Tuesday, July 27, 2010

It Does Not Look To Be Going Very Well. NEHTA’s HI Service Seems To Be Stalled and May Not Be Utterly Safe.

Nicely in time to throw a tiny spanner in the Gillard Election Plans we have the following:

NEHTA, vendors lock horns over HI service

THE $90 million Healthcare Identifier system intended to help save patients' lives is sitting idle as key components do not exist.

And there are no plans in place to make the service available where it is most needed - in GPs' offices.

Doctors and medical software developers are "bitterly disappointed" that it will be years before patients see any benefits from the new HI service, built to support expanded electronic information-sharing across the health sector.

Although Medicare allocated a 16-digit unique patient identity number to every Australian in its database on July 1 to meet a deadline set by Health Minister Nicola Roxon, the number is only available by phone and cannot be used by anyone.

And the National E-Health Transition Authority plans to initially roll-out the system to public hospitals only, with a series of pilot projects underway over the next two years; however, public sector hospitals will be unable to use the identifiers to communicate with other health providers.

Medical Software Industry Association president Geoffrey Sayer said the consultation process was "dysfunctional", resulting in a "flawed" implementation plan devised by the federal-state government-owned agency.

"The real improvements in safety, quality of care and efficiencies will only come when the GPs, specialists, diagnostic services, aged care and allied health professionals are part of the system," Dr Sayer said.

"There is no plan for that despite our repeated warnings to NEHTA, and our willingness to help.

"It's like having a critical vaccine locked up in a warehouse, and not talking to the trucking companies about how to get it to doctors."

Software-makers have been hamstrung in doing the necessary work to interface medical practice systems with the HI service, as technical specifications were not released before the HI legislation was passed late last month, and this work will take some months.

Allocation of HIs to medical providers is also many months away, while the key security component, the National Authentication Service for Health, is not ready.

More here:

http://www.theaustralian.com.au/australian-it/government/health-identifier-on-road-to-nowhere/story-fn4htb9o-1225896894328

as well as the following:

Developers warned against Medicare contracts because of e-health safety concerns

THE Gillard government is refusing to back the safety of its Healthcare Identifier service, leaving users with liability for system failures.

The Medical Software Industry Association has warned its members not to sign development contracts with the operator, Medicare, under these conditions, and is trying to negotiate changes with the Health Department.

Association president Geoffrey Sayer said the $90 million identifier service -- intended to support the electronic exchange of patient information across the health sector -- may sit idle for years, as key components did not yet exist.

The association also rejects the National E-Health Transition Authority's plan for a soft launch over two years to public hospitals only, saying patients' lives would be lost due to delays in getting the system into GPs' hands.

"Nehta has had more than 18 months to prepare for the July 1 go-live date, but has not yet begun developing a rollout plan for the wider community," Dr Sayer said.

"There's no sense of urgency, despite the fact this system will actually help save patients' lives."

Dr Sayer said the identifier project, managed by Nehta, had been a debacle, and it was "incredibly frustrating" to have patient identifiers that could not be used.

Many more details here:

http://www.theaustralian.com.au/australian-it/developers-warned-against-medicare-contracts-because-of-e-health-safety-concerns/story-e6frgakx-1225897185267

Now for the regular readers of this blog none of this will come as any surprise.

We already knew that the National Authentication Service for Health (NASH) was not anywhere near ready and also knew the difficulties with the National Registration Scheme was likely to have an impact.

See here for that article.

http://aushealthit.blogspot.com/2010/07/this-may-be-further-blow-to-progress.html

Additionally I have been saying for ages that implementation of the service to a useful stage was going to be a long process.

What is new here is that direct from the ‘horse’s mouth’ we are hearing of a serious fracture between the Medical Software Industry and NEHTA. No doubt there will be all sorts of denial and spin put on this report and I can assure you – knowing those involved – that they would not have made these comments to the Australian unless the levels of unhappiness were pretty extreme.

Note that there is a bit of a chicken and egg problem here. Unless NEHTA comes down from the mountain and really works to co-operatively and comprehensively clear the various issues raised by the Medical Software Industry Association (MSIA) it will all go nowhere for the foreseeable future. That would be really sad – recognising that key to all this is to have the implementation done collaboratively with both the Software Vendors and those who are expected to use the identifiers.

I have also pointed out previously that I have some concerns about the quality of the identifying information on which the Health Identifiers are based. You don’t need much of an error rate when the system is in actual use to potentially cause mis-linkage of patient records. The risks of that sort of outcome are obvious. Hence my suggestion we really do run some pilots at scale to make sure these risks are imagined and not real.

As an aside it is probably only weeks before the bitter divisions on the Standards for Electronic Transmission of Prescriptions also break into the public domain as we see more and more of NEHTA’s agenda unravel and delivery time-tables slip. All I can say is watch this space!

In the context of the election my comments of a day or so ago stand – with the addition that both sides need to come clean and explain just what they see as the future for NEHTA and what they plan to fix the obvious dysfunction. Dreaming I guess!

David.

9 comments:

Dr David More MB, PhD, FACHI said...

