Editor's Note: Dr David More is recognised as one of the health informatics industry experts and we are pleased to carry his column in i2P. For this month we have selected his comments in regard to the Rudd Government's scorecard in e-health after 12 months in office. David More makes a blunt comment, and as he says, " I am vitally interested in making a difference to the quality and safety of Health Care in Australia through the use of information technology. There is no choice.. it has to be made to work!"
And thereby lies the challenge for Nocola Roxon, Minister for Health & Ageing.
A day or two ago the now one year old government released a progress report card (that it wrote on itself!).
The report card can be downloaded from here:
I thought it would be important to report what I found in the health area and specifically e-health domain.
Reporting on e-Health is easy. What I found is zip, zilch, nada etc!
On the health sector the news is a little more encouraging.
From page 10 we have:
Progress in the first year:
· Additional Funding for Public Hospitals: Public hospitals are a critical part of our health system. The Government has allocated $1 billion to the states and territories to relieve the pressure on public hospitals.
· Elective Surgery Waiting Lists: In its first year, the Government provided an upfront investment of $150 million to the states and territories for an immediate blitz on elective surgery waiting lists. The hospitals are on track to reach the target of about 25,000 additional procedures by the end of 2008. This funding is part of a $600 million package to increase the number of elective surgery procedures completed within the clinically recommended time.
· Systematic Improvements to the Hospital System: As part of this $600 million package the Government is providing $150 million to the states and territories for systematic improvements to the hospital system.
· Access to Doctors: The Government is on track to commission 31 GP Super Clinics by 2011, with eight Clinics already commissioned. The Government has also established new GP training places, allowing 175 additional new doctors to begin training over the next two years at a cost of $148 million.
· Access to New Medicines: Since November 2007 the Government has agreed to four major new or extended listings on the Pharmaceutical Benefits Scheme at a cost of around $750 million.
· Aged Care and Community Health Services: The Government has allocated an additional 1,350 residential aged care beds and over 100 community care places in areas of high need, funded through the first stage of the Government’s $300 million program to provide low cost loans. The Government has also provided $350 million in additional revenue for aged care facilities; $2 million over four years to establish an Ambassador for Ageing; an additional 2,000 transition care places for older Australians at a cost of $293.2 million over four years; and $389.5 million over five years in grants and recurrent funding to support hospitals and community health services.
From page 11 we have (the future major directions):
The Government recognises the importance of responding quickly to the future challenges facing the nation, and is committed to ensuring that a comprehensive reform program is delivered, including:
· A New National Healthcare Agreement: The Government has been negotiating a new National Healthcare Agreement with the states and territories.
· A New Accreditation System for Health Professionals: The Government is working with the states and territories to develop and implement a new single national registration and accreditation system, initially for ten health professions. The new arrangements will take effect by 1 July 2010.
· A National Primary Healthcare Strategy: The Government is developing a National Primary Health Care Strategy to better tackle the health challenges of the 21st century, and make sure that families can get the health care they need. A discussion paper was released on 30 October 2008, and written submissions can be made until 27 February 2009.
It seems Ms Roxon’s mention of the National E-Health Strategy in the speech of a week or so ago has somehow got dropped. Slightly heartening is that the National Primary Healthcare Strategy mentions e-Health as one of the 10 areas of interest and discussion. The questions asked are however basic at best.
• What is the role for eHealth in supporting the provision of quality primary health care?
• Where should the Government prioritise its actions in relation to implementing eHealth reform?
• How can the various information systems be integrated (e.g. state health services and general practice)?
Additionally – while pointing out there is work to do – the report exaggerates, grossly in my view, just how far GPs have got so far. Suggesting that usage is as follows means their definitions and mine of usage are pretty different.
“Levels of computerisation in Australian general practice have increased over the last decade or so. A secondary analysis of the Bettering the Evaluation and Care of Health (‘BEACH’) survey conducted over 2007 and 2008 shows that the majority of GPs reported using a computer at work (96.7%) for the following purposes:
- electronic prescribing (92.3%);
- billing (89.4%);
- electronic medical records (85.6%);
- ordering tests (82.2%);
- other administrative (83.6%); and
- internet/email (81.5%).”
(The reference provided is also dated 2006 and refers to aged care computing for some reason?)
For the detailed obsessed pages 66 to 72 provide a Ruddian list of every initiative list that cost more than about $1.50.
To date health policy from this Government is in my view un-imaginative, ideologically driven and lacking insight into what fundamental reform of the Health Sector might actually achieve.
Two things are clear:
First, much of the, even rather pedestrian, reform so far announced needs a substantial e-Health Infrastructure. Without investment in this area little will change.
Second it is by no means clear this requirement is recognised.
The Council of Australian Governments meeting next week (November 29) will be the last chance for anything important to happen this term – given the inevitable delays, budget cycles etc.
I can’t say the tea-leaves look good! I hope I am wrong.