eyelash growth

LABOR came into office with Health Minister Nicola Roxon promising to put e-health back on the agenda. She has failed.

What we have got is a healthcare identity number for every resident, but it will be years before doctors can even access the number, except by phone, let alone use it in any meaningful way.

Ms Roxon may have learned you can’t make software work by waving a ministerial direction, but there’s not much else to show for $98 million.

Medicare has assigned a 16-digit unique identifier against every record in its database — surely a very straightforward IT task — and as a result may, over time, clean up its dirty data.

Failure to consult means software developers are only now beginning to build interfaces with the system — which has never been tested in the real world.

The twin healthcare provider identifier system is in meltdown — with the process reportedly plagued with errors — long before it expands to capture the details of some 500,000 never-before registered allied providers.

Right now, it can’t even deal with the smaller number of GPs and specialists who are well-known through professional processes. Work hasn’t even begun on the separate identifier for health IT service providers — cobbled together because existing services had been overlooked in the regulations.

The key control system, the National Authentication Service for Health, is yet to appear on the starting blocks.

Most importantly, Labor ducked the hard questions on patients’ rights to privacy and consent for sharing of sensitive health information.

Enter Plan B. Why not hand over responsibility for electronic health records to patients instead? yes, that’s what we are getting under Labor: personally controlled e-health records, at $466.7m over two years.

A brilliant stroke. If consumers "control" their own e-records, problems such as consent, data security and liability are no longer the government’s concern.

Hey, it’s cheap, too. Because people will have to pay commercial providers — like Microsoft, Google and new entrants such as health insurers — to set up and maintain their own records, government is off the hook on cost as well.

It’s hard to see why Labor needs to throw in a half-billion dollars as burley when the sharks are already circling.

Perhaps the money will go to the new problems — exactly how public and private provider systems will interact with dozens of products used by patients.

But patient-controlled e-health records won’t deliver the other Holy Grail: population health benefits. Putting individual records into separate silos will mean the data is not available for mining by medical planners and researchers.

That will mean it cannot be monitored for pandemics and unusual disease patterns, or to detect adverse effects caused by medication. nor is there long-term data for optimising clinical treatments and management of chronic illnesses. and we’ll miss the chance to shed light on rare conditions, like unusual forms of cancer, through long-distance, specialist collaborations. Meanwhile, the Coalition ended its last term of office with then health minister Tony Abbott seared and in retreat on e-health.

In August 2007, he looked back on his first speech as minister, in November 2003: "Failure to establish an electronic patient record within five years, I said, would be an indictment against everyone in the system, including the government.

"Back then, my thinking was that people in the health system were at least as capable as those in the finance system. If eftpos could link billions of bank accounts and financial institutions around the world, it should surely be possible for every patient’s file to be copied, indexed, stored and securely made available to the patient and authorised treating professionals, via the internet.

"in retrospect, I had underestimated the difficulty of shepherding independent professionals and insular institutions through the thickets of patient privacy and sheer force of habit."

But Mr Abbott lost his nerve and pulled the plug. Ironically, the best examples of e-health today are rooted in HealthConnect, and are the basis for the latest, if limited, progress now touted by Labor and Nehta.

It is, of course, quite untenable for the opposition not to have a plan for e-health. It’s like arguing there’s no need for ambulances — you simply can’t have a modern healthcare system without IT.

But the Coalition may have a point about the National Broadband Network — you don’t need high-speed for everything. yes, it’s necessary for live streaming of surgery, but Skype is quite acceptable for simple tele-health consultations, if a doctor wants to check a wound or rash.

Meanwhile, if Mr Abbott wants some spare cash for e-health, he might care to take a look at whether his baby is delivering worthwhile outcomes.

Nehta spends a lot of money on political lobbying and "communications", including a blog that lashes any perceived criticism and has now taken the boot to Mr Abbott.

It also "sponsors" organisations such as the Royal College of General Practitioners, to the disquiet of some members. No details have been revealed, but Nehta is paying $30,000 for the college’s conference in Cairns in October. Nehta is also a major sponsor of the Health Informatics Society of Australia’s conference in Melbourne next week, has sponsored several Australian Information Association lunches, and has a presence at every health IT event on the calendar.

Whether this substitutes for actual consultations with consumers, doctors and industry is a moot point, in my view, not to mention whether this is the way we should be spending our precious e-health dollars.

There is also a need for scrutiny of the nation’s top health bureaucrat, Jane Halton, who as federal health secretary and Nehta’s longest standing board member, shows a remarkable lack of grasp of e-health in her Senate estimates appearances. in both roles, Ms Halton has enormous power to move e-health forward, and yet we haven’t seen it.

dearnek@theaustralian.com.au

Reality of national e-health moves fall short of promises