E-health in a tangle

Excerpted from Australian Doctor, 20 March 2009:

With so much reform in the offing, does the Rudd Government have the political will to finally make e-health a reality? Ray Welling investigates.

Ordinary Australians can use their bank cards all over the world or seamlessly connect their laptop to a wireless net work from Broome to Berlin, yet their critical health data can’t be shared with their local hospital or even the pharma cist down the road.

This is despite extensive international and Australian research pointing to significant savings in lives as well as public health expense when health IT innovation is applied.

This year researchers in Texas reported in the Archives of Internal Medicine that increasing the automation of hospital notes and records led to a substantial decline in mor tality rates for all conditions studied. An author of the study said that by computeris ing health records, more than 100,000 lives a year could be saved in the US alone.

Closer to home, a 2002 Australian Institute of Health and Welfare study found that up to 18% of medical errors — many of them fatal — were due to inadequate availability of patient information.

According to the study, these adverse events account for as much as 3% of the gov ernment’s total cost of care — $3 billion a year in avoidable cost.

A business case for a national electronic health record program was published last year by the National E- Health Transition Authority (NEHTA), which suggested a net benefit to the Australian economy of between $7.5 billion and $8.7 billion over the first 10 years.

Australia is not the only late adopter of e-health. In the US, just 1.7% of hospitals sur veyed in 2008 had fully imple mented a comprehensive patient e-health records system across all units of their hospi tals and only 7.9% had imple mented a basic system.

However, the US is much closer to fully sharing health data. Electronic health initia tives were specifically men tioned in former US President Mr George W Bush’s last four State of the Union addresses, and USPresident Mr Barack Obama announced shortly before his inauguration that he was dedicated to making 100% of personal health records available electroni cally within five years. He backed that up by allocating $US20 billion in his initial economic stimulus bill to the task. Electronic health records were specifically mentioned in his maiden speech to the US Congress in February.

SO what’s happening in Australia? It’s not that we’ve been ignoring e- health. It is estimated that more than $5 billion has been spent by state and territory governments, GP divisions, and others on e-health devel opment activities in the past 10 years.

Those initiatives include a program by General Practice Network NT to have the entire NT population regis tered for shared electronic health records by 2010, bed side electronic records and clinical decision support tools being trialled in SA hospitals, a $250 million Enterprise Information Repository in Queensland, and a hospital- based electronic health record system deployed in the South Eastern Sydney and Illawarra Area Health Service in NSW, which is soon to be rolled out across the state.

But for e-health to make a real difference, national co- ordination is needed. On a national level, NEHTA was set up with Commonwealth funding in 2005 to develop core technical foundations for e-health in Australia, such as clinical terminologies, infor mation messaging standards and designing unique con sumer and care provider iden tifiers.

Other than this, however, none of the local or state groups developing e-health systems are talking to each other or working to create sys tems that can be integrated across borders. Some can’t even be integrated across hos pitals or surgeries in the same state. It’s a situation that brings to mind the 19th cen tury, when each colony built its railway systems using incompatible rail gauges.

Read the full story here (password required – let me know if you’d like a full copy).

E-health funding ‘boost’ unwrapped

David More offers informed comment on last week’s e-health budget announcement in his Australian Health IT blog. While the media headlines trumpeted a big win for e-health spending (ie, funding for the National E-Health Transition Authority) out of the money allocated at the Council of Australian Governments meeting, David points out that the growth in funding is largely due to the states matching federal funding.

Importantly, he points out that “What this funding of NEHTA for the next few years has done has ensured that its leaders feel vindicated in the way they have behaved – they have essentially been ‘patted on the head’ – and any real stimulus for ‘root and branch’ change has been lost.

“There is also a bit of a problem in that without a co-ordinated national direction it is a little murky as to who will be able to get the full value out of the planned NEHTA spend.

“More importantly what has been lost is the opportunity to put in place the sort of national strategy and national governance of e-Health. This will lead, almost inevitably, to waste and inefficiency in how the new money is spent. Of course that waste and inefficiency will be dwarfed by what will flow from failing to properly automate the health sector.”

He concludes that “What has also been lost is an opportunity to commence planned co-ordinated investment in Health IT in a way that is designed to maximise benefit to all the actors within the health system.”

