E-health move will not be held back by privacy worries, NSW Health says

Health officials advice people worried about privacy issues related to the use of electronic health and medical records to not be doubtful as the real health advantages far exceed the little potential drawbacks.

The deputy director-general of NSW Health, Dr Tim Smyth said the state is working actively on the introduction of e-medical records and is going for a business case to provide electronic prescribing service.

Dr Smyth regards privacy worries related to electronic medical records are overemphasized and can trigger unnecessary concerns.

He said, "I've never seen privacy as an obstacle and it's often used as an excused by some players not to do anything."

He said in a speech at an e-health forum in Sydney, people often confused privacy which is data a person wants other people to know, with the security of that information.

Dr Smyth said, "Being able to transfer information is critical (and) e-health has the potential to reduce errors."

With Healthelink, health records are only accessible by authorized health care providers under the signed contract to "respect the privacy of records and to maintain confidentiality of the information".

David Roffe, CIO of St Vincent's & Mater Health Sydney said people in chronic care usually want to share their health information.

He sad e-health systems for the management of medication cut down errors and NEHTA-compliant secure messaging is the way forward.Adam Powick, consultant of Delloitte e-health stated, "People place a great deal of trust in the health system and for good reason."

The use of passwords, with regard to information security remains a concern, said Dr Smyth, as NSW doctors who moved, for example, from Blacktown hospital to another in the city have to change their passwords due to different systems operated, and he is working to get the issue solved.

NEHTA releases strategic plan

By: Karen Dearne

THE National E-Health Transition Authority has released a strategic plan repositioning itself as an implementation agency with a role well beyond its present funding to 2012.

"Since its establishment, there has been a misalignment between NEHTA's current direction and the expectations of the various stakeholder groups," the plan says. "As the organisation evolves it is important to ensure a foundation exists for 'what' it has been put in place to deliver."

NEHTA will "co-ordinate and manage the uptake of e-health systems which are of a high priority, interoperable and scalable" nationwide.

Chief executive Peter Fleming said the 2009-2012 plan outlined how NEHTA would fulfil its mission in relation to delivering the National E-Health Strategy adopted by the Council of Australian Governments last December.

"We have considered our future work program based on the (Deloitte) strategy and other important work completed this year, including the National Health and Hospital Reform Commission recommendations," he said.

"As a result we have produced our plan to clearly show our stakeholders the directions we are taking to drive the adoption of e-health."

The four priorities echo program outlines produced by the organisation since its creation as a not-for-profit company owned jointly by all state and federal governments. These are to urgently develop the essential foundations required to enable e-health; coordinate the progression of the priority e-health solutions and processes; accelerate the adoption of e-health, and lead the progression of e-health in Australia.

However, the 46-page document contains little new information, and lacks clear action plans or timelines, with most of the real work scheduled post-2012.

While the Deloitte strategy recommended establishing a fresh, independent, national e-health body to handle investment, implementation and regulatory functions - potentially leveraging NEHTA's assets - NEHTA says it is "in a unique position to drive the e-health agenda" within Australia.

"NEHTA has an overarching sense of the landscape of e-health, both nationally and internationally," it says. "This places us in a strong position to orchestrate key activities and inform key decisions."

In January, Mr Fleming told The Australian a number of large-scale production pilots would start this year but so far there has been no major announcements.

Fleming heads medical e-data project

By Karen Dearne

AUSTRALIA's new e-health boss, Peter Fleming, has a solid technology background and a long-held vision for electronic reform of the health sector.

Mr Fleming, appointed chief executive of the National E-Health Transition Authority yesterday, said he intended to deliver a system that would have "major benefits for the entire nation".

Most recently National Australia Bank's technology and business integration general manager, Mr Fleming previously spent five years as chief information officer of health group Mayne, with oversight of its pharmaceutical business.

"In my time in Mayne we saw the real benefits of being able to move transactions electronically," he said.

"It was a vision that we always thought - once it could be done at a national level - would provide tremendous benefits in removing duplication and also in enhanced patient care."

Mr Fleming replaces Andrew Howard, who has been acting chief executive since the sudden departure of former chief Ian Reinecke in April. Dr Reinecke's resignation followed criticism of NEHTA's structure and lack of consultation with outside stakeholders, contained in a review by Boston Consulting late last year.

