There are some statistics that are so photogenic that politicians cannot resist throwing them about, time after time, and sure enough, when Health Minister Tanya Plibersek told the CEDA conference today that ehealth would give Australia a great bang for its buck, she gave another workout to some figures that her predecessor, Nicola Roxon, used just a year or so ago.

The figures concern the number of hospital admissions that are medication related. According to Plibersek, the number comes to about 190,000 per year, or two to three per cent of the total admissions each year. That, she said, costs $660 million per year, which alone represents not that much less than will have been spent on the PCEHR over four years. According to the minister/s about 15,000 are due to inadequate patient information. For patients over 75, up to 30 per cent of admissions are known to be medication-related, with up to three quarters of these potentially preventable.

She used as an example a story she’d recently heard about an elderly man who collapsed in a shopping centre from “a perfectly preventable interaction between medicines”. She said that the incident occurred after the man’s GP and his specialist changed his medication independently of each other — without knowing what the other had done.

The figures she referred to come from a study by Libby Roughead, an associate professor and Dr Susan Semple, a research fellow, at South Australia’s School of Pharmacy and Medical Studies. Having already  written about them, and had the ministerial application of these figures described by Keith Heale as “either ignorance or wilful misrepresentation”, I thought I’d make some enquiries at the source, so I rang Libby Roughead in Adelaide.

I’m sure the minister will be delighted to learn that according to Roughead, electronic health records “absolutely should help us address that problem”.

And she says that EHRs are also likely to be invaluable in helping with another problem: the use of drugs when patients are released from hospital. She says that one study indicated that for every two people discharged, at least one has a missing script. And while she doesn’t have figures for this, she says that the opposite is also true: patients are being discharged with drugs that they should no longer be using.

In fact, according to her, ehealth records will become even more critical as increasing numbers of allied health practitioners start prescribing.

I don’t know if some of the other figures Plibersek used are old hat, but I found the fact that  “in any week, one in three Australian GPs see a patient for whom they have no current information” and more than one in five GPs face that situation every day very interesting.

She also used some figures on the duplication of tests. One study, mentioned in the journal of Clinical Pathology, indicated more than 7% of all tests ordered in a hospital’s immunology lab were unnecessary duplicates.

The speech indicated increasing awareness within government of the importance of ehealth apps.

“If we can partner with industry to create the right environment,” she told the conference, “eHealth has the potential to act as an innovation hub for app designers. And I trust if we get it right, that many talented designers out there will create new, revolutionary eHealth apps.”

Whenever life gets you down – when you’ve got the flu and laryngitis for instance – there’s nothing better than popping into bed with an inspiring book or article, and re-setting your emotional defaults.

For me, the Pharmacy Guild’s national chairman, Kos Sclavos, does it every time.  Somehow, Kos conjures up an age when knights of old (pharmacists) did battle with dragons (doctors) and won the hands of fair ladies … Julia Gillard’s? Tanya Plibersek’s?

The way Kos sees it, and he never seems to tire of telling us, doctors have been undermining confidence in the PCEHR because they want to control it.  Pharmacists, on the other hand, are a concerned and generous group of professionals who want to link benefits like electronic prescriptions to the PCEHR, and are dying to assist the average person in embracing the national ehealth record system.

In this month’s Pharmacy Journal of Australia, Kos returns to the theme, declaring that the guild’s MedView initiative – “connecting the pieces of my medications puzzle” – may be “the critical element that engages both consumers and health professionals”.

He says that if the PCEHR is going to be “more than just a registration system from July 1″, MedView will “need to be promoted widely to the Australian public”.

He describes MedView as a national ehealth initiative designed to improve patient health outcomes by giving healthcare providers the ability to view a combined record of a patient’s medications history.

“For the first time, MedView will provide a combined record of prescribed and dispensed medications for patients across community, hospital and aged care settings. Whether a patient is going in for day surgery, visiting a new specialist, or having a regular checkup, this information will allow prescribers to see a snapshot of current medicines and, importantly, will give an accurate indication of adherence to medications.”

I think I want one. Well, perhaps I don’t want one that gives my GP an accurate indication of adherence to medications. Could I have one instead that gives them a slightly inaccurate view? You know how they can go on about one’s forgetting to take the daily dose every now and again.

At any rate, MedView, says Kos, is “strictly for use by consent only”.

