In August 2007, in one of his last speeches as federal health minister, Tony Abbott admitted that the statement made in his first speech in the portfolio in November 2003 that failure to establish an electronic patient record within five years would be an indictment against everyone in the system, including the government was a rashly declared standard.
As shadow minister for health, Nicola Roxon was critical of the Howard government's failures in this area, stating that e-health in Australia lacked a coordinated national approach and national leadership.
However, the Rudd Government's election policy was very light on e-health details, despite the crucial need for health IT infrastructure and services to help deliver health-care reforms, and the Government is yet to indicate any commitment or funding for e-health measures.
It is salutary to note that a report produced by the King's Fund in Britain last year found that a decade of expensive National Health Service hospital reforms had failed to deliver expected economic benefits because the proposed e-health program, recognised as key to productivity improvements and health gains, was well behind schedule.
And such has also proved to be the case in Australia. Contracts for the development of a unique patient identifier have only just been signed, despite budget commitments made in 2006, and progress has lagged in many areas.
There is no need to commit to new spending, when more than 50 per cent ($41.5million) of the funds allocated to e-health in 2006-07 remains unspent. Money has never been a problem for e-health, but national agreement on a vision and focused and strategic long-term planning have been in short supply.
Many consultants have prospered, many projects have been set up and fallen over with no lessons extracted, and our e-health system is currently as national and as unified as the railway system was last century.
Who now remembers the Australian Health Information Council or the $128 million HealthConnect program it was to deliver? The Health Information Council disappeared and was replaced by the mysteriously named National E-Health Transition Authority, which is now also going through a shake-up in the wake of the recent resignation of its chief executive and a tough report from an outside review.
The Boston Consulting Group's review, finalised last October, made a number of critical points about the transition authority and its work to date, in particular that the transition authority must start to communicate sensibly and openly with stakeholders, and work with them to meet needs. Most tellingly, the review called for a national health IT strategy to be developed.
It is shocking to realise that one does not currently exist.
Despite this, the transition authority is preparing a business case for a personal e-health record to be made to the Council of Australian Governments without any involvement by the public or clinical professionals, and without any explanation as to whether a personal e-health record is the same as a shared e-health record, which used to be the focus of the transition authority's work.
The transition authority has responded to the report's recommendations by agreeing to open up the board to be more representative of stakeholders, and to look offshore to find the IT skills that are needed to move the agenda forward. The task of developing a national strategy has been allocated to the Australian Health Ministers' Conference, back where it all began more than five years ago.
The transition authority's website trumpets its role in supporting the health-care system in improving the quality of health-care services, streamlining multi-disciplinary care management, and improving clinical and administrative efficiency.
We need all those support systems to help reform our health-care system, and we need them in place as soon as possible.
In driving forward health reform, the Health Minister must also drive forward national e-health reforms, or put all the likely gains at risk.
Dr Russell is the Menzies Foundation Fellow at the Menzies Centre for Health Policy, University of Sydney/Australian National University.