Roxon lost on e-health, opposition claims

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.

Peter Dutton

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.

Klaus Boehncke

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.

Klaus Boehncke

"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.