interRAI aged care assessment elements mapped to mandatory quality indicators

Queensland researchers have mapped clinical, functional and psychosocial items in the interRAI assessment system for residential aged care to the now mandatory quality indicators (QI) collected and reported each quarter by RACFs, which the researchers say could in future significantly streamline data collection if implemented.

Researchers from the University of Queensland’s Centre for Health Services Research (UQCHSR) have been evaluating the use of interRAI’s long term care facility (LTCF) assessment system for use in Australia.

It is widely used for assessing the function and health of frail older adults in New Zealand, Canada and the US, and is being used as a data standard to build a minimum data set in the Aged Care Data Compare project being run by UQ and the Digital Health CRC. (This research consortium has also worked on developing Australia’s star rating system.)

Now, it has been mapped to the Department of Health and Aged Care’s mandatory set of quality indicators, which include pressure injuries, unplanned weight loss, falls and major injury, polypharmacy and antipsychotics, activities of daily living and incontinence care.

The new study, led by senior research manager Nancye Peel, found that 71 discrete data items required by the QIs can be effectively collected through the interRAI LTCF.

Of these, the researchers say, 26 items, including 22 clinical care and four administrative elements, are required to closely approximate the nine clinical care QIs. The study also showed there would be minimal need for data modification.

“The interRAI LTCF system not only meets but in some cases exceeds the requirements set by Australian aged care quality standards, reducing the burden of data collection while enhancing care quality,” Dr Peel said.

The researchers say the findings from the study present a promising pathway towards more efficient care management and reporting in the aged care sector, and promise to relieve facilities from the cumbersome process of managing and reconciling data across multiple, non-integrated systems.

Senior researcher and geriatrician Len Gray, who is a fellow of and strong advocate for interRAI, said the adaptation of the interRAI system aligned with the international trend in interRAI nations to use a unified data source for multiple quality indicators.

“This is a prime example of our philosophy of ‘collect once, use many times,’ which not only ensures compliance with Australian standards but also enhances the ability to monitor and improve patient care,” Professor Gray said.

“Adopting interRAI not only fulfills mandatory reporting requirements but also enriches the quality of care through comprehensive diagnostic, risk, and severity assessments.”

The report, Deriving Australian Mandatory Quality Indicators from the interRAI Long Term Care Facility Assessment System, is available from the UQCHSR website.

MediSecure breach “isolated” to pre-2024 prescription data

The suspected ransomware attack on former electronic prescription exchange vendor MediSecure has been “isolated” and the incident has not affected the prescribing and dispensing of medication using the national prescription delivery service, the National Cyber Security Coordinator Michelle McGuinness said.

In an update to last week’s data breach report, Lieutenant General McGuinness said her team at the National Office of Cyber Security within the Department of Home Affairs was still working to build a picture of the size and nature of the data that has been affected.

It is understood that MediSecure still held “limited” prescription information along with patient and healthcare provider personal information from prescriptions distributed before MediSecure ceased acting as one of two electronic prescription exchanges in November 2023.

MediSecure issued an update emphasising it was not a current participant in Australia’s digital health network. “As such, this cyber security incident does not impact the prescribing and dispensing of medication,” it said.

“The cyber security incident relates to data held by MediSecure’s systems up until November 2023.”

Lt Gen McGuinness said her information was that no current ePrescriptions have been impacted or accessed.

“The Department of Health has confirmed there has been no impact to the ePrescription services currently in use,” she said.

“On the basis of technical advice from MediSecure to date, the original compromise has been isolated and there is no evidence to suggest an increased cyber threat to the medical sector.

“We are looking closely at any evidence about whether identity documents have been compromised in the breach, and are working with MediSecure, Services Australia, and state and territory credential issuing bodies to build a full picture of the impacted dataset.”

Services Australia issued advice saying that individuals do not need to take any action related to their Medicare, pensioner concession, healthcare concession, and Commonwealth seniors cards, numbers for which appear on prescriptions.

Services Australia said it was examining other potential affects on individuals’ identity security associated with breached card numbers.

