In this budget brief from the parliamentary library Dr Rhonda Jolly explores whether the current tinkering around the edges of the health record could be a prelude to a new strate
In this budget brief from the parliamentary library Dr Rhonda Jolly explores whether the current tinkering around the edges of the health record could be a prelude to a new strategy.
Dr Rhonda Jolly writes:
E health makes use of developments in computer technology and telecommunications to deliver health information and services more effectively and efficiently. The e health funding provided in this Budget represents the Government’s response to recommendations made in a 2013 review into its predecessor’s Personally Controlled Electronic Health Record (PCEHR) system.
Prior to Budget night, Health Minister Sussan Ley announced that the Government would provide $485 million over four years to restructure the current system. The Minister suggested that this funding would deliver ‘a fully functioning national e-health system’ that could save taxpayers $2.5 billion per year within a decade, and an additional $1.6 billion in annual savings for the states and territories.
There are to be a number of major changes to current arrangements under the restructured system. These include a name change—the PCEHR will become the myHealth Record. Unlike the PCEHR, responsibility for myHealth is to be situated within a new body, the Australian Commission for eHealth. This body, which is to be established by July 2016, will take over from the National E-Health Transition Authority (NEHTA).
In response to criticisms of the model adopted under the PCEHR that required patients to request that an e health record be set up, the revamped system will trial a system that will automatically create an e health record for participants. It will be necessary for patients to request that they are not included in the system—that is, they will have to ‘opt out’. Commenting on the proposed model, a Government spokesperson maintained that rather than changing directly to the new system, the trial will be necessary ‘to ensure public confidence in the system is maintained’ and to ‘assist in evaluating the effectiveness of associated public awareness and information dissemination and education and training for healthcare providers’.
Many stakeholders appear to be pleased with the decision to trial the opt out model. Leanne Wells, from the Consumer Health Forum (CHF), for example, has stated that the approach ‘will require active leadership from the Minister, an open and transparent process and a public education campaign to ensure community and clinician confidence in the security and reliability of the scheme’. The Australian Medical Association (AMA) appears supportive of the proposed revision and the Royal Australian College of General Practitioners (RACGP) considers it would help to ensure future policy could be based on evidence. RACGP president Frank Jones has added, however, that the organisation considered it crucial that the trial was directed by medical practitioners, not bureaucrats.
The RACGP has observed also that it would closely examine details of the revised system as they emerge, since it is eager to see where funding is to be allocated and whether training in its use will be provided to general practitioners. Moreover, the RACGP is keen to see if, and how medico-legal issues associated with the new model will be resolved, whether arrangements for governance for the new e health commission will be appropriate and whether those arrangements will include stakeholder representation.
Not everyone is satisfied that the Government’s approach will deliver a well-functioning solution. E health analyst, Steve Wilson, believes it is simply not possible to switch from opt in to opt out records unless the fundamental architecture of the system is redesigned to include a ‘privacy by design’ function which is attuned to the new model. Wilson contends:
… you simply cannot invert the consent model as if it’s a switch in the software.
Academic Dr David Glance has commented also that while changes may increase the general usage of the e health record system, the system itself ‘remains fundamentally flawed’ because there is no guarantee that all health professionals involved in patient care will participate and supply information, nor is there a guarantee that information supplied will be complete. In addition, the system will continue to allow patients to withhold information so that records may not be complete—and acting on such a record ‘becomes a significant clinical risk’ for health professionals. Dr Glance considers that there are other models that may work better than that proposed by this, and the previous government, and that some alternative models have the benefit of not needing centralised infrastructure, and as a result, not needing government involvement.
In a variation of Glance’s proposition, former Senator Amanda Vanstone has declared that perhaps it is time to say with regards to e health projects in general that ‘enough is enough’ and to ‘outsource the job to the private sector’. Bernard Keane, from the online journal Crikey, is similarly unimpressed with the proposed changes to e health records. Keane declares the Budget simply ‘warms over’ a ‘dud’ Labor idea, which he labels ‘one of the most spectacular wastes of money of recent decades after War on Terror funding’.
