Wednesday, May 09, 2012

There Were A Few Wrinkles In The Detail of the Budget That Are Worth Pointing Out.

First it is useful to have a look at the Medical Observer summary.

Budget key points - Budget targets PIP for e-health, immunisation

9th May 2012
Below are the main points affecting general practice from last night's federal budget papers, see today's regular e-news for more.

2012-13 FEDERAL HEALTH BUDGET KEY POINTS

e-Health
National e-Health Program – continuation: $233.7m SPEND
The Government will provide $233.7 million over three years to implement the National e-Health Program including the rollout of the PCEHR.
Allocation will also provide money for:
  • NeHTA to further develop national standards and operate national infrastructure services;
  • the Office of the Australian Information Commissioner to provide regulatory oversight of the national e-Health services; and
  • the Department of Human Services and the Department of Veterans' Affairs to provide support services to PCEHR participants.
Other e-Health measures:
Telehealth incentive payments to be cut from July 2013: $183.9m SAVING
National Health Information Network (HealthConnect program): $73.6m SAVING
Workforce & Primary Care
Practice Incentives Program (PIP) - more effective targeting: $83.5 SAVING
The Government will improve the efficiency of the Practice Incentives Program (PIP) by more effectively targeting incentives to medical practitioners.
The Government will:
  • include a requirement for general practices to participate in the PCEHR system to receive the e-Health PIP incentive;
Lots more details of other changes are found here:
Crucial to a better understanding of what is going on is the document covering Outcome 10 in the Health Budget.
This can be downloaded from here:
To be clear here is what they think they are doing:

Program 10.2: e-Health implementation

Program Objectives

Provide national eHealth leadership
The adoption of eHealth will improve the quality, safety, efficiency and coordination of health care by reducing the fragmentation of information across the health care sector. The Australian Government will lead the rollout of eHealth technology and services nationally by partnering with the state and territory governments to fund the National eHealth Transition Authority (NEHTA). NEHTA will continue to develop the foundational infrastructure and standards necessary for eHealth, including clinically safe, secure and interoperable eHealth specifications for adoption by public and private health care providers.
Develop systems to support a national eHealth system
The introduction of the Personally Controlled Electronic Health Record (PCEHR) system in 2012-13 represents a key milestone in the Government’s strategy to increase Australians’ access to eHealth services. The PCEHR system will enable individuals to register for their record either online, by phone or via selected Medicare shops, and once created the individual will control access. The system will create a better and more efficient health care experience for participating consumers, with a smoother transition of information between care settings, a reduction in the time spent reiterating clinical history or waiting for test results to be located, and a reduction in adverse medical events. Consumers will be able to track their health progress, medications and allergies, while health care providers will have more up-to-date information at the point of care for better clinical decision making. Building on existing capacity and capability and expanding on the geographic footprints of the lead sites will enable a steady and incremental approach to ensure privacy, clinical safety and quality, and ensure that the tangible benefits of the PCEHR system can be monitored, evaluated and reported.
A national eHealth system will be reinforced by the operation and promotion of the Healthcare Identifiers (HI) service. These unique reference numbers give individuals and providers confidence that health information accessed through eHealth technologies is linked with the correct individual at the point of care.
Similarly, the National Authentication Service for Health will issue digital certificates to providers, ensuring that access to sensitive health information is secure. The Department will fund the Office of the Australian Information Commissioner to oversee eHealth legislation, provide consumers and health care providers with information and guidance, and initiate and conciliate complaints.
Provide eHealth services
In 2012-13, the Department will commence delivery of the Telehealth Pilot Program, which uses the National Broadband Network to give patients access to primary health care and specialist consultations from their own homes. The focus of the program will be on aged care, cancer care and palliative care.
----- End Extract
Note the subtle change in governance and note the emphasis on a steady incremental approach. It seems NASH is yet to start as it is talked about in the future tense.
An astonishingly different picture emerges here from the figures on the split of funding. The figures  that follow that shows just how the spending has slowed.
2011-12 Estimated Final $372,856 M(illion)
2012-13 Budget $82,102M
2012-14 Budget $117,464
and then in the years that are not funded $15,102M and $14,884M.
It is also important to go here to look at what is proposed for the PIP program:
Here is how the changes are described:
“In 2012-13, the Australian Government will introduce new eligibility requirements for the Practice Incentives Program (PIP) eHealth Incentive to encourage general practices to keep up-to-date with the latest developments in eHealth and to promote uptake of the Personally Controlled Electronic Health Record (PCEHR).
The new requirements will encourage general practices to safely and securely share accurate electronic patient records to enhance the quality of care provided to patients and undertake activities such as electronic prescribing and use of the PCEHR system.
The Department will continue to consult closely with the National eHealth Transition Authority, the PIP Advisory Group, medical software developers and Medicare Australia in the development of the new requirements and to ensure that the appropriate software is available to practices with sufficient lead time to prepare for implementation. In 2012-13, the Australian Government will introduce new eligibility requirements.”
---- End Extract
The detail will clearly come out in due course. Already I am seeing some pushback from the RACGP and AMA.
What is also interesting is this table:
If you look at e-Health what you see is that in fact e-Health spending taken over the forward estimates has been dropped by $20M or so - by cutting telehealth and the National Health Information Network (I thought that died years ago - it was called Healthconnect!)
In summary I see in all this a lot of funds movement and a real cut in the total investments being made - especially in the next 12 months.
No one can imagine that the PCEHR is finished, that it is ready to switch on and that all the feeder systems are up and working. There are a lot of moving parts and it is hard to know what is actually funded and what are just pipedreams at this point. Clearly some operational funding is now with Medicare and so on.
I would love to know 2 things if anyone knows.
1. What the roughly $20M p.a. on the National Health Information Network was and what has this been doing over the last few years?
2. What this is about?
$35.0 million - Regional Queensland eHealth project;
See:
There is a lot more reaction coming - but I think those who seem to think the budget is wonderful news for the PCEHR and NEHTA are smoking something very potent and mood elevating!
At least one other commentator sees things similarly:

