $43 billion – The Federal Government’s objectives for the NBN can be “implemented within the $43 billion estimate of capital expenditure by deploying fibre to 93 percent, fixed-wireless from the 94th to 97th percentiles and satellite to the final 3 percent of premises”.
• 1.6 million – Communications minister, Senator Stephen Conroy, says extending fibre to 93 per cent of premises would potentially add another 1.6 million premises to the FTTP network, including 1.3 million new premises expected to be built by 2017-18.

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http://www.theaustralian.com.au/business/stephen-conroy-confident-of-nbn-deal/story-e6frg8zx-1225862269632

Stephen Conroy confident of NBN deal

• Blair Speedy
• From: The Australian
• May 05, 2010 12:00AM

THE federal government is confident of reaching an agreement with Telstra for the telco to shift its network traffic to the $43 billion national broadband network. It also plans to reintroduce legislation to split the company in two next week.

Speaking after a business breakfast in Melbourne yesterday, Communications Minister Stephen Conroy said he would release the findings of an implementation study by business consultants KPMG and McKinsey this week, but would not respond to it until a period of community consultation was complete. He was confident the study would support the economic case for building the NBN, regardless of the nature of Telstra's involvement.

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http://www.theaustralian.com.au/news/opinion/rollout-of-a-disaster/story-e6frg6zo-1225862269608

Rollout of a disaster

• Malcolm Colless
• From: The Australian
• May 05, 2010 12:00AM

DESPITE the bravado from Communications Minister Stephen Conroy, it is clear the federal government must reshape its strategy for a national broadband superhighway if it wants to prevent this policy dream turning into a financial and logistical nightmare.

The government's $43 billion plan - which materialised out of thin air a year ago - to connect 90 per cent of Australian homes, schools and businesses (10 million premises) with super-fast fibre-optic cable within eight years was always unrealistic. For a start, meeting this target would require at least 5000 premises to be connected every day for the life of the project.

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http://www.theaustralian.com.au/australian-it/canberra-moves-a-step-closer-to-e-government/story-e6frgakx-1225861762308

Canberra moves a step closer to e-government

• Andrew Colley
• From: The Australian
• May 04, 2010 12:00AM

THE federal government has moved a step closer to its aim of using web technology to promote transparent administration, but the Coalition has labelled the effort as just "blah, bureaucracy and boffin-speak".

Finance Minister Lindsay Tanner and Special Minister of State Joe Ludwig yesterday announced that the government had accepted most of the findings of its Government 2.0 taskforce.

The taskforce, which reported its findings to the government in December, was established to come up with ways to use the internet to make public service information more readily available and promote stronger engagement between government and citizens.

Of the 13 recommendations the government only challenged a handful.

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Enjoy!

David.

Can DoHA, Medicare and NEHTA be Rescued from Their Incompetence and Mismanagement?

The following appeared a few hours ago.

60 Health Software Experts fly to Sydney to progress Australian eHealth

Monday, 10 May 2010 13:17

Medical software industry leaders have arranged to fly to Sydney to help the Government resolve the technical issues associated with the Healthcare Identifiers program.

Over 60 CEOs are meeting in Sydney on Monday to resolve the remaining technical issues for the Australian Governments key Healthcare Identifiers Service. The intent is to help the government meet its deadline to launch this ground breaking eHealth initiative on 1st July.

Contrary to media reports that the project was seriously in trouble and flawed the members of MSIA who are engaged with the government believe that the issues are largely technical and with this level of expertise gathered in one room, the solutions will be found,

This eHealth initiative is a first step in supporting healthcare providers to improve the quality and safety of healthcare in Australia.

Dr Geoffrey Sayer, President of the Medical Software Industry Association, (MSIA) says “this shows fantastic commitment and willingness from industry to support the government’s reforms in e health”. Dr Sayer said he believed this was “the biggest gathering of healthcare software leaders” ever in Australia.

Dr Sayer said he was delighted that senior executives from Department of Health and Ageing had agreed to attend and provide a briefing to industry on the policy levers around the legislation. This will certainly assist industry in ensuring a fast up take of the Healthcare Identifiers. There have already been a range of collaborative meetings amongst key stakeholders to ensure a smooth roll out on July 1st.

The Department of Health and Ageing is finalising a commitment to industry including NEHTA and Medicare and the MSIA welcomes that initiative.

“However international experience has shown that if we are to effectively deliver improved safety and quality of health management in Australia it must be adequately funded” said Dr Sayer. “We are therefore urging Minister Roxon to include sufficient capital investment in eHealth within 2010-11 budget allocations.”

For More Information:

Contact: Bridget Kirkham CEO MSIA

The MSIA is the national peak body for the medical software industry. With a growing membership of over 100 members the MSIA is recognised as the official “voice” of the industry. It represents its members in a range of forums, working groups and committees and has negotiated a range of important changes with government and other stakeholders. www.msia.com.au

This release is presumably a response to this which appeared on Friday.

Emergency e-health meeting called

• Karen Dearne
• From: Australian IT
• May 07, 2010 4:51PM

LEADING medical software-makers are meeting on Monday to hammer out policy and technical concerns over the Rudd government's Healthcare Identifiers project in a worsening crisis as the proposed July 1 launch date looms.

It's understood more than 70 members have agreed at short notice to attend a full-day industry roundtable in Sydney, as Health Minister Nicola Roxon's departmental chiefs and Medicare officials hustle to fix key regulatory matters threatening to derail enabling legisation for the HI service in the Senate.

