Tasmania puts money where its mouth is

Tasmania pulled off a bit of a stunner this week with the release of its digital health strategy a day or so before the state budget, announcing the first tranche in what is a substantial investment for the state in digital health. $475 million over 10 years is a lot considering Tassie’s small population and its historic underspend on healthcare, and while money has certainly been shovelled into hospital infrastructure over the years – including $689m in Royal Hobart’s K-Block – digital health has never had much of a look in.

There have been some notable digital health initiatives – the country’s first prescription monitoring system, the Tasmanian medicines formulary and controlled drug management system, a statewide health directory, and the first real go at a statewide eReferrals system that is up and running and scoring runs. (A lot of this is with the help and initiative of Hobart software and data specialist HealthCare Software.) All of the state’s GPs use either Best Practice or MedicalDirector, the two pathology providers accept eOrders, and telehealth has been well established in the private sector for over 15 years.

That said, the Digital Health Transformation (pdf) program is in another league. It proposes that Tasmania will be the first Australian state to deliver a fully integrated healthcare system and it will use digital health to get there. Funding of $150m over four years will kick it off, with another $325m over the following six years to see the implementation of a full electronic medical record, a shared patient record viewer for all clinicians, an electronic patient record for ambos and an uplift to patient administration and pathology systems.

Looking at the strategy closely, particularly mentions of a digital front door for patients through a consumer portal and early initiatives through digital wayfinding and patient flow management, it seems apparent that Tasmania likes the look of what the ACT has done with its digital health strategy. Tasmania has certainly realised that its ambulance crisis needs fixing sooner rather than later so has prioritised that and there’s a bigger emphasis on primary care, but otherwise the ACT’s plans could easily be mirrored.

The strategy is, we think, a pretty good one. Money will flow initially to the procurement and pilot of the EMR in the first four years, but more importantly it will be aimed at supporting existing programs like the eReferral system and getting foundational infrastructure up to scratch before diving headlong into an EMR. What we are most impressed with is the emphasis on an integrated system, that hospital EMRs are not the be all and end all, that general practice is supported all the way through, and that community care providers and mental health are equal partners.

The money is substantial for a population of just over half a million people with only four public and seven private hospitals, but for a state with the oldest population, some of the worst health outcomes in Australia and not a lot of money in the kitty, using digital health cleverly to ease the burden on frontline health services is the only way to go.

In other news, last week’s election result has seen not just a change of government but a change in the whole political process in Australia. Labor will get a majority in their own right but there is no doubt in the slightest that they will have to pay attention to a vastly expanded cross-bench in the lower house, and negotiate with the same in the upper house. This can only be a good thing for democracy, and we hope beyond hope that it can help to put an end to the funding wars between the states and the federal government, particularly over healthcare.

While the new health minister and aged care minister won’t be announced until next week, we do hope that former shadow minister Clare O’Neil continues in the aged care portfolio, where she has been very effective and knowledgable in what is one of the big-ticket issues Labor has promised to address. Shadow health minister Mark Bishop may prefer to go back to the environment portfolio now that Terri Butler has lost her seat. If he does move on, we’d love to see someone like Catherine King return to the portfolio, or a newbie like Senator Murray Watt installed.

The number of clinicians elected this year has been notable, including new members like neurologist Monique Ryan, GP Sophie Scamps, infectious diseases physician Michelle Ananda-Rajah and ED specialist Gordon Reid, along with returning members with clinical backgrounds like paediatrician Mike Freelander, gastroenterologist David Gillespie, former nurse Ged Kearney and pharmacist Emma McBride.

Whoever they choose, the good news is that new Prime Minister Anthony Albanese wants to continue with a version of the previous government’s pandemic-related national cabinet idea and consult with the premiers and first ministers much more closely, now that CHOGM appears to be dead. Even if it is just on healthcare, this will be a win. There is a big list of issues that need to be addressed in the first one hundred days of the new government, including foreign relations, climate change, the Indigenous voice to Parliament, and the horrifying debt situation, but nothing is more pressing than health and aged care. Please, people: just fix it.

In our poll question last week, held just before the election, we asked: Is adequate funding for health and aged care an intractable problem that will never be fixed? Two thirds agreed: 62 per cent said yes, 38 per cent said no.

We also asked: If yes, why? If not, what do you think can be done? Here’s what you said:

This week, we ask:

Is Tasmania’s digital health transformation plan on the money?

Vote here or leave your comments below.

Comments  

+1 # Lynne Everett 2022-05-28 09:08
Small nitpick here -- not ALL GPs in Tasmania use MD or BP, just the non-Indigenous sector. The Indigenous sector is hopeful that more money for the e-referral system means they'll finally be able to use it, as it doesn't currently talk to Communicare.
0 # Ian Mcknight 2022-05-28 15:08
Or, the indigenous practice(s) could move to the software products that 97% of Tasmanian GPs are using, and therefore avail themselves of all the benefits and development associated with a majority use program. If we want to be pedantic we can mention that 1 Tas practice uses Genie and 1 uses Medtech32. Much like the Electronic Discharge Summary delivered for 99% of Tasmanian practices a few years ago, I would argue again for not delivering or delaying a majority benefit because a tiny% want to stay out of mainstream programs.
0 # Lynne Everett 2022-05-29 09:12
Firstly I was not arguing for "not delivering or delaying a major benefit", I have no issue with the fact that they have a system that works for "99%" I would just like it to work for 100%. As for "staying out of mainstream programs", Communicare IS the mainstream program for Aboriginal Medical Services Australia-wide.
0 # Ian Mcknight 2022-05-29 11:48
RE mainstream, yes I mean't mainstream GP. I would like it to work for 100% of programs anyone may decide they want to use to. However this delays a solution because you have to create standard stuff that is compatible with everything, it makes the task that much harder. I would rather see the delivery of an outcome that works for 99% now, rather than one that delivers on 100% in 2 years time. I'm a big fan in helping things keep their momentum while momentum is there. When something is rolled out by a bureaucracy, the more it is delayed, the greater the chance it may not be delivered at all.
0 # Kate McDonald 2022-06-03 12:29
Is Tasmania’s digital health transformation plan on the money? The vast majority said it was good: 88 per cent to 12 per cent who were negative.

We also asked what could have been done differently, or even better. Here’s what you said.

- The plan is excellent - getting the execution right seems to be the enduring issue

- Less wastage in politically based restructuring of the departments over 30+ years and more on integration of services and supporting processes and technologies.

- Consideration of future integration with national and international systems needs to be built into the data design, if not the platforms to be used.

- Don't know

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