David More wrote: > See Comments in Message > > 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?
David, if one's outlook is one of unrelenting pessimism, as yours seems to be, then there is Buckley's chance of anything ever bearing fruit. But not all of us are so pessimistic. Otherwise the only kind of health informatics which would be of interest would be the kind pursued by Philip Nitsche (see http://news.bbc.co.uk/2/hi/health/778139.stm ). >> 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! My cynicism and preparedness to give up? Nuh, I have a realistic outlook, informed by the historical performance of various players, but I remain cautiously optimistic. And I haven't retired to join the ranks of the health informatics commentariat - not yet, at least. I still do real work on useful stuff, as do many other contributors to this list. > 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. I have expressed disquiet in this forum (or its predecessor, before you joined us) about NeHTA's lack of transparency and often rather peremptory consultative processes, and about the time lag between issuing some vague hints about their intended direction and issuing some more substantial documents clarifying exactly what they meant. This has happened with respect to secure messaging, and has caused small players like ArgusConnect some grief as would-be customers for their products and services have sat on their hands waiting for NeHTA's pronouncements. However, I do think that NeHTA have indeed, perhaps for the first time for a high-level health IT body, specifically identified the correct cornerstones - discrete, feasible initiatives of urgent and practical importance - which together (and in isolation, to some degree) will facilitate progress to be made on a wide range of fronts by a wide range of players. This is a pleasant change from the grand, all-encompassing but ultimately impractical visions such as those espoused by the late HealthConnect project. And recent NeHTA documents identify specific technical means to the identified ends. I may not agree with every one of those technical means, but it is refreshing to have a health IT authority which worries about HOW things are to be done, not just hand-waiving about what they wish might be done, somehow. > 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. I am sorry if I have been guilty of sniping, but don't worry, I only have a pea-shooter. But you want to know what I would do if I ruled the world (or were king for a day)? Well, just like Woody Allen did when he became dictator of San Marcos in his wonderful spoof "Bananas" (see http://www.imdb.com/title/tt0066808/ ), I would order everyone to wear their underpants on the outside. Tim C >>> 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 >>>> _______________________________________________ >>>> Gpcg_talk mailing list >>>> [email protected] >>>> http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk >>>> >>>> __________ NOD32 1.1403 (20060210) Information __________ >>>> >>>> This message was checked by NOD32 antivirus system. >>>> http://www.eset.com >>>> >>> ------------------------------------------------------------------------ >>> >>> _______________________________________________ >>> Gpcg_talk mailing list >>> [email protected] >>> http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk >>> >> __________ NOD32 1.1403 (20060210) Information __________ >> >> This message was checked by NOD32 antivirus system. >> http://www.eset.com > _______________________________________________ Gpcg_talk mailing list [email protected] http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk
