A day or so ago we had the Senate Estimates Committee’s Community Affairs Committee probe Australian e-Health with information provided by the Secretary of the DoHA and the Officer principally responsible for the area.
Of course, because NEHTA is not part of government there was no possibility to seek information from it directly. In my view this is the key catastrophic flaw in governance of e-Health in Australia. NEHTA is utterly unaccountable to any entity which might understand what they are doing and is – as it is well known - simply driven by a collection of public sector CIO’s who have no interest other than the hospital system in their State. Who cares about the rest of the Health System? No one is the answer!
The lack of control the Department has on National E-Health strategic direction is emphasised by this report from the Australian on Friday.
Government stumbles on e-prescription system
Karen Dearne | June 12, 2009
PHARMACY Guild members have briefed top Health bureaucrat Jane Halton on their plans for privately-owned electronic prescription exchanges as the federal department struggles to regain control over the issue.
Frustrated by the lack of action, several commercial e-prescribing projects have been unveiled in the past year, forcing health officials into an unseemly scramble after horses already seen to have bolted.
The department is yet to announce the selection of yet another consultant for the key task of "identifying options for governance and ownership of a national e-prescribing and medication dispensing system", along with associated business cases, costings and implementation timelines.
In particular, the intrepid tenderer will have about eight months to determine whether such a system should be government owned and operated; government owned and commercially operated, or commercially owned and operated - a decision the department and federal Health Minister Nicola Roxon have managed to duck until now.
The new contract offer, which closed in April, is intended to follow through on recommendations made by KPMG in its report to the department on e-prescribing and dispensing in June last year.
KPMG noted there was a "clear imperative" to address the governance of such systems, and the information likely to be held within them -- ranging from live prescription data in transaction hubs to repositories of de-identified data for health and medication policy purposes.
.....
"A clear imperative is that the issues of control, access, security and integrity of systems are recognised as high priorities for determining appropriate governance arrangements surrounding the ownership and stewardship of each system."
....
Ms Halton undertook to provide a statement detailing the work NEHTA is due to complete and implement this year.
More here:
http://www.australianit.news.com.au/story/0,24897,25626538-15306,00.html
Summary. We are so far behind with all this we won’t even know what we want to do until next year. By then of course the horse will have well and truly bolted – and of course once they have a report – DoHA then needs to act. Hard to see this happening by 2011 at earliest. Buy shares in the private providers of e-prescribing in my view. The Government has been left utterly flat footed!
A few other key topics were also addressed. First the National E-Health Strategy. (Page 72 on)
“Senator BOYCE—I have got some questions on that. I was just wanting to have yet another update on where this is at. The health ministers all endorsed, I understand, a national e-health strategy which had been developed by Deloitte in December 2008. What funds have been put aside for the implementation of the national e-health strategy now?
Ms Morris—Senator, the national e-health strategy is endorsed by all Australian governments and each individual government will commit money to it. Within the Commonwealth government, we have some ongoing funding which we will commit to parts of the strategy. That is in the forward estimates. But any major investment will be a decision of COAG.
Senator BOYCE—How much is currently in the forward estimates?
Ms Morris—In our forward estimates for e-health—
Senator BOYCE—I must have missed that figure.
Ms Morris—it is $51 million, exclusive of the money we are putting in to fund NEHTA, which was $108 million over three years.
Senator BOYCE—$51 million, exclusive of the money for—
Ms Morris—Of the money that the Commonwealth is committing as its share of NEHTAs forward
funding, which was, I think, from memory, $108 million over three years, Senator.
Senator BOYCE—The $51 million is over the forward estimates?
Ms Morris—Yes, Senator, but any agreed joint investment will be a decision of COAG.”
So there you have it. $51 million for a 4 year program to implement the e-Health Strategy. Hardly the funds the report recommended – Not even 10%!
See here for what was actually recommended:
http://aushealthit.blogspot.com/2009/05/what-should-be-in-budget-for-e-health.html
Page 73 on we have discussion – or non discussion - on the NHHRC plan!
“Senator BOYCE—There have been a number of submissions recently, following on from a supplementary paper from the National Hospital and Health Reform Commission paper on e-health, suggesting that the approach that is being taken is deeply flawed. Would you like to respond to that?
Ms Halton—Can you be precise, Senator? A number of papers from whom?
Senator BOYCE—Submissions, I thought, that followed the release of the supplementary paper.
