Search Results for: health information

By Pip Brennan, Electronic Medical Record Consumer Reference Group Convenor

I was lucky enough to attend the Digital Health Festival 2024 in Melbourne, with WA consumer and health professional colleagues. The Health Consumers’ Council in WA negotiated to obtain three free consumer passes, and WA Health’s Electronic Medical Record (EMR) Program Team funded travel for myself and HCC Engagement Coordinator Kieran Bindahneem. We met Ricki Spencer in Melbourne, they are a member of the EMR Consumer Reference Group and split their time between WA and Victoria.

With eight concurrent streams and mostly 30-45 minute presentations, the Digital Health Festival was definitely overwhelming. Some of the concurrent presentations offered headphones, and these were by far the easiest presentations to stay focused in.

At the entrance was the stand where I took the opportunity to include a message about the importance of consumer involvement. #NothingAboutUsWithoutUs. It was not a common idea, and presentations mentioning co-design usually meant different health and government professionals collaborating. The wrap up report for the Digital Health Festival doesn’t mention the word “consumer” or “patient” anywhere – we sit somewhere in the “Other” category in the pie charts and tables. I have been approached to speak at the Digital Health Festival in 2025.

What has stayed with me

• Dr Wonchul Cha’s keynote presentation about the Samsung Medical Centre in Korea, especially how the Patient Reported Outcomes surveys, which are integrated into their electronic medical record, achieve an 80%-90% response rate. They are a seamless part of the clinical appointment, and keep patient wellbeing right on top of the agenda.
• Meeting up with consumer advocates including Mehmet Kavlakoglou, Harry Iles-Mann, and Ricky Spencer. Some quiet times talking outside the hub-bub of the Festival were restorative and insightful.
• Talking to Healthcare Information and Management Systems Society (HIMSS) staff and filling in a missing piece of the PROMS puzzle in my mind – how they need to be integrated into an EMR and used as part of care to get the return rate that really tracks patient outcomes (see Samsung example above).
• Listening to a CSIRO presentation on the work they’re doing regarding consent processes and how to have ongoing consent facilitated when our data is used for research – consumers aren’t actively involved yet, but hoping they will be soon.
• Panel discussion on how AI is supporting clinical decision making where one speaker suggested that over time, clinical trials may not be approved unless they have already gone through AI as this will reduce potential harm to patients.
• I don’t need to feel total despair that each state and territory is doing its own thing regarding electronic medical records. Interoperability is still going to be technically possible. It is the number one consumer priority! The key challenges we have in relation to digital health are actually cultural – but the interoperability work at the federal level mandating interoperability is helpful.

Some reflections

• What would it be like to have a consumer-co-led digital health festival with a focus on research translation, rather than research commercialisation? Some presentations were very sales-y.
• Most states and territories have implemented their EMRs without significant or meaningful consultation with consumers, and even in some cases clinicians. Not so in WA! And after the conference the WA Budget announcement confirmed that WA will be funded for the next three years to develop a tender and appoint a supplier for WA’s EMR.
• We have an EMR Consumer Charter in WA and a Consumer Reference Group working with the WA Health Team. We are upskilling ourselves and reflecting on what are key consumer priorities for an EMR. See our web page for all updates.

By Clare Mullen, Executive Director

So, there’s a few spats going on on social media at the moment in relation to health finance. Like on this post on LinkedIn where people representing surgeons, and people representing private health insurers, seem to me to be arguing about which one of them is going to charge the patient for the cost of surgical items.

So – it’s Saturday morning, and I have a bit of time, so I thought I’d try to see what some of these interests might be.

First up – the average salary of a surgeon

I couldn’t find any publicly funded sources of information from my quick search. But this article from Medrecruit (a medical recruitment firm) say they’ve used Australian Tax Office data to come up with an average taxable salary of $394,000 a year. The same company writes that neurosurgeons – like those who do spine surgery – can earn up to $800,000 a year.