The shakeup led to new blood on the board, including the appointment of Australian Securities and Exchange chairman David Gonski as chairman.

Mr Gonski yesterday announced Mr Fleming's appointment, saying the board would work with him to "meet the challenges of the national health agenda".

Although Mr Fleming is not well known in e-health circles, it is understood he was chosen for his experience in large commercial projects.

He started his career at Coles-Myer, where he spent 17 years in the IT department before moving to Colonial Group for seven years and rising to chief information officer.

At Colonial, Mr Fleming was involved in installing a new banking system for the State Bank of NSW. Aushealthit blogger David More said Mr Fleming's biggest challenge would be "coming seriously to grips with a health sector that is severely frustrated by the lack of progress" in e-health.

"He should be stepping back and thinking reflectively about how the authority should interact with the rest of the sector, after its deep disconnect," Dr More said.

"It will be incredibly difficult to attract the levels of investment NEHTA seems to be contemplating without a demonstrable cultural change and improved relations with other stakeholders."

Dr More also warned that the corporate command culture may not sit well with the "professional democracy" of healthcare.

"A difficult implementation in a commercial organisation where the CEO can just tell people to do stuff is very different from this situation," he said.

Meanwhile, NEHTA's board and the Council of Australian Governments are awaiting a comprehensive national e-health strategy being developed by Deloitte. The report is due in a matter of weeks.

Mr Fleming said it would be premature to talk about the strategy, as he had yet to read the draft documents and meet the consultants.

"I need to spend some time understanding the plans and the work done to date, but I really want to work with the team to build a solid action plan for delivery," he said.

"That will obviously mean a huge amount of work with all of the key stakeholders to ensure a common approach." Mr Fleming said he would "certainly be very keen" to speak to the health IT industry and clinicians.

"I'll be looking at the long-term strategy and the best way to do that," he said. "It's an exciting challenge, and the potential benefits for the nation are part of the attraction."

Mr Fleming does not take up his new post until September 29, but he hopes to attend some of the e-health sessions taking place in Melbourne this week.

Michael Legg, president of the Health Informatics Society of Australia - which is holding its annual conference this week - congratulated Mr Fleming.

"We look forward to working closely with him to put in place the infrastructure Australia needs to address the critical shortage in health services that we're going to have," Mr Legg said.

Leaked details show modest costs for e-health

By Karen Dearne

NATIONWIDE electronic health infrastructure will cost a modest $1.5 billion over five years, or $2.6 billion over a 10-year rollout, according to leaked funding details.

Federal and state ministers have kept tight wraps on costings and timetables since agreeing last December to adopt the National E-Health Strategy, prepared by Deloitte.

The $1 billion to $2 billion range "represents a relatively modest investment" when compared with the total annual health spend of $90 billion, with $60 billion coming from all levels of government.

Deloitte found that "tangible benefits" from implementing the e-health strategy "are in the order of $5.7 billion in net present value terms over 10 years".

Annual savings from a fully integrated system "are estimated to be about $2.6 billion in 2008-09 dollar terms".

The leaking of financial information and costed work programs on David More's AushealthIT blogger website appears to reflect growing frustration with the lack of progress on e-health.

Last month, medical and consumer groups told the National Health and Hospitals Reform Commission they were astonished it had failed to put information technologies at the heart of reform plans.

Dr More, a clinician and health IT expert, said he hoped today's federal budget would deliver a "substantial boost" for the health sector. "But I fear we may be disappointed," he said. "Really, $300 million per annum is small beer in terms of the whole health budget."

Dr More said the costs and benefits contained in the full Deloitte report had been available to all state and federal health bodies for more than six months, "and it is quite wrong in my view that the public does not get a chance to debate the merits" of the proposals.

The strategy identifies four key areas for investment, including foundational activities ($370 million over five years), e-health solutions ($630 million), change and adoption ($470 million), and governance ($30 million).

Big-ticket items include a national e-health solutions investment fund ($500 million over five years) and care provider incentives ($400 million).

In particular, Deloitte called for the present National E-Health Transition Authority to be disbanded, and a fresh e-health entity with a governing board and regulatory powers established.

