“Australians living in remote and regional areas are dying preventable deaths from treatable conditions because of a lack of access to health services.
The damning assessment is contained in a new Australian Institute of Health and Welfare report on rural and remote health, which finds that those in the bush rely heavily on general practitioners to provide primary healthcare services in the absence of specialist doctors.
But patients most in need of GPs often can’t access them, with those in remote areas six times as likely as those in metropolitan centres to report they had no access to one.”
” Aboriginal and Torres Strait Islander people are more likely to have higher rates of chronic conditions, hospitalisations and poorer health outcomes than non-Indigenous Australians
The differences in health outcomes in Remote and Very remote areas may be due to the characteristics of these populations.
The proportion of the population that is Indigenous, is much higher in more remote areas
However, more Indigenous Australians live in Major cities and Inner regional areas (61% of Indigenous Australians) compared with Remote and Very remote areas (19%) “
The AIHW report finds people in remote areas die five years before their city counterparts, with a life expectancy of 76 years.
More than 70 per cent of those living in regional areas are overweight or obese, less than one in 10 eat the recommended number of serves of vegetables per day, and one-quarter have high blood pressure or mental health problems.
Rural Australians are dying of diabetes at much higher rates than city dwellers, and many cancers go undetected because of a lack of access to screening programs.
“The rate of potentially avoidable deaths increased as remoteness increased,” the report says. “These are deaths among people aged 75 and under from conditions considered potentially preventable through individualised care, and/or treatment through existing primary or hospital care.”
The Australian College of Rural and Remote Medicine said the situation was a “tragedy”.
“We have a rural health crisis that extends right across from our Aboriginal and Torres Strait Islander people to our rural communities,” said college president Ewen McPhee.
“I think it’s a tragedy that rural communities continue to be neglected.”
In many tiny towns across the country, residents rely on the Royal Flying Doctor Service to provide access to a GP.
Yesterday in Stonehenge in remote central Queensland, doctor Arthur Beggs and nurse Jo Mahony flew in to provide the fortnightly mobile GP service for the town and surrounding areas of about 50 people.
“A lot of people don’t want to bother us unless they are really unwell and that’s really typical of the stoic, outback approach,” Dr Beggs said.
The RFDS has introduced a chronic disease management plan to the town, tracking baseline health measurements and flying specialist allied health practitioners in every few weeks to provide extra services.
Dr Beggs knows the challenges of being a rural GP, but says the difficulties are outweighed by the satisfaction of the work.
“I find rural and remote medicine fascinating and much more fulfilling than I do city-based medicine,” he said.
A recent report published by the Medical Deans of Australia found only 15 per cent of medical students in their final year of study said they were interested in becoming GPs, the lowest figure in five years.
Dr Beggs said attracting GPs to rural and remote areas was key to improving health outcomes in the bush.
“Modern medicine is all about specialties,” he said.
“The specialties can seem a more lucrative and controlled environment than the realms of general practice, which is unfortunate because general practice gives you a much better overview of people and their health.”
Overall, more Australians live in Major cities compared with rural and remote areas
. In 2017, the proportion of Australians by area of remoteness was:
72% in Major cities
18% in Inner regional areas 8.2% in Outer regional areas 1.2% in Remote areas
0.8% in Very remote areas (ABS 2019b).
On average, people living in Remote and very remote areas were younger than those living in Major cities ( gures 1a and 1c).
Australians aged 25–44 were more likely to live in Remote and very remote areas and Major cities compared with Inner regional and outer regional areas. However, a higher proportion of people aged 65 and over lived in Inner regional and outer regional areas and Major cities, compared with Remote and very remote areas ( gures 1a, 1b and 1c).
Rural and remote Australia encompasses many diverse locations and communities and people living in these areas face unique challenges due to their geographic isolation.
Those living outside metropolitan areas often have poorer health outcomes compared with those living in metropolitan areas. For example, data show that people living in rural and remote areas have higher rates of hospitalisations, mortality, injury and poorer access to, and use of, primary health care services, compared with those living in metropolitan areas.
Health inequalities in rural and remote areas may be due to factors, including:
challenges in accessing health care or health professionals, such as specialists social determinants such as income, education and employment opportunities higher rates of risky behaviours such as tobacco smoking and alcohol use
higher rates of occupational and physical risk, for example from farming or mining work and transport-related accidents.
Despite poorer health outcomes for some, the Household, Income and Labour Dynamics in Australia (HILDA) survey found that Australians living in small towns (fewer than 1,000 people) and non-urban areas generally experienced higher levels of life satisfaction compared with those in urban areas (Wilkins 2015).
Rural and remote Australians also report increased community interconnectedness and social cohesion, as well as higher levels of community participation, volunteering and informal support from their communities (Ziersch et al. 2009).
Part 3 National : Closing the Gap / Have your say CTG deadline extended to Friday, 8 November 2019.
The engagements are now in full swing across Australia and this is generating more interest than we had anticipated in our survey on Closing the Gap.
The Coalition of Peaks has had requests from a number of organisations across Australia seeking, some Coalition of Peak members and some governments for more time to promote and complete the survey.
We want to make sure everyone has the opportunity to have their say on what should be included in a new agreement on Closing the Gap so it is agreed to extend the deadline for the survey to Friday, 8 November 2019.
This will help build further understanding and support for the new agreement and will not impact our timeframes for negotiating with government as we were advised at the most recent Partnership Working Group meeting that COAG will not meet until early 2020.
There is a discussion booklet that has background information on Closing the Gap and sets out what will be talked about in the survey.
The survey will take a little bit of time to complete. It would be great if you can answer all the questions, but you can also just focus on the issues that you care about most.
To help you prepare your answers, you can look at a full copy here
The survey is open to everyone and can be accessed here:
“The Aboriginal-led and governed study will be larger than any previous study of Aboriginal and Torres Strait Islander adults.
It aims to provide information for communities, services and policy makers to improve Aboriginal and Torres Strait Islander health and wellbeing.”
Dr Mark Wenitong, study co-investigator from the Apunipima Cape York Health Council.
In an Australian first, the Australian National University will partner with key Aboriginal and Torres Strait Islander peak bodies to conduct a national study of Aboriginal and Torres Strait Islander wellbeing.
The study name, ‘Mayi Kuwayu’ means ‘to follow Aboriginal people over time’ in Ngiyampaa language, the family language of the study’s director, Associate Professor Ray Lovett from the National Centre for Epidemiology and Population Health at ANU.
“The survey includes questions that people have told us matter to them as Aboriginal and Torres Strait Islander people.
Those things include connection to country, cultural beliefs and knowledge, language, family, kinship and community, cultural expression and continuity and self-determination and leadership, along with health”, Associate Professor Ray Lovett said.
The study will be rolled out in the second half of 2018 and will provide much needed evidence on Aboriginal and Torres Strait Islander culture and its impact on health and wellbeing.
The team has developed the survey questions with Aboriginal and Torres Strait Islander people from across the country over the last three years.
An Aboriginal and Torres Strait Islander governance committee will oversee the study, and ensure that it adheres to principles of Indigenous data sovereignty and governance.
All Aboriginal and or Torres Strait Islander people aged 16 years or older can be part of the study.
” Democratised data is key to unlocking genuine regional empowerment in people taking responsibility for their own futures
We are committed to working with Aboriginal and Torres Strait Islander people.
Establishing data governance arrangements will be important.
We need to engage fully with Indigenous Australians in the process of developing, designing, collecting and utilising data.
We need to place a greater emphasis on the use of regional data. This will allow communities to take ownership of placed based actions and to hold governments and service providers to account.
We also need to look at ways to improve data access while at the same time always ensuring individual privacy is maintained.
