The following appeared a day or so ago.
By Josh Taylor, ZDNet.com.au on October 22nd, 2010
The Federal Government's e-health plan is not about saving taxpayer money but about using health funding more efficiently, a senior public servant has told Senate Estimates this week.
In response to a question from Labor Senator Mark Furner on what potential savings the government's $466.7 million investment in e-health programs could deliver for the taxpayer, Jane Halton, secretary for the Department of Health and Ageing, said that any savings made would ultimately be spent elsewhere in the health system.
"The thing I know about health is there is no such thing as a saving because someone else will come along and spend the money. It is like there is no such thing as an empty hospital bed. What it enables you to do though is to spend the money that you do have more wisely and more efficiently," Halton told the hearing.
"In other words, we can use the dollar that we have in the health system to deliver more services, to deliver better quality of care and therefore to improve outcomes," she added. "The Department of Finance will find that in evidence and then I will be on the fatwa list for not delivering a saving."
The benefits for e-health, Halton said, would be to reduce medical errors and prevent deaths and duplication of testing for patients through the availability of reliable information contained on e-health records.
I thought the full transcript might make a good read - for accuracy against my notes of last week
SENATE COMMUNITY AFFAIRS
Wednesday, 20 October 2010
Members: Senator Moore (Chair), Senator Siewert (Deputy Chair) and Senators Adams, Boyce, Carol Brown and Furner
Participating members: Senators Abetz, Back, Barnett, Bernardi, Bilyk, Birmingham, Mark Bishop, Boswell, Brandis, Bob Brown, Bushby, Cameron, Cash, Colbeck, Coonan, Cormann, Crossin, Eggleston, Faulkner, Ferguson, Fierravanti-Wells, Fielding, Fifield, Fisher, Forshaw, Hanson-Young, Heffernan, Humphries, Hurley, Hutchins, Johnston, Joyce, Kroger, Ludlam, Macdonald, McEwen, McGauran, Marshall, Mason, Milne, Minchin, Nash, O’Brien, Parry, Payne, Polley, Pratt, Ronaldson, Ryan, Scullion, Stephens, Sterle, Troeth, Trood, Williams, Wortley and Xenophon
Senators in attendance: Senators Abetz, Barnett, Bilyk, Boswell, Carol Brown, Fierravanti-Wells, Furner, Humphries, Ludlam, McEwen, Moore, Parry, Siewert, Trood and Xenophon
Committee met at 9.02 am
HEALTH AND AGEING PORTFOLIO
Senator McLucas, Parliamentary Secretary for Disabilities and Carers
Department of Health and Ageing
Ms Jane Halton, Secretary
Ms Rosemary Huxtable, Deputy Secretary
Primary and Ambulatory Care Division
Ms Megan Morris, First Assistant Secretary
Ms Liz Forman, Assistant Secretary, eHealth Strategy Branch
Hansard Transcript: 8.02 pm
CHAIR—We are going to go into outcome 10, and we want to start with 10.2 because a number of the senators want to start with that—so e-health to start with. I know that Senator Boyce and Senator Furner both have questions in this area.
Senator SIEWERT—So do I.
Senator BOYCE—Since last estimates we have managed to put through the healthcare identifier legislation. Could you just update me on where we currently are with that please, Ms Halton or Ms Morris?
Ms Halton—Absolutely, we would be delighted. Can I say, just while the officers are coming to the table, from a health perspective how absolutely, really, over-the-moon delighted we were that that legislation was the last piece of legislation that passed the parliament. I genuinely think that in terms of long-term revolution in health care it will be one of the most significant decisions the parliament will have taken, so we were very pleased that it was passed.
Senator BOYCE—One of the more bizarre efforts I have seen in the Senate. When I started speaking we were not actually intending to put the legislation through, but by the time I had finished speaking the government decided that they would recall the reps so we could.
Senator FIERRAVANTI-WELLS—The last of the death knell.
Ms Halton—That was something that there was much cheering about in the department. I can tell you we were very pleased, thank you.
Senator FIERRAVANTI-WELLS—We were very cooperative, Ms Halton. We could have been not so cooperative.
Ms Halton—We were very pleased, thank you.
Senator BOYCE—So, I asked if we could just have an update on what that wonderful event has meant.
