We had a Senate Estimates Community Affairs Committee hearing on Wednesday.
The cast included:
Senators:
Senator Nash
Senator Moore
Senator Smith
Senator Carole Brown
Bureaucrats:
Adjunct Professor Halton
Ms Linda Powell - FAS E-Health
Mr Paul Madden
As usual I have placed the bits I found interesting in italics.
The discussion began about 8.30pm
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CHAIR: We are now moving on to outcome 10: health system capacity. We have questions beginning with the e-Health review. There are none for chronic disease and treatment.
Senator MOORE: Could I get some guidance. I asked a couple of questions earlier about the diabetes review plan and I am wondering whether this is the right place. Mr Smyth said some of the questions are better asked in this outcome. Is that right? It is too confusing. We will put them on notice and see what happens. One of the answers may be referred to later in the program.
I have questions on the e-Health review. Can you give us an update on how many e-Health records have now been created? Do we have an update?
Prof. Halton : Indeed we do.
Ms Powell : On 26 February there were over 1.4 million consumers who registered for an e-Health record. There were in fact 1,431,097.
Ms Powell : Yes.
Senator MOORE: Put that on notice. But you do keep that data and you can refine it to, say, areas that are getting into the system more quickly than others and whether there are peaks and troughs.
Ms Powell : I have the state breakdown with me. In New South Wales there are 427,238. Victoria has 287,766. Queensland has 293,072. South Australia has 155,731. Western Australia has 117,348. The ACT has 53,782. The Northern Territory has 19,326. Tasmania has 59,479. Should you notice that it does not quite add up, that is because there are a couple of hundred left over who either do not register their state or have multiple states or something like that.
Ms Powell : The promotion that is going on at the moment is primarily through Medicare Locals and through state hospitals. State hospitals in fact have been very active lately, because many of them are starting to load discharge summaries straight into the PCHR, and they are encouraging people to sign up as they are admitted to hospital or as part of their pre-admission procedures.
Senator MOORE: So the particular strategy of linking it to the discharge records has been successful?
Prof. Halton : Absolutely. I watch these numbers on a day-by-day basis. I only said the other day to Mr Madden that it is interesting to watch those numbers. We are seeing high 3,000s and low 4,000s every business day of people who are being registered, and that is coming from the state hospitals starting to connect.
Prof. Halton : There are some private ones, but there is a very conscious, deliberate—
Prof. Halton : Yes.
Senator MOORE: At the last estimates you advised that all public hospitals in Queensland had gone live with e-Health records. You said it is something you are watching every day. Has there been any particular impact in Queensland. I know that there is a strategy in Queensland to do so. Have the Queensland figures shown the same process that you just explained?
Ms Powell : The data is quite clear that most consumer registrations are through assisted registration. The main way that that happens is either through Medicare Locals or through hospitals. Because we have seen continued growth in that area, we think that it is mostly coming from hospitals.
Senator MOORE: Has there been a strategy or a process working with GPs to encourage people to go to these records?
Ms Powell : Yes, there has, through the Medicare Locals, who have been working for quite some time with GPs in that area. We also provided funding to the RACGP to do three projects over the last year and they in turn worked with ACRRM, the Australian College of Rural and Remote Medicine, on some of those projects. We also work collegiately with all of the peak bodies, sharing information, and in the past we have spent quite a bit of effort, together with NETA, speaking at conferences and various other appropriate venues.
Ms Powell : Yes. All of the Medicare Locals are engaged. We have also had specific separate engagement with AMLA, Australian Medicare Local Alliance, and we also had a program where we targeted a number of specialist Medicare Local sites which had particular expertise in this. We set them up as hub sites to provide extra help and support to the Medicare Locals with less expertise in this area.
Senator MOORE: At the last estimates, there were 56 hospitals using the system. Do we have an update on how many more hospitals have taken it up in that time?
Ms Powell : Yes.
Mr Madden : There are 155 public hospitals now using the system.
Senator MOORE: That has been a significant increase in those months. Do we know why in that period? Was there a particular focus in that time?
Mr Madden : Yes. The plans to get the public hospitals connected was through an agreement with all of the states and territories and NETA. Each of those were at different levels of development across the last nine months. I think most of their plans, except for the Northern Territory and Victoria, were connecting by March this year. They are all coming to fruition, with the Northern Territory still in the future and Victoria with only a couple of hospitals rather than the whole state.