Improved access to data can help drive research, and help build an evidence base to support and drive policy that improves outcomes for First Australians.
We know a one-size-fits-all approach is not the most effective way to improve outcomes for Aboriginal and Torres Strait Islander people.
It will put behind us the negative mindset, replacing it with a positive narrative focused on enabling Indigenous Australians to lead lives they value while at the same time ”
The 2017 Menzies Oration delivered by Professor Ian Anderson AO. Speaking about ‘Democratising Data/Building a platform for Indigenous Development’. Darwin NT Friday 24 November
Introduction
Ya Pulingina. Pangkerner Ian Anderson Palawa Trowunna: Trawlwoolway, Pairrebenne, Plairmairrerenner. Kartoometer mynee larrakia teeanner. Carnee meenee nenener nicer Lanena.
I would like to thank the Menzies School of Health Research and Director, Professor Alan Cass, for inviting me to speak tonight and for hosting this event.
It is a great honour to deliver the 2017 Menzies Oration.
I would like to take this opportunity to congratulate the Menzies School of Health Research for its ongoing commitment to examining and understanding Indigenous health. Research undertaken by the school has made a significant contribution in improving the health and wellbeing of Aboriginal and Torres Strait Islander peoples across Australia.
I would also like acknowledge the many distinguished guests attending today:
the Honourable Vicki O’Halloran AM, Administrator of the Northern Territory;
Professor Lawrence Cram, Deputy Vice-Chancellor and Vice-President Research and Research Training; and
Professor Alan Cass, Director of the Menzies School of Health Research
Today, I would like to discuss the importance of data within the policy context.
Data can be an extraordinarily powerful tool.
Data shapes so much of our society. Governments, businesses, non-profit organisations and individuals all use data to inform their decision-making.
We live in a data age.
The Australian Productivity Commission in their inquiry on Data Availability and Use drew on IBM estimates [1]:
‘the amount of digital data generated globally in 2002 (five terabytes) is now generated every two days, with 90% of the world’s information generated in just the past two years’
In addition to significant growth in the amount of data being collected, we also have the opportunity to better use our data assets. We have more sophisticated technologies to analyse and integrate data—in fact, we are also able to analyse more data, more quickly at lower cost.
By way of example, decoding the human genome involves analysing 3 billion base pairs—when this was first done in 2003, it had taken over 13 years at a reported cost of around $1 billion. Presently, it can be done in a day at a cost of approximately $3,000. [2]
Many people here tonight are in some way involved in the production of data. You might collect data as part of service delivery or part of a research project, analyse data to build information and evidence, or use this information and evidence to make policy decisions.
Data collected through research, survey and census or from the administration of government programs and activities, has played an important role in guiding policy and practice, particularly in Indigenous affairs.
Public data is a national asset. However, its value is only realised when data is transformed into information, and more importantly knowledge.
Data can help shape debate, identify areas of need, and be used to analyse the effectiveness of policy and other actions.
But, for this to occur, the data must be of high quality and we must collect the right data. Moreover, it must be accessible to all. I would also like to stress that data is not useful in isolation and must be combined with the skills and capabilities to make the most of it.
Democratising data – Data and Indigenous peoples, changing approaches
Now, in using the phrase—democratising data—I am signalling a change agenda to create the systems and platforms that ensure end-users are able to access data in a timely way. One that is relevant to a wider audience and allows data to be used.
The availability of data on Indigenous Australia has reflected broader politics.
It is reasonable to infer that in the late 19th century when representatives of the then six British colonies—New South Wales, Victoria, South Australia, Western Australia, Queensland and Tasmania—came together to draft up Australia’s constitution, Aboriginal and Torres Strait Islander people were not factored in.
It is probable that those who considered how the soon-to-be-federated country might operate did not want to include Indigenous people in financing arrangements for the states, or for the development of services or planning purposes.
It is also possible the founding fathers of the Australian federation did not think Aboriginal and Torres Strait Islander people were long for this world. That they were a dying race.
Under such scenarios, there would have been no need for information about Australia’s Indigenous population to be collated. The ‘race’ clauses included in our original constitution reflect this.
It was not until the successful 1967 referendum that paved the way for the Commonwealth to take on responsibility for the administration of Indigenous Affairs at a national level that Aboriginal and Torres Strait Islander people were formally included in our population counts. This marked the start of the first phase of Indigenous data development in Australia.
In the years that have followed, data sets concerning Indigenous Australians have slowly been built up. The Australian Bureau of Statistics, for example, has developed a clear picture of the lives and experiences of Indigenous Australians.
Over the past three to four decades, significant improvements have been made in the availability and quality of Indigenous data.
This includes Indigenous data obtained through our national survey program run by the Australian Bureau of Statistics. Equally important has been the collection of vital statistics—such as, data on births and deaths, hospital data and Medicare data.
However, the most significant innovation over the last two decades has been the development of performance measurement systems. These systems draw on data made available through our data collections systems. They have been developed with the specific purpose of enhancing policy decision making processes.
Perhaps one of the most sophisticated data sets relating to Australia’s Indigenous population can be found in the Indigenous health sector.
The move earlier this century to start strategically using data through vehicles such as the Aboriginal and Torres Strait Islander Health Performance Framework reports marked the beginning of the second phase of Indigenous data development in this country.
The first Aboriginal and Torres Strait Islander Health Performance Framework report was produced in 2006. Commissioned by the Australian Health Ministers’ Advisory Council (AHMAC), the data in these reports, updated every two years, and has been used by Australia’s political leaders to inform their decision-making in Indigenous Affairs.
Data is collated across three tiers: health status and outcomes; determinants of health; and health systems measures. Significantly, the measures had strategic value and ‘buy in’ from the states and territories.
The data contained in the Aboriginal and Torres Strait Islander Health Performance Framework played a pivotal role in the decision by the Council of Australian Governments to allocate resources in 2008 to address Indigenous disadvantage. However, just as importantly, the data informed where the resources would be allocated.
The collation, analysis and strategic use of Indigenous data by our political leaders is one thing—I will discuss this further when I describe our proposed approach to the refresh of Close the Gap—but making data accessible and relevant to a wider audience—and in this case, Aboriginal and Torres Strait Islander people—is another thing altogether.
Too often, data is not presented in a way that is accessible for Aboriginal and Torres Strait Islander people. Furthermore, it is interpreted in a way that is not connected to Indigenous reality.
Our apologies that we cannot publish the full oration speech here :
“The report, compiled by the Australian Commission on Safety and Quality in Health Care, shows us that high hospitalisation rates often point to inadequate primary care in the community, leading to higher rates of potentially preventative hospitalization
The most disturbing example of this has been the higher hospitalisation rates for all of the 18 clinical conditions surveyed experienced by Aboriginal and Torres Strait Islander Australians, people living in areas of relative socioeconomic disadvantage and those living in remote areas.
Chairman of Consumers Health Forum, Tony Lawson who is a member of the Atlas Advisory Group.
“Additional priorities for investigation and action are hospitalisation rates for specific populations with chronic conditions and cardiovascular conditions, particularly:
Aboriginal and Torres Strait Islander Australians
People living in remote areas
People at most socioeconomic disadvantage.
Please note
Features of the second Atlas include: Analysis of data by Aboriginal and Torres Strait Islander status
Mr Martin Bowles Secretary Dept of Health launches the Second Australian Atlas of Healthcare Variation#Atlas2
A new report showing dramatic differences in treatment rates around Australia signals a pressing need for reforms to ensure equitable access to appropriate health care for all Australians, the Consumers Health Forum, says.