“Patients who give permission will have their records stored securely in a national repository, from which healthcare professionals to whom the patient has given consent will be able to access the information from their existing desktop software.”

What is fascinating to me is the way a knight like Kos seems to do a lot of socialising with dragons, err, GPs.

“Many doctors,” he writes, “have expressed their concerns to me regarding patients who do not opt into the PCEHR and, thus, MedView.”

Even more fascinating, these GPs have apparently told Kos that they are considering not prescribing controlled drugs to these patients. “As health professionals, they feel they are obliged to see full medication and prescribed history before they can make clinical judgments on the appropriateness of continuing therapy for controlled medicines. MedView will allow health professionals to see how many different prescribers of medications the patient has and the recent history using various drop-down fields. A doctor will be able to select information from the previous week or 90 days;  and there is enormous flexibility in the reporting functionality of MedView.”

Seems a bit drastic, doesn’t it? Are doctors really going to insist that their patients sign up the PCEHR and MedView, or risk not being able to receive prescriptions? Anyway, that’s what Kos says, and right now, I’m prepared to suspend my disbelief. The tale is too absorbing to want to spoil it with doubts and demurrals.

The fact that I had to sit in my GP’s waiting room for 50 minutes this morning listening to other patients making the most awful hacking noises, to say nothing of the 12-year-old boy pleading for his life in one of the consulting rooms (injections don’t really hurt that much, do they?) has probably made me even more susceptible to the ehealth message, but I thought the first On The Record email newsletter which popped into my Inbox this afternoon was a pretty good effort. I shouldn’t complain, I suppose, given that in Campbelltown, some patients are waiting up to three hours.

In the meantime, I’m supposed to avoid talking as much as possible, use an antiseptic gargle and a nasal spray, and hope that by some miracle, my voice will suddenly reappear for a performance with South of the River Choir on Thursday evening. Somehow, I’m not feeling optimistic. In fact I’m finding it a considerable effort not to just roll up into the foetal position and go to sleep.

And if I dream, I’d like to dream about a future, say five years from now, where the PCEHR’s features extend to booking an appointment with the GP online, and having an app that tells you whether there’s going to be a delay. That way, I wouldn’t have been 10 minutes early this morning.  And I would have brought something to read. That would be a welcome advance, in my book.

Dr Barri Phatarfod from the Curlewis Street Bondi GP, which has been trialling the PCEHR as one of the wave sites, tells On The Record that it takes a lot of pressure off GPs. Right now, I’d like to see some features that take a lot of pressure off patients.

I know I should have stayed tucked up in bed, but this article in The Guardian by European Commission vice-president Neelie Kroes, about a new vision for healthcare in Europe got me thinking.

Kroes suggests that the key to financially viable healthcare systems lies more with “new approaches for telemonitoring, electronic prescriptions, and applications that help prevent people from needing acute care and allow the elderly to live independently in their homes” than with massive projects such as the UK’s National Program for IT.

He [sorry, She - I knew I should have stayed tucked up in bed] writes that many of these innovations were tested in Britain’s Whole Systems Demonstrators, and showed “huge benefits for patients, medical specialists, and care workers” while “consideably” reducing health care costs and increasing productivity”. In fact, there was a 45 per cent reduction in mortality rates and 20 per cent reduction in emergency admissions.

Kroes refers readers to a report from a new European Union eHealth Task Force, which he says confirmed those findings.

“We need to face some hard facts” she says. “In healthcare we lag at least 10 years behind virtually every other area in the implementation of IT solutions. We know how technology can positively transform our daily lives, including the ways in which we communicate, learn and do business. Yet we continue to hold back when it comes to health.

“By implementing IT solutions to preventative and continuing healthcare, we can improve the lives of everyone in need of services. Central to taking this leap forward is the need to put patients in control of their personal data – while also using anonymised data to deliver life-saving innovation.

“On a practical level, we also need to get all our systems connected and talking to each other while ensuring both transparency and accountability. And, of course, this vision can only function once internet access is a reality for all Europe’s citizens. Achieving this vision will take time and effort, but progress is being made.”

Meanwhile, the ehealth.gov.au website which I wrote about recently has now gone live. It includes the national eHealth Record Learning Centre – a new online tool to help Australians learn about the PCEHR.

My flu has unfortunately worsened and I now can hardly speak. I hope to be back on board next week. In the meantime, back to bed.