So, between the 2023 article from Medrecruit, and a 2023 article from GlassDoor I feel comfortable reaching the conclusion that:

• the average salary of a surgeon in Australia is around $340,000/year

Then to health insurer profits

The five biggest health insurance companies in Australia, according to the national consumer group Choice Australia are:

• Medibank
• Bupa
• HCF
• NIB
• HBF

So I looked at the most recent annual reports (for 2023) for all of these companies. Some headlines:

• Four of these five companies reported multi-million dollar profits last year – the exception is HBF who reported a loss of $87.7m, down from a loss last year too.
• The average annual profit reported across the four was $344m/year.
• Collectively, they reported profits of $1.3b.
• Two of these five are set up as not-for-profit organisations – HCF (profit of $171.4m) and HBF

And so to the salaries of senior staff in health insurance firms…

I looked at what private health insurers pay their senior staff. (As a passing observation, if I didn’t know better I’d say that these firms don’t want you to work out what their senior staff get paid, because many of the reports make this information as opaque as possible. But I do know better. Except for HCF – they *really* don’t want you to know so they don’t publish it.)

Taking out HCF (because they don’t make that information available online), the average pay for the Chief Executive of the three other health insurance firms that reported a profit (or surplus) is $1.6m a year.

As a comparison, the average for adult full-time earnings in Australia is $101,000/year. When you do a comparison that includes all earners (i.e. including those working part-time), the average annual salary is $74,500.

(And the CEO at HBF is reported as having been paid $731k to June 2023.)

So what?

So what does this mean? Is this just me whingeing about people who work hard to earn their money?

Nope. This is me trying to reconcile the reality of healthcare in this country. Where your socio-economic status determines your health, but where we’re seeing more outrage about which bit of the health system that’s making lots of money for the companies and people involved in providing that healthcare is going to pass on the cost of that healthcare to the people needing the healthcare.

It’s time for full transparency in health finances

As an informed health consumer, I find it really frustrating how challenging it is to find out about the financial interests in health. I want to know if the person or company providing me with care is doing it for my benefit, or for theirs.

This website from the Federal Government is a good start to find out about likely out of pocket costs for treatment you might be considering – https://medicalcostsfinder.health.gov.au/

And as someone who speaks regularly to people who are battling to get access to the healthcare they need – either having to overcome financial challenges, or grapple with bureaucratic processes that seem to have been designed by people who don’t give a fig about the people trying to access healthcare (which I know isn’t true!) – I want to see a much stronger voice for consumers and the community on this issue.

So let’s have full transparency on health finances. A few ideas off the top of my head on this Saturday morning:

• If any healthcare provider receives any public funding (like Medicare), let’s require them to publish information about profits, and any individual salaries over the average annual salary
• If any provider negotiates financial deals – like commission to preferred providers, or incentives for particular types of treatment – let’s require this to be published, and the information be made available to the consumer when they’re making a decision about treatment options
• Along with the Choosing Wisely questions, let’s add a question about “What are the financial implications for you – the provider – in any of the options we’re discussing?”

WA has been talking about getting an Electronic Medical Record for decades but to date, this has not exactly eventuated.

The first iteration of a digital record in our state came about when the Fiona Stanley Hospital was built in 2013. A newer version of this digital medical record has been in the process of being rolled out across our vast state since 2022. This has been done in preparation for a full Electronic Medical Record.

A project of this scale will require significant investment. During 2022-2023, a Business Case was developed and has now been submitted to treasury for consideration.

In 2021, HCC worked on a Consumer Charter for an Electronic Medical Record. If our state is successful in obtaining funding for the full Electronic Medical Record, there will still be a 10-year process to get a finalised version working in all our public hospitals. That means consumers will still be able to influence the design to ensure it meets our needs, as well as clinician and health system needs.

What do consumers think?

Consumer Involvement

HCC has been funded by WA Health to establish a Consumer Reference Group to help shape the project.

We will run three webinars between now and June 2024, and our Consumer Reference Group will meet four times within that period as well. We aim to build on the work of the Consumer Charter to provide considered feedback about our concerns and hopes for the key elements of an Electronic Medical Record.

