Budget 2015: Govt planned for $700m investment in PCEHR

The big-ticket item for eHealth in this year's budget – the multi-million dollar investment in the PCEHR for a further four years – was originally provisioned to be $700m, according to the budget papers.

Tonight's budget confirms that the government will provide $485.1 million over four years to continue the operation of the PCEHR, make some improvements and implement trials of opt-out arrangements.

The budget papers also reveal that the government originally thought $700m would be required. It is now claiming the difference as savings that will be redirected to fund other health policy priorities or be reinvested into the Medical Research Future Fund (MRFF).

The MRFF turned out to be another big winner on budget night, with the government promising it would return $10 million this financial year and more than $400 million over the next four years.

However, this will come at the expense of other programs such as preventative health research, any GP Super Clinic that has not commenced construction, and the Department of Health's flexible funds, which are discretionary funds used by DoH for worthy projects.

Cutting flexible funds and preventative health research will achieve “savings” of $962.8 million over five years from the current financial year, the government says, which may be invested in the MRFF.

While Health Minister Sussan Ley said expenditure on health overall would see a moderate increase of $2.3 billion over last year to $69.7 billion, the budget papers show the extent of the cuts to public hospital funding announced in last year's budget.

The change to the funding formula announced last year will see the growth in federal expenditure on hospitals plummet by up to 10 per cent a year to 2018-2019. This is despite increasing costs to the states and is expected to see a shortfall of up to $57 billion over 10 years.

New spending includes an extra $1.3 billion over four years listing new medicines and vaccines on the PBS and to set up a National Cancer Screening Register, with the introduction of a new screening test for cervical cancer.

Extra funds will be given to the Royal Flying Doctor Service, and funds for after-hours GP services previously allocated to the After Hours GP Hotline and Medicare Locals will be clawed back and redirected to a new after-hours GP practice incentive program (PIP).

Ms Ley said the government will also continue working with stakeholders on the development of a National Diabetes Strategy due for release in late 2015. This is expected to include the use of eHealth as part of an integrated approach.

The government has also returned $200 million in funding support for the state and territory governments for dental services that it stripped in last year's budget.

Smaller items include extending Medicare eligibility for telehealth to optometrists to support the use of video conferencing with ophthalmologists, and an MBS item to enable routine monitoring of implanted cardiac devices to be provided remotely.

In early reaction to the budget, the Australian Medical Association said the modest positive measures in the budget were still overcome by the “lingering profound negative effects” of last year's budget.

AMA president Brian Owler said there was a clear inference in the government's statements that its planned review of the MBS was expected to be a savings exercise. He also criticised the continuation of the hospital funding policy, saying it had been “savagely” cut in last year's budget.

He welcomed the investment in the PCEHR and some funding for Aboriginal Community Controlled health organisations this year, but took a swipe at the lack of detail in both the budget and at the pre-budget briefing sessions or lock-ups.

A/Prof Owler said it was evident that the health sector was not impressed with the withholding of budget detail in the health budget lock-up.

“It was insulting to have the leaders of Australia’s health organisations locked in a room with no budget detail,” he said.

Posted in Australian eHealth

Comments   

# Mat Tyler 2015-05-12 22:44
An informative update Kate, thank you and well done.
# Diane 2015-05-13 01:11
Can doctors really not see the damage this will do to patient trust? Medical data should never be shared online except with explicit patient consent - this will risk lives.
# Simon James 2015-05-13 01:36
Hi Diane,
For better or worse the transition from opt-in to opt-out arrangements will continue to provide patient control over the content of 'their' government held record.

As I understand it, patients will still need to consent to information being uploaded into the new 'opt out' record on a case by case basis, as is currently the process on the couple of dozen occasions it happens across the country each week. I assume the ability for patients to suppress information will also be retained.

I note that the current patient control aspects of the system have put downward pressure on clinician propensity to engage with the PCEHR, but it remains to be seen whether this reticence will dissipate as Australians are each given an empty PCEHR / myHealth Record in the years ahead.
# Jess 2015-05-13 11:24
Quoting Diane:
Can doctors really not see the damage this will do to patient trust? Medical data should never be shared online except with explicit patient consent - this will risk lives.


