This article is by David More, the Sydney-based principal of e-health and management consulting group More & Associates. It first appeared on his blog and is published on ZDNet.com.au with his permission.
commentary I think it is fair to say it has been a bad weekend. As reported over the weekend we have had the following statement from the Council of Australian Governments (COAG) on e-health.
E-health
COAG noted the progress of the National E-Health Transition Authority and agreed to the continued funding of $218 million (50:50 cost shared between the Commonwealth and the states) for the period July 2009 — June 2012 to enable it to continue its existing work program.
The Commonwealth contribution is as follows:
E-health (NEHTA)
- 2009/10: $28.7M
- 2010/11: $39.2M
- 2011/12: $41.0M
Total: $108.9 million. This is one half of the total as the rest will come from each of the states.
As pointed out by a correspondent this is really very rapid growth from the 2007/08 financial year's sum of $38.715 million to approximately $82 million in 2011/12.
The real increase in activity could actually be a little more than the figures indicate, given all the consultants that can be replaced with more permanent staff now funding is clear for the next 3.5+ years.
If this is to be all the new money for e-health ($30-40 million extra per year over current spend at Commonwealth level and almost certainly flat to negative spend in the states (Mr Garling SC's recommendations for NSW Health IT notwithstanding) then progress, if any, will be dreadfully slow!
David More
(Credit: AusHealthIT blog)
What this funding of NEHTA for the next few years has done has ensured that its leaders feel vindicated in the way they have behaved — they have essentially been 'patted on the head' — and any real stimulus for 'root and branch' change has been lost.
There is also a bit of a problem in that without a co-ordinated national direction, it is a little murky as to who will be able to get the full value out of the planned NEHTA spend.
More importantly, what has been lost is the opportunity to put in place a sort of national strategy and national governance of e-Health. This will lead, almost inevitably, to waste and inefficiency in how the new money is spent. Of course that waste and inefficiency will be dwarfed by what will flow from failing to properly automate the health sector.
It is clear that without judicious, planned — but quite large — investment in health IT that our health system is drifting towards the unsustainable. Not getting going now in a serious and coordinated way will come back to cost us all dearly in the future (much like not addressing climate change early means you pay a lot more to fix things up later).
With this expensive and large outcome of this COAG meeting it is virtually certain that Commonwealth investment in Health is going to exceed 10 per cent of GDP, if not get close to 11 per cent, especially as our economy contracts because of the 'global financial crisis'. Health IT can slow this growth — but only if you invest in it!
What has also been lost is an opportunity to commence planned. coordinated investment in health IT in a way that is designed to maximise benefit to all the actors within the health system.
Whoever decided not to fund and implement the Deloitte-developed National E-Health Strategy for Australia — after so many stakeholders agreed we need such action — is to be utterly condemned.
Ultimately it is the Federal Minister who must take responsibility for this decision and she should be asking very hard questions to assure herself she has not made a major mistake, which will cost a great deal to remedy both politically and financially.
Remember, not only has the National E-Health Strategy been canned but also has the IEHR, which was the reason NEHTA was said to be mainly developing their infrastructure. Talk about 'being all dressed up with nowhere to go'!
We now have a situation where there is confusion between the Deloitte strategy and the NEHTA IEHR proposal. The Deloitte approach is correct — but because the waters have been muddied — neither have gone forward. That is a huge mistake, in my view.
The only, and last, hope left is that the Australian Health Ministers Advisory Council Meeting (AHMAC), which meets at the end of the week (I am told), unlocks funds from the National Health Infrastructure Fund to get things going properly. I understand this fund is separate from the COAG funding.
As far as the future is concerned, if that last hope does not come off, I see only fragmentation and waste with worsening levels of quality and safety within our system. Sad that.
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