Senator MOORE: On notice, how many are not? I do not know how many hospitals there are across the country. If we have 155 up, it would be nice to know how many are not, and perhaps why. We will come back to that at next estimates. Ms Powell, you mentioned specialists. We have doctors and hospitals signed up. Do we know how many specialists have signed up in their own right to encourage their patients onto an e-record and to use that process? They were a particular group when this process was being thought about, in terms of moving records around—that it would be useful for people going in and out of specialist care to have an e-health record. Do we have that data?
Ms Powell : We have data on the number of providers that are registered. There are specialists who would be using the system through hospitals. We do not have any data that suggests specialists on their own have registered. There would be many who are working through hospitals.
Ms Powell : We know how many general practices, pharmacies, hospitals, aged care, residential services and other healthcare providers, which is primarily allied health.
Ms Powell : I think it is every day.
Senator MOORE: On notice, can we please have a month-by-month breakdown of enrolments since its inception until now? Is that the kind of data we can get?
Ms Powell : That is very easy to provide.
Senator MOORE: That would be great. Is it correct that the review into the PCEHR has now been completed? We believe the minister made a statement on 20 December 2013 saying that the review has been completed.
Ms Powell : That is correct.
Senator MOORE: We believe there was an FOI request to get that review. My understanding is that it was refused. Is that correct?
Ms Powell : That is correct. It was not provided because the department did not have the report on that date.
Ms Powell : Yes.
Ms Powell : No.
Senator MOORE: The FOI request is not current; okay. Is it expected—this is for you, Minister, because we know this is in the ministerial purview—the review will be made public?
Senator Nash: I cannot answer that. I am terribly sorry, Senator, but I will certainly make some inquiries for you.
Senator MOORE: You would understand that this committee and particularly some senators in this committee have had a passionate interest in this particular issue. We have been watching this with interest.
Senator Nash: Indeed. And, as you know, Senator, I do understand very well the intent and commitment of this committee.
Senator MOORE: Ms Powell, you said that at the time the FOI was actually put in the department did not have it.
Ms Powell : That is right.
Senator MOORE: Can you tell me what ongoing costs the department holds as an appropriation to administer the PCEHR?
Ms Powell : Funds terminate on 30 June.
Senator MOORE: I would expect, Minister, the answer to the next question is, 'Future funding is part of budget considerations'. Is that the response?
Senator Nash: That is under consideration, obviously, Senator, but I would note that I understand the funding running out on the 30th was due to the previous Labor government. I would stand corrected—
Senator MOORE: That was the end date, in terms of 30 June, that any decision beyond 30 June 'is under consideration as part of budget process.'
Senator Nash: Indeed. But I do note that the reason it runs out on 30 June is because of the previous Labor government.
Senator MOORE: The last question is: has the department provided a brief to the minister on the review?
Prof. Halton : There have been ongoing discussions with the minister in relation to the review, Senator, most certainly.
Senator MOORE: So when the review document is produced and provided to the minister the department often makes further comment and discusses the process.
Prof. Halton : I think the review was provided to the minister first, actually, and obviously once we have received it we have had discussions with the minister about it.
Prof. Halton : I have. I personally have.
Prof. Halton : We would have to that on notice. I cannot actually remember.
Ms Powell : It was done by Richard Royle, Dr Steven Hambleton—
Ms Powell : Yes.
Senator MOORE: We will be waiting for the answers to come back. That will be lovely. Thank you. The data you are going to provide about the history: are those figures public anywhere, in terms of the ongoing scrutiny of the figures that come out on a daily basis? Has there been some compendium of those figures on a website? I could not find it. I'm just checking.
Prof. Halton : We will check that, Senator. The officer thinks that NEHTA might. We certainly get them daily. But we will check.
Prof. Halton : Yes, yes. It is hardly a secret.
CHAIR: I think Senator Smith has one question.
Senator SMITH: Yes. I was just interested in the numbers of people who had signed up to eHealth and how many of them had a clinical record or document attached to that registration. How is that working?