It doesn't sound like you know how the PCEHR works?
The P and C stand for Personally and Controlled - the person individual controls their own PCEHR, not the doctors.
# Matt 2015-05-13 11:38
People bleating about the privacy of the PCEHR when they all post their lives online anyway for all to see
# Brett Mc 2015-05-13 11:40
Sensible transition to opt-out; will certainly save $$ in trying to get people to register. The challenge is to make the MHR (myHealth Record) useful and easily accessible.
# StephenB 2015-05-13 12:42
The concern I have is that without an established EHR framework ("PC" or not, but this is better!) - how many lives will be lost? Without an effective EHR what damage is continuing to be done to rising costs and unfortunately reduced effectiveness in primary care? Agree.., the risk to privacy etc have to be taken into consideration however if EHR ensures a better healthcare outcome for my loved ones ie. may even save their lives why would I deny that? The question I would ask - why is the government continuing to underfund getting it right?
# Diane 2015-05-14 02:36
To Simon and Jess, I have read up on the detail of the system, including reading through the legislation, during the submissions process. Unless it's changed since then, patients aren't able to remove information once it's been uploaded, they can only hide it in a 'locked envelope' system, which is still online and still accessible to hackers, as well as emergency staff. So if something does get uploaded that the patient doesn't want there, or if they change their mind afterwards, they can't remove it completely. Their only option at that point is to opt-out altogether, and even then, NEHTA will still keep the data.
# Simon James 2015-05-14 10:57
Hi Diane, I'm not dismissive of these concerns in the broad sense, and I'd absolutely recommend to patients that are concerned about their records being "accessible to hackers, as well as emergency staff" that they opt out of the system before their records have a chance to be populated.

By opting out of the PCEHR -- or any other eHealth system for that matter -- they are also opting out of any benefits that it may (one day) deliver, so this is something patients should educate themselves about and weigh up to the best of their ability.

The government departments and agencies involved with the PCEHR thus far have done a dreadful communications job (both patient and doctor facing) and there's little doubt many of the 2m people that have opt-in PCEHRs have no clue about such matters. However I can only assume that the move to opt-out arrangements will be supported by public awareness campaigns so people that share your views should have ample opportunity to make alternative arrangements.

International evidence from the UK and NZ suggest the vast majority won't opt out, which is something the government of the time should have reflected on when they set up the current system to fail.
# John Turner 2015-05-14 17:29
What a complete waste of resources the present PCEHR is. How many people are actually using it?

A central electronic record for patient health is a good idea in theory but the reality is something else particularly given the poor IT communications infrastructure in large areas of the country.

Throughout the late 90's to the present time the government has wasted untold millions on supporting IT systems in General Practice through the PIP this is because they did not stipulate a standard for such systems and left it to the market to determine, consequently there are many different systems out there that do not "talk" to each other and if you wish to change systems the data transfer is a nightmare.

I am reminded of the Victorian government's waste of Hundreds of millions of tax payers Money on the Myki electronic ticketing.
# Richard Lawrance 2015-05-15 12:22
Based on the data available in the PCEHR Review report, the system's uptake was exceeding both targeted expectations and reasonable uptake expectations that could be forecast by a grounded theory such as Rogers' Diffusion of Innovations . The notion that uptake is poor is one perpetrated by government without any analytical construct. The 18 month hiatus in certainty created by the PCEHR review is far more likely responsible for any downturn in uptake than the attractiveness or usability of the system itself.

Now that the engine seems to be restarted by government, my concern is more for the management of the information in the MyHealth record as it grows in size and document type. SNOMED-CT is a terminology based system. The two feed systems - primary care and hospital care - use different systems of clinical classification (ICPC and ICD-10-AM respectively). Clinical classification systems are far more useful in a quality framework - both for clinicians and funders (not to mention population health analysis) - than SNOMED-CT. Until the interactivity between these three information-man agement paradigms is addressed as a key feature of MyHealth record functionality, the agglomeration of data in the system risks becoming an ever expanding data 'waste management repository'.
# Moses 2015-05-28 10:31
It's a noble idea - but why throw good money after bad? If they couldn't do it for 500M$ until now why do they think it will work now? Adoption rates are so slow as they don't trust the privacy of the program and the possibility that it will be linked in the future to insurance companies etc.. The model should be that NO access is allowed to patient information and ALL data in encrypted with Patient & Doctor cards. In Germany - if a doctor wants to view patient information online he needs the patient to swipe their national card as a double authentication. There is a lot more to PCEHR then meets the eye... It was not planned appropriately from the beginning and that's why the adoption rate was so low and double the amount in a questionable move in this budget

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