Budget 2010: Devil is in the details for e-health - industry group

E-health software providers are concerned about whether the voluntary e-health records will eventuate, and whether enough money has been committed

Industry groups are cautious about the e-health funding announced by the Federal Treasurer, Wayne Swan, in the 2010/2011 budget, with worries the funding may not be enough and detail is too scant for a proper implementation.

Medical Software Industry Association (MSIA) president, Geoffrey Sayer, told Computerworld Australia, that while "any investment is a good investment," the devil is in the details about how the funding will actually translate to a national e-health system.

As predicted by industry groups, electronic health became the biggest point of ICT investment in the Federal Government's 2010 Budget, with Swan announcing a $466.7 million commitment to voluntary, personally controlled electronic patient records over two years.

The e-health funding is part of a larger, $2.2 billion investment in the health sector which the Government expects to fund through the increased cigarettes excise, amounting $2.3 billion over the next two years.

In delivering the Budget, Swan the opt-in records system - which will provide health history, pathology and radiology summaries and prescription information - would help modernise the health system and would improve "patient safety and health care delivery". It would also help to reduce cost duplication in the health sector.

"These are landmark reforms — the biggest since the introduction of Medicare — and they are fully funded over the forward estimates," Swan said. "Combined with the agreement reached at COAG, our investments will deliver better health care."

However, the e-health commitment falls shy of the $5 billion estimates some were touting for the total health budget, as well as the total budget industry groups were hoping to secure for e-health systems.

The funding is also short of estimates from independent reports released in recent weeks. One such report, by consulting firm Booz & Company, found Australia would need to spend between $4 billion and $8.5 billion to implement a comprehensive, national electronic health system that could save the Government up to $7.6 billion per year by 2020.

With the $466.7 million set to be distributed in two allotments -- $185.6 million in 2010/2011 and $281.2 in 2011/2012 -- this funding will likely dry up before the 2012 deadline for the electronic health record project recommended in the National Health and Hospitals Reform Commission's (NHHRC) study, A Healthier Future For All Australians: Final Report, in June last year. Of the eight recommendations outlined in the NHHRC report, only patient records and unique health identifiers have been addressed by the Government.

Not all are negative about the funding; in fact, some are ecstatic about it.

"What the Government has provided for here is the funding for the first two years of that program in full," the National eHealth Transition Authority (NeHTA) chief executive officer, Peter Fleming, said. "It provides everything that we asked for."

Sayer acknowledged that it was a "positive step forward," but that the next steps were critical to its effectiveness.

The MSIA is an industry group representing 96 medical software companies, which met recently to discuss another pressing e-health project; the unique health identifiers which are expected to begin operation on 1 July this year.

Sayer said the funding for health records would likely come on top of existing funding allocated to the identifiers program, which was a preliminary requisite for the records themselves. However, Sayer expressed concern over how the funding would eventuate for e-health providers, and whether the Government was truly committed to implementing such a system.

"To suggest that having an opt-in system is going to cut the 190,000 hospital admissions associated with medication errors may be ambitious," he said. "There's a lot of the building blocks that would be required for the system to work are still in progress and not done, from the NeHTA work program and other activities."

The other concern focuses on the balance between e-health systems for hospitals and those for community healthcare providers such as GPs and specialists. Sayer said the traditionally hospital-centric focus emphasised by the government-run NeHTA and jurisdictional bodies in states and territories meant information wasn't being shared effectively in the community, where the vast majority of medical care actually occurs.

The University of Sydney Professor of Surgery, Professor Mohamed Khadra, agreed with Sayer's sentiments, believing a truly effective e-health system would be built from the GPs and clinics upwards.

"The GP is the person coordinating patient care; they're the ones that need to have access to hospital records and data," Khadra said. "While what happens in a hospital is critical in the process, it's actually pre-care and post-care from the hospital that's vital, and if the GP doesn't know what's going on, it's a real shamozzle."

"I've heard those concerns raised a number of times," NeHTA chief executive officer, Peter Fleming, said. "The primary healthcare environment is extraordinarily important to us with these implementations; I think that's been well articulated from the Minister [Roxon's] announcements and from the government as a whole in terms of the financial input into the primary care sector."

However, Fleming wouldn't comment on whether GPs would be incentivised to implement e-health systems and share electronic information between clinics and hospitals.

Work has already begun on the electronic health records. NeHTA has submitted a business case to the Coalition of Australian Governments (CoAG) which, once ratified, can begin the consultation process with key stakeholders in the system; GPs, patients and the MSIA included. Fleming also said that key specifications in the formulation of the forthcoming identifiers scheme would inevitably flow through into the health records, providing a technical foundation on which e-health providers would be able to begin building nationally consistent solutions.

The records will be regulated by the Office of the Privacy Commissioner through $500,000 in existing funding over two years.

Budget Papers mandate state and territory governments continue existing investments in e-health.

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