Philip Davies, Professor of Health Systems & Policy at the University of Queensland’s School of Population Health, is encouraged by the National Health and Hospitals Reform Commission proposals around e-health. He writes:

“Much of the debate following the release of the National Health & Hospital Reform Commission’s (NHHRC) report A Healthier Future For All Australians will inevitably, and rightly, focus on issues of health care governance, funding and models of service delivery.  Some of the Commission’s most far-reaching recommendations could, however, be those relating to e-health.

The Commission is to be commended for providing one of the clearest, most powerful and potentially most effective statements of how to move the national e-health agenda forward.  Its key recommendation is that every Australian should be offered the opportunity to have a person-controlled electronic health record (PEHR) – a comprehensive electronic repository of health-related information generated by, and accessible to, themselves and their health care providers.

There’s not much new in that idea.  The concept of electronic health records has been around for a very long time; but the Commission’s approach has two distinctive, new features.

First, it suggests quite categorically, that Governments should play no part in “designing, buying or operating IT systems” to support PEHR.  That’s a job which, according to the Commission, can safely be left to the private sector.  Governments, in turn, should focus on the essential tasks of defining standards for those PEHR systems and regulating their use.  State and Territory Governments will also need to continue developing ‘in-house’ patient administration, communication and other IT applications to enable their public hospitals to interface with PEHR systems.

Second, the Commission proposes a series of deadlines for public and private sector health care providers to become e-enabled and able to write to, and read from, individual patients’ PEHR.

To reinforce the point, the Commission goes on to recommend that Government funding in the form of Medicare subsidies or direct payment for public hospital services should be withdrawn from any provider who fails to meet the relevant deadline.

The notion of a future Commonwealth Government withholding Medicare subsidies from non-compliant GPs and specialists might be viewed as “courageous” by the standards of Yes Minister’s Sir Humphrey Appleby but, if it is seen to be serious, it has greater potential to accelerate the development and uptake of e-health than any of the pilots, strategies or other initiatives that have gone before.  It is also entirely consistent with the view that, if e-health really is essential to ensure the safety and quality of contemporary health care, then there will come a time when Medicare should not subsidise unsafe, un-e-enabled services.

Private sector PEHR operators will want to be paid, but it will be in Governments’ and patients’ interests for those opertaors to compete on price and quality grounds to attract market share.

Beyond its recommendation that Governments shouldn’t directly buy PEHR systems, the Commission is less clear on how it sees the future funding of e-health.  One possibility might be for the Commonwealth to give every Australian an annual or biennial entitlement to a Medicare-like payment which could be used to buy a subscription to any registered PEHR service.

The level of such a payment would need to cover the full cost of subscribing to a robust, basic PEHR service so that no-one was excluded.  If they wished, individuals, employers or private health insurance funds might then choose to ‘top-up’ the Government subsidy to access more sophisticated PEHR which offered additional, value-adding functions.

Another important question concerns the costs that private sector health care providers might face in acquiring systems and revising their business processes in order to become e-enabled (and, eventually, to remain Medicare-eligible).  There will no doubt be an expectation that the Commonwealth Government should offer grants or subsidies to help meet those costs.  That could be expensive especially if, as the Commission has suggested, we see more professionals becoming Medicare eligible over the next few years.

On the other hand, it may be argued that such costs are (like receptionists, telephones and examination couches) merely one of the costs of doing business as a health professional in the 21st century and should be built into providers’ professional fees.  Indeed, if e-health makes providers more efficient then the cost may, in fact, be negative.  There is clearly more work to be done to develop an appropriate policy response in this area.

The NHHRC has made the way forward for e-health much clearer.  The challenge for Governments now is to follow through with the standards, regulations and financial arrangements that will enable the Commission’s clear and bold vision for a market-based system of PEHR to become a reality.”

• Professor Davies is a former senior Federal health bureaucrat

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