To date, only a brief executive summary of the Deloitte report has been released, even though the strategy was endorsed by the Australian Health Ministers' Conference as "a practical framework".

Rudd Govt to abolish patient privacy

By: Suzanne Tindal

The Australian Medical Association (AMA) has slammed draft legislation brought forward by the Federal Government, which will allow it the right to access individual patients' records.
This is 'Big Brother' at its worst.
The draft, which the AMA said had been released last Thursday night before the Easter long weekend, would mean the government had the power to "require a document, extract or copy containing health information (within the definition of the Privacy ACT 1988) about an individual".
The legislation had its grounds in making it possible for the government to conduct administrative checks"This is an act of bureaucratic voyeurism that strips patients of all rights to privacy. It presses the face of government at the keyhole of every surgery in the country. Doctors will be compelled to hand over highly sensitive medical information to justify Medicare claims potentially including a patient's intimate concerns and examination findings, their test results, weight, sexual health, infections ... nothing is protected.
"Worse still, under this legislation patients don't even have the right to know that their records are being accessed. There is no compulsion to even advise patients, let alone seek their permission," Capolingua said.
"Government has no business accessing these records. This information is between the doctor and the patient, and must remain so," she concluded.
There has been a lot of attention on health record privacy in recent times with the attempts to introduce national electronic health records, as they would make private information more readily available. The government is facing the need to pass new legislation to make the introduction of an individual health identifier possible, which the National e-health Transition Authority believed would take until next year.
The office of Federal Minister for Health and Aging Nicola Roxon was unable to provide comment in time for this article.

Roxon lost on e-health, opposition claims

By: Suzanne Tindal

The Federal Government's lack of a true electronic health agenda had left an opposition offer of bipartisanship on the issue dangling useless by the wayside, Shadow Health Minister Peter Dutton said yesterday.
"[Health and Aging Minister] Nicola Roxon and I don't always have a perfect made in heaven relationship, but nonetheless, when I first sat down with Nicola coming into this portfolio only six months ago I gave her an undertaking that we would — on the issue of e-health — provide bipartisan support," Dutton said speaking yesterday at the Annual Health Congress in Sydney.
We've seen no evidence of an agenda which we can support as we go forward.
The upfront expense and long lead times of e-health solutions meant that the benefits wouldn't be delivered for what was politically, a long time, according to Dutton.
Yet the offer was not being used, the shadow minister said: "I offered that bipartisanship from day one. The offer stands today, and we've seen no evidence of an agenda which we can support as we go forward."
His comments echoed those made by Booz and Company principal Klaus Boehncke at the conference. "It's fair to say that political leadership has not been exhibited here as it has elsewhere," he said, pointing to US President Barack Obama, who put e-health onto the agenda in his first address at the White House, the German Federal Health Minister Ulla Schmidt's spruiking of her country's e-health card and the tremendous drive in Singapore to get electronic health records up and running by 2010.
"What you see then in Australia because of this lack of leadership is that many of the states are pursuing their own separate visions of e-health programs," Boehncke said.
The lack of drive and vision has seen talent go overseas to where the fruits of its labour might be implemented, he said. "[There are] disillusioned Australians from the National E-health Transition Authority and from Queensland Health and from a lot of healthcare areas, working hard to make sure that Singaporeans get an electronic health record next year."
What you see then in Australia because of this lack of leadership is that many of the states are pursuing their own separate visions.
In order to move from this point, Boehncke highlighted three areas he thought needed urgent attention, the first being a national e-health investment strategy which was "much more than a business case" since it defined what would be built, for whom and why. NEHTA currently has a business case for a national e-health strategy, which needs to go before the Council of Australian Governments before funding can be allocated to it.
The second was a national infrastructure and definitions around how data would be shared, where it would reside and who owned the data. Where the data resided would go into consultation after the business plan was approved, according to NEHTA CEO Peter Fleming, speaking at an IIR conference last week.
"At this stage the current thinking is that we will not have one central electronic health record that everyone's part of. The expectation is that there will be multiple electronic health records around the country and that those health records will be provided by various players. In some cases it may be health insurers, in some cases it may be Google or Microsoft, it may be professional bodies," he said.
"Where I think we will end up is that we will have a large indexing service not dissimilar to the type of web technologies we know today that knows where an individual's records are stored and can pull that data back as required. Given the current physical restraints, I think that index will also contain some summary data, things that might be required in an emergency.
The last issue Boehncke outlined was the national health identifier, which he spoke on in expanded fashion since it touched upon prior work of his with the past government's controversial Access Card. "[NEHTA is] developing a number for every Australian. But having a number isn't the same as developing an identifier," he said. Boehncke said it was necessary to have that number linked to the physical person, for example, by using a card, but when he asked people in Australia how they thought the person would be linked to their number, he received a lot of different answers.
This type of stuff really makes the things that were stored on the Access Card seem insignificant.
"I get high-ranking state health ministry officials that tell me people in Australia don't need to be identified securely because they trust their GP... The GP will identify the patient," he said. "Other people tell you oh no, no, no, there'll be a new Medicare card. It'll be a smart Medicare card."
Those people thought it would be easy to upgrade the Medicare card to take on new duties, but it wouldn't be, according to Boehncke.
"Let me tell you, from my Access Card experience I know that's not going to be easy because you're moving from a payment card to what becomes an identity card. And you'll have all these questions like we had with the Access Card. Like can you put a photo on it."
When someone asked if the government was dithering because it was frightened of opening up an Access Card type can of worms, Boehncke said that an e-health card would be much more frightening than the previous government's controversial card because of the type of data it would have stored on it.
"This type of stuff really makes the things that were stored on the Access Card seem insignificant because your health data holds a lot more information about you," he said. "To be afraid of an Australia Card when you are trying to identify people in the health setting might be natural when you look at the Australian history in a lot of these debates," he said.
Yet he believed people would voluntarily take up an e-health card because unlike the Australia Card of the Access Card, an e-health card has a true value proposition — the opportunity to save lives.