International health IT week in review: May 19

Research on telehealth-enabled acute care, digital health wave in India after Ayushman Bharat Digital Mission, “significant overhaul” of South African medical records needed, future for virtual health in the US, LEAP in Health IT funding, digital health and the European Health Technology Assessment Regulation

Telehealth-enabled acute care does not drive in-person follow-ups

mHealth Intelligence ~ Anuja Vaidya ~ 16/05/2024

The researchers contended that evidence on the effectiveness of telehealth visits for managing acute care conditions is limited compared to research on telehealth benefits in managing chronic conditions.

Digital wave in healthcare with online records, scanning QR codes

News18 ~ Himani Chandna ~ 16/05/2024

Patients are not only scanning but, in turn, are creating or using their digital health records. It means they will have access to digital prescriptions, pharmacy records, diagnostic reports and multiple health records in one place – on the mobile phone, eliminating the need to carry paper-based prescriptions or reports.

NHI needs massive overhaul of digital medical records in South Africa

MyBroadband ~ Myles Illidge ~ 15/05/2024

The National Health Insurance (NHI) plan requires a significant overhaul of South African medical records to fit within a common, shared Digital Health Platform in the country.

Telehealth is far from dead, says Providence’s virtual care chief

Medcity News ~ Katie Adams ~ 15/05/2024

This year has been a messy one for virtual care companies, but that doesn’t mean that telehealth is dead, according to Eve Cunningham, Providence’s chief of virtual care and digital health. In her view, virtual care can definitely still be an important part of the care delivery model — but only if it is embedded into the greater healthcare delivery ecosystem.

HHS announces new funding opportunities for AI, behavioral health projects

Healthcare IT News ~ Mike Miliard ~ 13/05/2024

New LEAP in Health IT money from ONC is meant to find and fund innovative new approaches to evaluating EHR data quality for machine learning models and driving IT adoption by behavioral health providers.

New EU assessment framework for digital health on the horizon?

Healthcare IT News ~ Tjasa Zajc ~ 10/05/2024

A harmonised European Health Technology Assessment Regulation (HTAR) is set to come into force in 2025, but the mandatory application of the regulation does not cover digital health technologies. The EDiHTA Project aims to address that.

Blog: Budget bingo for aged care IT as sharing by default back in the news

The big budget largesse laid out on Tuesday night for aged care technology and the Strengthening Medicare program was somewhat overshadowed, as was the rest of the news this week, by the cyber attack on MediSecure that was reported yesterday.

It’s still unclear exactly what the nature of the incident was and whether it was a ransomware attack as has been suggested, but if it was, the hackers chose a pretty poor target. A good little company in the past, MediSecure is barely a going concern these days following its loss to rival eRx in the bid to become the sole delivery service for PBS electronic prescriptions in Australia.

MediSecure did vow to stay in business but it what remains of it is, as far as we can see, not too much. It still obviously held some personally identifiable data as it reported the attack as required to regulators such as the OAIC and ADHA, and the Australian Cyber Security Centre and the Australian Federal Police are on the case.

The good news is that the vast majority of any data held by MedSecure in its prescription exchange was transferred over to eRx last year, and MediSecure is no longer switched on for PBS prescriptions in prescribing software. We are unaware of any other businesses that it’s actually involved in.

(Meanwhile, every two-bit IT security firm in the country and around the world has got their PR people to fire off to the media some boilerplate “commentary” from their “experts” on how healthcare organisations can improve their security “posture”. Ambulance chasers the lot of them.)

Elsewhere in the news this week, Tuesday night’s budget had a few surprises, not the least of which was the unexpectedly large sum of money allocated to aged care. Most of the $1.4 billion is going to what is described as “significant technology and platform maintenance and enhancements” as well as a bit to get the new Support at Home (SaH) program off the ground by July next year.