Ms Morris—Thanks to the cooperation, the legislation was passed on 24 June, it received Royal Assent on 28 June and the regulations were made on 29 June 2010. Medicare Australia commenced operating the Healthcare Identifiers Service on 1 July. Identifiers have been assigned to approximately to 23.5 million individuals since then, approximately 390,000 healthcare professionals and two healthcare organisations.
Those two healthcare organisations are, in fact, the jurisdictions of Tasmania and the ACT.
Senator BOYCE—So, they are health departments, so to speak?
Ms Morris—Yes, and they are effectively—I am not sure if trialling is the right word—the early adopters who will be working out what, if anything, the issues are for jurisdictions.
Senator BOYCE—So, they have been assigned?
Senator BOYCE—Have they been used?
Ms Morris—What we need for them to be used is other things happening in the e-health space. What you are probably aware of is that we have announced some early lead implementation sites for the personally controlled electronic health record, and they will be early adopters for use of the individual health identifiers, using them and linking them to other things as that becomes available.
Senator BOYCE—Where are these sites, and when will they actually be using identifiers?
Ms Morris—The lead implementation sites are in the Hunter Valley in New South Wales, Brisbane north and in Melbourne east.
Senator BOYCE—When will they happen?
Ms Morris—Have they started already?
Ms Huxtable—The funding of the lead implementation sites is a two-phase process. In the first instance there is money being provided to assist them with developing their implementation plans. We are now in the process of receiving those plans, and on that basis there is a second tranche of investment. So, while I have not actually reviewed the plans personally, certainly the use of identifiers is one of the key elements in those sites and we would be expecting the development of those to be quite soon.
Senator BOYCE—Do we not have dates for when this implementation is due?
Ms Huxtable—As I said, I have not personally reviewed the implementation plans. I am not sure if one of the other officers at the table has, but we are certainly talking about a near term. The lead implementation sites are expected to be very well advanced in their work over the next 18 months or so and so it would be within that time frame.
Ms Morris—We would be looking at probably around March next year, but the date is not yet confirmed.
Senator BOYCE—March next year?
Ms Morris—Yes, I would not want you to say at next estimates, ‘Ms Morris, you said by March next year’, because it is not yet confirmed, but that is in the ballpark.
Senator BOYCE—No, but about March next year.
Ms Huxtable—We will get those plans and come back with them when we have a better answer.
Senator BOYCE—As I understand it the medical software industry still does not have final specifications; is that correct?
Ms Morris—This is a date I can confirm. By March next year software vendors will be able to test their products with independent testing labs.
Senator BOYCE—Test their products with labs?
Ms Morris—Yes, to ensure that software correctly uses the identifiers and supports patients’ safety.
Senator BOYCE—But that is not individuals and organisations using identifiers, is it?
Ms Huxtable—That is the system by which identifiers are used, so once it is incorporated—
Senator BOYCE—If the software is ready by the end of March one presumes people have not installed it and started using it by the end of March as well. Are you saying that will just happen instantaneously? The testing is using?
Ms Forman—You are right. Once the—
Senator BOYCE—Sorry, I am just having trouble hearing you, too. I blame the acoustics, not me.
Ms Forman—You are quite right; until software is actually installed in the systems of the healthcare providers, they will not be able to download and use the identifiers, so that is a really key step. There are actually two sorts of levels of testing for that to happen, but it is expected to happen by March or before.
Senator BOYCE—When will the final specifications be done that would allow people to develop the software?
Ms Forman—The specifications are being released progressively. NEHTA is working very closely with the MSIA on reviewing those and using them in their development as we move forward. There are a couple of things that were late amendments to the legislation, as you will recall, that do need to be incorporated into the system; but for the majority of users that development and planning work can be starting much earlier than that. We would anticipate that by March the software vendors would actually have had the specifications and had an opportunity to do all their development work. And in March, or before, the independent laboratories would be ready for them just to go in and test.
Ms Halton—At the risk of using the anecdote to prove the point, I should tell you a very short story about personally being in a health facility recently, not professionally, and standing behind someone in a queue to pay a rather large amount of money as it happens for something, and the person in front of me said—now this is only in Canberra, I will acknowledge—‘Would you like my unique health identifier?’
Senator BOYCE—And the answer was?
