The Background to and Present State of Health ICT In Australia

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The development of Health ICT in Australia has had a very long gestation. What has happened is probably best considered under three headings.

Contents

GP Computing

The advent of workable, reliable personal computers by the mid 1990’s was a necessary but not sufficient stimulus for General Practitioners to start adoption. The keys to adoption was a very generous Government incentive package and the development by Medical Director of the necessary software to enable the printing of prescriptions - that could be made available at very low cost via advertising sponsorship (since abandoned). The following outlines the story to 2006. It is fair to say the program was so effective that by then adoption was 90% + of practitioners

The Australian PIP Program

The Australian General Practice, Practice Incentive Program (PIP) has been in operation since 2001. In this program accredited General Practices are provided with financial incentives to reach various performance targets. The PIP grew out of the Better Practice Program in response to a series of recommendations made by the General Practice Strategy Review Group (GPSRG) that reported to the Government in March 1998.

  • Payments are made on the basis of a factor termed the Standardised Whole Patient Equivalent (SWPE) which is an estimate of the level of practice complexity and activity based on information gathered by Medicare Australia during its payment processing for Medicare funded services.

The typical General Practice will be about 800 – 1600 SWPEs per full time doctor – e.g. a 4 man practice will have a SWPE of about 4000. The statistically average FTE GP sees 1,000 SWPEs annually according to Medicare Australia. The overall program is by no means trivial having cost $250+ Million in 2005/06. One component of the PIP focuses on the deployment and use of Information Technology in General Practice. The IM/IT PIP program used to cover three areas until it recently was updated – with different requirements for payment eligibility – in November, 2006.

  • In the earlier version the payments were as follows:

Tier 1 - Providing data to the Australian Government - $3.0 per SWPE Tier 2 - Use of bona fide electronic prescribing software to generate the majority of scripts in the practice - $2.0 per SWPE Tier 3 - The practice has on site and uses a computer/s connected to a modem to send and/or receive clinical information - $2.0 per SWPE Thus to receive $7000 a year per practitioner a practice essentially had to fill in a few practice profile forms, utilise prescription printing software that could be obtained very cheaply or free from HCN Ltd and have a modem to pick up results electronically from a local pathology provider. Given the economic life of a PC is about three years this amounts to a very substantial payment for a PC and a printer. Even if a networked environment for three to four practitioners was deployed $60,000 - $80,000 would be more than enough to fully fund the system, its installation and a considerable profit! It should also be remembered that prescription printing – and most especially repeat prescription printing - is one GP computing function that has been demonstrated to save GPs time and thus money. Despite this we (the public) paid them to start using it!

  • Under the new payment scheme the criteria have been updated.

For Tier 1 the practice has to record electronically the allergies of a majority of their active patients and to have in place adequate internet and anti-virus security measures. This gets the first $4.0 per SWPE. For Tier 2 the practice must record major diagnoses and current medications in the patient’s electronic record. This generates an addition $3.0 per SWPE. On the basis that there are a little over 4000 practices are signed up for the IM/IT PIP payments, and that they have an average of three practitioners each, this is costing approximately $84 Million per annum.

  • What was actually going on here was that the Government via Medicare Australia is paying GPs to undertake the most basic parts of electronic patient record keeping and setting the expectations so low that only minimal benefits are likely to flow.

To quote Mr Abbott (the then Federal Health Minister) from a press release of December 2005 which was based on a speech entitled: Better records make better doctors A speech by Minister for Health and Ageing, Tony Abbott, to the Australian Medical Association E-Health Forum, Canberra, 8 December 2005. “Five years ago, the Health Ministers' Council first committed all Australian governments to the development of an integrated IT-based health record system. Over the past decade, the Commonwealth Government has paid some $600 million in IT-linked GP Practice Incentive Payments. Over the past 18 months, the government has committed $60 million to the Broadband for Health initiative, designed to ensure that every general practice and pharmacy has access to business-grade connectivity. So far, the government has committed more than $110 million to developing HealthConnect, including $9 million in half-funding the National Electronic Health Transition Authority which aims to standardise usage and facilitate inter-operability of federal, state and private health IT systems.” See: here (Accessed September, 2012)

  • There has been some fiddling with the criteria for receipt of PIP payments since (with the addition of some requirements for GP Software certification) but the largest - and most demanding changes - were announced in the 2012 Budget.

To quote the Government: “As a recap, the key messages are: - The PIP eHealth incentive, announced in the 2012-13 budget, aims to encourage general practices to keep up to date with the latest developments in eHealth - The five requirements and associated compliance dates are: o 1. Integrating Healthcare Identifiers into Electronic Practice Records - February 2013 o 2. Secure Messaging Capability - February 2013 o 3. Data Records and Clinical Coding - February 2013 o 4. Electronic Transfer of Prescriptions - February 2013 o 5. Personally Controlled Electronic Health Records - May 2013 - The PIP eHealth Product Register is intended for Practices to check if they have compliant software - More information will follow shortly on how vendors can list their products on the PIP eHealth Product Register. In the meantime we encourage you to peruse the information enclosed in the slide pack.” The slide pack is found here: (Accessed September, 2012) This is a very major change and it will be of interest to see just what compliance with these pretty demanding changes are achieved in under a year from the announcement.

