The Australian Digital Health Agency is expecting the medical profession to make a huge effective financial contribution in time and effort to make a flawed My Health Record System even a very partial success. The profession won’t wear it I believe.
An Efficiency Audit of the #myHealthRecord was published by the Australian National Audit Office (ANAO) on Monday 25 November.
Here is the direct link:
The broad conclusion regarding the Program was as follows in point 6 of the conclusion:
“6. Implementation of the My Health Record system was largely effective.”
However, with that said, the Auditor-General then went on to express significant and important concerns with respect to major aspects of the cyber-security of the system, a lack of a Privacy Impact Assessment of the system following the move to opt-out and aspects of the plans for assessment and realisation of actual benefits from the system.
It is the third area I wish to focus on – not in any way to diminish the importance of the other two – they are key and critical.
Here are the key claimed benefits for the My Health Record:
“Potential health sector economic benefits were estimated from 2017 to 2027, totalling $14.59 billion. The benefit categories identified were as follows – with possible measures:
- ‘Improved health outcomes: if clinicians have greater access to medication information, it will result in avoided hospital admissions and saved lives’ — requiring evidence of reduced hospital admissions, lengths of stay, emergency presentations, and general practice visits;
- ‘A much more efficient health system’ — requiring evidence of reduced healthcare provider time gathering information and communicating with other providers;
- ‘Avoided duplication of diagnostic tests’ — requiring evidence of reduced expenditure on duplicate tests due to better access to pathology and diagnostic imaging information;
- ‘Putting the person at the centre of their healthcare’ — requiring evidence of improved patient self-management through increased use of care plans, mobile apps and advance care plans linked to My Health Record; and
- ‘Enabling innovation and developments in healthcare’ — requiring evidence of system improvements arising from secondary use of data and innovation in care delivery.”
Ignoring the obvious issue of trying to value such totally woolly ill-defined benefits to two decimal places any consideration must be balanced against the total expected investment with is slated to be of the order of $3.3 billion ($1.15B to 2016 and an additional $2.13B to 2027) for hardware, software services and the like.
So what we have is a very rubbery and unsubstantiated claim for benefits based on theory (as the A-G said – “The plan estimated the potential health sector economic benefits from implementing My Health Record as an opt-out model. Estimates were derived from academic studies rather than being extrapolated from actual My Health Record usage, due to a lack of sufficient historical data. Estimates were reviewed by a clinical reference group and clinicians from ADHA and Health. The plan stated that ‘estimates were calculated conservatively’.” With figures of this quality, which are essentially guesses, one wonders how they would know.
The costs are equally unknowable over a decade (what new technology may emerge etc.) but for one important value input which is not accounted for at all.
This is the cost / value of the time devoted by clinical users of the system to use of the system over a decade of usage.
If we assume each GP spends 1 session in total a day (15-20mins) on data entry and review, which would usually be billed at about $80, we can see a very interesting outcome.
The RACGP says the are about 36,000 active GPs.
Assuming 260 working days for $80 each = $20,800 in forgone income for each GP.
Assume 36,000 GPs all are involved at this level and we arrive at $748m p.a. And this assumes no donation to Government coffers from all the specialists (No wonder the ADHA is keen to involve them) which may easily double the total forgone payment while typing and searching for data.
Excluding the PIP payments of $50,000 per practice of which there are about 6300 – $315M in total if they all claim the payment – there is, at least, a net $400M or more of myHealthRecord subsidy to the system operation provided in kind by just GPs if they use it as hoped.
So, in summary, overall, we have a system with very ill-defined benefits, which are a long way out time-wise, being heavily subsidised in kind by the profession, when it does not offer them much they can recognise in value for either them or their patients.
No wonder the level of keenness expressed as recently as a few days agoy by the RACGP President is very low. Even modest use of the system, for little clinical value, costs the GP real income! Things will really have to change a great deal to get any significant GP use of the system and any real quantum of the imagined benefit.
My bet – it just won’t happen!
David More is a retired clinician with a very long term interest in Digital Health and the saga of the #myhealthrecord.