Regardless of the legitimacy of these types of criticisms, it is most likely too much to expect any government to abandon the PCEHR in its entirety, given the substantial investment in the e health project made by various federal governments since the 1990s. And as Steve Hambleton, the former AMA President and current chair of NEHTA has remarked, while the PCEHR could have been more efficient, the foundations of the e health record system are in place. So it may be impractical to abandon work already accomplished. Nevertheless, at the very least, technical issues such as those raised by Wilson would seem worthy of further investigation. So too is the idea that the opt out trials should not only include advice from health practitioners, but also the expertise of medical health information technicians.
It may be that the suggestion from long-time critic of the current e health record system, Dr David More is pertinent—the funding in this Budget represents ‘a holding action’; that is, a prelude to the development of what Dr More thinks will be a ‘new’ strategy for e health. It is more likely that the new strategy will actually be a variant of the old strategy, simply because it is too costly and difficult to replace existing e health architecture. At the same time, it will be interesting to see how the opt out model contributes to a new or improved or revised strategy, and to what extent the suggestion of more inclusive system development, which has accompanied the myHealth announcement, is realised to the satisfaction of government, health practitioners, medical software and other industry stakeholders and patients.
. Department of Health, Review of the Personally Controlled Electronic Health Record (Royale report), December 2013.
. S Ley (Minister for Health), Patients to get new myHealth Record: $485m ‘rescue’ package to reboot Labor’s e-health failures, media release 10 May 2015.
. K McDonald, ‘Budget 2015: money for PCEHR reboot is to last four years’, Pulse+IT, 11 May 2015.
. Consumers Health Forum, Online health records trial a big step forward, media release, 19 May 2015.
. Australian Medical Association (AMA), Spectre of 2014 Budget overshadows modest measures in 2015 health budget, media release, 12 May 2015 and McDonald, op. cit.
. S Wilson, Why the Govt can’t simply go opt-out for e-health, itNews, 11 May 2015.
. D Glance, New name and opt-out policy won’t save the personal health record, The Conversation, 11 May 2015.
. A Vanstone, ‘Increased taxes a sure loser’, Canberra Times, 11 May 2015, p. 4.
. B Keane, Deficit, schmeficit: Hockey focuses on the short term, Crikey, 13 May 2015.
. A Gartrell, Budget to revive health scheme on life support, Sun Herald, 3 May 2015, p. 10.
. D More, ‘Here are the main details of the e-health area of the Budget for 2015-16. Very, very interesting!’, Australian Health Information Technology blog, 13 May 2015.
. A Gartrell, Budget to revive health scheme on life support, Sun Herald, 3 May 2015, p. 10.
. D More, ‘op. cit.
Reema Rattan writes:
While the federal election is still months away, issues of health funding are already dominating the news. A Grattan Institute report released yesterday, for instance, noted the greatest budgetary pressure facing Australia comes from sustained increases in health costs.
Last night, ABC TV’s Q&A featured Health Minister Tanya Plibersek and Shadow Health Minister Peter Dutton who faced up to questions from the audience with the knowledge that their responses must win over voters in this election year.
They were questioned a range of health issues – from hospital funding and health workforce training to organ donation and end-of-life care. We’ve asked our experts to assess their performance.
Nov 21, 2011
How can we ensure a sustainable health system? Plus recent articles on surgery waiting lists, e-health and gambling reform
The Commonwealth Parliamentary Library's FlagPost blog has published a number of articles recently that may be of interest to Croakey readers - on health expenditure, elective surgery w
The Commonwealth Parliamentary Library’s FlagPost blog has published a number of articles recently that may be of interest to Croakey readers – on health expenditure, elective surgery waiting times, e-health and gambling reforms. More info below…
Anne-marie Boxall writes:
The sustainability of Australia’s health system is becoming a key concern for Australian governments, along with those in many other advanced economies.
But, with growing demand for high quality health care, an ageing population and rapid advances in medical technology, what can be done to keep a lid on health expenditure?
This recently published Research Paper outlines the key mechanisms the Australian government has to control health care spending, and it proposes some potential options for reform.
In a recent speech on the sustainability of the health system, the Finance Minister, Penny Wong, highlighted the problem policymakers now face: health care expenditure is projected to continue to rise, but the pool of taxpayers is shrinking.
According to The Treasury’s 2010 Intergenerational Report, health care will consume about two thirds of the projected increase in government spending over the next 40 years if current trends continue. Clearly, this is not going to happen because changes will be made. But what changes?