Ms Halton—And the answer was, ‘Actually our software is not yet enabled but—’
Senator BOYCE—That is precisely my point, Ms Halton.
Ms Halton—But my point is that, one, the receptionist in this place knew that it was coming and they had not yet got the software, and two, that someone—it would only be in Canberra—actually had already gone and got their unique health identifier. This was a dialogue of two people who actually knew what they were talking about and one said, ‘I would like to use it’, and the other said, ‘You will be able to shortly.’
Senator BOYCE—Nevertheless, the minister has said that all Australians will have their PCEHR by July 2010. We know that cannot happen. When will it be?
Ms Morris—It is July 2012.
Ms Morris—I would just also add on software developers that so far we have got 80 software vendors who have requested something called the developers kit. So they are engaged with us, and NEHTA and Medicare Australia are continuing to consult with the MSIA. There are a lot of things—
Senator BOYCE—Has the developers agreement between Medicare and the software vendors been signed off and agreed to by both parties?
Ms Morris—So far 14 of them have signed the agreement.
Senator BOYCE—What are those 14 doing about insurance and indemnity?
Ms Morris—I do not think I could answer that. I do not know.
Senator BOYCE—Was that not one of the issues, though?
Ms Forman—We would not have access to that information.
Senator BOYCE—But was that not one of the issues that was a sticking point for the agreement? Would you not know that?
Ms Forman—I think that is an issue that has been raised by the MSIA.
Senator BOYCE—Who would they have raised that with then, if it was not with you?
Ms Forman—It would be with NEHTA and Medicare, I would say.
Senator BOYCE—With Medicare and NEHTA?
Ms Huxtable—Because Medicare is running the IHI service.
Senator BOYCE—So, if I do raise that with Medicare tomorrow, do you think that I may possibly get an answer? You cannot answer me. We will keep going.
Ms Halton—I actually will let them know of your interest.
Senator BOYCE—I just wanted to quickly move on to the structure of NEHTA. I know, Ms Halton, we have talked about this before, with the directors being all the health secretaries of Australia.
Ms Halton—Plus an independent chair and an independent—
Senator BOYCE—I asked some questions relating to travel and so forth, and got a response that said: Provision of this information to the department is not required, and is not provided in NEHTA’s annual reports. I got some figures around the costs of travel, the employment of contractors and consultants for 2008-09, which you took out of their annual reports, of $30 million spent on contractors and $26 million spent on consultants. That could not be broken down any further because NEHTA was a private company, had not mentioned it in their annual report and no-one could answer questions regarding that. I was interested to note also on the website, the Boston Consulting Group report—
Senator FIERRAVANTI-WELLS—Them again.
Senator BOYCE—Yes, Boston Consulting Group in 2007—
Senator FIERRAVANTI-WELLS—Don’t they have a branch office in PM&C?
Senator BOYCE—In 2007, yes. The Boston Consulting Group in 2007.
Ms Halton—Point taken. I have a report received before the election—I think that is the point the senator is making.
Senator BOYCE—It was reported after the election but it was—
Ms Halton—Contracted before the election.
Senator BOYCE—obviously conducted prior to the election. I am now having trouble finding the document. On 25 October 2007 the report was put out, Minister. You would be aware that that report said:
However, the main problem of NEHTA’s Governance lies in the way the Board is perceived by the eHealth stakeholder community. Notwithstanding the benefits of having state and federal CEOs engaged and supporting standards, a significant number of stakeholders raised doubts about the Board’s composition.
It says they were very concerned about the lack of transparency and what they perceived to be the conflict of interest between health departments as board members of NEHTA and as service providers, users et cetera.
The four main issues raised with it were that NEHTA lacked an independent chair—and that has been remedied—… and board members to assist with senior stakeholder engagement.
• The board members have a potential conflict of interest between their jurisdictional roles and supporting NEHTA …
• Board members do not have the necessary time or depth of technical expertise to provide strategic direction to management on some topics.
And there was a ‘rapid turnover of board members’. At that stage the average tenure had been 13 months. And the very strong recommendation to overcome—and I quote—the ‘mistrust that existed’ around the NEHTA board was that the structure be changed. What has happened since?
Ms Halton—I think if you go on with that report—you have already pointed to the recommendation for an independent chair. That was taken up. There was also a recommendation that there would be independent members. There is one independent member on that board. There is a dialogue going on about another independent member of that board—
Senator BOYCE—What do you mean by a dialogue? Who is having the dialogue?