NEHTA CEO Peter Fleming’s statement to the organisation on the ehealth Budget funding has got me thinking about the need for proper acknowledgment of outstanding achievement in the public interest. What he said was this:

“This funding will allow NEHTA to continue its important work to build and support the rollout of the eHealth agenda. In light of this vote of confidence I would like to congratulate all of you on the hard work you have done and the dedication you have shown to the job of designing and building the new eHealth system. Your work is important and your effort is appreciated.”

In an era where so many massive government IT projects have gone completely off the rails, what NEHTA has achieved is truly remarkable.

The challenges faced by these dedicated professionals went beyond the sheer complexity of the project. They also had to contend with the bitter opposition of vested interests and a vicious and concerted campaign of negative publicity, most of it completely untrue, organised by The Australian and blogger David More. I can only imagine how dispiriting it must have been to read one outrageous slur after another – assurances that what they were working on was “a train wreck”, that there was widespread bullying of staff etc. – and somehow shrug it off and continue to make progress on something that will save lives and make the delivery of healthcare more efficient and less costly.

Australia owes them a debt of gratitude. Alas, you can expect The Australian, More, and the MSIA to continue to work hard to deny them due acknowledgment, and to continue to justify their petty intrigues.

I’m struggling with a bout of flu right now, so perhaps my threshold for resisting sick-making statements has been seriously impaired, but Michael Legg’s comment on one of the more-than-usually idiotic posts on David More’s blog has got me gasping for air.

“Thanks David,” writes Legg, “you provide a great service to our community.”

Which particular great service is he talking about? Well, More has given us the benefit of his calculations on ehealth funding provisions in the Budget. Declaring that “ehealth has been cut to ribbins” and “this will take a decade if it ever happens”, he accuses Health Minister Tanya Plibersek of making “some really nonsense claims” and asserts that NEHTA’s budget has been slashed by more than 60 per cent.

If the community needs hysterical opinion and tendentious rants, rather than facts and calm logic, then Legg is right: More provides a great service.

In fact, the allocation was in line with industry expectations and will allow Australia’s solid ehealth progress to continue.

I’ve had some fun with the minister recently, but in my opinion the fact that she was able to win what is, given the economic environment, significant funding for ehealth, does her great credit.

What More does not seem to be able to get into his head is the fact that having spent $466.7 million in the past two years on the framework for a PCEHR, we don’t need to continue that level of funding. It shouldn’t be that hard to understand, should it? We’ve moved into a new phase which requires less funding.

We have built the NASH, for $23.6 million. We don’t have to build it again. We don’t have to hire Accenture and its partners to duplicate the national infrastructure. It is now in place.

And what was it that More had to say about that? Oh yes, he offered the winning consortium his condolences, and observed “They are being driven to deliver an unworkable solution which will wind up being an enormous waste of money. If I were a vendor this is a contract I think I would have liked to lose!” Unworkable? A contract you’d like to lose? Somehow one can’t imagine any ehealth vendor that wants to stay in business offering More a seat on its board, or queuing to award the man a community service award.

In the past two years we’ve seen substantial external contracts; funding for the wave sites; teams of architects and analysts and those “tiger teams” that worked on the PCEHR standards and specifications; comprehensive testing and engagement projects. It’s sensationalist tripe to describe a situation where you move out of the initial development phase as “cutting ehealth to ribbons”.

According to the Budget documents (there’s a full list of the health announcements here) this is the funding for the new regime:

• $161.6 million to operate the Personally Controlled Electronic Health Record (PCEHR) system for the next two years, including registration and customer support, adoption support and benefits monitoring and evaluation;
• $4.6 million to maintain safeguards for privacy-related aspects of the PCHER system. This will mean that people can be confident that the privacy of their personal health information is fully protected; and
• $67.4 million as the Commonwealth’s share of joint funding with the states and territories for the National EHealth Transition Authority (NEHTA) work program for the next two years. This is to operate and maintain critical services and standards for the secure electronic exchange of health information, including healthcare identifiers, authentication services and eHealth standards.

Under its new funding, NEHTA will be able to continue its role, including to “further develop national standards and operate national infrastructure services”. It will work on projects like the inclusion of pathology results in the PCEHR.