E-Health, PCEHR, Nehta: Losers in Australia’s Budget

Posted on
What all those talking of funding boosts and so on are forgetting is that these funds are much less than in the previous two years and that there was essentially no-ongoing funding - so just how can this be a boost?
David.

6 comments:

Anonymous said...

DLR 34.95 Health & Hospital Funding

Qld Project: E-Health to Support Integrated Care in Regional Queensland

Weipa, Cooktown, Bamaga, Thursday Island, Atherton, Mareeba and Mossman

B said...

The incentives scheme looks a little suspicious to me.

The government seems to be suggesting that GPs will be blackmailed into using the PCeHR.

Where does that leave the patients, who supposedly have an opt-in option? Will the GPs be in a conflict of interest?

It seems a strange strategy. If the PCeHR is good enough to stand on its own two feet then such blackmail shouldn't be necessary.
To resort to such measures rather stinks. IMHO

Anonymous said...

A Departmental spokesperson would say that nothing has changed - the patients have an opt-in option, and the doctors, who have no real power, have a simple choice to make - take the money or leave it.

B said...

So how do they assess if a GP uses the PCeHR? I would have thought that a GP could only use an eHR if the patient had one.

Or is it just that the GP says they will use the system if the patient opts in?

Still seems strange to me.

Anonymous said...

I don't think there will be much requirement to use the PCEHR initially. The ePIP will probably be tied to how many people have been signed up to the PCEHR by the doctor.

Probably the next level of ePIP will then be volume related tied to the number of electronic scripts that are transmitted to a Prescription Exchange Service [PES].

There may also be a third level where the doctor receives an ePIP each time the eMR in the PCEHR is updated by the PES.

Anonymous said...

Is it a bad thing to pay doctors by volume for the number of electronic scripts they pump up?
A doctor may mistakenly think that he is being encouraged to prescribe more than necessary medication!
Also, persuading patients to have a PCEHR in order to receive payment seems perverse.
More likely GPs will get paid if they simply register to participate - after all it is not their fault if none of their patients do not choose (personally control) to have a record. But it DEFIINATELY IS their fault if their patients are so well managed that there is little or nothing to report to the PCEHR in the way of significant medical intervention. It's enough to give them the ePIP.