Read the entire post here.

NEHTA and the budget, part II

In a follow-up to my earlier post about NEHTA’s budget spend, they’ve gone from being criticised for underspending their budget to criticised for over-spending on the wrong things. Australian IT reports that the authority has more than doubled its spend on administration – staff, consultants, etc. – over last year, 169 people costing nearly $30 million. My calculator tells me that works out at nearly $178,000 per head, so either they have the best-paid staff in the public service, or the consultants, who account for $13 million of the total, are raking it in. Hey, how do I get on the gravy train?

Australians want e-health records

Australians support the introduction of an Individual Electronic Health Record (IEHR) and would agree to their medical records being included in the service.

This is according to a poll conducted on behalf of the National E-Health Transition Authority (NEHTA), which showed that 82% of respondents believe an IEHR would save lives and improve health services by having important medical information immediately assessable. 77% of the 2,700 people surveyed across Australia indicated they would want their records added to the service.

“This research confirms Australians endorse the use of electronic health records if they are introduced with all the necessary levels of privacy and security,” said NEHTA chief executive Peter Fleming.

The news was welcomed by AMA president Rosanna Capolingua, who reiterated the organisation’s long-time support of electronic health records, but also highlighted issues such as patient confidentiality and system access, as the issues delaying implementation. “Maybe not next year, but hopefully soon after we may see some movement,” she suggested.

Security and safety around the electronic storage of medical information was a key consideration, with 79% of those polled indicating it was important any future IEHR offers patients the ability to quarantine sensitive or very personal medical information. The poll also showed that Australians feel strongly about choice in relation to the IEHR. 78% of respondents said the IEHR service should be voluntary.

– From 6 minutes

Don’t they want this to work?

I know governments are usually taken to task for overspending their budgets, but the Federal Department of Health is getting a reputation for underspending when it comes to e-health. The Australian reports that the DoH spent only $42.5 million out of the $53.8 million allocated for e-health implementation in 2007-08. This follows on from the previous year, when the Department spent only $37.5 million from a budget of $79 million allocated to national products, including the failed HealthConnect.

Exactly what did it spend money on? According to the report, the department saw success in the development with the National E-health Transition Authority (NEHTA) of individual and provider identifiers, standardised clinical terminologies and secure messaging standards.

“In addition, the department worked closely with NEHTA on the development of targeted packages to support the implementation of electronic discharge, specialist referral and pathology clinical services,” it says.

“The department also contributed to the development of the National E-Health Strategy through the national e-Health Information Principal committee. When the strategy is implemented, it will allow significantly greater inter-jurisdictional and national co-ordination of e-health policy direction.” 

Hunh??

The report says a major achievement was an e-prescribing trial in the Northern Territory, in a community pharmacy and aged care setting, resulting in fewer misplaced prescriptions and delays in mailing or faxing scripts.

However, as The Australian points out, “industry observers have noted that the trial involved a limited, point-to-point transmission service, rather than a scalable interchange system needed for a robust national e-prescribing system.”

What we really need to know is, what was that $11 million supposed to be spent on? What is being unnecessarily delayed because of government disorganisation and apathy? How much longer has the promised e-health nirvana been pushed back?

Government dragging the e-health chain in Australia

Excerpted from a special report I wrote for this week’s Australian Doctor

Jim Clark was known as Silicon Valley’s $3 billion man: the first person to start up three companies that were each capitalised at $1 billion or more. Starting in the 1980s with Silicon Graphics, a pioneer of film and CGI animation, he grew bored with that and helped found Netscape, which launched the world’s first widely used web browser, in the early 1990s.

But his timing failed him when it came to the third venture, an attempt to automate health care. In the late 1990s, Clark set up Healtheon, an online platform joining payers, providers and consumers in an effort to squeeze inefficiencies out of the $US7 trillion a year US industry. The company was quickly capitalised at $US20 billion, largely on the strength of Clark’s reputation.

However, Healtheon struggled to get any of its projects off the ground, encountering resistance from every angle. Doctors said they were too busy to learn new things, and besides, they didn’t want better communication with patients — face-to-face was just fine with them. Health maintenance organisations and insurance companies, meanwhile, turned their backs on a no-risk opportunity to save 90% on transaction costs — they didn’t want to make it easy for people to make claims, because the more arcane the rules for reimbursement and the more complicated the claim process, the easier it was to delay payment and the more likely customers would drop lengthy appeals for payment.

