Pulse+IT Blog

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.

Crowd-sourcing the cost of the PCEHR

A billion dollars is such a nice, round figure. It is also a nice, big figure. So big in fact that it seems to have attached itself to every mention of the PCEHR despite it being difficult to find evidence that it is in fact the true cost of the system.

A recent example is an article by News Corp's veteran health reporter Sue Dunlevy following a Senate Estimates hearing, in which Greens health spokesman Richard Di Natale asked a few pertinent questions about the hold up in the government's response to the Royle review into the PCEHR.

Ms Dunlevy calculated that if the PCEHR cost $1 billion to build, and there were currently about 42,000 shared health summaries on the system, then that would mean each shared health summary cost $24,000.

That sounds about right on the face of it, but that also means accepting that the $1 billion price tag is correct. There are some questions over this, despite it having become an article of faith.

In Senate Estimates, Senator Di Natale asked the Department of Health's first assistant secretary for eHealth, Linda Powell, how much both governments had invested in the system so far.

“It depends on what you count and when you want to count it from, Senator,” Ms Powell replied, rather mysteriously.

PCEHR lost in the political turmoil

It seems like just yesterday that Department of Health CIO Paul Madden was taking great delight in taking the mickey out of Pulse+IT's seemingly obsessive reporting on all things PCEHR.

In fact, it was at the Rural Medicine Australia (RMA) conference in Sydney last November, when Mr Madden, responding to our question as to why most people found out about what was happening with the PCEHR through the pages of Pulse+IT rather than official channels like NEHTA or DoH itself, gently mocked us for writing about its slings and arrows so constantly.

We're still writing about it, but it's getting harder and harder to keep up the enthusiasm for what now seems to be considered a forgotten relic of previous adventures. Figures on the tiny amount of shared health summaries on the system seem to show that most GPs have lost their enthusiasm entirely. (After one year of operation, the PCEHR contained 2000 SHSs; by the end of two years of operation, this had grown to 23,000. Last December, the number was 38,200.)

Getting ready for GP co-payments

If, as expected, the government introduces a $7 co-payment for bulk-billed patients in tomorrow's budget, how do you think this will affect general practice workflow and IT configuration?

There has been no detail provided by the government describing how the co-payment will be administered, with the Sydney Morning Herald's Peter Hartcher perhaps the only reporter who has received answers to these sorts of questions.

“Under Peter Dutton’s plan, the Medicare rebate paid to the GP would fall by some $5 to offset the new copayment,” Hartcher wrote on Saturday. “So that would be a saving to the federal budget of some $600-700 million a year. But the GP would get to keep the other $2.”

What that seems to suggest is that the $7 will not be sent to Medicare, but retained by the practice. Hartcher says GPs will be able to waive the $7 charge in cases of hardship, however this scenario would presumably leave the practice $5 worse off when compared with current bulk billing arrangements.

He also suggests that the new fee will apply from the first of July next year, allowing time for the change to be bedded down.

Submissions to the PCEHR review panel

As several submissions to the panel charged with reviewing the PCEHR have now become public, Pulse+IT has compiled a table of documents from expert groups and industry organisations who have answered the call for comment.

The deadline for submissions to the PCEHR review panel was Friday, November 22, with the panel due to report back to Health Minister Peter Dutton in mid-December.

This table will be updated as new submissions are released, and we've also provided as an extra resource links to previous submissions made by the various organisations. These include the calls for public comment on the draft PCEHR concept of operations in 2011 and the 2012 Senate Community Affairs Committee inquiry into the legislation for the PCEHR Act.

If your organisation has made a submission to the review panel, feel free to email it to us for inclusion in this table at This email address is being protected from spambots. You need JavaScript enabled to view it..

We also encourage readers to comment on these submission below or to contact us with your views directly.

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