Australia's State governments have called for federal funding to help implement the national e-health record by July 1 next year.
The Victorian Government in particular has accused the Department of Health and Ageing (DoHA) of failing to discuss Federal Government plans with state and territory governments ahead of implementation, according to a submission released this week.
In the Victorian Government's submission [pdf] to the Department of Health's draft concept of operations for the $467 million e-health records system, Victorian state health minister David Davis said the Federal Government's plans had ignored advice from the Council of Australian Governments (COAG).
COAG, which last week agreed a national health reform agreement worth $175 billion in extra federal funding for public hospitals, had discussed the requirement for a national approach to e-health as early as 2006.
A communiqué between the council members, dated April 2010, had outlined the importance of collaborating on a national e-health agenda. However, Federal Government plans to implement the record were announced without state support a month later as part of the 2010/2011 Federal budget.
The national health reform agreement signed last week identified extra services for emergency departments and in-patient requirements over the next two decades but made no mention of state participation in the Federal Government's three major e-health agendas: national identifiers, the e-health record and a telehealth rebate to promote video conferencing between city specialists and regional doctors.
The lack of discussion, according to the Victorian Government, left a hole in the funding required to implement the records and required infrastructure by individual state governments.
While the Victorian Government had provided "in-principle support" for the unique identifiers distributed by Medicare Australia to all Austrralian citizens in July last year, it did not support the push for records without a proper risk assessment for individual states.
Such an assessment was underway by individual states, paid for via funding from the government's lead e-health body (NEHTA).
"The missing element is providers having local clinical systems (electronic medical records) that are compliant with the national standards and able to interoperate with them," Davis wrote in the Victorian State Government's submission.
This would include the systems required to provide discharge and event summaries as well as specialist letters that would all form different components of an individual's health record, he said.
"As yet the Commonwealth has provided no financial support to the jurisdictions for essential state-based IT system reforms that would be necessary precursors or adjuncts to implementation."
Davis wrote that a previous estimate on the cost of eHealth records was $4 billion, but the Victorian Government did not consider this figure as reliable.
A spokesperson for the federal Department of Health and Ageing denied states would receive additional funding outside of money already allocated toward national infrastructure.
States volley for funding
NSW Health chief information officer Greg Wells has also called for more funding for health IT to address what he considers an under-investment at both State and Federal level.
In an interview with iTnews, Wells pointed to Britain's ailing $11 billion NHS IT project as a benchmark for funding, despite the possibility the project would be dumped.
"You could debate the [funding] number until whenever," he said.
He defended the Federal Government's current $467 million capital cost to build the PCEHR, but warned that the investment announced to date was purely foundational. The project would require ongoing funding, he said.
The NSW Government had itself committed $1.2 million toward hosting one of the 12 e-health implementation sites for testing the use of e-health records on an opt-out basis out of the now-defunct Healthelink pilot site in western Sydney.
"There's going to be another pool where we all run around looking for cash," he said.
Systems clarification required
Whilst the Federal Government's program would ultimately require integration and participation of state public hospitals and specialist communities, other state governments have nonetheless forged ahead with their own, disparate ICT strategic plans.
The NSW Government had pushed ahead with its own electronic medical record rollout across public hospitals. A business case to extend the rollout of FirstNet - the subject of some criticism by doctors earlier in the year - was expected to face state Treasury in September.
However, in a separate submission to the Federal Department of Health, SA Health chief executive David Swan called for greater clarification on how the federally-mandated systems would work in order to integrate them with existing state strategic plans.
SA Health has continued moves toward electronic master patient indexes, patient administration systems and secure messaging platforms.
Swan said the strategic plan put the SA Government agency in a "reasonably strong position" to support the PCEHR, but pushed for the national e-health body and Federal Government to finalise e-health records requirements in order to fit forward jursidictional plans.
There was some immediate overlap between South Australian and national plans, with IBM currently tasked to build a national secure authentication system for the national initiative that may ultimately become incompatible with the system being implemented by the state government.
The draft concept of operations for the PCEHR had undergone more than ten revisions before facing public release earlier this year, and was expected to undergo significant changes following public consultation.