Three Years Too Late – NEHTA Asks What’s Next?

A few days ago I heard about an 80 minute Panel Session that NEHTA is planning to conduct on 20 March 2007. (The date is one day before the Health E-Nation Conference being organised by CHIK Services on 21 March)

The information I received is as follows:
_________________________________

“Planned Panel Session

Title

Joining the Dots… What’s Next

Aims

To identify the priority areas for action to enable e-reforms to progress to national implementation.

To identify the most significant outstanding obstacles to progress and what must be done in the next 12 months to address these priority issues.

To enjoy a lively discussion with questions and comments from the audience.

Interview questions

What do you believe are the 1 or 2 key areas for action over the next 2 to 3 years? Please give brief, specific examples to illustrate your points.

What do you believe is the single most important thing we need to do to accelerate e-health in the next 12 months from the point of view of health consumers or patients? And also from the point of view of health professionals?

What is your organisation currently doing to accelerate e-health reforms? Example?

Is there any other significant issue you would like to raise?”
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I was also told it is planned there will be panellists from six to eight different relevant organisations.

What is to be made of this?

My first reaction was to ask – Why was this work, which is essentially aimed at setting strategic and short term directions, not undertaken three years ago?

Then it occurred to me ponder – hang on – isn’t NEHTA meant to be managing the delivery and implementation of e-Health in Australia? How is it they don’t know the answers to all these questions as part of their strategic plan? If the aim of this Planned Panel Session is to confirm current directions I would be re-assured – but for NEHTA to now be asking what the priorities and barriers are at this point – three years into the mission – seems just quite absurd.

As readers of this blog will know I have been banging on about the need for an action orientated National E-Health Strategy, Business Case and Implementation Plan for a good while now! My answer to NEHTA’s request therefore is quite straightforward. Put simply what NEHTA has to do is as follows:

1. Recognise that their customer is not the NEHTA Board but the Australian Health Sector, and the 20 million people who use the services provided by it.

2. Swiftly enrol competent expertise and find the resources and funds to develop a consultative, inclusive, National E-Health Strategy, Business Case and Implementation Plan.

3. Use the Business Case to secure the appropriate level of funding required to move forward

4. Implement the agreed and recommended plan nationally.

I have had a feeling in the last few months that I have been missing something, else we would be seeing more constructive activity than seems to be the case. I have formed the view that the lack of an agreed national strategy is fundamentally a major obstacle to progress. Broadly speaking what I think we are now seeing is the following:-

1. State Governments working to use Health IT to try to get their hospitals working better (albeit with different levels of success and urgency) and starting to try and communicate with the relevant GPs and Specialists.

2. Most GPs and Specialists lacking the motivation (or the right incentives and support) to move beyond basic practice computing and prescription printing until future directions become clearer. (Note: there are all sorts of good things happening at many Divisions but somehow the task of co-ordinating information and skill sharing seems less than ideal).

3. The medical software industry is responding where it can but it lacks confidence in the stability of the direction being taken and the preparedness by Government(s) and practitioners to invest.

4. Service providers (labs, radiology etc) are optimising internal operations and providing external messaging of results etc largely only when asked. Electronic ordering is still at a low level.

5. A significant and consistent lack of support for implementation of already developed standards as well as some caution around standards which exist on paper but are not yet demonstrably implemented.

6. An evolving but still non-interoperable secure electronic messaging environment which lacks certainty in the forward directions that will be successful resulting in slow investment and complexity of use for end users.

7. A clear sense that the HealthConnect proposal(s) is/are going no-where in the next 3-4 years at best and that in reality HealthConnect has been canned.

8. Scepticism regarding announcements in areas such as e-prescribing, supply chain and medicine terminology among others.

Development of a comprehensive National E-Health Plan can, if funded and sponsored at the right level, provide the confidence, financial security and direction to get over the log-jam.

There are a few critical requirements for national E-Health Plans to be successful. These include at least the following:

1. That the plan be designed for the way the Health Sector in a country works in terms of funding, service delivery and so on. The implication is that what is done in the US, UK, Canada or Europe will only offer ideas – not a comprehensive solution.

2. That the plan, once developed, be sponsored, funded and committed to on a bi-partisan national interest motivated mode. Implementation of a plan of the type required is a major long term project and as far as possible politicisation needs to be avoided.

3. The plan be conceived to address the health system as a whole – and not fall into all the traps of Commonwealth / State rivalry, friction etc.

4. Inclusiveness of all the relevant stakeholders (Consumers, Providers, Government, Health Funds etc)

5. Focussed on delivery of clinical benefits for patients along with facilitation of health sector safety, efficiency and effectiveness.

6. Recognition that the benefits from the use of Health IT are often not captured by those whose work practices are changed and who may also bear additional costs.

7. Recognition that significant incentives for change will be required.

8. Recognition that Health IT is an enabler of Health Sector Reform and Improvement and that leadership of and commitment to Health System redesign is also needed.

There are a number of major strategic choices that also need to be made. Among these are (in no particular order – they are all crucial):

1. The level of standardisation that is to be imposed and at what level(s) this is to happen – as there is a trade off between user choice and the degree of inter-operation and information sharing that can be achieved without undue complexity.

2. Whether the approach to development and implementation will be ‘top down’ (as broadly it is in the UK) or ‘bottom up’ (as broadly it is in the US). This will ultimately drive a strategic E-Health Architecture for the county and the route by which that architecture will be evolved in practice.

3. The respective place and role(s) of the Government(s), the health service providers, the private sector software industry and so on the overall mix of how things are achieved.

4. Whether a Shared EHR or a messaging paradigm will be adopted and whether a distributed or centralised model will be adopted. There are a huge range of shades of choice that may be made in this area.

5. The suite of standards that will be utilised and how compliance with those standards will be obtained, certified and maintained.

6. The level of local and regional autonomy that will be available and the areas of the strategy where this will operate.

7. The amount of system development, service provision etc that will be undertaken centrally by Government(s) versus the use of commercially provided software and services.

8. The approach to risk management and to issues such as the verification of solution suitability and piloting of proposed solutions.

9. The funding model to be adopted and the approach to be adopted to benefits identification, management, realisation and distribution.

10. What is preferred and the optimal method of software provider and user / public / consumer involvement in the selection, deployment and use of Health IT and what consultative approach should be used in development of the strategy.

11. The strategies to be used in gaining public confidence regarding the privacy and security of their personal health information.

12. How best to take most advantage of the useful work undertaken to date in the field, while not constraining an optimal long term outcome for Australia.

13. The optimal governance framework and management structure for delivery of such a large and complex national initiative.

The benefits of providing clarity to all stakeholders on the shape of the future and the part they can play in advancing towards that future are obvious in terms of the levels of investment and benefits that will flow.

The best thing that could happen would be that the new AHIC and NEHTA jointly approach COAG / AHMAC to get such a planning process initiated as soon as possible.

I wonder whether those bodies have the ‘intestinal fortitude’ needed to step back, accept we are not getting anywhere fast, and initiate a new planning process.

I am reminded of the following quote:

There is a tide in the affairs of men,
Which, taken at the flood, leads on to fortune;
Omitted, all the voyage of their life
Is bound in shallows and in miseries.

William Shakespeare, Julius Caesar
Greatest English dramatist & poet (1564 - 1616)

The tide is rising right now!

David.