Ms Halton—Submissions to the commission?
Senator BOYCE—Yes.
Ms Morris—I cannot comment on those, Senator. I am sorry, I have not seen them.
Senator BOYCE—Would you not, in the normal course of things, see it?
Ms Halton—No, Senator.
Senator BOYCE—Okay. Is it possible for you to make inquiries around that?
Ms Halton—Anything that is provided to the Health and Hospitals Reform Commission is a matter for them to consider and then they are going to put out their report.
Senator BOYCE—Yes. Perhaps you could talk me through. They put out their report, and then what happens?
Ms Halton—The government will consider it. So we are expecting their report at the end of this financial year, and I think we discussed that yesterday, in terms of the printing timetable et cetera. So quite when it will be released, I am not sure, but certainly early in the new financial year is my expectation. I did say yesterday that I do not know what is going to be in the final report, but we did know that in the interim report they went to this issue, not necessarily in a great deal of detail, and I would be surprised if there were not something in the final report that went to this issue as well.
Senator BOYCE—I have had approaches from a number of players in the medical software industry who have expressed their annoyance and concern that they are being asked to modify software for NEHTA, but not having any reimbursement of costs around that modification. Have those concerns been brought to your attention?
Ms Halton—I am not aware of the precise request and from whom it has come, Senator, so I would not want to make a comment. You are suggesting that someone from the department has asked them to modify software?
Senator BOYCE—I am suggesting that as part of an implementation of NEHTA—and I am sorry, I do not actually know who would have asked them to modify the software. I can find that out.
Ms Halton—Yes. What that would probably be, without knowing the precise detail but just taking a wild guess, there are a series of NEHTA standards which will form the basis of connectivity nationally. In purchasing, when, now, governments purchase, that includes us but also others, we are all saying that anything we purchase should be compliant with NEHTA standards. Obviously, over a period, we all know the software changes and we all know that as more technology becomes a feature of the healthcare sector, it is our expectation that that software will be NEHTA compliant. So whilst I cannot talk about the particular case—
Senator BOYCE—Have people been given a period of grace for this or is it—
Ms Halton—There is no formal requirement for anyone to go back and upgrade their software. Being honest about it, my expectation would be that for anybody who is in the market at the moment, if they wish to stay current and commercially attractive, it would be in their interest to make sure that their software is NEHTA-compliant because that connectivity will increasingly be part of our healthcare sector.
Senator BOYCE—Nevertheless, would they have any indication from government—I suppose, we will do this a bit more broadly than a department—as to whether the purchase of their software might be ongoing? Could I just put it in these terms: if I am going to do some expensive upgrades to my software, I would like to have some sort of certainty that someone is intending to purchase it. Would that be a—
Ms Halton—Can I turn it around the other way?
Senator BOYCE—You could.
Ms Halton—The question of purchase is a matter for the purchaser; that is not us. The thing that we can be confident of is that all Australian governments are committed to an electronic health sector and that the NEHTA standards will categorically form part of that, and therefore an investment in compliance with NEHTA standards is not a wasted investment.”
What this tells you is that the outcomes and funding of any NHHRC is going to be late in the year at best. That is over a year since the Strategy was submitted and endorsed. Glacial is quick compared with the speed these people work.
We also learn that DoHA is in denial about the possible costs the ePIP program will impose of Clinical software developers. This is really just plain offensive to those who are cooperating with them in my view. I bet we will see token compliance and when the time to actually implement there may be some ‘unexpected’ problems.
It would be a very brave business that would put much faith in NEHTA delivery on the basis of their performance to date.
Page 74 on we have:
“Senator BOYCE—No. I take your point. You spoke yesterday about some sentinel GP practices; was that the term you used?
Ms Halton—That is correct.
Senator BOYCE—There are—and this was in the context of the swine flu—GPs who are using online
reporting already. Can you tell me a bit more about that?
Ms Halton—In fact, I was resisting describing to you sentinel chickens yesterday, and I am going to resist the urge as well today. ‘Sentinel’ means some—
Senator BOYCE—I think Thursday Island specialises in sentinel goats.
Ms Halton—Yes, there are sentinel things around the northern parts of Australia.
Ms Morris—Sentinel pigs.
Senator BOYCE—Pigs, are they?
Ms Halton—And we used to have sentinel chickens.
Senator BOYCE—I am glad we are using GPs now instead!