“A seven-fold difference in hospitalisation for heart failure and a 15-fold difference for a serious chronic respiratory disease depending on place of residence, are among many findings of substantial variations in treatment rates in Australia revealed in the Second Australian Atlas of Healthcare Variation,” the chairman of Consumers Health Forum, Tony Lawson, said.
“While there are a variety of factors contributing to these differences, the variation in health and treatment outcomes is, as the report states, an ‘alarm bell’ that should make us stop and investigate whether appropriate care is being delivered.
“These findings show that recommended care for chronic diseases is not always provided. Even with the significant funding provided through Medicare to better coordinate primary care for people with chronic and complex conditions, fragmented health services contribute to suboptimal management, as the report states.
“We support the report’s recommendation for a stronger primary health system that would provide a clinical ‘home base’ for coordination of patient care and in which patients and carers are activated to develop their knowledge and confidence to manage their health with the aid of a healthcare team.
“The Atlas provides further robust reasons for federal, state and territory governments to act on the demonstrated need for a more effective primary health system that will ensure better and more cost effective care for all Australians.
“The Atlas also examined variations in women’s health care, and its findings included a seven-fold difference in rates of hysterectomy and 21-fold difference in rates of endometrial ablation. The report states that rates of hysterectomy and caesarean sections in Australia are higher than reported rates in other developed nations. These results highlight the need for continuing support and information on women’s health issues,” Mr Lawson said.
This Atlas, the second to be released by the Commission, illuminates variation by mapping use of health care according to where people live. As well, this Atlas identifies specific achievable actions for exploration and quality improvement.
The second Atlas includes interventions not covered in the first Atlas, such as hospitalisations for chronic diseases and caesarean section in younger women. It also builds on the findings from the first Atlas – for example, examining hysterectomy and endometrial ablation separately, and examining rates of cataract surgery using a different dataset.
Priority areas for investigation and action arising from the second Atlas include use of:
Hysterectomy and endometrial ablation
Chronic conditions (COPD, diabetes complications)
Knee replacement.
Additional priorities for investigation and action are hospitalisation rates for specific populations with chronic conditions and cardiovascular conditions, particularly:
Aboriginal and Torres Strait Islander Australians
People living in remote areas
People at most socioeconomic disadvantage.
Healthcare Variation – what does it tell us
Some variation is expected and associated with need-related factors such as underlying differences in the health of specific populations, or personal preferences. However, the weight of evidence in Australia and internationally suggests that much of the variation documented in the Atlas is likely to be unwarranted. Understanding this variation is critical to improving the quality, value and appropriateness of health care.
View the second Atlas
The second Atlas, released in June 2017, examined four clinical themes: chronic disease and infection – potentially preventable hospitalisations, cardiovascular, women’s health and maternity, and surgical interventions.
Key findings and recommendations for action are available here.
The second Atlas shows rates of use of healthcare interventions (hospitalisations, surgical procedures and complications,) in geographical areas across Australia. The rate is then age and sex standardised to allow comparisons between populations with different age and sex structures. All rates are based on the patient’s place of residence, not the location of the hospital or health service.
The second Atlas uses data from national databases to explore variation across different healthcare settings. These included the National Hospital Morbidity Database and the AIHW National Perinatal Data Collection.
Who has developed the second Atlas?
The Commission worked with the Australian Institute of Health and Welfare (AIHW) on the second Atlas.
The Commission consulted widely with the Australian government, state and territory governments, specialist medical colleges, clinicians and consumer representatives to develop the second Atlas.
Features of the second Atlas include:
Greater involvement of clinicians during all stages of development
Analysis of data by Aboriginal and Torres Strait Islander status
Analysis of data by patient funding status (public or private).
Table of Contents
Chapter 1 Chronic disease and infection: potentially preventable hospitalisations
” This fourth national report on the Indigenous primary health care national Key Performance Indicators (nKPIs) data collection presents annual data on indicators collected from the June 2012 to the June 2016 reporting period.
Information is presented for 22 ‘process-of-care’ and ‘health outcome’ indicators for June 2016, which focus on maternal and child health, preventative health, and chronic disease management.
The report shows continuous improvements for the majority of indicators.
Yes the good news is , improvements were seen in 12 of the 16 process-of-care measures for which time trend data were available (Table S1 below ).
For 10 of these measures, the change was statistically significant.”
Data for this collection are provided to the AIHW by primary health care organisations that receive funding from the Department of Health to provide services to Aboriginal and Torres Strait Islander people.
Some primary health care organisations that report receive additional funding from other sources, including state and territory health departments, while a small number are funded solely by the Northern Territory Government (see ‘Chapter 1 Introduction’).
The purpose of the nKPIs is to support policy and service planning at the national and state/territory levels, by monitoring progress and highlighting areas for improvement.
The nKPIs can also be used to improve the delivery of primary health care services, by supporting continuous quality improvement (CQI) activity among service providers.
Over the period June 2012 to May 2015 (the period for which time trend data are available), improvements continue to be made across the majority of measures—indicating that health organisations continue to show progress in service provision.
The good news
Improvements were seen in 12 of the 16 process-of-care measures for which time trend data were available (Table S1).
For 10 of these measures, the change was statistically significant. The largest improvements (between 16 and 19 percentage points) were seen in data recording practices for the measurement of:
alcohol consumption, which rose from 38% in June 2012 to 57% in May 2015
birthweight, which rose from 51% in June 2012 to 69% in May 2015
smoking status, which rose from 64% in June 2012 to 80% in May 2015.
Results for process-of-care measures related to Medicare Benefits Schedule (MBS) health assessments (for children and adults) exceeded the 2016 trajectory of the Implementation Plan goals for the National Aboriginal and Torres Strait Islander Health Plan 2013–2023.
Improvements were also seen in 3 of the 5 health outcomes measures for which time trend data were available. For 1 of these, the change was statistically significant:
• Health of clients with type 2 diabetes—those with an HbA1c (glycosylated haemoglobin), with a result of ≤7% in the previous 6 months, rose from 32% in June 2012 to 35% in May 2015. (An HbA1c result of ≤7% is the optimum target encouraged by Diabetes Australia to ensure good glycaemic control and reduce the incidence of diabetes-related illness.)
Things to work on
Results for 3 process-of-care measures related to immunisation against influenza—clients aged 50 and over; clients with type 2 diabetes; and clients with chronic obstructive pulmonary disease (COPD)—and for the 1 process-of-care measure relating to cervical screening saw small decreases of between 1.3 and 2.6 percentage points. However, these were not statistically significant.
Results for 2 health outcome measures showed increases: the proportion of babies born with a low birthweight increased by 0.9 percentage points and people whose body mass index (BMI) score classified them as overweight or obese increased by 4.3 percentage points.
However, these increases were not statistically significant.
These results also remain in line with national data for Indigenous Australians.
” This index is used to look at the geographic supply of the clinical health workforce in seven key professions with particular relevance to Indigenous Australians, and to identify areas in Australia that face particular supply challenges.
The professions considered were general practitioners, nurses, midwives, pharmacists, dentists, psychologists and optometrists. “
The poorer health status of Aboriginal and Torres Strait Islander Australians, compared with that of non-Indigenous Australians, is evident throughout the life course.
Aboriginal and Torres Strait Islander babies are more likely to be exposed to smoking while in utero, are more likely to be born pre-term and with low birthweight, and are more likely to die before their first birthday than are non-Indigenous babies.
These inequalities continue throughout childhood and adulthood and are evident in indicators such as poor health, lower life expectancy and higher levels of chronic disease (AIHW 2015b).
The factors underpinning these differences are complex and interrelated, and include:
• higher levels of social disadvantage
• greater exposure to environmental risk factors (such as inadequate and overcrowded housing)
• sociocultural and historical factors
• poorer nutrition, higher rates of smoking and risky alcohol consumption
• poorer access to health services.