  • In summary the PIP Program certainly, via the use of very generous incentives has put computers on the desks of most GPs. However the levels of use now being requested to retain the incentives are likely to be quite challenging and there is already significant ‘push-back’ from the profession.

State Government Public Health Initiatives

Each of the individual States and Territories have, over the last 20 years, developed and attempted to implement various levels of automation in the organisations (mostly public hospitals) for which they are responsible. (The various applications that have been attempted will be discussed later in the course. Essentially the approach has been to do administrative and background tasks and the to move towards more clinically focussed initiatives). Most have met with considerable difficulty - with the HealthSMART Initiative being an obvious case in point. Where relevant various issues will be discussed as the various applications are explored.

National Initiatives

We are fortunate to have two recent documents both of which explain and dissect the initiatives that have been undertaken at the Federal Level in the Health ICT Space. The first is the National E-Health Strategy which was developed in 2008.

National E-Health Strategy

In early 2008, Australian Health Ministers, through the Australian Health Ministers' Advisory Council, commissioned Deloitte to develop a strategic framework and plan to guide national coordination and collaboration in E-Health. As part of this process, Deloitte conducted a series of national consultations which included Commonwealth, State and Territory Governments, general practitioners, medical specialists, nursing and allied health, pathology, radiology and pharmacy sectors, health information specialists, health service managers, researchers, academics and consumers.

  • The National E-Health Strategy developed by Deloitte, together with key stakeholders, provides a useful guide to the further development of E-Health in Australia. It adopts an incremental and staged approach to developing E-Health capabilities to:

• leverage what currently exists in the Australian E-Health landscape; • manage the underlying variation in capacity across the health sector and states and territories; and • allow scope for change as lessons are learned and technology is developed further. The Strategy reinforces the existing collaboration of Commonwealth, State and Territory Governments on the core foundations of a national E-Health system, and identifies priority areas where this can be progressively extended to support health reform in Australia. It also provides sufficient flexibility for individual states and territories, and the public and private health sectors, to determine how they go about E-Health implementation within a common framework and set of priorities to maximise benefits and efficiencies. Summary of the National E-Health Strategy (PDF 246 KB) Summary of the National E-Health Strategy (HTML Version) The full version of the National E-Health Strategy can be downloaded (PDF 3522 KB) The full version of the National E-Health Strategy (HTML Version) Here is the page link (Accessed September, 2012)

Parliamentary Library Review of e Health

The second is a review which was prepared by the Parliamentary Library in the context of the Parliamentary Debate on the National E-Health Record System Legislation. Here is the abstract of this very useful document which reviews the last 20 years of initiatives at a Federal level.

  • The e health revolution—easier said than done

Research Paper no. 3 2011–12 PDF version [1312 KB] Dr Rhonda Jolly Social Policy Section 17 November 2011

  • Executive summary

E health is seen by some as possibly the most important revolution in healthcare since the advent of modern medicine. E health makes use of developments in computer technology and telecommunications to deliver health information and services more effectively and efficiently. As such, it requires a different and radical way of thinking about the delivery of health services.

  • Since the 1990s, the potential of e health has been discussed globally, but it remains a work in progress everywhere, albeit that some countries have had more success instigating measures than others. There are many reasons for the slow adoption of e health. These include: the fragmented funding and governance of healthcare services, resistance of professions to changes in existing models of care, a lack of rigorous research evidence on the benefits that might drive change and a reluctance of politicians to be seen to be tampering with a politically-sensitive service. There may also be concerns about the costs and complexities associated with e health implementation and the need to resolve issues about how it will affect practitioners and consumers alike.

This research paper does not attempt to discuss all the aspects of e health in depth, for the subject is extensive, both technically and in policy terms. The paper provides instead an introductory overview of some of e health’s critical aspects. In so doing, it looks briefly at certain aspects of the overseas experience of e health policy development and considers some practical application case studies. For the most part, however, the paper concentrates on the evolution of e health policy in Australia.

  • For Australia, e health holds great potential in many areas, such as resolving the tyranny of distance or reducing the costs associated with caring for an ageing population. This notwithstanding, policy makers have discovered that there are many obstacles to developing national e health policies and programs. Some of these have been resolved; others persist; still others are only just beginning to emerge. While the paper discusses most of these in a broad context, it also focuses on particular issues, such as concerns about how e health will affect patient privacy.

The paper concludes that e health does indeed have great potential, but harnessing that potential has, and continues to require finding and negotiating a delicate balance between many interests and issues. The report is found here (Accessed September, 2012) Review of these documents will provide a rich view of both the history and an outline of current plans.

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