Filling in the gaps in PCEHR expenditure
As we mentioned last week, Pulse+IT is conducting an exercise that aims to gather as much data as possible on expenditure on eHealth activities in Australia, starting with the cost so far of the PCEHR.
We plan to take the headline figures and break them down to hopefully provide an accurate assessment of where the money has gone, for what purpose, and ultimately what the investment has delivered to the health sector.
As you'll see from our preliminary figures, we still have quite a few gaps to fill in before we can come close to a realistic breakdown, and it has become obvious that the main challenge will be finding out how much the states and territories have contributed from their own budgets beyond their share of funding for NEHTA.
It's pretty easy to outline the headline figures: since the announcement by Nicola Roxon in 2010, the federal budget papers show there have been three allocations for the build and operation of the PCEHR adding up to $739 million. However, it is not clear exactly where that money has gone, particularly the first tranche of $466m over two years announced in the 2010-11 budget.
What is also easy enough to find is the total contribution from the federal and state governments to NEHTA, which since its establishment in 2005 totals an enormous $972m. With NEHTA’s publicly announced funding set to expire at the end of this financial year – having been granted a 12-month funding extension by the new federal government – one of the questions that must be asked is whether this money has been worth it.
Very difficult to find, however, is a breakdown of how the federal budget spend has been divvied up between the Department of Health, the Department of Human Services, the build and operation of the PCEHR and the build and operation of the Healthcare Identifiers Service. Separating PCEHR money and other eHealth money from NEHTA money is also a problem.
For example, while we can track down about $98m that went to NEHTA for the early work on healthcare identifiers as well as the costs borne by DHS to operate it, how much of that can also be allocated to PCEHR spending? While the PCEHR and the HI Service can be considered two separate systems, the former is very much dependent on the latter.
And there are many other questions. How much was provided to the software vendor panels for their work, and whose budget did this come from? Is the operation of the National Prescription and Dispense Repository (NPDR) covered by the PCEHR operational budget?
Did Medicare Locals use part of their operational budget for PCEHR/eHealth work beyond the $50m allocated specifically to it in May 2012? And how much did McKinsey pay Aspen Medical to sign up all of those unsuspecting folks lurking around hospitals, fun fairs and village fetes?
We gave the Department of Health the opportunity to have check our rudimentary figures but have not yet had a response, so as questions about certain projects come up, we'll fire off questions to them. But the main point of the exercise is to see if the vast knowledge of the wider health IT sector can be garnered to fill in some of the gaps and suggest new ones.
For example, what does it cost the Australian Commission on Safety and Quality in Health Care to conduct clinical safety audits on the PCEHR? We know how much is given to the Office of the Australian Information Commissioner to investigate privacy matters, but is there documentary evidence that Standards Australia received $5m over two years for eHealth standards development?
How much has been spent on the eHealth Practice Incentives Program payments (ePIP) for general practice to fulfil the five requirements in the second round, and how much remains unclaimed because some practices can't really be bothered?
Today, we are opening up a read-only view of our figures so far. You'll see we have different spreadsheets for federal budgets, NEHTA funding, PCEHR funding, NASH funding and the HI Service, and we are also going to extend this early work further to look at actual use, starting with the HI Service.
In the end, it is the meaningful use of these systems that is the real measurement. With this resource open to the community, we can start to evaluate whether that is happening.