Access to health services is compounded by the fact that Aboriginal and Torres Strait Islander people are more likely than non-Indigenous Australians to live outside cities.
This population distribution is important because distance often poses substantial challenges for workforce recruitment and health service delivery, particularly in areas where populations are widely dispersed or isolated.
Access to health services and health professionals will not on its own eliminate the differences in health status between Indigenous and non-Indigenous Australians.
However, having access to appropriate, high-quality and timely health care can help to improve health and wellbeing.
For a start, it improves health literacy and self-management of chronic disease; it also provides links to services within and outside the health system, and improves screening and treatment of acute and chronic illnesses.
Thus, the extent to which there are gaps in the geographic distribution of the health workforce in professions with particular relevance for Aboriginal and Torres Strait Islander people is a critical policy issue.
This report looks at the geographic supply of the clinical health workforce in seven key professions with particular relevance to Indigenous Australians—general practitioners (GPs), nurses, midwives, pharmacists, dentists, psychologists and optometrists—to identify areas in Australia that face particular supply challenges.
Traditional measures of workforce supply (such as provider-to-population ratios) have shortcomings in that they do not take into account differences between areas in terms of their geographic size, location of service providers, and the location of populations across areas. These factors directly affect the capacity of providers to supply services, and the ability of the population to access those services.
To overcome these issues, a new Geographically-adjusted Index of Relative Supply (GIRS) was developed to indicate the supply of professionals in one area compared with another. The GIRS takes data on hours worked in clinical roles and on main practice location from the 2014 National Health Workforce Data Set (NHWDS)—combined with data on population size, geographic size and drive time to services—to create a score ranging from 0 to 8 for each of the seven professions in each Statistical Area level 2 (SA2) in Australia.
The area-level GIRS scores are combined with information on the spatial distribution of the Indigenous population. This is done for two reasons: firstly, to calculate the number of Indigenous Australians who live in areas with each of the GIRS scores and, secondly, to identify those areas with relative supply challenges for each profession individually and with challenges across multiple professions.
This work builds on previous Australian Institute of Health and Welfare (AIHW) reports focusing on access to GPs relative to need (AIHW 2014a), spatial variation in Aboriginal and Torres Strait Islander people’s access to primary health care (AIHW 2015a) and to maternal and child health services (AIHW 2016a).
Notes
This report uses a new measure developed by the Australian Institute of Health and Welfare—the Geographically-adjusted Index of Relative Supply (GIRS).
The GIRS scores were compared with the distribution of the Indigenous population to assess the extent to which Indigenous people live in areas with lower relative levels of supply.
The GIRS was developed to overcome limitations in using relatively simple provider-to-population ratios to compare areas with vastly different geographic characteristics. The GIRS takes data on hours worked in clinical roles and on main practice location from the 2014 National Health Workforce Data Set; it then adjusts it for three other factors—land size, population dispersion, and drive time to services—to create a score ranging from 0 to 8 for each of the seven professions in each Statistical Area level 2 (SA2) in Australia. Areas with lower GIRS scores are more likely to face workforce supply challenges than those with higher GIRS scores.
The report’s findings are as follows:
GIRS scores of 0 or 1 (most likely to face supply challenges) occur most often for midwives, optometrists and psychologists, and least often for nurses.
Over 19,000 Aboriginal and Torres Strait Islander women of child-bearing age (15–44 years) live in 120 SA2s with a low relative supply of midwives.
Over 85,000 Aboriginal and Torres Strait Islander people live in 56 SA2s with a low relative supply of optometrists.
Over 76,000 Aboriginal and Torres Strait Islander people live in 49 SA2s with a low relative supply of psychologists.
For each profession, a higher proportion of Aboriginal and Torres Strait Islander people than non-Indigenous people live in areas with lower GIRS scores.
While relative supply challenges are more common in remoter parts of Australia, the findings show that there is considerable variation in regional and remote areas.
There were 155 SA2s out of 2,091 (8%) with a GIRS score of 0–1 in at least one profession. Nearly 20% of Aboriginal and Torres Strait Islander people live in these areas, compared with 3% of the non-Indigenous population.
Over 72,000 Aboriginal and Torres Strait Islander people live in the 39 SA2s where at least four of the seven professions (that is, over half the professions) have GIRS scores of 0 or 1. Over 30,000 of these people live in the 13 SA2s where at least six of the seven professions have GIRS scores of 0 or 1.
The GIRS is an important resource for policy discussions on improving the supply of health services. It has limitations, however. In particular, it does not take into account outreach services and the distribution of the workforce supply within SA2s is unknown.
As well, it cannot take into account the adequacy of services, whether the services are financially or culturally accessible, or the extent to which they meet the needs of the populations within each area.
Future work could build on the GIRS by including these other factors.
Publication table of contents
Preliminary material
Contents
Acknowledgments
Abbreviations
Summary
Body content
1 Introduction
Structure of this report
2 Methods
Calculation of the GIRS
Data sources
Putting it all together
3 General practitioners
GP GIRS scores
Population distribution
Discussion
4 Nurses
Nurse GIRS scores
Population distribution
Discussion
5 Midwives
Midwife GIRS scores
Population distribution
Discussion
6 Pharmacists
Pharmacist GIRS scores
Population distribution
Discussion
7 Dentists
Dentist GIRS scores
Population distribution
Discussion
8 Psychologists
Psychologist GIRS scores
Population distribution
Discussion
9 Optometrists
Optometrist GIRS scores
Population distribution
Discussion
10 Conclusion
Discussion
End matter
Appendix A: Selection of geographic scale
Appendix B: Detailed data sources and methods
Workforce data
Other data sources
Geocoding of service locations
Population centroids
Manual adjustment of area centroids
Calculating drive times from population centroid to service locations
Proportion of SA2 population within a 1 hour drive of nearest service location
” The report has also pointed out ongoing areas of health inequality in Australia, driven by socioeconomic factors and social determinants.
Communities suffering socioeconomic disadvantage continued to have systematically poorer health including lower life expectancy, higher rates of chronic disease and higher smoking rates.
Aboriginal and Torres Strait Islander peoples recorded improved health indicators in some areas, including lower rates for smoking and infant mortality.
However, the report found life expectancy was shorter by 10 years than for non-Indigenous Australians, and Aboriginal and Torres Strait Islander peoples continued to suffer higher rates of diseases such as diabetes, coronary heart disease and end-stage kidney disease.
The impact of risk factors such as smoking, physical inactivity, poor nutrition and harmful alcohol use have been emphasised as significant contributors to Australia’s rising rates of chronic disease.
This is an opportunity for health leaders and the Commonwealth Government to heed the report’s message that lifestyle factors and social determinants are significant contributors to ill-health, and to address the issues of health inequality and the importance of reform across all of our care systems “
The life expectancy gap between Indigenous and non-Indigenous Australians remains about one decade, according to new statistics.
The latest report from the Australian Institute of Health and Welfare (AIHW) said that while health outcomes had improved for Aboriginal and Torres Strait Islander people, they still remain below those of non-Indigenous Australians.
The biennial report, published today, shows Indigenous males born between 2010 and 2012 have a life expectancy of 69.1 years, a decade less than their non-Indigenous counterparts.
The gap for women was slightly lower at 9.5 years.
Between 2009 and 2013, 81 per cent of all Indigenous deaths were of people under 75. This is more than twice the rate of non-Indigenous Australians, which stands at 34 per cent.
The latest statistics come 10 years after the establishment of the Closing the Gap campaign, which aims to end the disparity on life expectancies.
Earlier this year, Prime Minister Malcolm Turnbull pledged that the Government would better engage with Indigenous people in “hope and optimism rather than entrenched despair”.
