Welcome back to another thrilling year in the world of digital health, which kicked off for the new year just as we ended the old: consumed by confusion over telehealth policy. The Australian government seems to change the rules on telehealth as often as it changes its underwear and it must be said, the elastic is getting a little bit frayed.
Last Sunday, after repeated claims about telehealth being “permanent” and “10 years rolled out in 10 days”, we experienced yet another change in the rules. According to various statements from the Department of Health, health minister Greg Hunt, the AMA and the RACGP, the rules that applied to MBS-funded telehealth in the early stages of the pandemic were to be reinstated for the next six months to help general practice cope in the face of the Omicron wave.
Pulse+IT has been running our annual eHealth year in review series this week as we wind down for an extended holiday, but we did take a bit of time out to read up on Australian health minister Greg Hunt’s announcement that telehealth will apparently become a “permanent” feature of the MBS. In amongst a lot of hyperbolic announcements amounting to what seems like eleventy billion dollars in funding for the government’s COVID-19 response, we discovered that the “permanent” telehealth measure merely amounted to just over $100 million over four years.
It appears that the guts of this measure is that a patient can be phoned or consulted by video and the GP can claim for it if they have seen that patient in person in the previous 12 months, as is allowed now under the COVID-19 provisions. The only change is the permanent bit. However, the government’s plans for voluntary patient registration are destined to restrict this further in the future to only those patients registered with one practice. It’s not exactly the free for all the press releases promise but Mr Hunt managed to roll out RACGP president Karen Price for the announcement, which is apparently all that matters.
This week saw international standards body HL7 celebrate the 10th anniversary of the adoption of the FHIR specification, which has since become one of most widely used standards in the world for healthcare interoperability. Created by Victorian Grahame Grieve and now adopted by any global health software company worth its salt, FHIR is widely touted as nothing short of a revolution in health IT.
We remember doing some of the first reporting on FHIR back in the early days, when we were alerted to the concept by former chair of HL7 Australia Klaus Veil. Klaus told us back in 2012 that FHIR was “the latest trending interoperability technology that has taken the eHealth world by storm”, and he was right. The promise was that it would be faster, easier and far more comprehensible than standards like HL7 v3, which got so bogged down in its own complexity that it was pretty much dropped.
As the Omicron variant of the coronavirus plunges the world into new waves of restrictions and reinforces that COVID-19 is here to stay, governments around the world are struggling to communicate a long-term plan for living with the virus. This is most obvious in the public squabbles over vaccine mandates and passports, but also in shifting the burden from acute to primary care.
It is very clear that we will need to live with COVID-19 in the community for the foreseeable future, and we very much need to come up with long-term solutions on how to manage it as efficiently and financially sustainably as possible. The obvious answer is in technology solutions, of which there are many but which very much need to be backed up by long-term workforce reforms and needless to say, a bit of cash.
Pulse+IT celebrated its 15th anniversary just a few months ago and while we don’t like to reflect too much on the damage those long years have wreaked upon our good looks, modest charms and superior intellect, it would be remiss of us not to mention some of the dashed promises and forlorn hopes that have accompanied our journey.
Our first issue was printed in August 2006, featuring a glamorous photo of a Canon camera and a rather unpleasant skin cancer to illustrate a story on digital clinical photography, along with the wise words of our first ever covergirl, then health minister the Hon Mr Tony Abbott.
Victoria has moved along at a rapid pace in releasing a tender this week for its planned health information exchange (HIE), the first step towards streamlining access to medical records across the public hospital system. As locals like to argue incessantly, Victoria’s devolved public health system has positives and negatives, but the COVID-19 pandemic has certainly shown up that disparate information systems and services can be a drag on a unified pandemic response.
As such, earlier this year the Crisis Council of Cabinet agreed to a plan to consolidate pathology services across Victoria, including the different laboratory information systems (LIS) that are used in the state, of which we are aware of at least four, all in various instances that do not speak to others. NSW is in a similar situation, and it is looking to consolidate its LIS systems through the NSW Single Digital Patient Record (SDPR), the successful vendor for which is due to be announced shortly.
We must admit that we are still scratching our heads at Australian health minister Greg Hunt’s recent announcement of a new $180 million package to support COVID-19 care in the community in the future. There are some interesting bits, such as the subsidy for pulse oximeters for positive patients to use at home, and a small amount of money for medical deputising services and district nurses to visit COVID patients at home.
But putting aside the fact that there is simply no excess workforce capacity for nurses to visit people at home, let alone GPs – medical deputising services may be in a different boat – nor can we find a compelling reason behind the announcement that GPs will be paid an extra $25 to see COVID-positive or suspected COVID-positive patients face to face, in addition to existing MBS items.
