In what has been a massive week for digital health in Australia – a new authority set up to implement NSW Health’s $1 billion SDPR just as the CIO departs, thousands flock to a hugely successful Digital Health Festival in Melbourne, a couple of state budgets and the launch of Pulse, the podcast, which is destined to rule the airwaves – the Productivity Commission’s research paper on the savings to be seen from better implementing digital technology in healthcare certainly topped it all off.
The paper, Leveraging digital technology in healthcare, is a fascinating, positive look at the promise of digital technology in healthcare and how governments can help facilitate the digital transformation of health, concentrating in particular on electronic health and medical records, telehealth, remote monitoring and AI.
It measures the savings being gained by telehealth (mainly in terms of reduced travel and waiting time for GP patients); the benefits of digital technology including AI on workforce tasks (estimates as high as 30 per cent of workers’ time); and some huge savings through the roll-out of electronic medical records in improving workflow efficiencies and reducing duplication of tests.
There was also some much needed dismantling of 12 years of puffery over the potential of the My Health Record, adopting the now legendary “shoebox of PDFs” description of the system by Tasmanian GP Donald Rose in his submission to the Senate inquiry into the system in 2018.
But it was the figures about potential annual savings by using EMR systems and reducing duplicated tests that caught our eye. According to Commissioner Catherine de Fontenay, “making better use of data in electronic medical records systems can save up to $5.4 billion per year by reducing the length of time patients spend in hospital, and $355 million in duplicated tests in the public hospital system alone”.
We have some experience with grand claims of massive savings, including those for electronic health records like My Health Record. Back in 2016, then health minister Sussan Ley was spruiking annual savings of $2.8 billion through reduced adverse events and test duplication by using MyHR, with potential savings of $7.6 billion over four years.
Even further back in the day, we remember our old mates from Deloitte estimating that the net direct benefit of a national electronic health record that came to be called the PCEHR were expected to be worth approximately $11.5 billion over 15 years by reducing avoidable hospital admissions and GP visits.
The Prod Comm paper does make the distinction between an EMR and an EHR – while taking a particular delight in trashing the history of the My Health Record – but we do take issue with its methodology. While it did look at international studies on reductions in pathology and radiology tests following the introduction of an inpatient EMR, and how they can shorten length of stay in both admitted and emergency care, the evidence doesn’t really stack up for Australia.
The Prod Comm has taken figures on reduction rates in ED length of stay and in duplicated tests from those experienced by Melbourne’s Royal Children’s Hospital following its implementation of Epic in 2016. As there are no similar figures from other implementations in Australia, it has assumed that RCH’s experience can be replicated in other hospitals.
We take issue with this. RCH’s implementation is an exemplary one that has shown quite remarkable outcomes, but the hospital is a relatively small one at 340 beds and it is a paediatric hospital. Its neighbours in Parkville – a large and complex adult hospital, a maternity hospital and a cancer centre – all use the same system but have yet to report any savings. Nowhere else in Australia, including states like NSW and Queensland that have had EMRs for years, have reported anything close to RCH.
“We assume that the reduction rates are a result only of the EMR system implementation and that this reduction holds true across all types of public hospitals, not only paediatric hospitals,” the report says, somewhat dubiously. “To overcome the absence of sector-wide data on EMR use in hospitals, we measure benefits assuming a current public hospital uptake of EMRs with functionality akin to that of the Royal Children’s Hospital Melbourne.”
$5.4 billion in annual savings is certainly a headline figure – and the Australian Financial Review thundered about it – but it is just an estimate based on what we think are somewhat dodgy assumptions.
That said, the paper is a pretty good one that takes aim at years of underuse and underperformance of My Health Record, while making some recommendations on how to improve it, most of which the Australian Digital Health Agency is already doing under the modernisation program. There are some errors that the digital health community will notice – apparently, people are being paid to upload data to My Health Record – but it is a good shot in the arm for sector. You can read it here.
Elsewhere, the Digital Health Festival was in full swing this week. This has morphed from a tiny do a couple of years ago to a real player and was thoroughly enjoyable, although there was a bit too much vendor flimflam for our liking. This was balanced out by the launch of the soon to be legendary Pulse podcast and some good stuff from actual digital health projects and implementations, the best of which for us was Kath Feely’s talk on sharing data with patients at the Parkville precinct. It was terrific.
It was also one of our most popular stories for the week, but the top spot went to the announcement of the head of a new implementation authority for the NSW SDPR, just as one of the driving forces behind the project, eHealth NSW CEO and NSW Health CIO Zoran Bolevich, decided to up sticks after eight years and head to the Australian Institute of Health and Welfare. After eight years in the gig at eHealth we don’t blame him, but it is an unusual time to be heading off.
We asked your thoughts on the SDPR implementation authority in last week’s poll, where readers were split 52:48 in favour of the new authority. Here’s what you said.
This week, we are asking:
Do you agree with the PC’s estimate of savings through digital technology?
Vote here and leave your comments below.
The key word is “potential” savings. They will not be realised without correct implementation and use of the systems as tools for health process redesign and optimisation of decision making.