Indigenous sobriety rate higher than non-Indigenous Australians
While smoking rates have been falling nationally, they remain high among Indigenous Australians, with 44 per cent of Aboriginal and Torres Strait Islander people aged 15 and over describing themselves as a current smoker.
The report states that 42 per cent smoke daily, 2.6 times the rate of their non-Indigenous counterparts.
However, Indigenous Australians drink less alcohol than non-Indigenous counterparts — 26 per cent of Aboriginal and Torres Strait Islander people aged 15 and over had not consumed alcohol in past 12 months.
This equates to a sobriety rate 1.6 times that of non-Indigenous Australians.
Potentially avoidable deaths — categorised as deaths that could have been avoided given timely and effective health care — accounted for 61 per cent of deaths of Indigenous Australians aged up to 74 years between 2009 to 2013.
This was 10 per cent more than their non-Indigenous counterparts.
Australians are living longer than ever but with higher rates of chronic disease, the latest national report card shows.
According to the Australian Institute of Health and Welfare’s Australia’s Health 2016 report, released today, Australian boys can now expect to live into their 80s (80.3), while the life expectancy for girls has reached the mid-80s (84.4).
A boy born and girl born in 1890 could only expect to live to 47.2 and 50.8 years respectively.AIHW
The single leading cause of death in Australia is coronary heart disease, followed by:
Grouped together, cancer has overtaken cardiovascular disease (heart disease and stroke) as Australia’s biggest killer. Cancer is also the largest cause of illness, followed by cardiovascular disease:
Burden of disease, by disease group, Australia, 2011AIHW
Chronic diseases are becoming more common, due to population growth and ageing. Half of Australians (more than 11 million) have at least one chronic disease. One quarter have two or more.
The most common combination of chronic diseases is arthritis with cardiovascular disease (heart disease and stroke):
Australians have high rates of the biomedical risk factors that increase the risk of heart disease and stroke. Almost a quarter (23%) of Australian adults have high blood pressure and 63% have abnormal levels of cholesterol.
Lifestyle choices
Fron Jackson-Webb, Health + Medicine Editor, The Conversation
The good news is Australians are less likely to smoke and drink at risky levels than in the past.
Australia now has the fourth-lowest smoking rate among 34 OECD countries, at 13% in 2013. This is almost half that of 1991 (24%).
The volume of alcohol Australians consume fell from 10.8 litres per person in 2007–08 to 9.7 litres in 2013–14. This is the lowest level since 1962–63. But 16% of Australians are still drinking to very risky levels: consuming 11 or more standard drinks on one occasion in the past 12 months.
Around eight million Australians have tried illicit drugs in their lifetime, including 2.9 million in the last 12 months. The most commonly used illicit drugs are cannabis (10%), ecstasy (2.5%), methamphetamine (2.1%) and cocaine (2.1%).
Use of methamphetamine has remained stable in recent years. However, more methamphetamine users are opting for crystal (ice) rather than powder (speed).
The bad news is Australians are still struggling with their weight. Around 63% are overweight or obese, up from 56% in 1995. This equates to an average increase of 4.4kg for men and women. One in four children are overweight or obese.
Junk foods high in salt, fat and sugar account for around 35% of adults’ energy intake and around 39% of the energy intake for children and young people.
Most Australians (93%) don’t consume the recommended five serves of vegetables a day and only half eat the recommended two serves of fruit. Just 3% of children eat enough vegetables, though 70% consume the recommended amount of fruit.
Almost half (45%) of adults aged 18 to 64 and 23% of children aren’t meeting the national physical activity recommendations. These are for adults to accumulative 150 to 300 minutes of moderate intensity physical activity or 75 to 150 minutes of vigorous intensity physical activity each week. Children are advised to accumulate at least 60 minutes of moderate to vigorous physical activity every day.
Lifestyle choices have a huge impact on the risk of chronic disease; an estimated 31% of the burden of disease in Australia could have been prevented by reducing risk factors such as smoking, excess weight, risky drinking, physical inactivity and high blood pressure.
Proportion of the burden attributable to the top five risk factors
Rob Moodie, Professor of Public Health, University of Melbourne
This report outlines a number of positives in Australia’s health – our life expectancy, the health services at our beck and call, major declines in tobacco and road deaths. We’re doing well, it says, but we could do better.
If we took prevention and health promotion far more seriously, we could do a lot better.
The report nominates tobacco use, alcohol, high body mass and physical inactivity as the chief causes of preventable illness and the chief causes of our increasing level of chronic illnesses. Yet national investment in prevention is declining.
Tobacco use is rapidly declining because of really effective measures (plain packaging, advertising bans and increasing price through taxes) that save lives and enormous amounts of money over a lifetime for people who used to smoke.
However, we can’t seem to make any major dent in the commercial, industrial and lifestyle diseases related to junk food and drinks, harmful consumption of alcohol and car dependency.
We’ve known what will work for many years but the power of some of these unhealthy industries is still overwhelming – a situation in which our politicians fear these industries and their associations more than they fear the voters.
Our collective health would have been much better if we’d been able to follow the guidance of our own national task forces and learnt from other countries. The report card should read, “Doing well, but could have done a lot better”.
Inequities
Fran Baum, Matthew Flinders Distinguished Professor and Foundation Director at the Southgate Institute for Health, Society & Equity, Flinders University
Australia’s Health 2016 shows many Australians are not getting a fair go at health. There is a gradient across society whereby the richer the area you live in, the longer you can expect to live. The difference between the highest and lowest is four years.
Deaths by socioeconomic group: 1 = lowest; 5 = highest
The gradient is evident from early life. Children most at risk of exclusion – those from poor areas who experience problems with education, housing and connectedness – are most likely to die before they reach 15 years from potentially preventable or treatable causes.
Our most glaring inequity is the ten-year life gap between Aboriginal and Torres Strait Islander Australians and others. Indigenous life expectancy is 69.1 years for males and 73.7 years for females.
Compared with the non-Indigenous population, Indigenous Australians are:
3.5 times as likely to have diabetes and four times as likely to be hospitalised with it or to die from it
five times as likely to have end-stage kidney disease
twice as likely to die from an injury
twice as likely to have heart disease.
Australians living outside major cities have higher rates of disease and injury. They also live in environments that make healthy lifestyles choices harder (such as more difficulties buying fresh fruit and vegetables) and so their risk of chronic diseases is increased.
The data on who has private health insurance coverage points to the emergence of a two-tiered health system, where those who can afford to pay receive better access and quality of care. Just 26% of those in the lowest socioeconomic group have cover compared to about 80% of the top group.
Coverage with private health insurance and government health-care cards
Professor Stephen Duckett, Director of the Health Program at Grattan Institute
Over the last decade, health expenditure grew about 5% each year, above the 2.8% average growth in Gross Domestic Product (GDP). As a result, health took up an increasing share of GDP.
Spending more on health means Australia spent less on other things. This is not necessarily bad, as long as the benefits from that increased expenditure – such as increasing life expectancy or increased quality of life – are worth the increased costs.
But spending above GDP growth cannot continue indefinitely. And the last few years saw an increase in rhetoric about health spending increases being “unsustainable” from so-called “futurists” and politicians.
Australia’s Health 2016 shows a slowing of the real growth rate in the most recent two years to about half that of the previous decade – 1.1% from 2011-12 to 2012-13 and 3.1% from 2012–13 to 2013–14.
This suggests the “unsustainability” rhetoric is at least overblown and potentially prompting budget decisions which are counter-productive, such as introducing a co-payment for general practice.
Commonwealth government expenditure was more or less stable over these most recent two years, declining 2.5% initially then increasing 2.4% in the last year.