It’s obviously also going to have some additional work to do, with the Budget’s announcement of new eligibility requirements for the Practives Incentives Program eHealth Incentive (ePIP), outlined in Program 5.3 of the Department Outcomes.

“In 2012-13, the Australian Government will introduce new eligibility requirements for the Practice Incentives Program (PIP) eHealth Incentive to encourage general practices to keep up-to-date with the latest developments in eHealth and to
promote uptake of the Personally Controlled Electronic Health Record (PCEHR).

“The new requirements will encourage general practices to safely and securely share accurate electronic patient records to enhance the quality of care provided to patients and undertake activities such as electronic prescribing and use of the PCEHR system.
“The Department will continue to consult closely with the National eHealth Transition Authority, the PIP Advisory Group, medical software developers and Medicare Australia in the development of the new requirements and to ensure that the appropriate software is available to practices with sufficient lead time to prepare for implementation.”

While I haven’t yet been able to establish whether it will have any ongoing role with the PCEHR beyond that, what is clear is that a lot of the staff that have been on NEHTA’s payroll will be moving across to the PCEHR.

In its first three years of operation, I think the organisation’s funding amounted to around $70 million per annum, and the new arrangements seem pretty similar.

The evidence being led in central London’s Southwark Crown Court in relation to charges against three former iSoft executives (a fourth, founder and then-chief executive Patrick Cryne is not in court because of ill health) makes fascinating reading.

According to Strand News court reporting agency, whose report is carried in eHealth Insider, Cryne and his co-accused, Stephen Graham, Timothy Whiston and John Whelan, motivated by “personal financial gain”, tried to deceive investors by creating “huge discrepancies” in the published accounts of the company – since sold to CSC – in the middle of the last decade. Each denies conspiracy to make misleading statements, promises or forecasts, contrary to the Financial Services and Markets Act 2000 and section 1 of the Criminal Law Act.

The court was told that Ian Storey, the former financial controller of iSoft Group PLC, sounded the alarm after discovering the company had published a string of false accounts.

One can imagine why the case is scheduled to run for three months: In 2010, Storey was banned from practising as a chartered accountant for eight years and ordered to pay £20,000, after admitting to a professional tribunal that he had, on a number of occasions between November 2003 and November 2005, provided false and misleading information to iSoft’s former auditors in relation to a purported iSoft contract. That arose from an investigation by The Guardian, which was subsequently gagged. The original iSoft auditors, RSM Robson Rhodes, also faced a disciplinary hearing over the matter.

Storey told the court he blew the whistle after he realised the firm’s apparent financial position was “not strictly correct” after the accounting firm Deloitte was hired to carry out due diligence on a contract with the Irish Health Service said to have been signed in 2003.

According to the news agency, the court heard that Storey emailed Deloitte saying he was ‘”able to confirm” the report had been reviewed and that iSoft was “happy” with the report. He said that when Deloitte asked him to “specifically confirm the facts of the report are materially correct” in a second email, he passed it on to Whiston. He also said he understood Whiston had sent an email saying iSoft was happy with the report.

After that confirmation was sent, jurors heard that Storey had a telephone conversation with Deloitte in which he had been forced to “dance around” certain issues.

Later that year, Deloitte took over as iSoft’s auditors and began a review of old contracts, the court heard.

Storey said he received an email asking to see a copy of the contract the company claimed to have signed in October 2003, but he told jurors he was unable to find one.

He said that he asked Graham’s PA for a copy of the contract and was instead handed a “heads of agreement” document that iSoft had secured from the Irish Health Executive.

The following week, Storey contacted Deloitte to raise his concerns and an investigation was launched. Storey resigned from his role later that year.

With just a little more than 24 hours to go before we learn how ehealth will fare in the Federal Budget, I’ve been talking to software vendors working on the PCEHR about their views. It seems they are mostly quietly confident that there is not going to be a dramatic cessation of funding.

“We are all assuming money will be allocated, and we are working on that basis. If  that doesn’t happen, the cat will really be among the pigeons. It would be a very great shame if the project came to a grinding halt. We haven’t given it that much thought, to be honest. We have just been working away on the basis that the project will continue. If you didn’t believe that, you wouldn’t do anything.”

There is a widespread belief that Health Minister Tanya Plibersek’s comments about July 1 essentially being just the beginning of an ehealth journey indicate that funding will continue.

