Australia's e-health strategy has been endorsed by the National Health and Hospitals Reform Commission, which also puts the federal government back in the driver's seat after disastrous delays through the Council of Australian Governments process.
"We want our future health system to be powered by the smart use of data and enabled by the electronic flow of essential information between individuals and health professionals," the commission says.
"Data should enhance decision-making, drive improvements in clinical practice, guide how resources are deployed and provide feedback to promote improvements across all health settings.
"Key to this is a structured, robust communication matrix that connects all participants with relevant, accurate and secure information, in real time."
The commission says it concurs with the direction of the National E-Health Strategy -- produced by Deloitte and adopted by the nation's health ministers at COAG late last year. The strategy is yet to be publicly released.
A copy obtained by The Australian shows the commission has backed Deloitte's recommendations and costings in full.
"There is a critical need to strengthen the leadership, governance and resources committed by governments to giving effect to the (Deloitte) action plan," the commission says.
"This includes providing support to public health organisations and incentives to private providers to augment takeup and successful implementation of compliant e-health systems.
"It should not require government involvement with designing, buying or operating IT systems."
The current lack of interoperability standards, and the inability to send and receive high-quality data -- even within healthcare settings -- should be addressed as a matter of urgency.
The commission estimates an extra $1.2 billion to $1.9bn is needed to fund an e-health system, including between $600 million and $900m for national e-health standards; $500-$800 million for training and support for medical practitioners; $35m-$65m for consumer education, and up to $100m for new research, performance monitoring and governance programs.
These priorities and costs mirror Deloitte's estimated costs of $1.5bn over the next five years for foundation standards, awareness campaigns and a new e-health governing body to replace the sometimes troubled National E-Health Transition Authority.
The commission appears to have accepted Deloitte's view that a fresh start is required, recommending that the federal government "takes responsibility for and accelerates" the development of policy and "open technical standards" -- leaving the National E-health Transition Authority without a role in this space. The report says e-health standards should be developed by state governments, technology vendors, health professionals and consumers, and wants national agreement on a framework by 2011-12.
The federal government should also lead work on personal e-health records, unique healthcare identifiers and authentication services -- currently under the purview of NEHTA, which is hampered by operating as a not-for-profit private company jointly owned by the jurisidictions.
The commission says "mounting cynicism" over the pace of e-health has resulted in calls to "stop the talkfest, and get on with setting a dedicated budget and definite delivery dates", including clear, responsive and responsive governance.
"There remains a small window of opportunity to capitalise now on the considerable investments to date," it says.
The commission recommends adopting a "middle-out approach", echoing Deloitte's "guided market" plan that attempts to avoid the opposite extremes of an industry free-for-all and bureaucracy's dead hand.
Meanwhile, the commission understands its demand that the federal government make payments for health and aged care services dependent on providers' ability to accept and send data electronically is controversial.
"We know the concept of patients controlling access to their own health information may be confronting to some," it says. "This is only one part of the broader environment, and does not remove the need for ongoing development of e-health records by health services, including strategies to integrate information across the care continuum.
"But patients have always had the right to choose whether to share some or all of their information with the professionals they consult."
AushealthIT blogger David More said the commission's report would allow a "reboot" of the local e-health program, but warned that "leadership, governance and change management issues will be critical, as will public trust over the management of health information".
Dr More said the commitment to funding the e-health strategy was positive, and the "broader possibilities of reform are now much more likely to be achieved".
Last year, Deloitte blasted the health ministers over chronic underfunding. "In 2007, estimated local IT spending in healthcare was $1.25bn compared with $7.4bn in financial services and $6.3bn in communications," the Deloitte strategy says. "Based on 2005-06 national healthcare expenditure of $86.9bn, IT investment across the sector represents 1.4 per cent of the total spend.
"This is far short of the estimated $9bn invested by the financial services sector and less than the 4-5 per cent benchmarks for IT spending in healthcare in countries like Canada."
Deloitte also pointed to the "lack of continuity of key political and bureaucratic health sector leaders", saying it made long-term reform difficult to sustain.
Deloitte recommended a guided approach that combined the central co-ordination of key operating and governance issues with flexible market innovation.
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Autor(en)/Author(s): Karen Dearne
Quelle/Source: Australian IT, 28.07.2009
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