Health expenditure by area (adjusted for inflation)
Savings to the government came from shifting costs to consumers, by slowing the growth in government subsidies to private health insurers, and also by slowing spending on pharmaceuticals.
This latter slowdown was achieved through tighter controls on payments to drug manufacturers and because some big-selling drugs came off patent, resulting in falls in prices.
NACCHO Aboriginal Health Newspaper Next AGM Edition
” A new snapshot of Australia’s health has found we are living longer than ever before, but the rise of chronic disease still presents challenges in achieving equal health outcomes for Indigenous Australians and people living outside metropolitan areas.
Minister for Health Sussan Ley pictured above with Dr Mukesh Haikerwal
As well as looking at factors influencing individuals’ health, today’s report also examines the health of particular population groups, and shows considerable disparities.
‘For example, while there have been some improvements overall in the health of Aboriginal and Torres Strait Islander Australians—including falls in smoking rates and infant mortality—Indigenous Australians continue to have a lower life expectancy than non-Indigenous.
Indigenous Australians, at 69.1 years for males and 73.7 for females, more than 10 years shorter than for non-Indigenous Australians,’
Indigenous Australians also continue to have higher rates of many diseases, such as diabetes, end-stage kidney disease and coronary heart disease.”
The Minister today launched the Australian Institute of Health and Welfare’s (AIHW) publication Australia’s health 2016, which provides an update on the health of Australians and the performance of Australia’s health system.
“Australia’s health 2016 shows us that about 85 per cent of Australians rate their health as good, very good or excellent, which is a testament to the significant investment of the Turnbull Government into the health of our nation, with about one-quarter of total government revenue attributed to health spending,” Minister Ley said.
“Our Government’s priority is to ensure the high performance and sustainability of our health system over the long term. This is why the Turnbull Government is working closely with stakeholders to progress a range of health system reforms.”
Total Commonwealth investment in health will grow to more than $71 billion in 2015-16 and this will increase to $79 billion within four years. The Turnbull Government’s investment in Medicare is at $23 billion per year and this will increase by $4 billion over the next four years.
“The report indicates that health outcomes for Australians have improved over time with life expectancy at an all-time high of 80.3 years for males, while a baby girl could expect to live for 84.4 years. Survival rates for cancer are also improving,” Minister Ley said
Minister Ley said that despite plenty of good news on health in the report, managing chronic conditions and their impact on Australia’s health system remained one of our greatest health challenges.
“The report shows that half of Australians have a chronic disease – such as cardiovascular disease, arthritis, diabetes or a mental health disorder – and one-in four have two or more of these conditions,” Minister Ley said.
“This is why our initial investment of almost $120 million in the Health Care Homes initiative is so important. It will help to keep those with chronic conditions healthier and out of hospital. It will give GPs the flexibility and tools they need to design individual care plans for patients with chronic conditions and coordinate care services to support them.
“We recently announced the 10 geographic regions that will deliver Stage One of this important initiative from 1 July next year, and we hope the results will lead more broadly to a better, consumer-focused approach to health care.”
Australia’s health 2016 is available on the Australian Institute of Health and Welfare’s website.
85 out of 100 Australians say they’re healthy—but are we really? AIHW Press Release
Most Australians consider themselves to be in good health, according to the latest two-yearly report card from the Australian Institute of Health and Welfare (AIHW).
The report, Australia’s health 2016 is a key information resource, and was launched today byfederal Health Minister, the Hon. Sussan Ley.
AIHW Director and CEO Barry Sandison said the report provided new insights and new ways of understanding the health of Australians.
‘The report shows that Australia has much to be proud of in terms of health,’ he said.
‘We are living longer than ever before, death rates continue to fall, and most of us consider ourselves to be in good health.’
If Australia had a population of just 100 people, 56 would rate their health as ‘excellent’, or ‘very good’ and 29 as ‘good’.
‘However, 19 of us would have a disability, 20 a mental health disorder in the last 12 months, and 50 at least one chronic disease.’
Mr Sandison said the influence of lifestyle factors on a person’s health was a recurring theme of the report. ‘13 out of 100 of us smoke daily, 18 drink alcohol at risky levels, and 95 do not eat the recommended servings of fruit and vegetables.
‘And while 55 do enough physical activity, 63 of us are overweight or obese.’
Mr Sandison said that while lifestyle choices were a major contributor to the development of many chronic diseases, other factors such as our income, education and whether we had a job—known as ‘social determinants’—all affected our health, for better or worse.
‘As a general rule, every step up the socioeconomic ladder is accompanied by an increase in health.
‘Compared with people living in the highest socioeconomic areas, people living in the lowest socioeconomic areas generally live about 3 years less, are 1.6 times as likely to have more than one chronic health condition, and are 3 times as likely to smoke daily.’
As well as looking at factors influencing individuals’ health, today’s report also examines the health of particular population groups, and shows considerable disparities.
‘For example, while there have been some improvements overall in the health of Aboriginal and Torres Strait Islander Australians—including falls in smoking rates and infant mortality—Indigenous Australians continue to have a lower life expectancy than non-
Indigenous Australians, at 69.1 years for males and 73.7 for females, more than 10 years shorter than for non-Indigenous Australians,’ Mr Sandison said.
Indigenous Australians also continue to have higher rates of many diseases, such as diabetes, end-stage kidney disease and coronary heart disease.
For people living in rural and remote areas, where accessing services can be more difficult, lower life expectancy and higher rates of disease and injury—particularly road accidents— are of concern.
In Australia, health services are delivered by a mix of public and private providers that includes more than 1,300 hospitals and about 385,000 nurses, midwives and medical practitioners.
Of the $155 billion spent on health in 2013–14, $145 billion was recurrent expenditure. Hospitals accounted for 40% of recurrent expenditure ($59 billion), primary health care 38% ($55 billion), with the remaining 22% spent on other health goods and services.
For the first time, the report examines how spending by age for people admitted to hospital has changed over time.
Mr Sandison said the analysis showed that the largest increase in spending between 2004–05 and 2012–13 was for Australians aged 50 and over.
‘This was due to more being spent per person in the population as well as the increased number of people in these age groups.’
Mr Sandison also said that while Australia’s health 2016 provides an excellent overview of Australia’s health at a point in time, there is still scope to expand on the analysis.
‘New to this edition is information on the changing nature of services provided by publicand private hospitals over the last 10 years; information about how geography affects
Indigenous women’s access to maternal health services; and about the increasing role ofinstitutions such as hospitals and residential aged care in end-of-life care.
‘Good data is essential to inform debate and policy and service delivery decision-making— and improving its quality and availability is at the core of the AIHW’s work.
‘We’re committed to providing meaningful, comprehensive information about Australia’s health and wellbeing—to help create a healthier Australia.’
Preliminary material
Title and verso pages
Contents
Preface
Acknowledgments
Terminology
Body section
Chapter 1 An overview of Australia’s health
Introduction
What is health?
Australians: who we are
How healthy are Australians?
Chapter 2 Australia’s health system
Introduction
How does Australia’s health system work?
How much does Australia spend on health care?
Who is in the health workforce?
Chapter 3 Leading causes of ill health
Introduction
Burden of disease and injury in Australia
Premature mortality
Chronic disease and comorbidities
Cancer
Coronary heart disease
Stroke
Diabetes
Kidney disease
Arthritis and other musculoskeletal conditions
Chronic respiratory conditions
Mental health
Dementia
Injury
Oral health
Vision and hearing disorders
Incontinence
Vaccine preventable disease
Chapter 4 Determinants of health
Introduction
Social determinants of health
Social determinants of Indigenous health
Biomedical risk factors
Overweight and obesity
Illicit drug use
Alcohol risk and harm
Tobacco smoking
Health behaviours and biomedical risks of Indigenous Australians
Chapter 5 Health of population groups
Introduction
Health across socioeconomic groups
Trends and patterns in maternal and perinatal
health
How healthy are Australia’s children?