“There is still a lot of work that needs to be done before a fully functioning PCEHR is in place,” one member of the software panel told me. “My view is that the government recognises that, although at this stage nobody seems to know how much more funding would be available.

“If there were no funding, it would be a very great shame.”

In the meantime, with the July 1 deadline looming, there is a distinct air of “heads down, bums up” among developers. “We are getting a lot of information on how to connect to the PCEHR and the requirements around that, working towards making sure that everybody connects in a way that will be clinically safe and usable. There are a lot of discussons around each set of requirements about what works and what doesn’t, and usually we agree on some adjustments which people feel are appropriate.”

There is also a belief that NEHTA and DoHA have dramatically intensified the engagmenet process. “There are a lot of forums and day conferences, and a movement to engage people on a more broad basis, rather than just focusing directly on software vendors that they have been talking to in the past,” one observer told me.

A battle-scarred hack like me tends not to wear his heart on his sleeve, but I admit to being completely charmed by Kathryn Eccles’ piece in Medical Observer in which three generations of GPs working at Sydney’s Cremorne Medical Practice – not far from where Joe Hockey’s GP is still presumably doing everything with pen and paper – discussed their introduction to digital technology in general practice, and its effects on the way they work.

There are some fascinating nuggets of information in there: Tony Andrew, who qualified as a GP in 1961 – back in the era of carbon paper receipts – reveals that most new patients find the practice through the Web and that despite embracing technology comparatively late, in the early 2000s, it has cut their overheads in half, from around 50 to 55 per cent to around 25 per cent.

“We have much more legible records, we have more accurate information in records and follow-ups and referrals work better,” he reports. “You don’t get mistakes with scripts because the pharmacist can’t read the handwriting. We don’t have to have all the storage for files, and we don’t have to have someone doing the filing … Things are much quicker. Billing is more efficient, the structure of notes much clearer and the way in which we can now collect and analyse data very helpful,” he says.

And because the GPs are connected via an intranet “we share knowledge much more effectively and everyone learns so much”.

Jennifer Roberts is a young doctor, having qualified only last year. As you’d expect she “wouldn’t know what to do with paper-based records”.

“I can only imagine working in a paper-based practice,” she declares, “and it would have been an absolute nightmare. It’s bad enough now keeping on schedule.”

As a baby boomer, Dr Alanna Horadam remembers as a child being taken by her father to see the computer he looked after at the University of New England.

“It took up the whole room and the room needed air-conditioning to ensure it stayed at a certain temperature. It was like something from Star Trek. If you put something in, the answer would come out in code and you’d have to decode it. ”

Having a tech-savvy husband meant she was an early adopter. They got their first computer in 1982 – which was just one year after the launch of the IBM PC – and two years later, through what we would now regard as primitive methods, they were communicating with the Mayo Clinic. In 1989, she became the first person in Bathurst to have a mobile phone. It cost $3000, “the battery was the size of a briefcase and coverage was fairly patchy”.

Just a year later they started using a computer for practice billing, and about five or six years after that it was managing appointments as well.

“I feel the changes have made me a better medical professional,” he says. “When patients lose a script, or a referral, I can just print another one rather than waste 15 minutes writing out an individual letter. I get an automatic heads up when prescribing medication for interactions or allergies. It’s become a big safety net.

“I see more patients, more efficiently, and more safely, and I can also do some work from home, rather than having to go back into the practice.”

It’s somehow inspiring, isn’t it?

Buried in this story from the UK’s eHealth Insider on the fact that the NHS Information Centre is to collect data on which GP practices are offering patients access to their medical records online – the consequence of a promise by Chancellor George Osborne that by 2015, everybody in England will have online access to their GP records (somewhat behind Australia’s schedule) – is a concept that I find quite fascinating: the patient as a health resource.

The idea comes from Dr Amir Hannan, a full-time GP at Haughton Thornley Medical Centres, where more than 1800 patients now have online access to their records. I’ve written about him a few times previously. He has established that patients who have access to their health records and the resources used by their doctors report needing to see their doctor less often and feeling better prepared to navigate the health system.

He says that the slow pace at which the roll-out of online records is proceeding will prevent the UK health system from achieving the productivity gains it needs in five years time.

“Essentially, we have to do more with less,” he says, “and the one resource that we are not using as best we can is the patient. The more we can enable the patient to do, the less of a burden it is going to be on us.”