With the political turmoil happening in the Australian Labor Party – and an election for leadership positions happening on Monday 4 December, 2006 – it seemed important to bring to the attention of my readers the views on e-Health of one of the key protagonists.
On the basis of these remarks I would be keen to see her succeed I must say – all other issues laid to one side.
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AUSTRALIA'S E-HEALTH REVOLUTION: PROMISE UNFULFILLED
Remarks to the ACT Chapter of the Australian College of Health Service Executives
Date: 18 June 2006
Remarks by
Julia Gillard, MP
Shadow Minister for Health
Introduction
Thank you very much for inviting me here this evening. It’s a pleasure to be able to join you for dinner once again, to celebrate the ACT Chapter’s 30th birthday, and to hear more about the work of the Australian College of Health Service Executives.
Health issues are never out of the news. Some days we hear of health care miracles, other days we hear stories of those for whom the system failed.
But whether today’s news story is a good one or a bad one, the fact remains that our health care system is in need of reform and we need strong national leadership to make that happen.
That’s why Labor has insisted that we must be bold enough to undertake long-term reform to address the gaps, holes and duplications in the system caused by the separate Commonwealth and State funding streams and to end the bickering, cost shifting and blame game that currently passes for the national management of our health system.
As individual health executives and as members of a key professional organization, you will be players in determining what reforms are needed, and in implementing them.
Which is why I thought that tonight I would address the issues around the information and communications technologies which must underpin these reforms.
Everyone agrees that new IT systems and capabilities can transform our health care system by revolutionising the way services are delivered, health care professionals work together, resources are managed and deployed, and research and its outcomes are communicated.
There is the expectation that the use of IT to integrate patients’ health records could help prevent over-referrals and over-prescribing and help minimise medical mistakes.
There is the hope that it can ensure that patients are more involved in their own health status and health care.
And without improved and consistent national data collection, we can’t assess the full impact of changes made, we can’t know the full costs and attribute them to the right funding source, and there can’t be full accountability.
Revelations from Senate Estimates
Let’s look at where we are today.
Recent developments suggest that our national e-health strategy has stalled. To be honest, I’m tempted to say it has been an expensive failure.
Following what the Department of Health and Ageing and Medicare Australia are doing in this regard is not easy. Responsibilities have shifted, programs have changed names, and the plethora of committees and advisory groups continues to grow.
One of the advantages of the Senate Estimates process is that you can, with a little effort, find out some of the things that the Government haven’t told us.
No Smart Card to enable patient access to e-health records
In Senate Estimates this time we around we discovered that Minister Hockey made the decision in May – unannounced – to scrap the Medicare Smart Card. At the same time, in his speech to the AMA Annual General Meeting, he let drop that the proposed Access Card will not have the ability to provide access to electronic health records.
In a speech to the National Press Club back in April 2004, I outlined how a second generation Medicare Card could link together the information that currently sits scattered across the health system and enable the management of a seamless health system for patients.
I spoke about a Medicare Card that could contain basic health information, the kind which would be useful in an emergency. I talked about how this Medicare Smart Card, when used with a unique patient identifying number, could give access to a patient’s full electronic health records. And I emphasised how important it was that the patient would control who was given access to their health data.
When Tony Abbott rolled out his Medicare Smart Card, with much fanfare in July 2004, I supported it.
But Tony Abbott’s Medicare Smart Card is dead, and there is nothing on the horizon to replace it, as Joe Hockey has made clear.
The whole-of-government Access Card now being developed under Joe Hockey’s oversight will replace your current Medicare Card and you won’t be able to access Medicare rebates without it.
But Joe Hockey’s whole-of-government Access Card isn’t about access to electronic health records.
We know that of funds committed through COAG to the National e-Health Transition Authority, $45 million will be spent on a unique patient number for every Australian, but there is no information as to how this system relates to anything else the Howard Government is doing.
We don’t know how it relates to Joe Hockey’s Access Card. We don’t even know how it relates to the fact that Medicare Australia will be spending even larger sums on developing a different unique identifier for each Australian.
What we do know is that Joe Hockey’s whole-of-government Access Card won’t do the job a Medicare Smart Card was supposed to do and his plans are fraught with uncertainty and privacy concerns.
HealthConnect has disappeared
From Senate Estimates we also learned that HealthConnect no longer exists as a program, leaving only three small HealthConnect initiatives currently running in South Australia, the Northern Territory and Tasmania.
Indeed, HealthConnect has disappeared from the lexicon of the Department of Health and Ageing and there is some revisionist history at work.
HealthConnect used to be described as a “the proposed national health information network to facilitate the safe collection, storage and exchange of consumer health information between authorised health care providers.” (2003-05 Health Connect Project Plan)
Now the Secretary of the Department of Health and Ageing says: “[HealthConnect] is not actually a program. We should be clear about that: HealthConnect is not a program. There were a series of projects that were funded historically. We have moved now from the trial stage. I think I said yesterday that we have continued with a couple of projects, but we are now moving into an environment where we are looking to a national approach to e-health.”
I think we can say that, in terms of a coordinated national initiative, we are not much further advanced in this area than we were back in April 1999, when the Australian Health Ministers agreed to set up the National Health Information Management Advisory Council (NHIMAC) to “oversee new strategies for more effective health sector information management”.
This Advisory Council then commissioned a National Electronic Health Records Taskforce to report on technology and health records which was done in July 2000.