Health of young Australians
Mental health of Australia’s young people and adolescents
Health of the very old
How healthy are Indigenous Australians?
Main contributors to the Indigenous life expectancy gap
Health of Australians with disability
Health of prisoners in Australia
Rural and remote health
Chapter 6 Preventing and treating ill health
Introduction
Prevention and health promotion
Cancer screening
Primary health care
Medicines in the health system
Using data to improve the quality of Indigenous health care
Indigenous Australians’ access to health services
Spatial variation in Indigenous women’s access to maternal health services
Overview of hospitals
Changes in the provision of hospital care
Elective surgery
Emergency department care
Radiotherapy
Organ and tissue donation
Safety and quality in Australian hospitals
Specialised alcohol and other drug treatment services
The Public Health Information Development Unit (PHIDU) has published an Aboriginal and Torres Strait Islander Social Health Atlas.
This presents a range of demographic, socioeconomic, health outcomes and service use data for Aboriginal and Torres Strait Islander peoples at the Indigenous Area level.
The 2016 release of the atlas includes updated data for the following:
Estimate Resident Population (ERP) data for 2015
Projected ERP data for 2016
Immunisation data for 2015
Deaths data now includes data for 2013
And new hospitalisations data for:
Hospitalisations by principal diagnosis and age
Ambulatory-sensitive hospitalisations
Maps for the Aboriginal and Torres Strait Islander Atlas can be found at the link below:
” The Federal Government will drive better patient outcomes for Australians living complex chronic illness as part of its Healthier Medicare reform package, by improving digital heath records and data around health outcomes that will make it easier to co-ordinate their care and measure their progress. “
The Hon. Sussan Ley Minister for Health Press release
“Doctors and other health workers need to have access to core clinical information in electronic medical records if the Federal Government’s My Health Record system is to deliver an improvement in patient care
Doctors treating a patient need to be confident that they have access to all relevant information, Shared electronic medical records have the potential to deliver huge benefits by giving health workers ready access to critical patient information when it is needed, reducing the chances of adverse or unwarranted treatments and improving the coordination of care.
AMA President Dr Michael Gannon
Pictured above meeting with the Health Minister and Prime Minister in Perth last week
“There is no question that individuals should have access to their own healthcare data but he believes that basic things need fixing first, such as making it easier for GPs to refer patients.
He says the technology was built by software vendors and NEHTA but has been gathering dust over the last few years and there is still no one secure, integrated system of referring people electronically.
“You start electronically, you finish electronically and everything in between is a mish-mash. You change the business model and then it’s really easy to send data to a national repository.”
Dr Pinskier, who chairs the RACGPs expert committee on e-health and practice systems. See full interview below
Releasing the AMA’s updated Position Statement, Shared Electronic Medical Records 2016, , AMA President Dr Michael Gannon said that giving patients the ability to block or modify access to critical information such as medications, allergies, discharge summaries, diagnostic test results, blood pressure and advance care plans compromised the clinical usefulness of shared electronic medical records loaded on the My Health Record system.
“But, if patients are able to control access to core clinical information in their electronic medical record, doctors cannot rely on it.
“Giving patients such control, as the My Health Record system does, is a big handicap to the clinical usefulness of shared electronic medical records.”
The Federal Government launched My Health Record earlier this year to replace Labor’s troubled Personally Controlled Electronic Health Record (PCEHR) system, and trials of its opt-out arrangements are due to commence in mid-July.
But the system, like the PCEHR, gives patients the power to control what goes on the health record, and who can view it.
The AMA said giving patients such control meant the My Health Record would never realise the full benefits of a national electronic health record system.
“All shared electronic health records must include core clinical information that is not subject to patient controls,” the AMA Position Statement said. “Certainty that shared electronic health records contain predictable core clinical information which is not affected, conditioned or qualified by the application of access controls, is critical to the achievement of the legislated objectives of the My Health Record.”
Like its predecessor, the My Health Record system has generated little interest among patients or doctors – in April just 798 health providers had uploaded a shared health summary to the system.
An AMA survey of 658 medical practices, undertaken last month, found GPs were reluctant to take part because of lack of confidence in the reliability of information it contained, combined with little patient demand and an absence of support for practices undertaking the task of creating shared health summaries.
Dr Gannon said the AMA encouraged individuals to take responsibility for their health and strongly supported the idea of a national shared health summary system, but it had to be the right one – one that supports clinical care.
“All health care workers involved in providing clinical care to a patient should have access to core clinical information,” he said. “Where specific information, other than core clinical information, is not made generally available, this should be made clear to treating doctors with a flag on the medical record.”
The AMA added that in ‘break glass’ emergency situations, implied consent must sometimes be assumed to allow access to the full medical record.
The Association said the system should also provide protections for doctors who acted in good faith but missed or were unable to locate critical data “because it is buried in a sea of electronic documents”.
Dr Gannon said shared electronic medical records should not be treated as a replacement for a patient’s medical record, and should not be treated as the single and definitive source of ‘truth’ regarding clinical information about a patient.
But he said it was an extra source of information, accessible at the point of care, that may otherwise have not been available.
As the new trials of the My Health Record roll out in Queensland, NSW, WA and Victoria, Government News asks clinicians what might help – or hinder – the progress of the revamped national individual electronic health record.
A bit of history
The idea of a national individual electronic health record has been around for decades, routinely popping up in report recommendations from government health agencies.
It was an idea former Prime Minister John Howard helped spread and one the National Electronic Health Transition Authority (NEHTA) was set up to drive in 2005.
Labour introduced the Personally Controlled Electronic Health Record (PCEHR) in 2012 after two years of GP trials.
But from its inception, the electronic health record has been dogged with problems and fraught with complexities and it still has not had the uptake needed to fulfil the vision of a concise patient record available in an emergency.
Academic Dr Helen Cripps compared the Australian e-health experience to that of Slovenia in her 2011 research paperTheImplementation of electronic health records: a two country comparison, and found Australia was making much slower progress.
In it, she lists a whole host of reasons for Australia’s sluggish progress in e-health: the country’s complex health care system, with state and federal involvement and a large private health sector; uneven adoption by clinicians; problems securely sharing data electronically between GPs and other clinicians; the proliferation of different electronic health record formats and systems; fears about data protection and patient privacy; a lack of national direction; the cost of infrastructure, maintenance and training and a disconnect between government-led implementation and software vendors.
The new Australian Digital Health Agency opened its doors on July 1, and appointed ts first CEO UK digital whizz Tim Kelsey. It is a clear sign that e-health is seriously back on the government’s agenda but what about the clinicians the government is relying on to make the record valuable?
Both Dr Nathan Pinskier, Chair of the Royal Australian College of General Practitioners (RACGP) and Dr Tony Bartone, Vice President of the Australian Medical Association (AMA), have weathered the vicissitudes of the electronic health record over the years.
They spoke to Government News about what pitfalls should be avoided this time around and where the road to success lies.
Dr Pinskier, who chairs the RACGPs expert committee on e-health and practice systems, says there is no question that individuals should have access to their own healthcare data but he believes that basic things need fixing first, such as making it easier for GPs to refer patients.
At the moment, when doctors want to refer patients, for example to specialists, physios and hospitals, they must wrestle with a number of different electronic systems (including Argus, HealthLink and MEDrefer), as well as using fax machines, scanners, emails and letters.
He says the technology was built by software vendors and NEHTA but has been gathering dust over the last few years and there is still no one secure, integrated system of referring people electronically.