$1.4 billion is certainly a headline number but there was precious little detail in the budget papers on exactly what it would be used for– which is unusual, as everyone likes to boast to about these things – and there was little discussion of it at a Department of Health and Aged Care special budget webinar featuring all five health and aged care ministers on Wednesday. In fact the ministers and the webinar host, DoHAC secretary Blair Comley, seemed to studiously avoid answering questions on it.

It seems likely that the money is to be spent on internal DoHAC and Services Australia payment and operational systems and not, as many aged care providers have been demanding, to invest in technology at the coalface.

Hidden away in the budget was a nice chunk for Healthdirect Australia for its virtual services, an extra $57.4 million for the Australian Digital Health Agency to continue its initiatives under the health delivery modernisation program and to update My Health Record – my word, they are churning through cash on that – and a little bit of money for system changes to MyMedicare which the RACGP was none too pleased about, but then again, they never are.

There was also $1.9 million marked for the CSIRO in one of the budget tables but no explanation for what it was for. Turns out it was to extend the terrific Sparked FHIR accelerator program for another year. This was confirmed at the Royal College of Pathologists of Australasia pathology informatics conference in Sydney this week, and by DoHAC assistant secretary Simon Cleverley on LinkedIn.

Speaking of pathology, also in the news this week was the sharing by default mandate and the removal of the seven-day delay, discussed during a very interesting Australian Association of Practice Management webinar this week. It seems that the legislation mandating sharing by default will not quite make it through Parliament this year and early next year is the most likely.

The seven-day delay may be dropped sooner, again angering the RACGP and the other medical colleges. But again, this is nothing new. We were reading up on our reporting from 10 years ago when the seven-day delay was first decided upon and the same arguments were made back then as they are today, despite plenty of evidence that anxiety over the release of test results is way over-egged.

Sharing pathology reports by default and the seven-day delay were both topics at the aforementioned RCPA seminar, but a much bigger topic was that there is still a huge amount of work to be done under the bonnet before they are a reality, not the least because of the ongoing difficulty with standardisation. Despite the fact that the college’s Standardised Pathology Informatics in Australia (SPIA) guidelines were approved by its board back in 2017 – after many years of work through the PUTS and PITUS projects on terminologies and units of measure – it is still a struggle for any lab to use them in a uniform way.

The RCPA has been running two pilot pathology informatics projects with public provider SA Pathology and private provider Sullivan Nicolaides Pathology, and it’s clear there is a long ways to go. Meanwhile, the private providers will still come under the pump to upload more path reports to the My Health Record, despite the majority of requests still coming in on paper. Until eRequesting is widespread – and there was $5m in the budget to boost this work under the Sparked accelerator – then whatever desire the federal government has for more path results on My Health Record, it is not going to happen quickly. More on that next week.

There were also some pretty great stories from vendors, including Best Practice’s new FHIR-powered mobile app, which received a huge amount of attention, as did Medtech Global’s new radiology results system. GP software vendors continue to innovate.

Those two stories were some of our most popular of the week, even more so than the budget, but all were overtaken by the MediSecure breach. We’ll have more on that next week too.

That brings us to the poll question for this week:

Were you satisfied with the federal budget’s health and aged care IT priorities?

Vote here, and leave your comments below.

Last week, we asked: Do you agree with the Productivity Commission’s estimate of savings through digital technology? We got a dismally low response to this poll so make of the results what you will: two-thirds (67% v 33%) disagreed with the estimate.

MediSecure confirms it’s at the centre of cyber security incident

Electronic prescription exchange MediSecure – which no longer acts as one of the national prescription delivery services for electronic prescriptions – has confirmed it is the organisation identified in a cyber security incident affecting the personal and health information of individuals.

In a statement today, MediSecure said it was “actively assisting the Australian Digital Health Agency and the National Cyber Security Coordinator to manage the impacts of the incident”.

MediSecure has notified the Office of the Australian Information Commissioner and other key regulators, it said.

National cyber security coordinator Michelle McGuinness said her office was advised yesterday by “a commercial health information organisation” that it was the victim of a “large-scale” ransomware data breach incident.