Uniform health system in the mill

By: Karen Dearne

LARGE-SCALE production pilots of a nationwide e-health system will start this year, with the National E-Health Transition Authority set the task of making this happen as quickly as possible.

Peter Fleming says he hopes to run pilot projects this year

NEHTA chief executive Peter Fleming has been given a mandate to create a uniform IT infrastructure, starting with an incremental build-out of existing clinical and communication platforms.

Federal and state government agreement on the urgent need for healthcare safety and efficiency gains - detailed in several recent reports - signals an end to years of under-investment and fragmentation as parties pursued their own technology agendas.

"Legislative changes are needed, but from a technical perspective we aim to be in a position this year to run some pilots," Mr Fleming said.

"We're in very close dialogue with a number of groups about trials of electronic medication management and hospital discharge summaries."

Late last year, the Council of Australian Governments approved $218 million in funds to extend NEHTA's operations.

Mr Fleming said the organisation was working with software vendors to assess their capabilities and move towards the goal.

Medical Software Industry Association president Vincent McCauley said members were "hopeful this is the year things happen".

"That, of course, remains to be seen, but we're keeping our fingers crossed," Dr McCauley said.

The association is advertising for a part-time general manager in response to increased industry involvement in consultations over national projects.

IBA Health Group chief executive Gary Cohen said there had been a fundamental shift in attitudes, and "not many in healthcare are interested in trying to preserve their own patch" any more. "People have realised that we have to do things differently, and we need a more national approach to healthcare delivery," he said.

Mr Cohen said the Rudd Government should be "emboldened" and develop a vision of investing in healthcare IT infrastructure. "There should be a central funding body that's responsible for allocating funds for infrastructure," he said.

"People within state health departments are locked into a particular environment - really, only the federal government has the capacity to make those big changes," Mr Cohen said.

Helen Hopkins, outgoing executive director of the Consumers Health Forum, said there was more recognition among health professionals and bureaucrats that people were important stakeholders.

"Consumers want access to their health information when and where they need it, so we're continuing to push for a full e-health record," she said.

"If that's going to take some time, they want some easier things first, such as their hospital discharge information to be sent to their GPs," she said.

Uniform health system in the mill

By: Karen Dearne

LARGE-SCALE production pilots of a nationwide e-health system will start this year, with the National E-Health Transition Authority set the task of making this happen as quickly as possible.

Peter Fleming says he hopes to run pilot projects this year

NEHTA chief executive Peter Fleming has been given a mandate to create a uniform IT infrastructure, starting with an incremental build-out of existing clinical and communication platforms.

