Australian E-Health finds itself at a crossroad - It is hard to know what comes next

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In the last few months there have been a number of releases and  events that we can look back on and see as quite seminal for the whole  Health IT endeavour in Australia.

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First, we had the release of the Federal Budget on Tuesday May 13, 2014. This has been one of the most contentious Budgets in recent memory, especially regarding some aspects relating to health (e.g. the proposed $7 Medicare Co-Payment). As far as e-Health is concerned, an additional one year of funding was provided to give Health Minister Peter Dutton time to work out what to do with the e-Health /Personally Controlled Electronic Health Record (PCEHR) program.
A detailed review of a range of the Budget measures undertaken by the Parliamentary Library and some commentary can be found at:
http://aushealthit.blogspot.com.au/2014/07/the-parliamentary-library-provides-post.html
Second, we had the release of the Royle review of the PCEHR which was requested by Minister Dutton on taking office. The PCEHR Review was handed to Government in December, 2013 (after having taken just six to seven weeks) and released following the Budget in May 2014.
The full Review can be obtained at:
http://health.gov.au/internet/main/publishing.nsf/Content/PCEHR-Review
A summary of the recommendations from the 91-page report are found on page 16 and, in very broad terms, can be summarised as recommending:

1. Much improved governance of the National e-Health Program - including the establishment of a broadly representative Australian Commission for Electronic  Health (ACeH) which reports directly to health ministers.


2. Dissolution / absorption of NEHTA into ACeH.


3. Transition of the PCEHR from an ‘opt-in’ and ‘opt-out’ system with every citizen having a record created and populated for them unless the citizen takes active steps  to ‘opt-out’.


4. Rename the PCEHR to the MyHR (My Health Record).


5. The undertaking of a range of reviews to eliminate duplication of activities between the ACeH and the Department of Health.


6. Privatisation of a range of current NEHTA / Department  of Human Services activities.


7. Reviews of a range of e-Health infrastructure programs to ensure they are working as intended.


8. Improved measurement, reporting and transparency on  all aspects of e-Health.


9. A range of steps to attempt to enhance clinical usability  and utility of the system.


10. A range of miscellaneous smaller initiatives.

Sadly, the review did not drill down sufficiently to ask the really important questions around the purpose and value of the PCEHR and whether the present design and implementation of the system was optimal or needed change. The assumption seems to be that the basics were all correct - a contention with which I strongly disagree.
It needs to be noted that the PCEHR Review was a report to government and, as such, was not binding on government.
Third, there was the surprise announcement that former President of the AMA and one of three members of the PCEHR review panel, Dr Stephen Hambleton, had been appointed chairman of the NEHTA Board. There was a universal view that this appointment was a ‘good thing’, however one is forced to wonder just what impact and control the good doctor is likely to be able to exert on a board and organisation he recommend be ‘dissolved’.
At the time of the publication of the PCEHR Review, it was announced there would be consultation with a range of stakeholders on the review’s recommendations to assist the Health Minister to work out what to do next. This review consultation process began in late July, 2014 and is intended to continue until September 1, 2014. There will also be an on-line survey at http://www.ehealth.gov.au.
The consultation process is very tightly constrained and, apparently, when completed and considered, government will consider the recommendations and move forward to implement its decisions.
It’s hard not to reach the conclusion that the government is struggling to work out exactly what it should do. It is already clear that some of the recommendations are not possible in the Review recommended timeframes and that budgetary constraints will put a limit on what will be spent to ‘fix’ all the issues identified.
There is also a considerable body of expert opinion that suggests a fundamental review of future options beyond what is contained in the Royle review should be undertaken, especially given the international experience of similar systems which suggest that the present national approach being adopted may not be ideal.
No matter what the consultation process throws up, I get the sense the very short consultation period may go some way towards preventing the best possible outcomes being reached. That said, I suspect that by early next year it will be clear where the government is heading. It is also possible that what is finally decided may be quite radical - such as outsourcing / privatising the entire initiative in order to let this very complex cup be ‘passed’ from government. It’s hard to argue the last 15 years has shown either side of politics as very good at this sort of technology adventure.
Whether the course the government is taking is the right one,  we will just have to wait and see!

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It’s hard not to reach the conclusion that the government is struggling to work out exactly what it should do. It is already clear that some of the recommendations are not possible in the Review recommended timeframes and that budgetary constraints will put a limit on what will be spent to ‘fix’ all the issues identified.
DR DAVID MORE

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Dr David More
Health IT Consultant
Dr David More is a Health IT consultant with more than 20 years’ experience in the e-Health area. His blog can be found at www.aushealthit.blogspot.com and covers all matters e-Health. He may be contacted via the links provided on the blog.