eHealth examination probes for private sector buy-in

By Julian Bajkowski

The private sector and medical providers could soon have a much bigger say in how Australia’s ailing efforts to create a national system of electronic health and medical records unfolds.

The Abbott government has revealed it now wants substantial input on what non-government providers can contribute to make eHealth a reality after federal Health and Sports Minister Peter Dutton revealed the terms of reference for a new probe into what almost a decade of development has achieved – and what it hasn’t.

Announcing a review foreshadowed before the election, Mr Dutton said the Coalition government still “fully supports the concept of electronic health records but it must be fit for purpose and cost effective.”

Clinicians, especially general practitioners, have long questioned why commercial practice management software systems have been able to come up with popular, user friendly and secure software while governments have struggled to create a useful or function back end.

Of the 10 points in the inquiry’s terms of reference – most of which go to either identifying or fixing well known shortcomings in the existing Personally Controlled Electronic Health Record (PCEHR) – three directly deal with fostering greater industry involvement.

Specifically, the government’s eHealth review wants to know:

•    The applicability and potential integration of comparable private sector products;
•    The future role of the private sector in providing solutions;
•    The policy settings required to generate private sector solutions

In August this year several key clinical advisors walked away in frustration from the National eHealth Transition Authority (NeHTA) amid strained relations between doctors and the then Department of Health and Ageing (DoHA).

Part of the breakdown in relations is believed to have centred around DoHA wresting greater control over the rollout of the PCEHR from NeHTA which is funded through the Council of Australian Governments (COAG).

The departure of senior clinical advisors in turn forced crisis talks between the Health Department’s Secretary, Professor Jane Halton, and the President of the Australian Medical Association (AMA), Steve Hambleton, over the PCEHR’s shortcomings, including its usability.

The support of clinician groups is essential for any national eHealth system to proceed because without it there would essentially not be any users.

As the incoming Health Minister, Peter Dutton isn’t taking any undue risks over potentially alienating the AMA.

While the eHealth Review will be chaired by Richard Royle, who is executive director of the UnitingCare Health group in Queensland, assisting him will be Dr Steve Hambleton, president of the Australian Medical Association.

At the same time, Andrew Walduck, the chief information officer of Australia Post has also been given a key role in reviewing the PECHR.

“The Review team’s expertise encompasses information technology, patient and medical services and business administration which I believe is the right mix to put the electronic health records program back on track,” Mr Dutton said.

Whether the rails of that track could head towards private enterprise and away from government is now a question many will be asking given most of the software that doctors use on their desktops and iPads has not been coded by the government.

The involvement of Australia Post’s tech chief in the eHealth review comes as the government continues to grapple with the post-digital future of the mail monopoly.

Among the balloons floated by Treasurer Joe Hockey are potentially using Australia Post’s retail premises to deliver some customer facing functions of Department of Human Services agencies like Centrelink and potentially Medicare.

Australia Post had been the hot favourite to take on the job of letting people sign-up for the Howard government’s welfare services smartcard, the Access Card, which was dumped in the run-up to the 2007 election.

Heavily championed by then Human Services minister Joe Hockey, the Access Card was one of a suite of measures to help eliminate queues and accelerate the delivery of government transactions while bring down the cost.

Other measures included getting financial institutions to play a much greater role in processing Medicare refunds via the bank-run Eftpos payments network under a system known as Easyclaim.

Launched in 2007, the innovation allowed claimants to get refunds sent directly to their bank accounts from the point-of-sale at a surgery, thus bypassing the queue at Medicare offices where over the counter cash refunds where costing governments up to $10 a piece.

Doctors initially demanded $1 per transaction to assist the government based on the initial slowness of transaction processing that they claimed took up to 11 minutes.

However a deal thrashed out between then Human Services minister Chris Ellison and AMA national president Dr Rosanna Capolingua settled on $75 million in subsidies for doctors to pay for for terminal and software upgrades and transaction fees – leading Mr Ellison’s colleagues to jest it was the most expensive lunch he’d ever eaten as a minister.

However the outsourcing of government counter services, especially in secure enrolment and identity verification, is a niche that Australia Post has already productively cultivated in areas including the lodgement of passport applications.

Earlier this year, Australia Post’s previous head of external affairs Jane McMillan suggested that it would be “wonderful” if an incoming Coalition government created a mandate for government agencies to use Australia Post’s digital mailbox.

Since then it has been reported that Ms McMillan has taken up a role as the head of Prime Minister’s press office.

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