As a result of the Taskforce report, the Health Ministers agreed to support the development and implementation of HealthConnect and the Better Medication Management System. The cost of the scheme was then cited at around $440 million over 10 years.
The Better Medication Management system morphed into MediConnect and then died after two small trials in Launceston and Ballarat.
HealthConnect trials began in 2002 and as I have noted, some of these continue today, but the reality is something considerably less than we might hope for after 4 years and an investment of more than $200 million.
To date the only real legacy we have is a document released in April 2005 entitled “Lessons learned from the MediConnect and HealthConnect Trials”.
It’s not what I would call bedtime reading. The report is pretty bland and the lessons learned are not obviously stated, but I guess this paragraph sums it up:
“An electronic health record system is technically feasible, but the underlying infrastructure and connectivity ….limited the success of most trails and will be critical to the successful implementation of HealthConnect.”
What went wrong?
Hindsight is always twenty-twenty and I’m certainly willing to acknowledge that introducing new approaches to the management and delivery of health care is not an easy task.
It’s as much about changing the culture and individual behaviour as it is about the sequences of putting the infrastructure and software in place, testing it, and spending resources wisely.
But I think there are some fairly obvious mistakes and some very real missed opportunities.
1. There was no real public statement of what a major investment in e-health would achieve.
The need for a major investment in e-health has been pretty well articulated at the macro level, with some very grand promises made. But at the grass roots level – the level where acceptance and adoption of new systems and approaches is required – individuals have found it hard to see the benefits and easy to see the disadvantages.
People in Tasmania saw no value in spending the time and money to get a full birth certificate and 100 identification points to get a Medicare smart card, with the only apparent difference from the current Medicare Card being the photo on it.
Busy GPs saw no value in spending more time in writing up electronic health records when many of their colleagues did not use the same IT system or in some cases, did not use an IT system at all.
Surely the single biggest objective should have been ensuring all hospitals could communicate with each other and with GPs electronically using the same medical terminology. To achieve this big objective would have required a true partnership with the States and Territories.
But rather than a single-minded pursuit of a big objective – an objective that would potentially save lives and dollars – what we have seen over the past five years is the Howard Government spraying funds on consultancies and individual projects.
Unfortunately, it seems the Howard Government is still on that same merry-go-round with Minister Hockey’s whole of government Access Card. Privacy issues in particular have not been addressed and already there are legitimate concerns about cost management.
Unless and until these issues are addressed and there is a clear statement of intent about the Access Card, the public are entitled to remain sceptical.
I am not the first person to criticise the Howard Government’s approach to e-health as unfocussed and uncoordinated. Back in 2004, the Boston Consulting Group released a report that made the following observations about a flurry of activity in e- health:
* The average project size was small with funding spread across many priorities;
* There were many areas of overlap, due in large part to a lack of national leadership;
* Decision-making was frustratingly slow and lines of responsibility were unclear; and
* There was a real need for the adoption of common standards.
Unfortunately these messages went unheeded.
2. People need to see the advantages of e-health systems for them personally.
There are some wonderful examples out there of how e-health can make a real difference in the effective delivery of health care services, with a positive impact on peoples’ health.
The use of IT to link specialists into the diagnosis and care of cancer patients in rural areas is a great example.
At Geelong Hospital Dr Stephen Bolsin has pioneered an individual performance monitoring system that uses small hand-held computers to continuously check doctors’ clinical performance against recognised standards, leading to better medical training, fewer adverse incidents and improved safety for patients.
But at the same time, grandiose talk about smart cards and shared electronic health records from the Howard Government has left many Australians concerned that
current systems to protect privacy and ensure secure transmissions are inadequate.
3. We must create a real partnership between the Commonwealth and the States.
As a consequence of the problems outlined in the Boston Consulting Report, the States and Territories felt they had to proceed with their own efforts in e-health, and several States have made some very significant investments.
This has led to the very real fear that we will end up with a national e-health system as fragmented and disconnected as the railway system once was. That means a lot of money and resources going to waste.
There was a real opportunity to address this issue in the context of the 2003-08 Australian Health Care Agreements. Unfortunately, that opportunity was lost.
4. Basic IT systems are not there in many parts of Australia
Finally, I think we must also acknowledge that until we have a situation in Australia where everyone can have ready access to super fast and affordable broadband access, there is no possibility of driving even the simplest proposals forward nationally. That’s why Kim Beazley has committed that a Beazley Labor Government would invest in a national broadband network.
Conclusion
I think we have to face the fact that a national e-health system is at least a decade off.
We have lots of good intentions and, finally, some important agreements in place between the governments. But we have very little of the needed infrastructure,
including the basics like broadband, only the first draft of a set of standard clinical terms, no current means of accurately identifying health care providers or patients, and no systems to ensure the privacy of shared e-health records.
A lot of money has been spent and I’m concerned that goodwill and opportunities have also been wasted.
I know you wouldn’t manage your health services in this manner, but the Howard Government’s management of e-health does matter to you and does impact on your work.
To fix the problem we will need a national, collaborative approach and strong national leadership. We will also need all your skills, insights and abilities. Only then can we begin to reap the benefits of the e-health revolution.
Thank you."
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It is hard to take much exception to much of what is said here. Perhaps it would be good to see a recognition of the need to develop a consensus driven National E-Health Plan and some real commitment to actual investment in the plan to operationalize it once developed.
This statement is as sound as could be hoped for and reflects a degree of understanding of the issues I have yet to see from any other National politician.
More power to her e-health arm!
David.
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