“I am working with agencies across the Australian Government, states and territories to coordinate a whole-of-government response to this incident,” Lieutenant General McGuinness said.

“The Australian Cyber Security Centre is aware of the incident and the Australian Federal Police is investigating.

“We are in the very preliminary stages of our response and there is limited detail to share at this stage, but I will continue to provide updates as we progress while working closely with the affected commercial organisation to address the impacts caused by the incident.”

Minister for Cyber Security Clare O’Neil said she had been briefed on the incident and the government convened a national coordination mechanism regarding this matter today.

“The national cyber coordinator, Michelle McGuinness, is leading work across the Australian government to support the company in managing this large-scale ransomware incident,” Ms o’Neil said.

“Updates will be provided in due course. Speculation at this stage risks undermining significant work underway to support the company’s response.”

MediSecure was in the past one of two prescription exchange services that provided electronic prescription capability for GPs and pharmacies.

However, under a somewhat controversial decision by the Department of Health and Aged Care to move to a sole provider model for prescription delivery services (PDS), MediSecure lost out to rival eRx and had its capability switched off in prescribing software in November 2023.

MediSecure had worked in partnership with eRx to become interoperable and to build a national data exchange (NDE) that is also used by the real-time prescription monitoring systems.

Patient data that it held in its servers has since been transferred to eRx as the sole provider of the NDE. Data from MediSecure sites is now fully transferred to the national PDS.

While it is no longer used by GPs or pharmacies for prescription exchange, it still provides some services for handling private prescriptions and to service eCommerce platforms for scripts that provides users with the option of their own script wallet and repeat reminders.

“MediSecure understands the importance of transparency and will provide further updates via our website as soon as more information becomes available,” according to a statement on its website. “We appreciate your patience and understanding during this time.”

Budget 2024: Extra funding for Healthdirect virtual services, Sparked and MyMedicare

Extra funding has been secured for Healthdirect Australia to expand its national and state-based virtual health services in this week’s federal budget, along with an extra year of funding for the Sparked FHIR accelerator and for system changes to the MyMedicare program.

Healthdirect has received $47.5 million over four years – and $14.1 million per year ongoing – to expand its offering to provide national and state-based virtual health services to assist consumers access the most appropriate care.

There is also $18m in funding to continue the government’s response to the Philip review into Medicare integrity and compliance, sparked by reports in the Nine newspapers and ABC’s 7.30 last year about the potential for widespread Medicare rorting and inaccuracies.

Headed by Pradeep Philip, the review recommended greater data checks in practice management software and the replacement of the ageing Medicare Common Assessment rules engine.

The Australian Digital Health Agency has received an extra $57.4 million to continue initiatives under the Health Delivery Modernisation Program and to update My Health Record.

And there is an extra $16m over four years to implement system changes to MyMedicare, enabling the payment of incentives to general practitioners and general practices to support wrap around primary care for frequent hospital users.

While it didn’t make the list in the budget papers, there is $1.9m for the CSIRO to add another year to the Sparked FHIR accelerator program. The year-long extension was confirmed at today’s Royal College of Pathologists of Australasia’s pathology informatics workshop, and by assistant secretary at the Department of Health and Aged Care’s digital health branch, Simon Cleverley, in a social media post.

Mr Cleverley said the funds would go towards the completion of work to develop a long-term roadmap to standards development across Australia’s healthcare system.

Funds have also been provided for planning work on developing an International Patient Summary (IPS) for Australia.

Mr Cleverley said there was also an additional $5.9 million over the 2024-25 financial year to continue the work underway to complete a business case for a national eRequesting capability.

“This funding will also enable the Department to complete policy work underway to establish a future national Electronic Clinical Decision Support governance framework,” he wrote.

Sharing by default mandate and seven-day delay lift likely in 2025

The legislative changes to mandate sharing patient test results with the My Health Record system by default and the move to drop the seven-day delay for most pathology reports are likely to come into effect early in 2025, but radiology reports, histopathology and genetic test results may be exempt from the change to the seven-day delay rule.