Slowing the growth in health care expenditure is not easy (this earlier Flagpost points out some of the challenges). Governments, however, do have some tools at their disposal. Continue reading “How can we ensure a sustainable health system? Plus recent articles on surgery waiting lists, e-health and gambling reform”
Oct 25, 2011
(Nov 23: see update at bottom of post) What are the strengths and limitations of eHealth technologies in primary health care?
(Nov 23: see update at bottom of post)
What are the strengths and limitations of eHealth technologies in primary health care?
Olga Anikeeva at the Primary Health Care Research and Information Service is drafting a “research round-up” about the use of eHealth technologies such as electronic health records, decision support systems and e-prescribing software by primary health care providers in Australia.
If you’ve an interest or expertise in the area, and can spare a few minutes – please have a look at her draft below and send your feedback by November 3 (contact details are at the bottom of the post).
eHealth aims to improve the quality and safety of Australia’s health system byintroducing a more efficient way to collect and share information such as prescriptions and test results.1 The primary health care sector could benefit substantially from thewidespread use of eHealth technologies.2 The National E-Health Transition Authority is currently working with numerous stakeholders, including GPs and allied health professionals to develop an eHealth uptake plan.2 This RESEARCH ROUNDup focuses on the use of eHealth technologies in primary health care, by exploring the benefits and current limitations of a number of eHealth tools. Continue reading “Your thoughts on the good and bad of eHealth in primary health care?”
Aug 22, 2011
Here's a thought: if you're over 30, you belong to the last generation to know a world without computers. It's not surprising that efforts to harness technology for youth health are usi
Here’s a thought: if you’re over 30, you belong to the last generation to know a world without computers. It’s not surprising that efforts to harness technology for youth health are using young people as the teachers and experts, as was outlined in an event at the National Press Club last week.
Below is an edited version of an address given by Associate Professor Jane Burns, Chief Executive Officer of the new Cooperative Research Centre for Young People, Technology and Wellbeing (YAW-CRC), with the title, The Happiness Highway: Leveraging technologies to improve wellbeing for young Australians.
By Jane Burns
Every young Australian deserves to be happy, healthy, safe and resilient – but what does this mean? Take Bronte as an example. Bronte’s childhood was a happy one. She’s from a well-off suburban family, she did exceptionally well at school, she was athletic, vice-captain of her primary school and had many friends. Bronte was a ‘normal’ run-of-the-mill kid. In fact, her normality was partly the reason why it was so hard for people to understand what was going on – mental illness simply does not happen to people like her.
Bronte barely survived adolescence. For 5 hard years her life spiraled out of control and was filled with suicide attempts, drug addiction, severe depression and intense anger. She was finally referred by her school to the Brain & Mind Research Institute (BMRI), a state-of-the-art clinical service in Sydney and diagnosed with bipolar disorder. As Bronte said afterwards: ‘It was pure luck that I stumbled across the BMRI. I was very lucky to walk through those doors and enter into quality care.’
Bronte’s story is not uncommon. However, receiving quality mental health care and getting it at the right time, is uncommon. Continue reading “How can technology be harnessed to help young people & “mental wealth”?”
Nov 30, 2010
Minister Nicola Roxon's two-day e-health summit starts in Melbourne today and you can watch the webcast
Minister Nicola Roxon’s two-day e-health summit starts in Melbourne today and you can watch the webcast here. Some background about who is speaking etc can be found in this report from The Australian’s IT section.
Meanwhile, thanks to Scott White from GP Access for alerting Croakey to this painfully entertaining clip, “If air travel worked like health care”, which remains timely. And no doubt will continue to be so for some time yet.
Oct 11, 2010
More (mostly) depressing reading on e-health: a bit on why, a lot on why not, and not much at all on how…
E-health: WHY? When it comes to e-health, we know at least some of the reasons why it should be a good thing (quite apart from the fact that the e-revolution is brin
When it comes to e-health, we know at least some of the reasons why it should be a good thing (quite apart from the fact that the e-revolution is bringing benefits to so many other aspects of life).
As a new Canadian study suggests, electronic drug information systems can help reduce adverse drug events and increase pharmacist and prescriber productivity. The study also finds that they increase “medication compliance”, but I hate that term so will instead report that they are associated with a more appropriate use of medicines.
The study, which estimates Canada’s investments in drug information systems will generate $436 million in cost savings and efficiencies in 2010, was released by Canada Health Infoway, “an independent not-for-profit corporation created by Canada’s First Ministers in 2001 to foster and accelerate the development and adoption of electronic health record systems with compatible standards and communications technologies”.
