Australian Doctors’ Fund Blog

E-health System May Be Doomed

March 18th, 2010

E-health System May Be Doomed

Written By Nicki Bourlioufas - Freelance Journalist - 22/02/2010

A national electronic health care record system would cost Australia billions of dollars and the highly fragmented nature of healthcare record keeping across Australia could make a centralised system difficult to implement.

Already, much money has been expended on developing e-health in Australia while a clear national strategy has not yet been established. After many reviews, reports and an estimated $5 billion spent on various e-health initiatives by state and federal governments, the country is no closer to realisation of a national approach to e-health, according to research firm Ovum Research in its National e-Health Strategy Progress in Australia report.

Despite this lack of direction, the federal government is pushing forward with the introduction of healthcare identifier records. By July, unique healthcare identifiers (HI) are expected to be assigned to all Australians. Legislation to underpin the 16-digit number – the Healthcare Identifiers Bill 2010 – has recently been introduced into federal parliament.

Estimated to cost between $1.2 billion and $2 billion, health identifiers will include a person’s name, address and medical records, allowing health providers to access a person’s medical records electronically. The numbers will be available on a secure system, operated by Medicare Australia. The federal government claims this will help avoid medical mix-ups or one person’s information being recorded on another patient’s file.

“The new identifier system will facilitate reliable healthcare-related communication, support the management of patient information in an electronic environment and provide the foundations necessary to support the development of a national e-health record system,” said the Health Minister Nicola Roxon after introducing the HI legislation into parliament in early February.

But it is up to healthcare practitioners whether or not they use HIs. Given the extra expense to healthcare providers of adapting existing software to conform to the numbers, some providers may be reluctant to participate in the program, which could undermine its success.

“Getting a broad range of healthcare providers to participate in the system is going to be critical in achieving widespread use of healthcare identifiers in the healthcare system,” said Ms Roxson.

Criticism has also emerged that HIs could compromise patient privacy. Consumer groups have complained of a lack of consultation and they are also concerned that the use of HIs could extend in the future beyond their initial intended use. Medical professionals say attempts to centralise record keeping for medical information could result in expensive failures given the dynamic and complex nature of delivering healthcare. In addition, the sharing of data electronically could never replace direct communication between clinicians regarding a patient’s care.

There have also been complaints that the HI system is being rushed to meet the July deadline. The Medical Software Industry Association has reportedly said that it has not yet seen a working version of the system - they claim at least six months of testing is required on current software in order to cater for any changes. Some experts say utilising existing technologies in the medical sector, as well as developing bottom-up or sector specific solutions, is a better and more affordable approach than a centralised record-keeping system.

Criticism has also come from the Law Council of Australia (LCA), which says a patient’s health information could be disclosed for reasons other than the provision of healthcare under the current HI legislation. “The Law Council submits that a clear statement of legislative intent regarding the limited use of a healthcare identifier is imperative and the exceptions relating to use or disclosure authorised under ‘another law’ at least need to be clarified, if not removed.”

To protect privacy, the LCA says the federal Privacy Commissioner should be given powers under the identifier legislation to conduct audits of use of the information. The AMA has supported this call. Indeed, the AMA says protection of patient privacy will be a critical factor in gaining acceptance from consumers and the medical profession in the implementation of e-health records.

Critical comment has also come from the Australian College of Health Informatics (ACHI), which says the Healthcare Identifiers Bill lacks clarity and foundation. “We are concerned that a substantial pilot of the HI system for evaluation has not occurred,” says the ACHI.

“The draft seems to establish the framework for an e-health system that may never exist or be funded … the information available regarding any possible framework is also very scant and inadequate. ”

The Council of Australian Governments (COAG) has provided $218 million over the next two years to fund the National E-Health Transition Authority (NEHTA), which is the lead organisation supporting the introduction of e-health in Australia.

E-health has already had a fragmented start. In January, the federal government scrapped a tender for the development of an e-prescribing program. While no reasons were given, the scrapping of the tender was a surprise to participants given its complexity and the resources already devoted to it.

International experience reveals problems with establishing e-health systems, including costly blowouts.

In January, Germany shelved the introduction of the country’s e-health card system, which has so far cost the nation 1.5 billion euro ($2.3 billion). The project, which had been intended to give every citizen an electronic card which held their health data, medical history, prescriptions and insurance status, was due to be launched in January 2006. But the program, one of the largest in Europe, is running at least three years behind schedule.

In the Canadian province of Ontario, a health minister resigned in October after a government report revealed a $C1 billion spending blowout at an agency tasked with creating electronic health records. A scathing auditor general’s report found about $C1 billion had been poured into the province’s e-health scheme, with little of value to show for it.

Elsewhere in Canada, the health minister of Saskatchewan Don McMorris said in December that creating a single electronic health record system for each Saskatchewan resident faced challenges, including fiscal ones. A government review found that electronic health records “takes a lot of time, a lot of investment, a lot of people,” though an implementation plan in that province is expected to be in place by early 2010.

In the UK, Chancellor Alistair Darling is reportedly considering postponing the UK IT health program which he described as “quite expensive” and “not essential for the front line”.

There are claims that the UK IT program, running since 2002, has an estimated budget of more than £12.7 billion ($23 billion). There are also reports of time delays, some claiming the program is five years behind schedule.

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