Saturday, February 23, 2013

The Calling Of An Election In September May Really Impact Developments In E-Health.

As readers will no doubt be aware the Prime Minister astonished the National Press Club audience by announcing an Federal Election for September 14, 2013 a good six months ahead of the time when such an announcement was required to be made. Despite the PM’s suggestion that this step would result in clear air for six months before the election campaign begins what has happened, not surprisingly, is that we are now in the midst of an eight month election campaign.
As we move closer to election day we can expect an increasing focus on just how the Labor Health and e-Health reforms have worked out. There are others well qualified to speak on overall Health Reform but in the e-Health domain we have already seen some considerable movement.
Dr Andrew Southcott (Member for Boothby in South Australia) is the Opposition spokesman on Primary Health and E-Health and it is interesting to see how his concern with present directions and execution is hardening.
Just over a year ago (21 February 2012) he told The Australian the following.
“Opposition e-health spokesman Andrew Southcott said the Coalition supported the concept of shared e-health records, but had concerns about the way the system was being implemented.
"Labor's implementation of the PCEHR since taking government in 2007 has received enormous criticism from industry for the poor management of the program's development and progress," he told the house last week.” [1]
Later in 2012 he told The Australian.
“Opposition e-health spokesman Andrew Southcott said that given "almost $1 billion of taxpayers' money has been spent or allocated for this in the past two years, it would be prudent for the Australian National Audit Office to examine the PCEHR program".
IT projects were "notorious for costing a lot more than expected and delivering a lot less than expected, and this seems to be in that category".
"I think we've had very poor ministerial oversight of this project," Dr Southcott said. "The infrastructure is not ready, the National Authentication Service for Health, which provides user verification and system security, is not ready, consumers could not register online and the GPs' software is not ready -- I'm told one of the largest GP providers won't have software ready until next February.” [2]
By mid-February this view had modified” to become the following.
THE federal government's controversial eHealth system to get the nation's medical records available online has had a dismal uptake from the public and the medical profession.
The scheme has been compared to the government's bungled roof insulation system by the Coalition's eHealth spokesman, Andrew Southcott, who called it ''Pink Batts on steroids''.”[3]
In the interim we have also had indicate the need for a careful review before further investment in undertaken.
One has to conclude, from these statements, that an Opposition victory in September will result in major change if not outright cancellation of the Personally Controlled Electronic Health Record (PCEHR) Program. It also seems highly likely the Program will become a point of Opposition attack - a fact that I am told is ruffling some bureaucratic feathers in Canberra.
As far as the Government has been concerned the level of public discussion has gone remarkably quiet over the last few months with virtually no public commentary or announcements in the last six months.
Two late breaking pieces of news have been the admissions at Senate Estimates in mid-February that only about 52,000 citizens had registered for a record - below the 500,000 who were expected by June 30, 2013 and some really rather left field news that a tiny US Company (MMRGlobal) is claiming it has patents over key aspects of the PCEHR. NEHTA and DoHA are said to be investigating the claims at the time of writing.
Overall, it seems to me that yet again what we are seeing are comprehensive failures of leadership and governance in the e-Health Domain. In my view most stakeholders have not been effectively engaged and persuaded regarding the Government’s plans
This short quote from a very recent paper by Professor Michael Georgeff and Dr Stan Goldstein for the ACHR tells the sad story of the derailing of the National E-Health Strategy which was meant to guide what happened but has sadly been sidelined. [4]

The National eHealth strategy and PCEHR

The National eHealth Strategy developed by Deloitte in 2008 [The National eHealth Strategy. Deloitte Touche Tohmatsu, September, 2008] laid out an approach to the implementation of a more digitally-enabled healthcare system. Three steams of activity were key to that strategy:
·         Build the basic infrastructure: connectivity, Individual Healthcare Identifiers, provider directories—the digital roadways and railways
·         Focus on high priority solutions: complete solutions that support chronic disease management, telehealth, and medications management
·         Invest in change management: assist stakeholders to manage the transformation to the digital world
However, somewhere along that path, the shared health record took centre stage under the name of a Personally Controlled Electronic Health Record (PCEHR).
A shared information repository is a key part of the basic infrastructure that governments need to provide. But a data repository—such as the PCEHR—is just infrastructure. As we have tried to emphasise in this report, it is the “apps” that count, not the data! It is the business processes and solutions that sit on top of the PCEHR and the rest of the national infrastructure that will make the difference to health care.”
What we have been left with is a lot of money being spent on a Program which lacked evidence for its approach and more importantly lacked the bi-partisan support which is so important for large scale multi-year IT Programs.
It is really hard to see how this can work out well between now and the election in just seven months time.
Collaboration and Connectivity: Integrating Care in the Primary Health Care Setting.  January 2013 ACHR - To be released 2013.