Hi Tim,
Let me try and answer your questions as best I can.
Movement to secure comms is doubtless the strategy as far as I can tell - witness the recent NEHTA publications I mentioned here last week - and yes - as I have said often the repositories are dead - estimated in 1999 to be $300M to set up and $160M to run - not on this budget.
Re-costs - The number I have suggested is bare bones indeed. Patient ID - of the strength to do electronic patient information transport has to be at least as good as passports or you will mix data up - what does it cost to issue 20Million ids of that quality (Hint ID card is said to be about $3.0B) Terminology should be much cheaper - needs maybe 20-30 expert staff for national delivery and maintenance and all the associated expenses and licenses to do it - 10-150M p.a. should cover it depending on how much SNOMED costs. Provider ID - again I would guess just a few million p.a. + set up costs. The cheapest possible is 100+M p.a. + NEHTA running costs -2-3 I guess p.a. Not much left of the $40M available. (Note these are my guesses - I don't have any special information or secret sources - its all based on public reports on what things have cost to do the same in Europe, US, UK etc)
Feel free to cost it yourself - $40M won't touch it. Or you could ask NEHTA or DoHA to give you the figures they used?
Re Use of Medicare Number - it is not an adequate ID for medical records nationally. Remember there are more medicare number by about 20% than people in the populations (see recent productivity commission report - it mentioned that I recall)
Tim, it is simply not enough to do anything that will make a difference I believe. And its goes to 2009 - then what - no recurrent funds committed.
Note: I believe these are good things to do - just not much will really happen with the proposed funds - and the risk of underinvestment is that all of it will be wasted like the $49.5 spent on HealthConnect to date (largely)
Cheers
David
---- Dr David G More MB, PhD, FACHI Phone +61-2-9438-2851 Fax +61-2-9906-7038 Skype Username : davidgmore E-mail: [EMAIL PROTECTED] On Sat, 11 Feb 2006 10:54:10 +1100, Tim Churches wrote:
> 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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