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In classical Fabian tradition, the federal Labor government has embarked on a series of reforms that will have an impact on the welfare of “Australian working families”.
The rationale for the health reforms (1) has been exhaustively detailed in the reports of the National Health and Hospitals Reform Commission (2) and the taskforces on the National Preventative Health Strategy (3) and National Primary Health Care Strategy. (4)
A significant and unifying theme in all these blueprints for health reform is the centrality and crucial involvement of general practice in achieving change.
Indeed, these reforms would come to nothing without the willing acceptance and widespread cooperation of general practitioners.
In the recent General Practice issue of the Medical Journal of Australia, Professor Michael Kidd summarises the reform schedules for general practice. (5)
However, there is mounting evidence that GPs are already experiencing difficulties meeting the constant and ever-changing demands placed on their practices.To impose yet another structural reform agenda in an already chaotic environment will be a monumental challenge.
Generally speaking, reform is more readily acceptable if it: lessens rather than increases the workload; improves the efficiency and effectiveness of tasks; increases the quality and safety of services; and provides tangible incentives for participants.
Without a doubt, a major source of frustration and consternation with the federal government’s reform agenda is the very clear sense that it is essentially a top-down approach, rather than a bottom-up consultative process.
In fact, if there were to be a national poll of GPs ranking current health reform initiatives, “e-health” — the use of digital data transmitted, stored and retrieved electronically in support of health care (6) — would definitely emerge as a major priority.
Such information technology infrastructure is crucial to all health care communication in the 21st century but, to date, all we have achieved in Australia has been to indulge in expensive and time-consuming chatter.
We have been talking the talk but not walking the walk!
It must be acknowledged that e-health has been on the federal government’s agenda for more than a decade.
In 2000–01, the then Health Minister, Michael Wooldridge, announced the planned development of HealthConnect — a national system of e-health records that could be shared over secure networks with strict privacy and consent controls. (7,8)
The system was trialled in pilot studies across the country and, in March 2004, the government allocated $128 million for national implementation. (8) But then, in 2005, Health Minister Tony Abbott (now leader of the federal Opposition) pulled the plug on HealthConnect. (7)
Around the same time, the federal, state and territory governments established the National E-Health Transition Authority (NEHTA), with a clear purpose: to lead the uptake of e-health systems of national significance; and to coordinate the progression and accelerate the adoption of e-health by delivering urgently needed integration infrastructure and standards for health information. (9)
Since its inception in July 2005, NEHTA has been spending just under $164 000 a day. (7) It is yet to deliver any e-health outcomes beyond a 2009–2012 strategic plan and the development of a national health care identifier system that was recently ratified by the Australian Government. (10)
In May this year, the federal government allocated NEHTA a further $466.7 million over 2 years, ostensibly to fund development of core national standards and tools that can provide all Australians with access to a personally controlled electronic health record from 2012–13.
The federal government will thus spend $639 315 each day on the implementation of personally controlled electronic health records. (7) Despite this, vigorous debate is ongoing as to who will actually control the records! Confusion reigns.
It must be remembered that the realisation of e-health infrastructure in Australia is underpinned by taxpayers.
Whether it will ever produce a functional electronic communication and record system, which actually improves health care delivery, is the million-dollar question.
Med J Aust 2010; 193: 69.
Posted: 26 July, 2010
Dr Martin Van Der Weyden is the Editor of the MJA.
This article is reproduced from the MJA with permission.
References
1. Australian Government Department of Health and Ageing. A national health and hospitals network for Australia’s future. Canberra: Commonwealth of Australia, 2010. (accessed Jun 2010).
2. National Health and Hospitals Reform Commission. A healthier future for all Australians: final report June 2009. Canberra: Australian Government, 2009. (accessed Jun 2010).
3. National Preventative Health Taskforce. Australia: the healthiest country by 2020. National Preventative Health Strategy. Canberra: NPHT, 2009. (accessed Jun 2010).
4. Australian Government Department of Health and Ageing. Building a 21st century primary health care system: Australia’s first National Primary Health Care Strategy. Canberra: Commonwealth of Australia, 2010. (accessed Jun 2010).
6. World Health Organization. eHealth for health care delivery. (accessed Jun 2010).
7. Dearne K. What Labor has to show for e-health spendathon. The Australian 2010; 15 Jun. (accessed Jun 2010).
8. HealthConnect Program Office. HealthConnect Business Architecture version 1.9. November 2004. Canberra: Australian Government Department of Health and Ageing, 2004. (accessed Jun 2010).
9. National E-Health Transition Authority (NEHTA) (accessed Jun 2010).
10. The Hon Nicola Roxon MP, Minister for Health and Ageing. Healthcare Identifiers: passed by Parliament [media release]. 24 Jun 2010. (accessed Jun 2010).
It is a bureaucratic paradise/and con job. The record will never be reliable because it will never be complete or accurate. I wonder if anyone has considered how the information is going to be transferred from individual doctor and practice records to this mega-data base. Is someone going to pay doctors to go through their patient records and do this? Finally, given the recent failures of privacy safeguards in ATO and Medicare, supposedly our most secure government agencies, who will trust the system?