The seven-day delay was instituted in 2014 but is due to be lifted following a recommendation by the Strengthening Medicare Taskforce to make sharing by default a reality.

The federal government plans to legislate that results be uploaded to My Health Record as soon as they are verified by December 2024, with the change likely to come into effect early next year.

Australian Digital Health Agency digital health educator Hina Bhimani, a former sonographer and radiographer, told an Australian Association of Practice Management webinar this week that Health Minister Mark Butler favours both better and faster access to pathology and diagnostic imaging reports for patients through the use of their My Health Record.

“On the back of the Strengthening Medicare Taskforce report at the end of 2022, Minister Butler has said that only one in five diagnostic reports were being uploaded to the My Health Record system,” Ms Bhimani said.

“And because of that, patients were being inconvenienced, leading to things like days off work, maybe having another procedure, another gap fee, which ultimately leads to frustration, and the wastage of time and money.

“As a result, he decided that uploading both pathology and diagnostic imaging reports to the My Health Record system should not be the exception. Rather, it should be the rule.

“The better access means that all diagnostic imaging and pathology reports must share their reports with the My Health Record. So the patients can have faith that their their reports will be made available to them.

“That’s the better access. The faster access refers to the potential removal of the existing delay on these reports for consumers.”

ADHA has been working with the private pathology and diagnostic imaging providers to ensure their systems are connected to My Health Record. The major providers signed agreements to connect in 2017 but only a few are currently uploading reports unless the request is made electronically.

There are current exemptions to the seven-day delay for certain tests, including COVID-19 and other respiratory infections such as flu, along with INR results and HbA1c.

While the plan is for this to change to sharing by default, there still will be exemptions to certain results being available immediately, Ms Bhimani said. These are being discussed by a clinical reference group and concern certain histopathology tests and genetic tests.

Patients also have the ability to request that a result not be uploaded to their record, and to hide or delete a report if they so choose.

Ms Bhimani said the actual date that the mandate will take effect is subject to the passing of legislation, which is likely early in 2025, but in the meantime there will be an increase in reports being made available now.

Ms Bhimani said while some point of care testing reports will be uploaded, at the moment specialist reports such as ultrasound reports that are produced by non-radiologists – gynaecologists for example – will not be uploaded.

“The scope of the mandate is looking at that but at the moment where it’s being drafted is radiologist reports only,” she said. “We did look at the fact that there are several practices or several specialities that do actually have diagnostic imaging equipment and do produce diagnostic imaging reports, but are not radiologists. They are not in the scope of the initial phase of the mandate.”

However, due to the complexity of radiology reports, it may be the case that the seven-day delay applies as a blanket to all radiology reports, because it is so difficult to declassify a report based on its findings.

“At this stage, the discussions are moving in the direction of keeping the seven-day delay for all radiology reports. It’s the pathology reports where that blanket removal of the seven-day delay is more likely to happen.”

Ms Bhimani emphasised that discussions were still being held and the legislative changes are yet to be drafted, so these suggestions are subject to change.

Short-stay hospital model of care in ANZ a feature at Future Health Summit 2024

A special panel session on insights and opportunities in healthcare in the Asia Pacific has been added to the Future Health Summit being held in Dublin at the end of the month, including a presentation on the use of a cloud digital medical record – and some innovative Irish solutions – in a new private hospital in Australia.

Paul Gladwell, ICT project manager for the $A75 million (€46m) Adeney Private Hospital being built in the Melbourne suburb of Kew, will discuss the selection of a cloud-enabled digital medical record (DMR) for the hospital, which opens later this year.

Adeney Private has strong links to Ireland: it is the first hospital in the Asia-Pacific region to implement the full suite of MEG quality management systems for patient care, and fellow Irish vendor Oneview Healthcare will also implement its patient infotainment system and allow patients to provide feedback from their beds.

Mr Gladwell is a former head of business technology for Mercy Health Australia and ICT strategy manager for St Vincent’s Hospital Melbourne.

The 30-bed short-stay hospital is a joint venture between a 42-strong group of specialist doctors and health insurer Medibank’s Amplar Health business.

