David More wrote:
> 
> Progress Towards Electronic Health Records
> 
> To underpin the efforts in refocusing the health system to promote better 
> health and 
> community care for all Australians, COAG agreed to accelerate work on a 
> national 
> electronic health records system to build the capacity for health providers, 
> with their 
> patient's consent, to communicate quickly and securely with other health 
> providers across 
> the hospital, community and primary medical settings. The Commonwealth will 
> contribute $65 
> million and the States and Territories $65 million in the period to 30 June 
> 2009.

That sounds less like the former HealthConnect vision of huge, shared,
central repositories and much more like a vision of a far more
distributed electronic health record (or rather, an "electronic health
record system") enabled by quick and secure communication. OK, I have
just restated the preceding paragraph - but my point is that the
emphasis is on secure communication (implying between distributed
clinical information systems or repositories), not on shared central
repositories.

Is that correct?

> Comment - This is a funding of $43.3M p.a.
> 
>  From February 2006, governments will accelerate work on a national 
> electronic health 
> records system to improve safety for patients and increase efficiency for 
> health care 
> providers by developing the capacity for health providers, with their 
> patient's consent, 
> to communicate safely and securely with each other electronically about 
> patients and their 
> health.  This requires:
> developing, implementing and operating systems for an individual health 
> identifier, a 
> healthcare provider identifier and agreed clinical terminologies; and
> promoting compliance with nationally-agreed standards in future government 
> procurement 
> related to electronic health systems and in areas of healthcare receiving 
> government 
> funding.

Goodness me, that actually seems like a sensible programme of work. Now
if it can just be implemented in a sensible, cost-effective fashion...

> Comment
> 
> The best estimate of the cost of Patient ID, Provider ID and Terminology 
> Services Costs 
> when operational is at least $100M p.a. to do it half way properly

David, where is this estimate published so we can examine its basis and
assumptions? A great many cost estimates for health IT initiatives are
produced by large IT consultancy firms who hope to pick up fat contracts
to implement those same inititaives, and teh estimates are based on
rather flimsy evidence or questionable (or at least highly arguable)
assumptions. Thus all such figures need to be carefully scrutinised
before being given any credence.

> Again I believe we are being dudded big time! This is again tinkering at the 
> edges - and 
> of course there is no public plan about what is intended other than these few 
> lines. 
> Anyone know any more detail?

The key question is how this relates to existing and planned State
health dept facilities and planned projects to create state-wide unique
patient identifiers and health service provider directories, often by
amalgamating existing regional medical record number systems and GP
directories etc. One has to ask the question: why not just jump directly
to a national health care identifier, particularly when we are already
80% of the way there with the Medicare number. Yes, it would take some
(minor) legislative change to allow the Medicare number to be used
universally, yes, Medicare numbers would need to be made unique to each
person, and yes, those not eligible for Medicare would need to be
accommodated, but these are all feasible extensions to the current
Medicare card/number. It all depends on timing. Hmmm, if left in the
hands of HIC, it could take decades...

Tim C
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