Medicare Locals key to eHealth adoption: AML Alliance

The newly elected chair of the Australian Medicare Local Alliance (AML Alliance) transitional board, Arn Sprogis, has called on the federal government to resolve the stand-off with general practice groups on how to adequately fund the implementation of eHealth reforms at a practice level.

Dr Sprogis, a well-known GP from the Hunter region of NSW who sits on the board of the Hunter Urban Medicare Local, was elected chair of the new AML Alliance last Thursday. The Alliance will take over some of the functions of the Australian General Practice Network (AGPN), of which Dr Sprogis has been a past critic, and will move to ensure that Medicare Locals can do their jobs of providing support for clinicians and patients at a local level.

He said the national organisation would not be a centralised body as in the past, and that its main role would be to help “smooth the path” of Medicare Locals when required.

“[The Alliance's] primary role is at the local or community level,” Dr Sprogis said. “The underpinning philosophy for us is, this is a community phenomenon and primary care is exactly that – primary – and primary means down to the community level. Medicare Locals will be the engine room of this process.

“[The Alliance] is a national organisation but quite different to other centralised healthcare systems. Ours is a decentralised system so as a national body our absolute role is to smooth the path so that those community organisations, the Medicare Locals, can do their tasks at a regional level. We will only do the stuff that needs to be done nationally or fill the gaps if anyone thinks collectively that they need filling. Other than that, we'd expect the Medicare Locals to get on with the task at the community level.”

Dr Sprogis said he was pleased to be able to welcome the extra $50 million in funding for Medicare Locals to help implement the government's eHealth records system just a day after becoming chair, even if the government had not indicated exactly how the money is destined to be spent.

“This is a clear and welcome signal of the pivotal role of Medicare Locals in the eHealth sector across the country,” he said.

“This investment over the next two years, will significantly shift the momentum for developing the PCEHR program for patients and general practices.

“A clincher for the primary healthcare sector in getting the PCEHR up and running is an investment of this magnitude into Medicare Locals to support general practices and other health providers to adopt and use the program.”

However, he also said the government needed to resolve the problem of general practitioners doing extra work for patients without adequate recompense.

“There is now a whole stack of business in general practice and other parts of the primary care system where general practices are now expected to do a lot of work which isn't face to face, which is important work and they need to do it, but it is not funded,” he said.

“This eHealth thing is just another one of those. That as a whole needs to be resolved and no one is turning their attention to it. How do you fund people to do work when someone is not present?

“The PIP [practice incentive payments program] was meant to do that, because it is a population-based funding formula for specific activity, but what we have seen a pattern of in the last 12 months is the removal of PIP items, not the addition of them. So I'd argue the government really needs to rethink population-based funding for individual practices and to reward them for the time they have to spend that is not face to face.”

He said he was a strong supporter of the government's eHealth reforms and the PCEHR, but said the missing link in the success of the program would be the development of business cases at an individual practice level.

“What's the business case for this?” he said. “What, at a practice level, is the business case that is going to drive this initiative within each individual practice and for each individual clinician? That is yet to be resolved. People are pretending it has been resolved but it hasn't.

“That is the government's next task, to work out how to resolve the business case at the practice end. Using a stick like withdrawal of the eHealth PIP isn't the way you go about doing that.”

The Australian Medical Association recently set out a list of fees it suggests individual practices could consider charging for work on eHealth records if the government does not budge on its current stance that no extra money will be allocated for work on the PCEHR and that it should be claimed under the longer MBS consultation item numbers.

Asked if general practitioners should consider this move, Dr Sprogis said, “I think if there is no other method put in place then it's not that they should, but they are going to have to”.

“If that is the only method they have for recouping the loss of business, for the effort required, then that would represent a pretty radical change in both the way the practices have operated and the patients have operated. People do it for accountants and for lawyers – they charge for a piece of paper to be photocopied – and we expect that, but I think if you want a nationwide system put in the place, then in the end that is the government's responsibility.

“That is what our society would expect governments to do, and if it is a specific request by specific individuals just for them, then they'd expect a charge to be levied against them individually. But where it is a nationwide, statewide or region-wide system, then everyone expects that this is a government responsibility.”

Posted in Australian eHealth

Comments   

# Greg Twyford 2012-05-23 10:17
Arn , who is a well-respected leader in General Practice, is right to point out the need to demonstrate the business case for further GP involvement in e-Health activities on behalf of the government. However, there is more to the story.

The unlikely-named 'Medicare Locals', the successors to GP Divisions, may have a role to play in this area, as they did in the initial program to move practices from manual to computer based clinical and practice management systems. However, while many practices now run more efficiently due to computerisation , the clinical benefits to patients of this technology adoption are yet to be demonstrated.

A significant spin-off from these changes in business processes has been the proliferation of the PIP, EPC and related care planning and health assessment activities. These latter activities currently remunerate GPs for clinical report-writing and liaison activities that are not 'face to face', and also remain unproven in terms of clinical benefit.

So, yet again, does the PCEHR, with GPs as the 'primary' implementation target, risk draining off more clinical resources, on the unproven and unlikely? I spend a lot of time in practices where patient waiting times grow daily as the GP workforce diminishes on a population basis, and wonder whether the health of Australians will benefit ultimately through their participation in these unproven activities.
# SJ 2012-05-23 13:15
Hi Greg,

Having seen beta versions of some of the GP software that will interact with the PCEHR some time after July, I'm not sure that the ongoing support of an existing patient PCEHR will have a large impact on doctors' time. However it is disappointing that government seems intent on resisting a 'PCEHR enrollment/esta blishment' incentive for GPs as this would have a far bigger material impact on adoption $ for $ than the more nebulous funding arrangements outlined in this article. Patient enrollment / consent / record creation etc is naturally where GP time will be consumed and there's little MLs will be able to do to change this.

But as to your point about the clinical efficacy of such systems, the slow adoption trajectory government is enforcing through its prevailing policies will limit and defer the ability for any substantive analysis to be conducted on the PCEHR system in this regard, but in any case these issues will play out in parallel to the more serious workforce problems the sector faces, and no amount of IT is going to help as you're obviously aware.

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