If you want to read reaction to this post go and browse:

www.ehealthcentral.com.au.

This site is a sponsored component of the NEHTA information campaign to make sure we are all thinking correctly and are fully informed as to just how well NEHTA is travelling.

David.

Anonymous said...

Well, if you want to know what NeHTA's CEO Peter Fleming thinks read this:

http://www.australianageingagenda.com.au/2010/07/27/article/E-health-slow-and-steady-wins-the-race/YXFSQXVDLS.html

Especially this:
Mr Fleming described the IHIs the “building blocks” for further reform: “The key is now to move from the foundation to the implementation.” “We’re slightly behind the eight-ball [in Australia] but on the other hand we have the ability to catch up quickly.

and this:
“Once we get it right, we will roll it out big time so that we can avoid any mistakes,” Mr Fleming said.

All from his own mouth and no help from anyone.

Anonymous said...

Sigh - dratted interfaces! Everyone thinks they are so simple, but they are often the reason why systems are late or do not deliver. But we shouldn't jump to conclusions for the HI system. Of course the specifications will have clearly specified the integration and interfacing requirements, including functionality to support all of the 'use cases'. After all, there is no use case at all if we can't connect to this system! Patience is required (or should that be spelt 'patients'?)

Anonymous said...

This is the telling line from Mr Fleming:

“You need to understand the possible workflow situations to work with it to get it right.”

It's quite clear that after 5 years Nehta do not understand much at all. They are now seemingly more concentrated on the spin than the work program. A national eHealth program that that can't get a handle on identifiers after 5 years and billions of $ makes the pink batts program look like a raging success.

The spin and battle lines will make the eHealth landscape look like the Somme after World War 1. It's time to end the reign of this Mad Monarch and restore some reasonable democratic governance.

Anonymous said...

Good point. Sadly people will also die due to lack of good governance of HIs project, as clearly a workable system is still miles away.
Lack of consultation with concerned consumers and medico resulted in a huge distraction over the legislation and a very untidy outcone.

But that mess also shielded from public view the nasty fact the emperor had no clothes. Well, clothes that can be worn now. But they'll be the finest suits you've ever seen - oh, sometime around whenever.

Perhaps NEHTA ought to have decided on the pattern first, gone to the tailors and put its order in

Anonymous said...

"Sadly people will also die due to" ..... this emotional rhetoric that should be avoided at all times. People die - that is a fact of life. Mistakes are made and will continue to be made - that is a fact of life. Systems can be improved and can continue to be improved - that too is a fact of life.

We should always seek to be improving on the way we do things and on the systems we use to underpin such activities for that is usually (not always) what makes the system better. That too is a fact of life.

But to use such crappy rhetoric as a form of emotional blackmail - such as "Sadly people will also die due to" - which seems to be the way so many see the justification for ehealth is pure rubbish.

The simple fact is that the systems need improving not because people are dying but because the systems are falling too far short of an efficient and acceptable way of doing things which information technology now permits; provided of course it is applied intelligently.

Anonymous said...

"provided of course it is applied intelligently" .... and competently by people with the appropriate knowledge and skills. The only problem is who are those people, who chooses them, how can they be empowered, who should manage them, are they manageable? What criteria should be used that are reliable enough to select those people to give us sufficient confidence that we will not simply be jumping from the frying pan into the fire?

Anonymous said...

Hang on, anon@9:41
I know health ministers shy away from mentioning preventable deaths on their watch, but I've always understood the phrses "improving patient safety" and "better health outcomes' were political euphemisms for fewer deaths - whether from preventable disease, horrible mistakes in hospitals, etc etc
If fewer deaths and better overall health for the population arent the objectives here, what is?
Have health officials and NEHTA drifted away from this key point? Is it now just about efficieny and cost-savings?

Anonymous said...

Dear anon@10:44
Preventable deaths is a small part of the overall problem.

The phrases "improving patient safety" and "better health outcomes" mean not doing the wrong operation on the wrong person, not administering the wrong medication or the wrong dose, not swapping (mixing up) the babies and allocating them to the wrong mother. The phrases mean doing things properly, getting things right, being more accurate, adhering to standards, following procedures, improving the system to make it safer for patients and to support and assist those who work in the system delivering the services and procedures, and to help the administrators and managers do their job where collectively they can all achieve better health outcomes. It's all those things and more.

Sometimes if something goes wrong someone dies, sometimes regardless of whether something went wrong or not they were going to die anyway, but more often than not when things go wrong the patient will suffer and the health outcome will be less than optimal but the patient will not die. As is so often said - the operation was a great success but the patient died.

So, with all due respect 10.44 Anon whilst no one wants people to die when there is no need for them to do so please try to appreciate that preventable deaths are only a small part of the overall problem and they need to be seen in that context, they need to be avoided where and when possible and there may (I repeat there may and hopefully there will) be fewer of them if the system is working better, more efficiently, more reliably, more accurately where fewer mistakes are made and where, when mistakes are made they are detected, rectified and appropriate measures taken to hopefully guard against them being repeated.