E-health: WHY NOT?*
Two articles in the latest Medical Journal of Australia explore some of the reasons why the promises of e-health haven’t eventuated, as did a presentation to the recent Public Health Association of Australia conference in Adelaide. Continue reading “More (mostly) depressing reading on e-health: a bit on why, a lot on why not, and not much at all on how…”
Sep 9, 2010
Online therapies in mental health; and the power of women’s sexual health – more reports from the global health conference
The global health conference recently held in Melbourne may be over, but the reports from it are still coming in. Tha
The global health conference recently held in Melbourne may be over, but the reports from it are still coming in.
Thanks to freelance journalist Tamzin Byrne* for coordinating the two posts below – the first from Swinburne University’s Mike Kyrios on the potential for e-health in mental health; and the second from Liz Sime of Marie Stopes International on the broad-ranging importance of women’s sexual health.
How can online therapies help mental health?
Mike Kyrios writes:
At the United Nations conference on global health in Melbourne, we were speculating whether the UN will achieve their heady “Millennium Development Goals” by 2015. There was lots of talk about poverty, hunger, environmental sustainability, education, gender inequality, child mortality and maternal health.
But where is mental health in all of this? Depression is the leading cause of disability in the world. By the end of this decade, it will be the second highest contributor to the global burden of disease. Post-traumatic stress is rife amongst survivors of trauma, disasters and war. As the UN works for peace and freedom, it should also address the mental health problems which arise from war.
So what are the current barriers?
Firstly, we don’t have a workforce that can deal with mental health difficulties throughout the world. We cannot respond effectively to the overwhelming mental health problems that follow natural disasters such as fires, tsunamis, earthquakes, and cyclones.
Secondly, we need to connect with rural and remote communities, and populations with special needs. We need to reach across cultural and linguistic differences.
Thirdly, we must empower individuals and communities to reduce their dependence on pharmaceutical companies and that limited approach to mental health treatment.
These are significant challenges, but promising solutions do exist. Continue reading “Online therapies in mental health; and the power of women’s sexual health – more reports from the global health conference”
Jul 22, 2010
The former editor of the BMJ, Dr Richard Smith, recently recommended
The former editor of the BMJ, Dr Richard Smith, recently recommended ten lessons for global health, including that the rich can learn from developing countries.
He wrote that there are many examples of innovation in poorer countries spreading to developed countries, and that poorer countries have a better chance of building sustainable health systems because they don’t have the inertia and vested interest of the top heavy systems built in developed countries.
Perhaps the report below – about e-health innovation by Aboriginal health services in the NT – is an example of this rule.
Greg Henschke, of the Aboriginal Medical Services Northern Territory, reports:
“The NT is a unique place. We’ve had invasions, colonisations, salutations, neglectful situations and interventions. Wouldn’t it be nice if we could actually get some technology happening up here that would help with Comprehensive Primary Health Care delivery and to Close the Gap in Aboriginal Health?
Well the Katherine West Health Board (KWHB) and the Aboriginal Medical Services Northern Territory (AMSANT) are proving that smart technology such as IPads can help with grassroots health service delivery. Continue reading “How the IPad is improving health service delivery in the NT”
May 12, 2010
The health budget contains plenty of new initiatives that warrant careful implementation and evaluation. But there is still a "troubling sense that initiatives are being hastily stit
The health budget contains plenty of new initiatives that warrant careful implementation and evaluation.
But there is still a “troubling sense that initiatives are being hastily stitched together to meet electoral rather than health priorities”, cautions Professor Philip Davies, a former senior executive of the Department of Health and Ageing, and now Professor of Health Systems and Policy at the University of Queensland.
“With so much money already committed to oiling the wheels of the recent COAG Agreement on hospitals, the health sector did pretty well to gain yet more funding in yesterday’s Federal Budget.
Three initiatives are particularly noteworthy.
The move to fund nurses in GP practices, and to do so without recourse to Medicare rebates, should do a lot to relieve pressure on many busy GPs. It should also make services more accessible and affordable for their patients. A flat $25,000 payment per GP might not be the most cost-effective approach and the money could arguably have been better targeted. As it is, there’s a risk areas that are already well-supplied with GPs will simply become equally well-supplied with practice nurses, but overall it’s a smart and welcome move.