A blistering speech by federal Health Minister Tony Abbott has shocked the IT health community and caused a bitter parliamentary rift over whether Australia's electronic health records should be held on a single massive database.
Speaking at a breakfast briefing at Parliament House last week, Abbott directly contradicted previous undertakings made by Human Services Minister Joe Hockey that the government was not out to build a "big brother supercomputer" or revisit the dreaded Australia Card concept.
However, after welcoming the technology-centric audience by saying it was "nice to see IT geeks have breakfast", Abbott told a stunned audience he saw "no reason why the relevant information [electronic health records] could not be copied to a central database and then onto an appropriately secure system".
He added the information could then be sent back to those sufficiently authorized to view the files such as doctors and health care providers.
The comments are understood to have sparked alarm at the office of Joe Hockey, who has spent the last fortnight attempting to stem privacy concerns over a proposed integrated smartcard solution to cover Medicare, Centrelink and a range of other government services.
While Abbot's Department of Health and Ageing (DoHA) is responsible for federal health policy, Hockey's Department of Human Services (DHS) is responsible for delivering services and infrastructure.
DHS absorbed both the Health Insurance Commission and Centrelink into its portfolio in April after sacking the boards of both organizations. It controls some $80 billion in funds for payments and services delivered to Australians each year.
Both departments have been ordered by the Prime Minister to cut costs significantly and improve service delivery, with information technology identified as the core focus for such efforts. Both ministers must also formally report their improvements to Cabinet by the end of the year.
While acknowledging a "central database" was not a preferential IT term in Human Services, a spokesperson for Joe Hockey's office sought to hose down the clear divisions, saying the contradiction amounted to a difference in language rather than substance.
"We are working together, we are developing solutions. DHS is working on a smartcard solution, it's not just being railroaded in. There is consultation with relevant groups," the spokesperson said.
Having raised the possibility of centralizing patient data currently held by various state health systems, Abbott said hundreds of millions of taxpayers dollars were being wasted each year through duplicated testing "because doctor number one cannot see the results from doctor number two."
E-health put on notice
Health Minister Tony Abbott has put federal health IT bureaucrats on notice saying he expects tangible results within a year, specifically functioning electronic health records and accompanying smartcard system - or heads would start to roll.
"I am sick of trials and studies and working groups," Abbott said.
"I want patients to see a difference in 12 months. If patients do not see a difference, we will have failed," Abbot said, adding he was not prepared to be "held hostage" by a never-ending chase for the latest and greatest IT solutions.
"For too long we have tried to achieve too much. The best is the enemy of the good."
Asked whether he was prepared to force Australia's eight state and territory health systems to adopt federal health IT standards by linking their funding to outcomes stipulated by Canberra, Abbott said that state health ministers were as frustrated as he was with the seeming lack of progress and that there was no need for [force].
He was far less generous to federal IT practitioners.
"Maybe I should make some federal public servants' pay dependent on outcomes," Abbott said.
A spokesman for Abbott insisted the comment was made in jest, but that public servants were still required to deliver within the 12-month window. "Look, it can't go on forever," the spokesperson said.
As for whether the government is considering a "central database", the spokesperson said Abbott meant "you have to put the information somewhere."
Whether the single largest IT undertaking in Australia's history can be built in a year remains to be seen.