A personal perspective on the reality of the PCeHR –what was promised, what was done, what was delivered.
“We’re doing this based on the hard work already achieved, not trying to build a one-size-fits-all system from scratch.” (Minister’s bold emphasis)
“I can confirm that the Government is not going to build a massive data repository. We don’t believe it would deliver any additional benefits to clinicians or patients – and it creates unnecessary risks.”(Minister’s own bold emphasis)
“the Government has committed $467 million to develop electronic health records into the future.”
Minister Roxon Opening Address to the eHealth Conference, Revolutionising Australias’s Health Care, Nov 2010.
Sounds good. All over the World eHealth has been recognised as one of the means of enabling governments to maximise their healthcare spend. President Obama called it the “low hanging fruit”, and the then Health Minister Roxon assured Australia that “e-health promises change that will transform Australia’s health care.” Implemented properly there is little doubt that the duplication, errors, and care co-ordination can be significantly improved. So what happened over the last 2 years and 11 months to result in Minister Dutton’s announcement that over a billion dollars has been wasted by the previous government?
The Rudd – Gillard – Rudd government’s National eHealth Strategy and the recommendations of the National Health and Hospital Reform Commission Report had support in the industry. The National eHealth Strategy was clear that there should be no top down, big bang approach. Industry should be given the support of some critical infrastructure, and left alone to get on with their business. The NHHRC said the plan “should not require government involvement with designing, buying or operating IT systems” - this had not worked anywhere internationally. In 2010 when Australia was about to spend $467 Million, there were reports of the UK Health Service National Programme for IT having spent £16 Billion without success.
There were many lessons which Australia could learn from, and there was almost a sense of optimism amongst industry in Australia. There was a sensible plan for a ten year rollout of ehealth. There appeared to be no political milestones. There was emphasis placed on the governance. There was pretty good funding. Despite concern over the grant of several million without tender to 3 of the “First Wave” sites, industry was slightly mollified by the explanation that there would be transparency of what occurred in this First Wave so that the lessons could be shared and industry spared some of the inevitable pain of change. Many in the medical software industry believed that the government was aiming for sustainable growth in the sector, good for innovation and productivity of an industry which Austrade lists as a key growth sector.
Almost three years down the track and with over a Billion dollars spent, industry optimism has been replaced by cynicism and disappointment. Australia has a very expensive piece of infrastructure which is not achieving its stated purpose. Roxon’s promise of mothers having their sick children’s medication histories at their fingertips appears ludicrous. The experience of patients, doctors, allied health care and the army of others involved in health services has not improved. In fact in some cases it is worse. Promising so much, and delivering so little. Ignoring international learnings and recklessly throwing millions of dollars at getting “numbers” of people registered without any interest in meaningful clinical outcomes. There were significant doubts as to whether there was in fact a level playing field. Even some of the keenest “eHealth heroes” have walked away. A huge loss for eHealth, the medical software industry and Australia.
Over the last 3 years we have had a government which pledged to do one thing but did the opposite, competed with industry, failed to collaborate and fostered a culture of secrecy. We continued to hear how successful the PCeHR was despite first-hand experience of its deficiencies. eHealth was misunderstood by the people who were charged with its implementation. The motherhood statements in grand Hotel Ballrooms about how all the “waves’ would provide critical lessons for the ehealth reform have all unravelled.
The reason I am pleased about Minister Dutton’s review is that it openly recognises the failure of the project and has 10 sensible terms of reference which acknowledge the important role the private sector should play. Some of us in the industry were starting to feel as though we lived in a parallel universe. The industry does not want much. If the government could simply do as little as possible and as much as necessary, we would be a lot better off. Fund national infrastructure like a workable National Authentication system, reward success, incentivise meaningful use. None of these are new ideas. They are all a part of the Strategy and Report which the previous Government said it followed. The “ massive data repository” which the government was not going to build, has been built. Whilst it may not be fit for the purpose which successive Health Ministers ascribed to it, it could be beneficially used as a national reporting database. It was never meant to do all the co-ordination and specialised tasks that are done by so many smart medical software systems. We all know that a one size fits all will not suit the diverse needs of the Australian health system.
I am glad that the review is only 6 weeks long. The industry deserves certainty and a clear direction. This whole project needs some sunshine to enable the eHealth reform to get back on track. The original road map is there and the medical software industry has the capacity to make it work. The above is an entirely personal view. In a fortnight the medical software industry members will be meeting to conduct live polling to consider the terms of reference and identify key areas in which they can contribute to the process of the Review Panel.
Emma Hossack is CEO of Extensia and the Secretary of the Medical Software Industry Association. The view above are, however, her personal views alone.