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".

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".

ICSGlobal sues Medicare

By: Brett Winterford

update Electronic health transaction company ICSGlobal has filed a lawsuit against Medicare Australia, accusing the Federal Government agency of anti-competitive behaviour over the development of its e-health transaction network ECLIPSE.

ASX-listed ICSGlobal said it had invested some $20 million and the better part of eight years into the development of an online exchange network dubbed THELMA, which connects private insurers, banks and healthcare providers to manage the settling of healthcare-related transactions.

The company claims to have made this investment under the assumption that the Federal Government had no interest in facilitating such electronic exchange itself.

But in 2004, the Federal Government announced the release of ECLIPSE, its own system for managing such transactions. The initial modules of the system went live in July 2004.

ICSGlobal subsidiary THELMA today confirmed it had now filed an application and statement of claim in the Federal Court alleging that Medicare contravened the Trade Practices Act by launching a service that competed with its business.

Tim Murray, CEO of ICSGlobal, said the company spent a full year in the 1999/2000 time-frame scoping the market for a medical transaction exchange network after private hospital customers informed him of a need for such a solution.

"We knew we were about to invest a substantial amount of money," he said. "Twice we went and saw both HIC [Medicare Australia's predecessor] and the Minister for Health [at that stage Dr Michael Wooldridge] in 2000 and in 2001. And we asked them: 'Do you have plans to address this problem in the private sector?'

"They both said no, on both occasions. They both said, in fact, congratulations, it is fantastic to see the private sector stepping in to do this."

THELMA went live in 2001. In 2002, HIC called for requests for tender for a system Murray claimed was "basically another THELMA." But the CEO derided this tender as "a sham".

"You can tell if a tender is a sham when they ask that all the intellectual property of the system has to be assigned to HIC, that the solution proposed has to be free of charge, and under the full control of the HIC. What private sector business could do that?" he asked.

"So sure, people responded to the tender, but they all said you can't have our intellectual property and we have to charge something. HIC then calls them invalid tenders."

Murray claimed HIC only put out the request for tender to convince the Federal Government of a need to build its own system. He claimed HIC approached the newly appointed health minister, Kay Patterson, following the tender asking for in excess of $50 million to build ECLIPSE.

"Once they closed the tender process, they [HIC] could then go to the Government and claim that there is nothing in Australia that can meet HIC's requirements," Murray said. "They could say, hand on heart, that because nothing like this exists, they will have to build it themselves."

Asked if ICSGlobal had any documented evidence that HIC/Medicare made any promise not to develop such a system back in 2000, Murray said his proof was limited to "minutes of meetings".

But Medicare/HIC's actions only became illegal, Murray alleged, by virtue of its offering the same service as an existing private sector company at zero cost. ICSGlobal interpreted this practice as being in breach of the Trade Practices Act.

If Medicare Australia charged a commercial fee that reflected the true cost of providing e-health services to the private health sector, he said, they'd be competing on a level playing field with THELMA, and the better solution would win.

"We would welcome the competition," he said. "But you can't have taxpayers' money being used to set up cartels to provide free products and services simply to kill off the private sector."

Murray claimed ICSGlobal's business "is still growing" in Australia, despite the conflict. But he claimed the development of ECLIPSE has forced his company to take most of its business offshore.

"You reach a point where you are trying to compete with a free product," he said. "Large chunks of the private health sector are saying, we like your system, but there's a free system coming so we'll wait for that."

Waiting, he said, was what the sector was becoming used to from Medicare. Murray accused Medicare of spending over a billion dollars on failed technology projects and said that the hospital claims module of ECLIPSE was running five years late.

"It's in Medicare's interests, to protect their position of power, to make sure the health industry stays inefficient," he argued. "Medicare is an empire for processing paper. History has proven they will aggressively target anything that threatens that."

A spokesperson for Medicare Australia said it "intends to vigorously defend these proceedings."

The case will go before the Federal Court on 4 September.