Ms Powell : How that works is: when you sign up you can elect to have a number of records automatically attached to your records. They are administrative records that already exist; so, for example, information drawn off the childhood immunisation register, MBS and PBS data. You can elect to have that added to your record and many people do that. Once you have a record, when you are working with your healthcare provider following a consultation, where it is appropriate that provider may choose to upload some kind of clinical record. You would not expect them to do that on every occasion; only for the sort of information that would be important and useful to share. There is also a large number of clinical records related to medications that are dispensed as well.
Senator SMITH: Of those figures that you shared with the committee, how many have elected to have a document uploaded or attached?
Ms Powell : The documents are actually uploaded by the healthcare provider. So in a consultation if there is a particular diagnosis they might say to the patient, 'This should go on your electronic health record. Would you like to do that?' That is a shared health summary—and discharge summaries. That same thing happens when you go into a hospital they will just check and they will upload it to your health summary. There are 18,744 discharge summaries—that data is a few days old—and 15,326 shared health summaries have been put up.
CHAIR: What proportion is that of the actual people who have registered? It is a fairly small number, isn't it?
Ms Powell : Over 1.4 million people have registered. What I am not telling you, because I do not know, is whether those shared health summaries are separate individuals or the same person. I do have today's figures. There are 19,227 discharge summaries and 15,544 shared health summaries.
Senator SMITH: Going back to your original evidence, when we talked about the quantum of numbers of people that had registered, what quantum were we talking about originally?
Ms Powell : There are 1,431,097 consumers who have registered.
Ms Powell : There are 35,000 shared health summaries attached. They all have records attached to them.
CHAIR: That could be 20 individuals, for all we know.
Mr Madden : The other part is the prescribed and dispensed. A key piece of information from the GP's perspective is prescriptions and dispensed drugs, for which we have 89,000 documents uploaded for dispensed drugs.
CHAIR: If everyone on that list is on 10 medications—
Mr Madden : It could be that one person has more than one.
CHAIR: Yes, I know.
Ms Powell : There are other important pieces of clinical information that consumers put in themselves, like their allergies and a bit of medical history, because there has to be a start date for that as well. There are 32,979 consumer entered health summaries and over 11,000 consumer notes.
Senator SMITH: I would like to understand this a bit more clearly. The 11,000 is not a subset of the 32,000; it is in addition to—
Ms Powell : It could be a subset, but I am not able to tell that.
Senator SMITH: So that I am clear, 1.4 million people have registered but there are less than 100,000 records, because the records do not necessarily relate to a person because a person might have more than one record. Is that correct?
Ms Powell : That is correct insofar as it relates to clinical notes entered by a healthcare provider. The other records, related to pharmaceuticals that have been dispensed, are also in there.
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Here is the direct link
Ms Powell would seem to have taken a few lessons in ‘not answering the question’ from Ms Halton.
The bottom line in PCEHR use is that of 1.4 million people having a record - only 15,000 summaries exist. Thus only 1% of the records that exist have had real clinical input and only 5% of the population are registered.
This far we seem to have spent about $60,000 for each record stored!
As a matter of record there is coverage here:
Slow take up for e-health records
- Fran Foo
- The Australian
- February 27, 2014
Department of Health Secretary Jane Halton speaking at a luncheon in Brisbane. Source: News Corp Australia
A LITTLE over 1 per cent of participants have used the $1 billion taxpayer-funded e-health records system to upload medical information nearly two years after it was launched.
The participation figure is generous at best since the Health Department is in the dark as to the actual number of individuals who have shared health summaries in the system.
Shared health summaries contain medical information such as diagnoses, allergies and medications and patients can have more than one summary.
And here:
E-health record signup boost on back of public hospital push
Summary: A total of 1.4 million Australians have registered for an e-health record as public hospitals have been increasingly encouraging patients to sign up for the service.
Take-up of personally controlled e-health records (PCEHR) in Australia is on the rise, with 1.4 million customers registering for the service as of February 26.
Health Department e-health division first assistant secretary Linda Powell told Senate Estimates last night that 1.4 million consumers have registered since the launch in mid-2012, with the bulk of registrations coming from New South Wales, Victoria, and Queensland.
The drive in take-up, which is up from 900,000 in November last year, was largely due to public hospitals registering patients, she said. A total of 155 public hospitals across Australia are now using the system to upload discharge summaries.
Department secretary Jane Halton said that the public hospitals have been critical in getting customers on board.
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I have to say that after 20 months and all that money this is not a great effort!
David.