Federal and state government agreement on the urgent need for healthcare safety and efficiency gains - detailed in several recent reports - signals an end to years of under-investment and fragmentation as parties pursued their own technology agendas.

"Legislative changes are needed, but from a technical perspective we aim to be in a position this year to run some pilots," Mr Fleming said.

"We're in very close dialogue with a number of groups about trials of electronic medication management and hospital discharge summaries."

Late last year, the Council of Australian Governments approved $218 million in funds to extend NEHTA's operations.

Mr Fleming said the organisation was working with software vendors to assess their capabilities and move towards the goal.

Medical Software Industry Association president Vincent McCauley said members were "hopeful this is the year things happen".

"That, of course, remains to be seen, but we're keeping our fingers crossed," Dr McCauley said.

The association is advertising for a part-time general manager in response to increased industry involvement in consultations over national projects.

IBA Health Group chief executive Gary Cohen said there had been a fundamental shift in attitudes, and "not many in healthcare are interested in trying to preserve their own patch" any more. "People have realised that we have to do things differently, and we need a more national approach to healthcare delivery," he said.

Mr Cohen said the Rudd Government should be "emboldened" and develop a vision of investing in healthcare IT infrastructure. "There should be a central funding body that's responsible for allocating funds for infrastructure," he said.

"People within state health departments are locked into a particular environment - really, only the federal government has the capacity to make those big changes," Mr Cohen said.

Helen Hopkins, outgoing executive director of the Consumers Health Forum, said there was more recognition among health professionals and bureaucrats that people were important stakeholders.

"Consumers want access to their health information when and where they need it, so we're continuing to push for a full e-health record," she said.

"If that's going to take some time, they want some easier things first, such as their hospital discharge information to be sent to their GPs," she said.

Patient tracking system unveiled to solve drug errors

By: Liam Tung

Australian citizens will be assigned a unique identifying number to help healthcare providers protect their patients from accidentally being given the wrong treatment.

Australians' Medicare records will be accessed to create the "Unique Health Identifiers" (UHI), under an initiative announced by minister for Health, Joe Ludwig.

While Medicare will be responsible for the design, building and testing of the UHI system, Australia's National E-Health Transition Authority (NEHTA) will coordinate the project to collect information needed to develop the identifiers, as well as develop requirements for an identity management system.

The system is meant to resolve the limitations of current identifiers -- name, sex, address and date of birth -- which has led in some instances to the wrong test results being applied to a patient, according to an earlier NEHTA report.

At present, medical service providers such as community GP clinics, pharmacies, private and public hospitals have diverse methods and systems to identify individuals, which can potentially lead to the mis-allocation of tests and treatment. Likewise, medical provider information is often stored on disparate systems.

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According to NEHTA, no clinical data will be contained in the records, but they will contain identification and demographic data collected from Medicare. Other potential sources of data may include Australia Post's Geocoded National Address File and Births, Deaths and Marriages Registries for date of death data.

Work on core components of the UHI project commenced in February last year when the Council of Australian Government approved a AU$98 million budget for NEHTA to deliver identifiers for individuals and healthcare providers, which together make up the UHI.

Previously Medicare was not permitted to use its records for secondary purposes such as the creation of the UHI, however, last August Senator Chris Ellison passed legislation allowing the department to do so.

A privacy impact statement is yet to be created for the system, although NEHTA expects the development process to commence in February.

The UHI program will also involve establishing identity management systems to authenticate healthcare providers, workers and patients that access the system. While individuals will be required to use a single factor authentication system, NEHTA plans to establish a two-factor authentication system with the use of smartcards for healthcare providers.

Secondary uses for information collected under the UHI system are yet to be defined, however, NEHTA has proposed that research bodies, such as the Australian Bureau of Statistics, will be able to access anonymised information.

Last year, the Australian Law Reform Commission (ALRC) recommended amending the Privacy Act to include "genetic" information under the definition of "health information", which will govern the use of information collected under the UHI. At present, the Privacy Act does not sufficiently cover genetic information, according to the ALRC.

Flying doctors spend $2.7m on bush health records

By: Suzanne Tindal

The Royal Flying Doctor Service (RFDS) has entered into a five-year AU$2.7m contract with IBA Health to create a standardised system for its electronic health records.