Ms Halton—We may want to rephrase that! The GPs who are performing that data-gathering sentinel function—I do not quite know what the verb is of that—are connected into what is called NetEpi. NetEpi is the approach to gathering which I think Ms Halbert was outlining for you. It is that epidemiological information in respect of the prevalence of whatever is the particular issue we are interested in.
Senator BOYCE—Sorry. I understood her to be telling me that we were actually piloting e-health for some GPs.
Ms Halton—No, she was describing—
Senator BOYCE—I was quite excited about the advance that we appeared to have made on that basis. When can we expect to see that?
Ms Halton—Sentinel GPs?
Senator BOYCE—With the new meaning that we have just given it.
Ms Halton—Yes, good question. There are a number of steps that are being taken by NEHTA which go to what we call those foundation elements. We have talked about this in the past.
Senator BOYCE—We have.
Ms Halton—NEHTA is working towards a rollout of those features by the end of this year.
Senator BOYCE—This calendar year?
Ms Halton—Yes. What I would be happy to do for you, Senator, because it is probably best that we get this absolutely accurate, is take your question on notice and give you an indication of what work NEHTA is due to complete and to implement this year.
Senator BOYCE—A chronology would be good.
Ms Halton—Yes. I am happy to do that.
Ms Morris—I would add that there are networks where e-health is being used by GPs and local hospitals and a variety of other health providers, but, in the absence of the national foundations that NEHTA is doing, those connections just are not scalable to bigger areas.”
We will all look forward to that timetable. It will be obsolete before anyone sees it and secret for sure. Any odds on seeing something publicly in less than a month. Pigs with wings etc I reckon we shall see before we see this chronology! Time will tell.
Page 75 on.
“Senator BOYCE—Do we have an agency that is responsible for the oversight of NEHTA’s implementation of this program? Who oversights it? The department, or—
Ms Halton—The board, actually. NEHTA is a company, and it is owned by all Australian governments, and the board—
Senator BOYCE—Who is the responsible minister? Does it have a shareholding minister?
Ms Halton—No, it is actually owned equally by all the Australian governments. So the board comprises the chief executives of the Commonwealth, state and territory health departments, and it has an independent chair and an independent member as well.
Senator BOYCE—Thank you.”
Ms Halton misspoke there. No independent member listed on NEHTA site as of today – Sunday 14 June, 2009.
She also highlighted that basically no one who knows anything is key to governance – see comments on who is at start of blog.
Again, as with other Senate Estimates Hearings, we have obfuscation piled on inaccuracy and either ignorance or denial. Bloody sad.
Open accountable Government is no-where to be seen here. All charade and no substance or honesty.
The full transcript is here for those with severe insomnia!
http://www.aph.gov.au/hansard/senate/commttee/S12050.pdf
David.
3 comments:
The top Health bureaucrat’s briefing by Guild members was a gentle but persuasive affair. Much empathy with the inordinate difficulties DOHA and the Minister had encountered with ehealth was expressed by the Guild members bringing Ms Halton to the brink of tears. The Guild explained how they could help solve all her ehealth problems with their superior IT solutions. The election cycle was mentioned in the context of the Guild’s ability to use its membership base to scare the living daylights out of every politician. The electronic cattle prod was tested on a couple of occasions to demonstrate its effect. Various implements of persuasive pleasure, such as thumb screws, carotid blockers, electronic clamps and prodders, were adroitly attached to the victim for later use before the meeting ended in understanding smiles all round.
The Government has stuffed ehealth up big time in every which way. I think your observation re the catastrophic flaw well and truly accounts for why this is so. NEHTA has always been totally non-accountable since it was established. The jurisdictional departmental heads listen only to their public sector CIO’s. In their world there is no other health system of any relevance outside the hospital systems in their respective States. Don't ever be deluded into thinking or believing cross jurisdictional co-operation is alive and well. It isn't. Interstate jealousies and rivalries abound. Each state has a different agenda and different imperatives. Politics is short term focused on the next vote, the next ribbon, the next election. The only interest the states have in the Feds is how much money can be extracted to prop up the State. NEHTA is simply an escape valve for letting of excess wind and they do that very well.
Board of Governance issues have never been addressed despite strong recommendations from the highly credible Boston Consulting Group, Deloitte, and Booz & Co. In that regard the incompetence demonstrated by the Board of NEHTA is incredible.
Letting off excess wind is a condition which arises from being bloated so we should not be surprised that NEHTA does it very well.
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