We invite you to join us for the webinars; more details will be available soon and we will post the recordings online for those who can’t make it.

Connecting Across our Whole Health System

“Interoperability” – our information able to be accessed by ALL our care team.

An Electronic Medical Record is all your health information from within public hospital walls. Consumers have said they are interested in their GP also being able to access important health information. Linking up residential and home-based aged care services has also been mentioned regularly. This is not the current focus of this program. Our role as consumer advocates is to link in with what is happening at a federal level with My Health Record. Ideally, we can help ensure the consumer ambition to have more integrated care is supported through digital innovations such as a patient portal that links up all our records.

Patient Portals

These are the public-facing part of an Electronic Medical Record – the part we will interact with. This is an area that we need to be able to influence the design of – seeing and changing appointments, being able to message the care team, etc. Continuing to link in with the federal developments of My Health Record will be a key consumer advocacy point.

Data Use, Privacy and Confidentiality

Connecting data across systems is currently very difficult. This makes it difficult for us to know if  health interventions are having the health outcomes we seek. An electronic medical record will generate data that could help us better understand the health outcomes being created through our health system. Meanwhile, My Health Record offers us the opportunity to lock down parts of our record, and know who has accessed our record, and we need to understand what might be possible in an Electronic Medical Record.

Patient Reported Outcome Measures and Patient Reported Experience Measures

Known as PROMS and PREMS and aiming to measure the patients’ views of their experiences and health, these measures are being developed in a piecemeal fashion in different areas of health and different parts of Australia (and the world). They will be part of the Electronic Medical Record and we need to be part of the conversation about what measures are used or developed.

Care Pathways – Sandwich or Biscuit?

Care pathways are informed by a number of factors, including evidence from clinical practice, research, and service improvement projects. These are a description of the best evidence informed care that consumers can expect. They are not meant to de-personalise care, rather care pathways are “guard rails” to support safe and high-quality care. These too will be encoded into the My Health Record and will require a coming together across WA’s public health system to agree on these. For example, if you are receiving diabetic care and experience low blood sugar in one part of the health system, you may be offered a sandwich. If you are in another part of the health system you may be offered a biscuit. How these are harmonised and developed across the state requires consumer input.

Pip Brennan, Consumer Consultant, February 2024

Australians are being asked to go to the polls on October 14th and vote on whether the Constitution should be amended to recognise a First Nations Voice to Parliament.

Health Consumers’ Council hosted a lunchtime discussion on 6 October for people in representative roles as health consumers, carers, people with lived experience or community members to meet and learn about The Voice, and discuss the implications for healthcare and health outcomes.

In this presentation, we review some factual information about The Voice developed by Reconciliation WA and look at some of the expected health impacts for Aboriginal people of The Voice.

• Click here to watch the recording of this session
• Click here to access the slides of the presentation

By Clare Mullen, Executive Director

The National Health Reform Agreement (NHRA) is an agreement between the Commonwealth government and the state government on a range of health issues.

• National Health Reform Agreement https://www.health.gov.au/our-work/2020-25-national-health-reform-agreement-nhra
• This is the information about the review https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/review-of-national-hospital-funding-agreement

The Federal Government has commissioned an independent review of this Agreement as it is the mid-way point of the Agreement’s term. The review team is due to report in August 2023.

I had the chance to speak with the Review team when they were in Perth this week.

Below are some of the points we plan to include in Health Consumers’ Council’s submission which we will submit by the end of June 2023. If you have further points you’d like to see included in that response, please email them to Jasmina Brankovich, HCC’s Systemic Advocacy and Policy Lead, jasmina.brankovich@hconc.org.au