(Credit: Royal Flying Doctor Service)

The new system will help the Service's health professionals with its 12,000 annual clinical appointments across regional Australia.

Clinicians will be able to remotely access a patient's medical history, including allergies, immunisation records and current medications, via the internet-based system, and update the information during check-ups.

In time, it is hoped the system will also be accessible in aircraft. The RFDS Queensland operations are already using Telstra Next G to achieve this.

Some areas the RFDS visits don't have internet access. For these places, the RFDS will work together with IBA to develop a customised system which will allow "briefcasing" of medical records — taking files that are needed on laptops and synchronising them with the system when the clinician again has an internet connection.

(Credit: Royal Flying Doctor Service)

Ideally, the files will be briefcased from a central location, according to Gary Oldman, RFDS acting national ICT manager, but it depends on the amount of bandwidth required by the application. The Service has a server room in Sydney which could be considered as the central location, however, he said nothing has been finalised.

To have a network on which the system can run, the RFDS has to link together its separate Wide Area Networks. The Service has four areas of operations: South East (NSW, Tasmania, Victoria), Queensland, Central, (South Australia and Northern Territory) and West (Western Australia). The Service has received a draft proposal from Telstra, which is looking to connect the regions via extranet.

The national network will form the backbone for other things, according to Oldman. "Once we've got an infrastructure, we can run other national programs: a national HR system; a national finance system; a national intranet."

The IBA contract includes the licence for the software, implementation, customisation, support and maintenance. Implementation work will start in July and continue to June 2009. Once the new system is in place, the old Service records will be migrated, Oldman said.

(Credit: Royal Flying Doctor Service)

The Service chose IBA Health because it had the bells and whistles but would also speak to other internal and external systems including State hospital, pathology and X-ray records, according to RFDS national health program manager Robert Williams.

"There are various products out there. However, the IBA iSoft product had the most functionality and met NEHTA standards," he said.

NEHTA is responsible for unifying medical records across the nation.

NEHTA appoints new CEO

By: Suzanne Tindal

The National E-Health Transition Authority has nicked a top technology executive from the National Australia Bank to be its new chief executive.

Peter Fleming will take the reins at the nation's peak e-health agency on 29 September, relieving acting chief executive Andrew Howard, who has been seconded from Victoria's Human Services Department for the past few months, where he was CIO. He will be returning to that role after he has conducted an extensive handover, according to a NEHTA spokesperson.

Fleming is currently general manager technology, business integration with NAB. He has also held a CIO position with both Mayne Group and Colonial Group.

NEHTA's previous long-standing CEO, Ian Reinecke, quit the group in early April this year.

The appointment of a new CEO followed that in July of a new chair, David Gonski, who said the board was looking forward to working with Fleming.

Also in July, NEHTA held the first meeting of its Stakeholder Reference Forum which aimed to improve the organisation's engagement with key stakeholders, including state health agencies, the Department of Health and Aging and several other clinician stakeholder groups and consumer representatives.

The Forum was set up in part as a response to a review by the Boston Consulting Group published last year.

Members of the forum signed a non-disclosure agreement which bound them from talking about specific topics, however some information was released.

The major priorities agreed upon at the first meeting were the development of an e-health business case for consideration by the Council of Australian Governments meeting in October this year, as well as devising a five-year plan.

The first major e-health implementations the group wanted NEHTA to focus on were developing systems for electronic discharge summaries, pathology reports, specialist referrals and medication management.

Liam Tung contributed to this article

Vic HealthSmart IT chief quits

By: Karen Dearne

THE director of Victoria's $427 million HealthSmart IT rollout, Fiona Wilson, has resigned from the Office of Health Information Systems for personal reasons.

"Ms Wilson will be relocating to be closer to her partner in Auckland, and I can confirm she will be leaving the Department of Human Services towards the end of October," a DHS spokesman said.

"For quite a while now, Fiona has been travelling across the Tasman to do her work here, and also continue her relationship with her partner in New Zealand."

The spokesman said there had been no decision made on an interim or permanent replacement for Ms Wilson but her departure was a big loss to the organisation.

"She has been a big driver in health ICT reform, and she has been critical to all the achievements to date," he said.