As Healtheon’s value tumbled to less than a hundredth of its peak value, in 1999 Clark merged the company with WebMD, an online medical company formed from the combination of several medical information web sites which had turned over only $US75,000 the previous year, and sold down his stockholding of Healtheon, telling reporters at the time: “I was naive — I’ll never invest in health care again.”

Ten years later, a reinvigorated WebMD is a billion-dollar company again, arguably the world’s most popular medical news web site for both consumers and health professionals, reportedly receiving 40 million visits a month as well as offering web-based services including online personal health records to users.

Meanwhile, Microsoft and Google have also entered this space, and thousands of patients are sharing their records electronically with providers, hospitals, pharmacies and general practices in dozens of countries, including Australia. Jim Clark, on the other hand, now spends most of his time building and sailing super-yachts and is perhaps best known in Australia as model Kristy Hinze’s boyfriend.

Clark had the right idea, but back in the last decade he was too far ahead of the curve to make it work. Now, however, e-health is an idea whose time has come.

“E-health is an idea whose time has not only come, it is overdue,” says Associate Professor Ron Tomlins, associate professor of general practice at the University of Sydney, who spent several years as chairman of the General Practice Computing Group.

Professor Tomlins said government and professional initiatives in Australia over the past 10 years that put computers, powerful software and broadband in practices have prepared a foundation that will enable GPs to harness the new online technologies that have been developing independently over the same period.

As more and more doctors turn to the Internet as a professional information source, more than 80% now report that the Internet is essential to their practice, according to research in the US by Manhattan Research. Consumers today, meanwhile, get more health information from the Internet than from their doctors, according to market research firm iCrossing.In Australia, trials of electronic health records and other online applications are under way in most states (see Case studies), while the Federal Government tries to set standards through the National E-Health Transition Authority (NEHTA) to ensure consistency, portability and security of records.

In Canada, the government has set a target of 50% of the population to have electronic personal health records by the end of 2009. In Australia, meanwhile, the government is “dragging the chain”, according to Professor Tomlins, with NEHTA recently announcing that it would be another 10 years before personal health records were in established use in Australia. Professor Tomlins said NEHTA is not moving fast enough, pointing out that it underspent its budget by almost $40 million last financial year.

“General practice is frustrated as hell in the lack of interest from the Commonwealth,” Professor Tomlins said. “The state governments are moving things along with projects such as Healthelink in NSW, SHER [shared electronic health records] and secure messaging projects in the Northern Territory and chronic health management programs in South Australia. But there’s a real danger that they won’t be interoperable and we will end up with a rail gauge situation.”

But regardless of that danger, Professor Tomlins says, the increase in data available to GPs puts them in a good position to use new technologies to improve patient care. “GPs have spent the past few years building up electronic databases for their practices,” according to Professor Tomlins. “Tools are now available to use that data to better understand how better care can be delivered to their patients. They can conduct clinical audits to mine that data, both clinical and financial, and benchmark themselves against other practices to find ways to improve the way care is delivered.

Surprise, surprise – e-health records >3 years away

The Australian Doctor website reports today that Australia “is at least three years away from introducing shared e-health records for every patient — despite $150 million being sunk into e-health programs over the past eight years.”

 

Federal Health Minister Nicola Roxon, when interviewed by the Australian Financial Review last week, refused to commit to a 2012 deadline for a national e-health record system.Clinical leader of the National e-Health Transition Authority (NEHTA) and ex-AMA president Dr Mukesh Haikerwal told Australian Doctor, “There is no element of the reform agenda that can succeed unless we have a decent underpinning by a robust e-health system.”NEHTA is believed to be looking initially at a minimum-quality data set – limited to information such as allergies, hospital history and medical conditions to ensure there is enough information “to treat the patient safely”.

RACGP e-health spokesperson, Dr Nathan Pinskier, said while a national e-health record would provide an informed framework for each patient’s care, “GPs were concerned about being overloaded with information not related to their interactions with the patient.”