DESCRIPCIÓN DE FUNCIONES 1.0.15I DIRECCIÓN GENERAL

At one end of the continuum is the centralised bureaucratic governance model under which decisions are mandated, rules and protocols are defined centrally, and there is a heavy reliance on direct supervision to ensure enforcement and adherence. If applied to E-Health, the

centralised bureaucratic governance model would drive E-Health adoption from a central mandate and all aspects of E-Health would be implemented through large scale national or State and Territory Government projects.

At the other end of the continuum is the free market governance model in which there is no clear central authority and a reliance on external parties such as customers, care providers and suppliers to cooperate with each other to collaboratively produce outcomes. The free market governance model would support strong collaboration and innovation, allowing existing grass-roots E-Health initiatives to continue with little or no intervention from a central authority.

National E-Health Strategy

Deloitte: National E-Health Strategy

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Between these two extremes lies the guided market model which balances the need for local initiative and innovation against the need to centrally coordinate specific aspects of

implementation. The guided market model is characterised by central coordination in areas of national significance, combined with greater flexibility and reduced central control and regulation in areas where the market is best positioned to play a role. The model relies on competition and the use of incentives, funding and compliance mechanisms to drive outcomes in the market place.

Recommended Approach

Analysis of the current state and progress to date of E-Health in Australia, together with the outcomes of the national consultation process, highlighted a consistent view that the guided market governance model is the most appropriate for Australia to adopt.

Based on the national track record to date, and also the inherently fragmented nature of the Australian health care system, it is considered extremely unlikely that a free market model will result in anything other than a significant amount of uncoordinated, non integrated E- Health activity occurring across the country. Given a lack of any national coordination, a free market approach is likely to further exacerbate the proliferation of disconnected information systems and databases across the health sector.

Conversely, a centralised bureaucratic governance model does not appear a realistic option given the virtual impossibility of centrally controlling activity across such a wide range of largely autonomous care provider individuals and organisations. Such an approach would unnecessarily stifle local innovation and activity and place too high a reliance on the delivery of large scale, high risk centrally driven projects.

Guided Market Model

The key consideration when designing a guided market governance model is to clearly distinguish between those elements requiring national coordination and those elements that should be driven by the market. With respect to E-Health, the design and implementation of national E-Health foundations such as standards, identifiers and data protection legislation should be centrally managed and coordinated to avoid duplicated cost and effort and to ensure that information is able to be exchanged across the health sector in a consistent manner. By contrast, the development of specific E-Health solutions that sit on top of these

foundations should be predominantly driven by the health care participant and vendor market. This approach reflects the reality that it would be extremely difficult, and of questionable value, to try and centrally manage the vast amount of disparate E-Health activity occurring across the Australian health sector. Within such an environment, health care participants and vendors should have the ability to develop E-Health solutions that meet their specific needs without being unduly constrained by a centrally controlled implementation model.

However, there is also a strong recognition that this activity needs to be much more strongly aligned than at present to ensure the achievement of desired national E-Health outcomes. Accordingly there is a requirement for a national approach that encourages the market to develop solutions that support agreed E-Health standards and priorities. This can be achieved through a nationally coordinated focus on targeted financial investments and incentives, regulatory frameworks, stakeholder change and adoption programs and solution compliance testing and certification.

Role of Government

Australian Governments have ultimate accountability for national health care funding and the delivery of national health care outcomes. Government should therefore have overall

responsibility for setting national E-Health objectives and priorities, funding the national components of the E-Health work program, and measuring progress against agreed E-Health Strategy deliverables and outcomes.

National E-Health Strategy

In a guided market model, Government will be responsible for the implementation of national E-Health foundations and for the establishment of appropriate policy and regulatory

frameworks to protect the integrity, privacy and security of personal health information. Government should also ensure that appropriate national education and training programs are in place to support the building of national health IT skills capacity and capability.

Government has an important role to play as a provider of a range of health care services. In this role Government will be responsible for directly funding, implementing and operating E- Health infrastructure and solutions in a manner consistent with overall national E-Health priorities and standards.

Beyond these specific responsibilities, the key role of Government will be to stimulate and encourage the market to develop quality E-Health solutions that are scalable, standards compliant and aligned with national priorities. This will involve responsibilities such as overseeing:

• The design and implementation of national incentive regimes

• The design and rollout of national awareness and education campaigns • The establishment of a national E-Health solution compliance function.