Ms Wilson was appointed to lead the OHIS when it was established in mid-2003 to manage the department's HealthSmart program - a four-year $323 million ICT refresh and rebuild across the state's public health hospitals, rural alliances and community-based health providers.

The project was originally due for completion in 2007. It remains unclear when the project would be completely rolled out.

Meanwhile the first implementation of the long-awaited Cerner clinical system "will formally commence" next month, Victorian Human Services secretary Fran Thorn recently told the Health-e-Nation conference in Melbourne.

Cerner's Millennium suite provides e-health records, appointments scheduling, diagnostic services, results reporting and e-prescribing applications.

"Engagement with the next round of health services is underway in anticipation of rolling out to agencies over the next two years," Ms Thorn said.

Last month, the Victorian Government allocated a further $104 million for the HealthSmart program in its budget for 2008-2009.

At the same time, the Human Services Department began consultations over a new whole-of-health ICT strategy for 2009-2013.

Meanwhile, Andrew Howard, who has been acting chief executive of the National E-Health Transition Authority, is set to return to the DHS following the appointment of Peter Fleming as NEHTA's CEO.

Mr Howard is the department's chief information officer.

E-health goes back to basics

By: Karen Dearne

FEDERAL bureaucrats are back in charge of the e-health reform agenda, with the Rudd Government allocating $60.6 million to solving the "challenges" of complexity, pace of technology development and lack of consultation with stakeholders.

E-health has taken a budget cut of $4 million to $60.6 million in 2008-09

Budget documents say the Government, through the Health Department, "will work with the states, professional groups and consumers, to address the aspects of e-health requiring national leadership and coordination. This includes the development of a national e-health strategy".

The declaration ends the arm's-length approach to e-health adopted by the previous government, which created the largely ineffective National E-Health Transition Authority (NEHTA) to manage the issue then cut existing projects such as the HealthConnect nationwide patient record-sharing system.

Underlining the shift away from NEHTA, the Budget statement adds that the department "will specifically oversee the development of national standards to enable compatibility of e-health systems across the national health network. The department is working to ensure health systems are interoperable, and can safely and securely exchange electronic health information between health professionals with patients' permission".

NEHTA founding chief executive Ian Reinecke resigned unexpectedly in late March, amid increasing calls for a clear strategy and state health departments embarking on their own, separate, health IT projects.

Andrew Howard, chief information officer of Victoria's Human services department, is currently acting chief executive while an international search is conducted for a replacement for Dr Reinecke.

A formal review by Boston Consulting found the authority had failed to communicate with health and IT industry stakeholders whose support was needed to resolve complex technical and workplace reform concerns.

In contrast, the new government has promised to consult with "medical groups, the software industry, other professions and the community to ensure the needs of all are taken into account" and the benefits of e-health properly communicated.

It's understood NEHTA will be required to report directly to department officials, who will "ensure work is delivered within agreed timeframes".

However, e-health has taken a Budget cut of $4 million to $60.6 million in 2008-09, compared with $64.6 million in the previous year.

In 2006-07, the Howard Government left $41.5 million unspent out of $79 million allocated to national health IT projects, as it lost interest in e-health reform.

Meanwhile, Medicare is developing the Unique Healthcare Identifier service needed to support the introduction of a national e-health record system.

Under a contract signed with NEHTA earlier this year, Medicare is working on a system that will generate individual identity numbers for patients, medical providers and healthcare locations such as GP surgeries, hospitals and clinics.

The Budget has provided $8.6 million over four years to streamline Medicare benefits claiming through electronic payments systems. GPs boycotted Easyclaim, introduced by the former government because it required practice staff to conduct Medicare claims functions and was difficult to use.

Human Services Minister Joe Ludwig said Easyclaim tied-up medical practices that wanted to do the right thing for patients in red tape. "This is the reason why, despite making $28 million available to drive take-up, the Liberals achieved rates of only 0.5 per cent of electronic patient claims".

And the Government has scrapped the Eclipse software system, originally developed by the Health Insurance Commission at a cost of $48 million to provide private patients with information about expected gap bills resulting from private health fund limits on doctors' fees.

The measure will save more than $20 million previously allocated to future development of the system, which is only used by a small number of private health funds.