It aims to provide high-quality, affordable healthcare and will not charge insured patients any out of pocket expenses across all specialities, which include plastics, gastroenterology, general surgery, ENT, orthopaedics services, vascular, urology, anaesthetics, oncology, and radiology.

It has an innovative, short stay model of care with both the prehab and rehab care delivered outside the hospital, providing continuity for patients when they are discharged.

A KPMG report commissioned by Medibank recently found that short stay models of care reduced the length of stay for hip and knee replacements by 50 per cent. Broad adoption of the short stay program across the health system could save 217,000 bed days in 2030, it found.

Adeney Private CEO Louise O’Connor said the DMR vendor InfoMedix was chosen as it was “the only DMR that had truly been co-designed with clinicians”.

“The platform is a key component of Adeney’s plan for innovative clinical and financial solutions that will extend beyond the four walls of the hospital,” Ms O’Connor said.

InfoMedix is widely used in Australia as a scanned medical record, but the platform has since transitioned into a fully digital platform powered by the AWS cloud since it came under new ownership in 2018.

The InfoMedix DMR has been rolled out by a number of St John of God hospitals in Victoria and Western Australia and will be implemented by UnitingCare Queensland (UCQ) in three hospitals this year. InfoMedix software is used by over 70 hospitals in Australia.

The Future Health Summit is being held at the Dublin Royal Convention Centre on May 29 and 30. Tickets are still available.

Department and HSE under fire for delayed digital health strategy

The Department of Health and the HSE have come under fire from the Oireachtas Health Committee for the delay in publishing the new national digital health strategy.

At a sitting of the committee on in early May, Department of Health secretary general Robert Watt and HSE chief operations officer Damien McCallion were grilled by Social Democrats TD Roisin Shortall as to why the Digital Health Strategic Framework – which was promised eight months ago – has still not been published.

“This committee has had two sessions over the past year or so on digital health and the importance of it,” Deputy Shortall said.

“We were told the framework would be published in September. Then we were told it would be March. We are now into May. We still do not know the reason for the delay.”

Mr McCallion said the framework is now complete and he expects it to be put to government “imminently”.

“The HSE and the Department of Health have worked together to finalise a digital health and social care framework that will guide priorities, development and investment,” he said.

“This is underpinned by a more detailed roadmap which sets down a clear path for the integration of digital technologies in the healthcare system and marks a crucial step in the journey towards a patient-centred and digitally enabled health and social care environment.”

Mr McCallion added that although the document has not yet been published, work is already progressing on a number of initiatives set out in the framework.

“We are advancing the implementation of a new patient app in 2024, the development of electronic patient records in key areas, such as the children’s hospital, and the development of a national electronic health record,” he said.

“In addition, we continue to implement solutions to support hospital and community services in their day-to-day operations across services such as laboratories, mental health, disabilities, older persons, primary care and palliative care. This includes the innovative use of robotics and exploring the use of artificial intelligence.

“Effectively, we have not waited for the framework to be signed off. We have continued to progress the work around each of the key initiatives.”

Mr Watt said while the strategy was ready, it has not yet been published. “The strategy is developed and has been circulated. Even though the overall strategy has not been launched … most of the key elements are being worked on and advanced.

“This is important. I do not want people to have the wrong impression,” he said. “The key projects encompassed within the strategy and a whole number of e-applications are being pursued. We are now developing a proposal with regard to electronic health records and tenders are going out. Many activities are happening.”

Budget 2024: $1.4b for “significant” aged care tech, $1.2b for Strengthening Medicare

$1.4 billion in “significant technology and platform maintenance and enhancements” was allocated for critical aged care digital systems in the yesterday’s Australian budget but the exact details of what the funds will be spent on remains unclear.

The funding is part of a big push in the budget in preparation for the new Aged Care Act, which is still being drafted but which the government has promised will be introduced this year, with a further amendment bill to establish the Support at Home (SaH) program to start on July 1 2025.

