Discussion on the Role of Government in E-Health
Facilitated by Dr Peter Garcia-Webb

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The Government perception of the problem is that doctors are not prepared to invest in the electronic health record and that the prime reason why the standard of medical practice is suboptimal is the outdated record keeping practices of the profession. The profession would regard these views as inaccurate, simplistic and insulting.

The solution recommended is to mandate or force the use of electronic records through financial penalties. The Minister has announced an intention to have some form of electronic EHR in 18 months and the Government is not intending to fund it and that market forces will drive. This focuses the question on who will pay. In order to invest in software the industry needs to assure their shareholders that there is a market, hence the issue of who pays is critical. If industry thinks no one will pay then nothing will happen. The Australian Government feels it has paid enough. Well let's look at what is happening in the UK for example - a program costing around 14 billion pounds. The Australian equivalent would be $14 billion - Australian. This makes the Australian Government investment in this area pale somewhat in the comparison. Where is the core infrastructure necessary to deliver the governments vision? The national patient identifier has yet to be approved for funding. Where is the disease coding system? Lets discuss whether this assessment is correct and plan a strategy for tackling these issues:

I can't believe that it will cost this much money. We have been told we have the technology, the medicare number could be used as patient identifier. What's the problem? (Marissa Lassere)

The cost to the economy of premature death and morbidity due to medical error may well exceed a billion dollars annually, based on estimates using the Department of Finance guide to cost-effectiveness analysis. 90% of the cost of information systems involves the change management. The overseas costings are real and doubtless are a true reflection. (Paul Doman)

Refer to report in Annual of Internal Medicine - the national (2005) estimate of costs for a national health information network for the US would cost over 5 years US$156 billion to establish and US$48billion annually to operate. Two thirds for the systems and one third for interoperability. There is a practical basis for these cost estimates. (Teng Liaw)
(Editors note: the report goes on to say that the establishment cost is the equivalent of 2% of the annual healthcare spending in the US over the 5 year period.)

The views expressed by the Minister suggest a lack of understanding of the reality of medical practice. Electronic records take longer to write. The amount of time spent on documentation is a few minutes. If we increase the writing time something has to give - longer working hours, less patients, less patient care or more referrals. This could just be an addition to the current red tape impost - those things that detract from clinical care. (Stephen Leow)

GPs have much of what is being considered already in their systems and are putting this information into referral letters. The next problem is the inability of hospitals and the people GPs refer to have with regard to receiving and sending electronic information. The problem with connectivity is the issue, not whether GPs will use the technology. (Trevor Lord)
Our practice put the effort in to build and implement an EHR as we saw the potential benefits. Vital that system development and uptake is a bottom up rather than top down process. Patients will not accept a central medical records system run by government or that privacy can be protected. (Bill Heddle)

As a vascular surgeon I get good referrals from GPs, the real problem is my lack of connection to the public hospitals. It seems an easy task but the problems are really at the State health system interface. If the Federal Government wishes to put pressure on any sector it should be the States. (Peter Thursby)

My costing is $7 billion saving with electronic information systems. The Government's role is to realise these savings. There is an expectation that the profession will deliver on better care anyway without Government bearing any of the cost. Our focus is on improving patient outcomes - we have to get the patients part of process so they are motivated to look after their own health. (Tom Wenkhardt)

We have heard suggestions from Government of mandating doctors and doctors suggest mandating the States. To have an effective health system everyone has a role and needs to play it - what we have to do is encourage that to take place. We need solutions which encourage high levels of participation (compliance). There is no doubt that the cost of computerisation is significant, the health workforce is 10% of the community, health costs in general are rising. We don't have to look entirely at new or additional money. Some of the resources that are being wasted could be recovered and help offset the costs. (James Kelaher)

Despite the criticism of GPs it has to be recognised that this sector is generally well ahead of the rest and these areas have to catch up. (Sally Glass)

The Minister's speech and reaction of the forum has diverted us from the seeking of solutions and a way forward. The Minister's style is to be provocative and we shouldn't read too much into this in terms of immediate concern. (Mukesh Haikerwal)