eReferrals, EMRs and the interminable telehealth saga

The dictionary definition of a saga is an Icelandic epic narrative, a long and complicated story in which famous families do this and that over a long period of time and there is a major element of heroic exploits. The common definition is of a long and complicated story to which there seems no end. The former sounds great; the latter sounds like health IT policy in Australia.

As a new federal government settles in in Canberra and a couple of state governments begin their respective roads to re-election with big-spending budgets and ministerial reshuffles, longstanding healthcare horrors lurk in the background, ready to trip up any new administration. For the feds, it is the deep trough of health and aged care funding, along with our old friend “permanent” telehealth. For the states, the funding trough is allied to a history of administrative bungling and an inability of the health sector as a whole to get with the times.

A case in point is our most popular story this week about the Queensland budget, which promised record spending on healthcare (known in political parlance as “brand new hospitals”). Hidden among the detail was a big bucket of funds to kick-start the integrated electronic medical record (ieMR) roll-out, which also in political parlance was “paused” back in 2019 to “optimise” the existing digital health stack. Everyone else said it was “dumped” temporarily due to clinician resistance and adverse media coverage, which is probably why the announcement didn’t make it into the official press releases. It’s back on the agenda now, though.

We’ve never been convinced that Queensland’s roll-out of Cerner has been more difficult than anyone else’s considering how devilishly complex these things are, but the Bananabenders do like to put up a fuss, and as such they are way behind on their implementation timeframe. $300m should solve that problem quick smart and the remaining health services that have been raring to go will now get their chance. The next Queensland election is in October 2024 so Queensland Health has two years to stuff everything up and then several months to recover before they face the public.

Not so Victoria, which goes to the polls this November and just today has lost some senior ministers, including minister for health Martin Foley. There was nothing in this year’s budget for health IT but lots of promises for health infrastructure, although in our experience it is all very touchy at the moment. We wrote a story a fortnight ago about a tender issued by Northern Health for a new radiology information system that seem to cause a meltdown in that health service’s media department, apparently because the minister wanted an announceable but we rained on his parade. Boo hoo. It did bring down hellfire and brimstone from Northern Health’s media department on us but even they have quietly retreated to their corner.

Victoria’s health system provided our most popular story for this week, concerning the ongoing saga of the roll-out of secure messaging in each health service. Monash Health has joined a few others in its determination to rule out faxed referrals, which has received pretty much universal acclaim, but in saga terms this should have been done years ago. (Keep an eye out next week for an update on what another state is planning to do with eReferrals. 10 years too late, but it’s getting there.)

The other big story this week was the drama that is MBS-funded telehealth, with the Australian National Audit Office announcing it would look into whether the Department of Health has effectively managed the expansion of telehealth services during and post the COVID-19 pandemic.

We’d normally say an immediate no but then we read the Royal Australian College of General Practitioners’ submission to the ANAO inquiry, and decided that some organisations are worse. Rarely have we read a more self-serving, utterly clueless document in our experience. Pretty much every complaint that the college makes about the department’s handling of COVID-19 telehealth has been caused by the college itself, beginning with its claim that changing rules and requirements “have created confusion and resulted in a significant amount of additional administrative work for GPs and practice teams”.

Guys, you asked for it! The college lobbied long, hard and persistently for MBS-funded telehealth when the pandemic struck, then very quickly got upset because online “pop-up” telehealth services got in on the act. The college then demanded their exclusion allegedly due to continuity of care reasons, got their way and are now whingeing about the existing relationship requirement as being too confusing.

The college insisted that face-to-face was the gold standard and telehealth was only a stop-gap, but when GPs did the majority of appointments on the phone, insisted that it was just as good as video. The department then reduced access to level C phone items on the MBS, pretty much arguing that if a patient needs to have a 20 minute-plus consult, they need to have eye contact, so of course the college kicked up a stink. They are also now whingeing about increased oversight of telehealth items, despite the obvious grounds for rorting that formed one of the arguments against pop-up services in the first place. The AMA is similarly conflicted.

This one is another on our epic saga list, joining secure messaging interoperability and electronic medical records. We don’t see any heroes riding to the rescue soon, so we reckon add this lot to the definition of a saga as a long and complicated story to which there seems no end.

That brings us to our poll question for the week. Rather than another interminable question about telehealth funding, we’ll go back to the saga that is the ieMR roll-out in Queensland. The ieMR uses Cerner’s Millennium platform, which has been in the news through the company’s multi-billion dollarydoo sale to Oracle. It also comes as major changes have been made to Cerner’s executive team in Australia, including a new MD and state heads. Our poll question last week asked whether you thought Oracle’s plans for Cerner were realistic.

It appears you were unconvinced: 79 per cent said no while just 21 per cent were in favour.

We also asked if you thought yes, they are realistic, what will those plans bring to the table for Australia? And if not, why not? Here’s what you said.

This week, we ask:

Is five years and $300m enough to finish the ieMR roll-out in Queensland?

Vote here or leave your comments below.

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