Saturday, September 25, 2010

My Prescription For Australian E-Health - In The Australian Sept, 25 2010

We cannot afford an e-health failure: national electronic health system

THE quality of Australia's electronic information infrastructure for its health sector is a barrier to the quality of our health system.

This infrastructure, called e-health, has been promised by both sides of politics during the past decade but hasn't been delivered.

That this hasn't happened matters because the delivery of safe, evidence-based and timely care requires information to flow accurately and reliably between those involved in the care of the patient. Additionally, it's important to have patients involved in reviewing and creating their own health information.

For years, management of financial records has been computer-based and communicated globally, but we struggle with health records. We can't obtain the improved efficiencies and effectiveness delivered to the financial sector until we crack e-health. Without such improvements the cost of health services is predicted to become unsustainable in the next decade or two.

This month The Australian has reported quite alarming, and accurate, information regarding what can only be interpreted as a significant failure in the governance and leadership of our e-health efforts in Australia.

For instance, an entity called the National E-Health Transition Authority -- which is meant to be central in delivering the electronic information infrastructure -- admits that, despite having had funding in the hundreds of millions of dollars in the past few years, it's largely failed to deliver.

A key NEHTA initiative, now recognised as having been very badly managed, is the development of a system to ensure users of the e-health infrastructure are properly identified and authenticated. This is critical as users will access sensitive private information.

For more than three years this project has defeated NEHTA internally. Now the authority is seeking external help to start again, essentially from scratch, as recommended in the 2008 Deloitte E-Health Strategy for Health Ministers. Who knows what effect this will have on the delivery of services, but it's certain to be significant.

Here's a second example of bungling. The Department of Health and Ageing has made substantial payments to GPs to encourage them to use a standard technology to facilitate information flows, but it co-ordinated so badly with NEHTA, which is meant to develop the standards, that tens of millions of dollars have been spent to no good purpose.

In my view these failures and the associated waste can be attributed to the incoherent and opaque arrangements for leadership and governance in place in the e-health sector.

That this is a big issue isn't news to anyone who's followed the progress of e-health in this country. In late 2007 the Boston Consulting Group reviewed NEHTA's progress for the NEHTA board and made the point that NEHTA was performing "in the red" on both stakeholder engagement and governance.

And while the Deloitte strategy has been widely welcomed by the sector and agreed by the Australian Health Ministers Council, progress on implementation of the governance and leadership recommended in this plan could only be described as glacial.

Despite what you may think, there's considerable political consensus at the leadership level on the need to make substantial progress in e-health. This seems to be at least one good thing to emerge from the recent election campaign.

As I read it, we have agreement from Labor, the Coalition and the Greens that introduction of reasonable levels of computerisation and electronic messaging within the health sector promises to have significant positive effects on quality, safety and efficiency within the sector, while recognising there are issues of information security and privacy that do need to be addressed.

This is a least a basic starting point for "moving forward".

Turning nice furry feelings and group hugs into real action is what's required.

We have a situation where the Prime Minister has expressed considerable frustration with progress in this domain. And when he was health minister, the present Opposition Leader expressed more than considerable frustration regarding what he was able to deliver in e-health.

The time to get this consensus working has well and truly come. The following steps are the key to long-term success.

First, develop, implement and fund an inclusive, responsive, authoritative and well-led governance entity, as recommended by both reports mentioned above. This body needs to work across the health sector, private and public, demanding accountability for funds expended at all levels for all projects.

Second, make clear that e-health is an enabling tool for what's needed for the health system. It's not an end in itself. E-health is an infrastructural element that will be crucial if we are all to have a safe, effective system that delivers improved quality of patient care, greater patient safety and improved economic efficiency and sustainability.

If we don't get the leadership, funding and governance of e-health right, the nation will be condemned to another lost decade rather like the one that's just passed, one with little real progress towards what was wished and hoped for and, indeed, what was promised.

It could have been a lot better, and it needs to be a lot better. Time is running short, so over to you, Ms Gillard and Mr Abbott.

David More is a medical specialist who has worked in the e-health area for more than 20 years. He blogs on the topic at


John Johnston said...

What continues to surprise me is that there remains a government perception that "big is beautiful". There are so many advances that can be made by well targetted modest amounts of funding that can have immediate cost and patient benefits. Within the right structure, there is a wealth of practical knowledge and capability in Australian SMEs that can advance ehealth uptake at lower risk.

Tom Bowden said...

In my view This is a well written piece and it certainly outlines some of the deficiencies of the present state of play.

In my opinion though, the real issue is around the reform agenda. IT is simply a tool to make policy and strategy work. In my view it is very difficult for NEHTA to make huge progress until the reform agenda is confirmed.

Sure, we want to see improvements in areas such as standardisation and messaging (I can't understand why a lot of this was not sorted out long ago) but in my view, swift progress will only be made once there is some real clarity about the future shape of the health system.

Perhaps we should be collectively putting pressure on for that?

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


I agree - but it won't happen till we get better overall management of strategy and direction. Then we can start to spend more wisely!


I hate to say it - but as they say solving that issue 'is well above my pay grade' - not that I don't think it is crucial and to date has also been incompetently handled as well.


Blog Phan Xuân Trung said...

Let e-health growth up as a tree. Everything must start from ground. The tree started from a seed. We can not sketch a big tree on the paper and make the tree from the sketch. We don't know how big the tree will be.

There are many stages for make a national e-health.
- First: make utilities that help health caring inside each hospital such as: e-prescription, e-drugs, e-labs, e-RIS... These elements must link together as a united system. This stage is a big advance on ehealth. This is not easy at all because the hospitals are quite difference on functions and structures but this stage is basic can not be ignored. The doctors and patients will be happy with the outcome from this system.
- Second: collect the main information from hospitals to a datacenter. No need to get all the information from hospital. Just some important data only. These data will be used for management at the higher level.
- With the patient code, the hospitals can see details of records from each hospital when needed.
- Most important is that the systems have to be webbased.

PHAN XUAN TRUNG - Vietnamese medical informatics expert.