The Medical Software Industry Association has requested a briefing from senior Health and Medicare staff on flaws in the regulations that threaten to shut down existing e-health programs and force IT service providers to employ a health professional in order to meet eligibility requirements.

http://www.theaustralian.com.au/australian-it/emergency-e-health-meeting-called/story-e6frgakx-1225863753171

My take on all this is simple.

NEHTA and DoHA simply condemn themselves from their own mouth by having to attend such a meeting six weeks before launch of a project that has been under development for a very long time (at least 27 months by my count).

They mark themselves as just plain incompetent and un-consultative - to have not noticed and remedied the problems ages ago!

Whatever the outcome and no matter how hard the MSIA work they really have just run out of runway. Clearly Project and Risk Management 101 is not well studied by this lot!

This is meant to be the lead item of key e-Health infrastructure for Australia and look how badly it has been handled. All those involved (on the Government side) in this need to be excluded from any significant further role and a new better style of leadership, governance and delivery quickly developed. Not a single extra cent should flow their way!

Has anyone else noticed that the IHI is planned for a 2-3 year roll out so, while important to get moving, all this fuss is just pure spin - presumably worrying about the outcome of the vote this week in the Senate. There is no way it should pass in my view until the concerns expressed in many of the most recent submissions are properly addressed. Let's do it once and do it right!

David.

The 2010 Budget and e-Health. What Must be Addressed if Catastrophe and Waste is to be Avoided?

There are a lot of rumours that the Federal Budget is going to contain some additional measures in Primary and Aged Care as well as some significant funding for e-Health.

This idea is supported here:

Primary role for e-health in low-spending budget

NBN, IT skills likely to be sidelined in next Federal Budget, but Henry Tax recommendations will play some part

• James Hutchinson (Computerworld)
• 07 May, 2010 16:40

Speculation on what the Federal Government may introduce in its annual Budget on 11 May has centred on e-health.

As part of the Budget, it is believed the Government will introduce $2 billion in funding for the health sector, following the announcement of a National Health and Hospitals Network and ongoing national health reform initiatives. While e-health measures were not included in recent health reform announcements, industry bodies have speculated that electronic health initiatives are still on the agenda and may be introduced as part of the budget.

"We think there's going to be something there and we think it's going to be pretty specific on e-health, maybe patient records," Australian Computer Society (ACS) chief executive officer, Bruce Lakin, told Computerworld Australia.

More here:

http://www.computerworld.com.au/article/345795/primary_role_e-health_low-spending_budget/

I first wrote about the possibility on the blog here:

http://aushealthit.blogspot.com/2010/05/apparently-we-are-to-have-electronic.html

Since then I have had a slow drumbeat of snippets passed on from here and there.

I also find it hard to believe the release of the Booz report which was also mentioned on the blog was co-incidental.

See here:

http://aushealthit.blogspot.com/2010/05/major-study-confirms-value-from-e.html

My understanding is that there might be up to $400M or so dedicated to the area over the usual budget cycle of 3 to 4 years.

If this turns out to be true my key concerns will be around how the money is to be spent, what it will be spent on and who will control and manage whatever is to be done.

My list of what should and should not happen is pretty much as follows.

1. The funding should be directed to the still unaddressed areas in the National E-Health Strategy – most especially in fostering capable leadership, governance and Standards compliance of a genuinely national effort.

2. The funding should be channelled into what I like to think of as ‘e-Health Australia’ which will be a new and better managed entity to replace NEHTA.

3. The new entity should conduct a ‘root and branch’ review (maybe with the Auditor General) of what has been, and is going on, at NEHTA and develop a plan which takes forward the good things that have been happening and terminates / modifies the things that are going badly or are a waste of money. Think of it as a ‘good, more broad, more responsive, more representative, more open and better led NEHTA – with a better brief – arising from the ashes of ‘bad NEHTA’

4. I would see the key new areas to be to undertaken to be large scale regional implementations, in conjunction with the private sector and private software providers to improve clinical messaging and clinical information exchange as well as investment in fostering improvement in primary care systems and services.

5. The new effort should recognise we are past the piloting stage and should be moving to commercial, regional scale implementation of models which may ultimately form a national e-Health infrastructure – just as has been happening for the last few years in the US.

6. I would see e-Health Australia re-invigorating and re-empowering (and funding) the Standards work done by IT-14 and the connectivity and integration work being done by IHE where this makes sense.

7. I would have e-Health Australia as a real statutory entity which would have a brief to support the whole health sector to move forward in a pragmatic fashion devoid of the excessive focus on the narrow jurisdictional needs of State Health Systems.

Unless we have something like this announced I see the risks of another real waste of money looming and I am pretty sure this is the ‘last chance saloon’ we are walking into!

David.

AusHealthIT Man Poll Number 18 – Results – 9 May, 2010.

The question was:

Will Health IT Get A Big Allocation in the 2011 Budget?

Results

For Certain

- 8 (25%)

Possibly

- 3 (9%)

Probably Not

- 13 (40%)

What Are You Smoking?

- 8 (25%)

Votes: 32

Comment:

Since this poll was set up it has become clear (from a range of sources) that there will be a significant investment in e-Health coming on Budget Night. Just how much and for what precise purpose is a budget secret!

So it seems only 25% of our readers are seriously in the know! I have to say that until yesterday I was with the 65%! Things can move quickly!

Again, many thanks to all those who voted

David.