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

-----

Make of all this what you will!

David.

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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.

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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.

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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.

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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.

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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.

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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.

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