“You start electronically, you finish electronically and everything in between is a mish-mash. You change the business model and then it’s really easy to send data to a national repository.”
Prescription for change
Data quality
Both clinicians say that the value of My Health Record will not be fully realised until there is decent data quality and coverage so that health providers can feel confident using the information.
Dr Pinskier says there are currently eight sources of data within the My Health Record and patients can also add their own data. Instead, he suggests homing in on the most vital pieces of information: bad reactions to medicines, current medications and allergies.
He recalls a hospital doctor searching through a jumble of sometimes conflicting records to find out what medication an out-of-town patient was on. The doctor eventually gave up and phoned the patient’s pharmacist.
“What’s the value if you have all these lists for providers to spend hours trawling through the records?” he asks.
Dr Pinskier says it is worth looking at alternatives, citing international examples such as Boston Open Notes, where local records of healthcare providers are made available to consumers. The patient sees exactly what the healthcare provider sees, which can also help reinforce medical advice, for example about how to take medication.
He says Scotland’s Emergency Care Summary is a good example of how local records work, calling it “simple, effective and functional.” The summary lists essential details such as a person’s name, age and GP and their medications, allergies and bad reactions to medicines, extracting the information from GP records.
“There is one source of truth, which is highly accurate and repeatedly uploaded to a national system. That is certainly regarded as a preferred model,” Dr Pinskier says.
Dr Bartone, Vice President of the nation’s peak body for GPs, agrees that the success of the individual electronic health record relies on good data and not just from GPs, who he says have always been “ahead of the curve” and early adopters of e-health.
The record also relies on getting good information from allied health providers, pharmacies and hospitals, amongst others, in order to get a useful medical summary. This could include pathology results, diagnostic imaging, immunisation, Medicare and Pharmaceutical benefit claims, organ donation, medication and advanced care directives.
He says records are not expected to be as detailed as those held by GPs, but a reliable, secure and useful summary.
“All of these things go into making up the record but at the moment we have got a situation where some hospitals’ IT platforms won’t allow them to upload information. For example, in Victoria whereas some hospitals were able to upload data right now,” Dr Bartone says.
“It’s about an emergency situation where the patient is unknown to the doctor who needs to get some information on them in a hurry. It’s never going to replace the GPs file … it’s not designed to be that.
“You don’t need all these details. Other providers need a snapshot of medications, tests and conditions; then they will move on.”
A Department of Health spokesperson said that the quality of information uploaded to the My Health Record system reflected the quality of the records kept in local clinical information systems.
“It is the responsibility of healthcare providers and is part of their professional standards that they keep accurate and up-to-date records about their patients,” said the spokesperson. “It is anticipated that records which are accessible by both patients and other healthcare providers treating that patient will see an improved quality over time.”
Getting clinicians on board
Dr Bartone believes the work needs to be clinically-led and the scheme’s practical implications for clinicians, such as cost and increased workload, properly thought through and addressed.
He says there has been a lack of engagement with clinicians, caused by “too many people with various agendas pushing different methodologies and ideas” holding the process back so that it failed to deliver enough value to consumers.
Although medics were consulted initially under the PCEHR, Dr Bartone believes this fell by the wayside when the project was delivered, with little thought to how it would actually work on the ground.
“They expected patients to be registered by doctors in their waiting rooms. That’s a cumbersome and difficult process and these are busy places,” he says.
“There was no awareness that this would impose a workload, red tape and duplication. There was lots of money but it wasn’t going to the right people.”
The results so far have been questionable in terms of outcomes and performance.
“The need to have a robust and reliable individual electronic health record is without question,” Dr Bartone says. “The issues thus far have been in terms of scope and implementation: how and who is controlling it and how it would be rolled out.”
But he says offering GPs payments to register a certain number of patients (which has been announced as policy) and making the scheme opt-out for patients, rather than opt-in (which has not, as yet), were both be good ideas.
The My Health Record trials have been a mixture of opt-in and opt-out, to test the public’s response. While the Nepean and Queensland trials were opt-out, two earlier trials in Western Australia and Ballarat, Victoria were opt-in.
Dr Bartone says it is imperative that the back-end of the system is easy for doctors to navigate and does not involve duplication of effort – which he says had only recent been possible through new software – so it does not impose an additional burden on doctors.
“There’s been lots of good will invested over the last four or five years. That will run thin if there are any further problems,” he says.
Another discouragement for doctors to use My Health Record has been anxiety that they may be prosecuted under privacy legislation for accessing or sharing information, a fear which Dr Bartone says resulted in disillusionment, even for rusted-on fans of electronic health records.
Government News put these concerns to the federal Department of Health.
A departmental spokesperson said the My Health Records Act 2012 specifically authorised the collection, use and disclosure of health information in the My Health Record so that there would be no breach of the Privacy Act 1988.
“This means that treating healthcare providers can access and use an individual’s My Health Record for healthcare purposes,” the spokesperson said.
The spokesperson said the penalties for unauthorised collection, use or disclosure of data – which can be up to $540,000 or two years’ imprisonment – did not apply to accidental misuse. Patients are also able to restrict or remove documents in their My Health Record.
“For example, if a healthcare provider inadvertently or accidentally accesses an individual’s My Health Record – they are not liable for a civil or criminal penalty,” said the spokesperson.
Healthcare providers can use their judgement about what they upload onto an individual’s My Health Record. There is nothing in the My Health Records Act 2012 that requires them to upload if they choose not to.
Dr Pinskier says that some of the difficulty getting a national e-health record off the ground stems from earlier efforts to appease everybody, patients and multiple healthcare providers, ending in an extremely complex system.
The national individual electronic health record became a hybrid of a clinical and consumer record, without quite meeting the requirements of either, he says.
“I think we need to go back to basics and ask what we want to achieve – what’s its core purpose?
“We are not addressing the questions of utility and functionality. There is still a really good opportunity to see what is it we’re trying to achieve, how best to achieve it and the steps needed to do it.”
He is emphatic about how this should be done.
“This is not a technological questions, it needs to be clinically led,” Dr Pinskier says. “We need to start again but we need the key clinical stakeholders involved and the clinical community needs to be listened to.”
My Health Record trials
Opt-in trials began in July in Ballarat, Vic and Western Australia. The Ballarat Health Service help patients register when they are admitted to hospital and their discharge summaries are uploaded to My Health Record.
In Western Australia, the trial involves helping chronically-ill patients register at selected practices and modifying chronic disease management software. This will give treating healthcare providers, including specialists and allied health professionals, access to patients’ My Health Records using connected software.
Opt-out trials are underway in the Nepean Blue Mountains area and Northern Queensland.
The Department of Health says the trials are being conducted to gauge consumer reaction to an opt-out system of participation, as well as looking at healthcare provider use and how much clinical information is uploaded to the My Health Record when most patients have a My Health Record.
Federal Health Minister Sussan Ley announced last month that the number of My Health Records in Australia had surpassed four million, with an average of 2,200 new registrations every day in the preceding four weeks.
“With changes to the General Practice Incentive, healthcare providers are increasingly contributing and viewing on-line health information about their patients,” Ley said. “We are now seeing one upload of clinical health information from a healthcare provider every 21 seconds.”
Ley says that every day, one in five GPs saw a patient for whom they have little or no information but My Health Record would change that.
“This may be a Medicare claim or pharmacy prescription, or clinical information uploaded by other healthcare providers such as a specialist, hospital and pharmacy,” Ms Ley says.
“With a My Health Record, both a patient and their healthcare professional can gain immediate access to important health information on-line.
“This can improve co-ordinated care outcomes, reduce duplication and provide vital information in emergency situations.
Ley says My Health Record puts the power in the hands of health consumers to decide who they shared their health information with.
