Much betwixt a SIP and a PIP

This week got off to a rather officious start when the Australian Digital Health Agency rolled out Health Minister Greg Hunt to belatedly do the honours in officially launching the national digital health strategy and its accompanying framework for action.

The strategy was in fact released last August although it is apparently just now going to kick off, while the draft framework for action was actually released in March and nothing much seems to have changed since then.

Mr Hunt did get to announce something new in the winning projects for ADHA's test beds program, which forms one element of the national strategy and is aimed at taking mature technologies and testing them out for their ability to support new models of care, before scaling those models up nationally.

There was a nice mixture of projects in the 15 successful bids although we were expecting fewer projects and a bit more money for each. $8.5 million for 15 projects over two to four years is not a huge amount in the scheme of things, especially considering the vast sums being promised to the CRC for Digital Health, which has only managed to announce one project so far.

While most sectors of healthcare have been covered in the test bed list we must say we were a little disappointed not to see anyone putting their hands up for a couple of areas that we think would be relatively simple and yet have profound effects for patient care.

One is the creation of a transfer document that could follow residents of aged care facilities or those receiving home care when they are admitted to hospital, detailing not just their physical ailments and their medication list but a description of their behaviours, mood and needs. This could be added to and draw information from both the My Health Record and the My Aged Care client record and would be invaluable to nursing staff in particular.

We also think some work could be done on a handover of care clinical document that contains more information than contemporary discharge summaries and could also follow patients as they move from primary care into hospital, perhaps into a sub-acute facility and then back into the care of their GP. The medications reconciliation projects will definitely help this but we would have like to have seen more.

The Royal Australian College of General Practitioners would certainly like to see a little bit more in terms of supporting its members to participate in the system. Two of our top stories this week were the election of the new RACGP president, Harry Nespolon, and the release of the college's position statement on the MyHR, which restates its view that if GPs are being asked to carry the load in this project, then they should be paid for it.

We agree. The college has long argued that using the ePIP as an incentive is not exactly fair as the money goes to the practice not the practitioner, and it is the GP's individual time and effort that is going into this exercise. GPs can claim for a longer consult item when preparing a shared health summary but we doubt that will ever be enough to make up for the smaller number of patients they'll be able to see in a working day.

We took this up with the Department of Health some years ago but its reasoning against the idea was that paying per SHS would do nothing for the quality of what was going into it. There's merit in this argument – and we found this blog by health informatician Tim Blake compelling, even if we didn't quite agree with the argument – but we remain firmly on the side of the RACGP and its argument that a service incentive payment (SIP) rather than a practice incentive payment (PIP) would get the GPs far more interested. To pay for it all, perhaps the Department of Health could look at scaling back the ePIP, which for well over a decade has subsidised general practices to use technologies they should be using anyway. That idea would certainly throw the cat amongst the pigeons, now wouldn't it?

The other big news this week included the completion of Alcidion's purchase of MKM Health and Patientrack and its first win as a combined offering for ACT Health, and the entirely unsurprising move by Orion Health to sell off its Rhapsody integration engine business to private investors for $NZ205m. That deal puts a value on the entire company of about $NZ255m, far below the spectacular paper figure of $1 billion when it jointly listed on the ASX and NZX in 2014 but a far more realistic one.

Orion Health's share price has steadily reduced since those heady days but the price was always over-inflated. A comment from one investor that “everyone was looking for the next Xero” says it all. Amid all of the hype about digital disruption and digital technologies transforming healthcare there is the cold fact that health IT is hard, and often not very profitable. With the sale of its crown jewel in Rhapsody, Orion Health at least is now back in the black. We'll see if delisting is around the corner.

That brings us to our poll question for the week: Do you think the government should pay GPs to use My Health Record?

To vote in our weekly polls, sign up for our weekend edition or leave your comments below.

Last week, our poll question was: Do you think HealthEngine can recover its reputation? In short, nope. Our readers overwhelmingly gave it the thumbs down, with 84 per cent saying no to just 16 per cent in the affirmative.

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