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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 19:51:14 +1100, Tim Churches wrote:
> David More wrote:
>> Hi Tim,
>>
>> Let me try and answer your questions as best I can.
> ...snip...
>> 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)
>>
>
> Yes, yes, and if you re-read my post, you will noted that I said:
>
> "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..."
You missed the main point - the cost of real ID.
>
>> 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.
>>
>
> No, but these NeHTA-led initiatives will supplant a lot of
> already-funded activity to do somewhat more limited versions of the same
> things (eg statewide or regional unique patient identifiers, health care
> provider directories). The task for NeHTA is to convince State and
> regional health authorities to disinvest in those and to re-invest the
> money saved into these national initiatives instead. If NeHTA succeeds
> in doing that, then there will be enough money.
What chance that, given the warring tribes?
>
> Wanting a confirmed budget beyond 2009 is unrealistic. (DM - Why its not that far away?) If it works as
> promised, or looks like it will work, then funding will be continued. If
> it doesn't work (like just about every other national scale health IT
> project, or pilots thereof, that I can think of), then the funding plug
> will be pulled. I am sure you are familiar with the phenomenon of
> funding being pulled from large health IT projects which don't deliver
> results within a 3 or 4 year time frame, aren't you, David (what is that
> rattling sound?).
Your cynicism and preparedness to just give up I reckon!
>
>> 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
>> $49.5m spent on HealthConnect to date (largely)
>>
>
> A little while ago you said in a New Matilda article (reproduced here:
>
> "...planned HealthConnect implementations have been drastically scaled
> back in both cost and likelihood to meet the goals of the original plan
> upon on which upwards of $100M has reportedly already been spent."
>
> David, which is correct, $100m or $49.5m?
Who knows - I was being maximally conservative in my new post .. others have said a good deal more. If you have accurate figures you could share.. its still a very large some of money largely wasted .. is it not?
>
> Tim C
Tim, if you love what NEHTA is doing..just say so.. if you think they are not quite up to it say that.. or if you like me find an absence of transparency and clear planning a travesty - say that - or anything in between.
You can sit on the fence and snipe for as long as you like - we all would like to know - given some influence - just what your plans are - mine are clear.
Cheers
David
>
>> 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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