SaH is replacing Home Care Packages from that data and will also replace the Commonwealth Home Support Program from 2027.

The new Aged Care Act will also underpin support the government’s response to the Aged Care Taskforce report released in March, which reviewed funding arrangements for aged care and found that the precarious financial state of the residential aged care sector is a barrier to innovation.

“Underpinning the aged care reforms, including those dependent on the new Act, significant technology and platform maintenance and enhancements will be funded to ensure critical aged care digital systems will remain contemporary and comply with legislation ($1.4 billion),” the budget papers say.

“Improved systems will help older people, their families and carers, access aged care services and reduce administrative burden for aged care providers by better integrating aged care and health systems.”

Extra home care packages will be provided in a $531.4 million pledge, which the government says will complement the roll-out of the Single Assessment System from July 1, 2024, which will provide older people with a single entry point and needs assessment for aged care.

$37.0 million has also been allocated to the My Aged Care contact centre to address increased demand and service complexity for older Australians and their families seeking aged care systems support.

Aged Care Minister Anika Wells said that since the 2022-23 budget, investment in aged care had increased by 25 per cent. This year’s budget was aimed at trying to strengthen the foundation to make sure that the new Aged Care Act will be a success for everyone who interacts with it, she said.

“Probably the headline thing that you’ll see in news coverage is that there’s $531 million provisioned for an extra 24,100 home care packages,” she said told a Department of Health and Aged Care webinar today.

“That’s designed to help the system stay afloat until new support at home comes in through the new act alongside some other measures that [Health Minister Mark Butler] has touched on …

“There’s $882 million designed to do things like to get older Australians out of hospital, provide better short term and transit stays, provide better virtual services to get people the specialist services that they need in place.

“I’m sure everyone’s favourite announcement is $1.4 billion for an ICT upgrade across the sector. That’s in a lot of different places. Again, very important, very worthy work that is designed to prepare everybody for the new Act and all the requirements and things that we want to do in the new Act.”

On the recommendations of the Royal Commission, Ms Wells said 69 of those recommendations had been delivered and from now on they will be delivered in tranches, with about 40 recommendations tied up in introducing the new Act.

Strengthening Medicare

As part of the $1.2 billion Strengthening Medicare package, states and territories will be funded with $882.2 million to deliver programs that help older patients avoid unnecessary hospital admissions as well as hospital outreach services in the community and virtual care services.

Health Minister Mark Butler said these initiatives were allied to the government’s focus on landing a new hospital funding agreement with the states under the National Health Reform Agreement (NHRA).

“We don’t just want this to be a financing deal that seeks to determine who pays what for existing hospital services,” he said. “We want this genuinely to be a reform agreement and I think there’s a real appetite at state and territory level to do that as well.

“There’s a particular focus in our discussions with states on the interfaces between different parts of the system, so how the hospital system interfaces with primary care with aged care and with disabilities. And last night, we talked about $1.2 billion of new investments the Commonwealth will make to improve those interactions between different parts of the system.”

Mr Butler said the ageing population and lack of transitional care was a critical challenge facing hospital systems, with older patients required to stay in hospitals way beyond the clinically recommended time because there’s nowhere to discharge them to.

“So there’s almost $900 million of investment in the budget in really targeting this area of challenge,” he said. “We’ve asked states for some some ideas, some proposals for innovative ways in which first of all, we can try to prevent older Australians having to go to hospital in the first place.

“Some of those models involve quite sophisticated virtual care, links between hospitals and aged care facilities in particular, but also geriatric in-reach from hospital systems into those aged care facilities.

“The other challenge is more the back end of the hospital system where people have had to go to hospital or ready clinically to be discharged, but are struggling to find a place that is able to take them. We’re also looking at innovative ways to expand those options.”

Mr Butler said there was also a package in the budget of $360 million for new initiatives in mental health, including a digital early intervention service for people having relatively mild bouts of mental illness or temporary periods of distress.

Head to Health centres, which cater for people with moderate to more complex mental health issues, will be rebadged as Medicare Mental Health Centres.