After just a few short months in office, Victoria’s new State Government has already canned the previous administration’s plans to roll out Apple iPads to every public sector doctor in the state and placed Victoria’s flagship $360 million e-health project HealthSMART on ice. But not everyone is happy to see e-health investment so dramatically rolled back in the state.

In a submission to the state’s upcoming budget process recently published online (PDF), the Victorian branch of the Australian Medical Association has called for the new Coalition State Government to commit $328 million over four years to ICT initiatives in the state’s health sector.

“Despite the promises of HealthSMART, Victoria still does not have ICT infrastructure that caters adequately for the needs of patients. The potential quality and safety benefits of IT are not being realised, costing time and money, and leading to poorer patient outcomes,” the AMA wrote in its submission, news of which was first published by Computerworld.

“Improved ICT will not solve all the problems in our health system, but these problems cannot be solved without improved ICT,” the AMA added.

The AMA wants the funding spend on an Apple iPad tablet for every doctor, which could display electronic drug charts, medication management systems and patient records, as well as funding specifically allocated to roll out medication management systems, build better interfaces between hospitals, general practitioners and aged care providers, and build wireless support in hospitals.

In addition, the group advised steady, recurrent funding could be spent on up to date computers for use by medical staff, remedying a lack of standardised software between hospital networks and providing for the replacement of “sub-standard hardware and software systems”.

“To build these missing links in Victoria’s ICT systems, we need to ensure that there is adequate ongoing investment,” the AMA wrote. “AMA Victoria recommends recurrent funding of $60 million per annum to ensure an adequate level of ongoing investment.”

The comments come as the new State Government appears to be turning away somewhat from e-health projects promised by the former Labor administration.

In November last year, then-Victorian Premier John Brumby promised every doctor in the state’s public hospital system would be issued with an Apple iPad if his incumbent Labor Government was returned to power in the state’s upcoming election. The Coalition never matched the promise, although it did indicate interest in “mobile technology” for health outcomes.

In addition, The Age reported in late March that departmental advice delivered to the new Coalition Government stated that the project would need another $200 million spent on it to justify the initial $360 million cost, with at least $95 million needed to complete the initial vision and the rest to go on replacing systems outside HealthSMART’s initial scope. Health Minister David Davis said as early as January 24 that the project would be reviewed.

This afternoon, a spokesperson for Davis said HealthSMART was being closely examined, but no decision had yet been made as to its future. It has been reported that a number of contractors working on the project had not had their contracts renewed, but the spokesperson said those staff had been working on projects coming to an end in any case — and on initiatives which were not necessarily key to HealthSMART.

However, it appears as if the Victorian AMA is determined to be vocal on the issue. Board member Dr Tony Bartone also issued a separate statement on the issue last week. “Doctors are concerned about Victoria’s failing health IT systems. There is a lack of resources for IT across the health sector,” he said.

“There are ongoing problems with hospital IT systems and the interface between general practice and hospitals. Patients require a seamless transition between acute and primary care settings but at the moment there are numerous roadblocks which impact on their ongoing health care.”

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The Australian Democrats has warned Health Minister Nicola Roxon’s Health Identifiers Bill appears similar to the previous Howard government’s ill-fated attempt to replace the Medicare Card with what it called an Access Card — which many saw as an attempt to create a national ID card.

In early February, Health Minister Nicola Roxon introduced legislation into Federal Parliament that would introduce a National Health Identifier to be implemented by the middle of 2010.

The health and social services Access Card project was terminated in November 2007 when Kevin Rudd’s Labor government took office, ending several years of debate about whether the card was an attempt to introduce a national ID card similar to the Australia Card — dumped as a project back in 1987.

“We are concerned that adequate protection needs to be included in any legislation to prevent “function creep” and prevent an expansion of the health identifier and related card to purposes other than explicitly for health,” said the Democrats in a submission to the Federal Government’s Senate Enquiry into the National Health Identifier service. The submissions were published last week online.

“This would create a defacto ID card with the potential to track people’s movement.”

The party added although the legislation was an important step in facilitating access to medical records, it was also important that there be a guarantee that it wouldn’t become mandatory to present all medical details in order to access healthcare services or Medicare benefits.

In general, most parties responding to the enquiry have praised the initiative, but a number have also echoed ongoing potential privacy concerns from the idea — including state health ministers.

In its submission to the enquiry, IT services giant CSC said the privacy safeguards in the legislation were “strong and adequate”. However, it also noted that there was a “noticeable absence of detail in the bill in relation to consent of individuals who want to choose to share their identifier”.

CSC also recommended that individuals be able to see the ‘audit trail’ online of who has accessed their health identifiers and for what purposes.

The Australian Medical Association echoed the concerns. “Much of the privacy concerns relate to the electronic sharing of patient information, which is not covered by the bill,” it wrote in its submission. However, the issue may not be that large due to Australia’s lack of up to date technology.

“We note that at this time, in Australia hardly any of the electronic systems that contain patient information are interoperable, so there is limited opportunity to share patient information electronically across more than one healthcare setting,” the AMA said.

Perhaps the most fiery submission came from e-health consultant David More, who runs the AusHealthIT blog. More believed the legislation was being presented in isolation from the necessary larger e-health agenda.

“The present proposed legislation is deeply inadequate and there are major implementation risks with the project overall, which I do not believe have been treated frankly by the enthusiasts for this bill in its present form,” he wrote.

“I have to point out that we have had at least a lost decade of (essentially no) progress in e-health. We are presently at a cusp, and if the right path is not chosen and implemented, it will be another decade before e-health realises its promise in Australia. Right now, I do not believe we are on the right path, and that the risks of expensive failure are very high indeed.”

Image credit: Sanja Gjenero, royalty free