• A key focus of the Agreement relates to how hospitals are funded – this is called Activity Based Funding (ABF) and it means that hospitals are funded based on the volume of services they provide (rather than receiving a block of funding as was the case previously). From our discussions with people across health, it seems this has led to some activities which would benefit consumers being understood by hospitals as not to be included – i.e. activities which might lead to services being provided in primary care/community care settings rather than in a hospital setting
• Funding based on fee for service inevitably leads to health services need to drive activity – when less activity in the hospital, and more in primary care would be best for the consumer
  • We note that NSW Health opted to initiate collaborative commissioning, using state funds to commission primary care services so as to reduce demand on hospital services – we’re not aware that this has been replicated in other states yet, including WA
• The role of “system manager” as it’s currently recognised – i.e. only of public hospitals – limits the value of a system manager role.
  • Given that managing hospitals relies heavily on the provision and functioning of primary/community care services – often commissioned and/or funded by the Commonwealth, there may be an advantage in exploring the role of “system manager” being expanded to all publicly funded health services in the state – including those in primary care.
  • Consumer input into commissioning and funding decisions should be mandated for all publicly funded health services – both at a hospital and primary care level. This may require investment in building the capacity and structures to support informed consumer input to these decisions.
• In response to the goals of the NHRA:
  • deliver safe, high-quality care in the right place at the right time
    • there is significant opportunity to improve funding flows across hospital/primary and community services – all too often consumer reps hear, that’s a function of “the other part of the system”.
  • prioritise prevention, and help people manage their health across their lifetime
    • there is little evidence that this goal is being achieved through any of the activities in the current agreement
  • drive best-practice and performance using data and research
    • this is difficult for consumers to comment on given the limited transparency of data about best practice and performance that is in the public domain
  • improve efficiency and ensure financial sustainability
    • the geographic and demographic characteristics of WA mean that “efficiency” and “financial sustainability” comparisons with other states is unlikely to be an effective way of measuring success for the WA community
    • We advocate for a recognition of the inherent “inefficiencies” in a health system that is delivering care across a vast geographic area, with very limited Federally-funded primary care provision in the regions – a national efficient price is unlikely to be sufficient to deliver safe high quality care in many parts of WA

With regards to the 6 reforms outlined in Schedule C of the NHRA:

• empowering people through health literacy – person-centred health information and support will empower people to manage their own health well and engage effectively with health services
  • from our position in the system, there is very limited evidence of any activity happening in this area
  • we would like to see a stronger role for community-led initiatives – including bi-cultural workers – to shift the dial on health literacy
• prevention and wellbeing – to reduce the burden of long-term chronic conditions and improve people’s quality of life
  • we note the publication of both state and national strategies relating to preventive health and obesity prevention, but see limited evidence of any investment in the implementation of these strategies at any level
  • we believe grassroots investment in building and maintain social capital is critical to this priority
• paying for value and outcomes – enabling new and flexible ways for governments to pay for health services
  • we believe there’s an opportunity for more consumer involvement in discussions to determine the framework for paying for value and outcomes
• joint planning and funding at a local level – improving the way health services are planned and delivered at the local level
  • in WA, we have limited evidence of this happening in practice. We acknowledge the benefit of having the three WA Primary Health Networks (PHNs) managed by the same organisation – the WA Primary Health Alliance.
  • We note the fact that in WA, the geographical areas covered by our PHNs don’t match the geographical areas covered by WA’s Health Service Providers and the challenge this creates for joint funding and planning
    • (In the metro area we have Perth North PHN and Perth South PHN, but South Metro, North Metro and East Metro Health Services)
• enhanced health data – integrating data to support better health outcomes and save lives
  • we would advocate for more local involvement and upskilling of WA consumers to inform the collection, publication and use of health data for the WA community
• nationally cohesive health technology assessment – improving health technology decisions will deliver safe, effective and affordable care
  • we are looking into this to inform our response.

We will also be considering our position on how Patient Reported Outcome Measures (PROMS) and Patient Reported Experience Measures (PREMS) could be used to inform how funding flows to different parts of the health system in future.

Overall, we will be calling for more local involvement and control of public funds that are allocated for the benefit of the WA community. For example, regional commissioning groups that agree funding priorities, planned outcomes, and performance measurement frameworks – to include multiple and diverse consumer and carer leaders working alongside local health system staff and policy makers who are well-placed to make decisions affecting the WA community.