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Monday, 17 May 2010 14:51

e-health needs more funds and a rethink


The Government's fooling itself if it thinks that the $466.7 million allocated in last week's Budget will buy it a national e-health record system,  but nor should it pony up billions to pay for a big bang electronic health network as the UK's £30 billion e-health initiative has proved a squib.

Health IT experts say it's time for a rethink on both funding and strategy - and some long overdue clarity about who should drive Australia's e-health initiatives.

Although consulting firm Booz & Co earlier this month found that a comprehensive e-health system could lead to healthcare savings of more than $7.6 billion a year by 2020, the report's co-author and Booz principal, Klaus Boehncke told iTWire today that $466.7 million wasn't enough to buy such a system. That would require an investment of $200-$400 per Australian - as much as $8.6 billion given the current population of almost 21.5 million.

While the Government's hardly racing to e-health, the Opposition could apply additional brakes if elected back into power. Opposition leader Tony Abbott noted in his budget reply speech last week: 'Of course, there should be an electronic health record but hundreds of millions of dollars have already been spent to make this a reality and no more should be spent until it's certain that we're not throwing good money after bad.'

John Backhouse, Information Builders' regional programme director for health care, who was in Australia last week to meet with chief information officers from a range of health authorities and hospitals, agreed with Booz's Boehncke that: 'The funds won't be sufficient for a country wide e-health record; but we have to ask some questions first.

'What is it the government wants to achieve with the e-health record? Are we trying to get an entire health record for the patient or are we creating a care summary record? Which one we are trying to achieve, and what is the usefulness of what it will enable the clinicians to do?'

This lack of clarity about what the Government plans to do in regard to e-health, or who will lead the initiative is frustrating many in the sector. As Boehncke noted:  'One of the issues which is unclear to me is, is this a two year plan, or part of a multi-year programme?'

There are some details of the $466.7 million programme on the website of NEHTA (the national e-health transition authority) which indicate that the money will be spent over two years, with Australians able to opt in for the programme from 2012-13. It also indicates that the e-health records will provide a health care summary featuring details of medications, immunisations and test results, which would be linked to the individual's health identification number which the Government hopes to introduce later this year.

What's not clear yet is which agency will drive the reforms. Boehncke said that: 'What you see in other countries, such as Singapore and Germany, is entities at arm's length from the government.' While the Government has set up NEHTA it has been largely focussed on developing unique health identifiers, and according to Boehncke does not currently have a mandate to drive the e-health programme itself.

'It has not been communicated by the Government how the money will be spent, who will run it, or whether they have the capacity,' he said.

What won't work both Boehncke and Backhouse warned is a 'top down' Government imposed information system for health authorities, patients and practitioners.

Backhouse warned: 'If you take the top down approach and do the same as the NHS...you can throw billions and billions of pounds at it,' and still not get a workable system. 'You need to take it bottom up, then aggregate the data to provide to executives in the health areas.'

'The big bang approach has been show to fail. The UK has thrown billions at it and so far we have name, address and date of birth.' According to Backhouse 'The National Health Service is seven years down the line with its national care integration system - they do have a spine - but it's not what they set out to do.'

Starting at the patient and GP level with e-health records and information management is similar advice to that provided last month by Bill Crounse, Microsoft Health's senior director, who suggested that the better approach was to develop information systems which centred on individual patients, rather than information systems focussed on the hospitals or health services. (Not surprisingly this aligns with Microsoft's own plans, to launch its Health Vault system in Australia within the next 18 months).

Boehncke suggested that the Government could make some early progress by better leveraging the existing Medicare information system, which now connects patients, most GPs and pharmacies, by piggybacking a medication management system onto that network. This would help guard against errors and adverse effects at the point in the health system where medication is dispensed.

The Booz report Optimising e-health Value, suggested better medication management could generate savings of $2.6 billion a year.

He also believed that GPs were well positioned to play a significant role in any national e-health initiatives. Backhouse agreed that GPs and primary care clinicians were a smart place to start with e-health records systems.

'The pathway should start with the GPs,' he said.  This approach would be cheaper and more effective.

'Clinicians treat as they find, and use diagnosis tools as methods to get to the root cause of the problem, so an e-health record will not have any impact on this clinical process. However an e-health record, if used as a summary record, is a powerful tool for managing community care, aged care and end of life care. This will enable continuity of care between multiple health care professionals. If this is done from a bottom up approach - local organisation to local authorities to regional areas - this will be a successful project.

'However, if done top down it will cost billions, lose focus and not achieve what it set out to do (like the UK) because you have to consider whom will feed the information path for the cleansing of all the data to be entered in the e-health record. As many of these systems are paper-based, the GPs will not have the time to re-write and the patients will not sit and re-type their entire history, nor should they be expected to.'


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