Ms Halton—The issue is basically with the size of the board and how many members are actually functional so there is an active—
Senator BOYCE—But who is discussing it: the board, the department, the minister or what?
Ms Halton—The board is discussing it and at some point that issue will come to a resolution. It is not resolved at the moment. The other thing is that I think if you actually go to that report it went to engagement with the sector; it went to some critiques in relation to the management of NEHTA. You will be aware that the senior management of NEHTA has turned over consequent on that report, so we have a new chief executive, a new and independent chair, David Gonski, whom I think is incredibly well respected and has a very long track record in terms of his capacity to bring that independence and clarity of thought to chairing institutions. There is Lynda O’Grady, who has a very significant track record and understanding of the IT sector.
Notwithstanding the fact that there is a lot of money involved and that it is a very difficult and technical space, the board would have a view I think—but I am happy to clarify this with them and come back to you— that a number of the issues in that report have been addressed, noting the question of an additional independent member because I think the recommendation was that there should be two independent members, not the one that currently exists.
Senator BOYCE—However, you mention that you have got 14 software vendors signed up to the developers agreement. I think it was 80 who have received the information and are not comfortable to sign up because they cannot buy indemnity or insurance protection in Australia for Medicare errors, so I think you still have to say there is a level of mistrust and a level of a sense of lack of consultation with the industry and NEHTA even today; is there not?
Ms Halton—I think the question of individual perceptions is a bit of a moot point.
Senator BOYCE—I do not think I am talking about just a couple of individuals.
Ms Halton—I think there are some people who are probably out on this issue. I think the board has a view that there is a—
Senator BOYCE—I can say I am not talking about just a couple of individuals.
Ms Halton—The board has a very clear understanding of the need to improve communication and consultation. There is a discussion at every board meeting about industry engagement, transparency engagement and the performance of senior management in respect of those issues is regularly, as in every meeting, discussed. I think it would be acknowledged that inevitably those things can be done better. There is of course the relationship here with Medicare Australia, who are actually contracted to deliver that particular service and the need for NEHTA to hold them, under the terms of that agreement, accountable for their performance—
Senator BOYCE—That is good.
Ms Halton—Remembering that they are—
Senator BOYCE—That is a body that this parliament can also hold to account.
Ms Halton—That is correct, but we actually have a commercial relationship with them in terms of that delivery, and that is a commercial relationship that is being pursued with some vigour.
Senator BOYCE—You are not suggesting by saying it is a commercial relationship that it is a commercial in- confidence relationship?
Ms Halton—No, I am not. I am simply saying we pay them to deliver something and we are going to hold them accountable for delivering it, as agreed.
Senator BOYCE—Nevertheless, someone who has kindly done the figures for me advises me that the Australian taxpayers have contributed $167,000 a day over the past—I think it was—five years towards the development of an e-health system, and it is not possible for us to ask questions about how funds of NEHTA were spent other than what the board chooses to put in the annual report.
Ms Halton—Let me make two points about that. I am very mindful of your concern to ensure there is transparency around this. As you know, there are commercial and statutory responsibilities in terms of what is reported in annual reports. However, I am very happy to take to the board any particular request you have in relation to improved transparency around some things, acknowledging that our funding is one share of the funding and I cannot compel the board to agree to a particular request, but I am very happy to take requests for improved transparency to the board.
Senator BOYCE—Thank you, but I guess my basic point would go back to the fact that it should not have to be done that way. But thank you for that offer and I will certainly write to you in regard to that.
Ms Halton—That would be fine.
Senator FURNER—Can you explain the benefits in respect of the introduction of the personally controlled electronic records system?
Ms Halton—How long have you got?
Senator FURNER—I have got as much time as you like but I am sure there are others who have some questions. Just a concise summary would be fine.
Ms Halton—We can start with things like medication errors. We have done the business case around this.
The colleagues can chip in when they have found their spot. We know that in regard to medication errors there are 90,000 admissions a year and getting on towards $700 million worth of costs. We know that health information quality and availability goes to about eight per cent of significant concerns in Victoria—if it is in Victoria, you can bet it is everywhere else—
Ms Morris—I am afraid I do not have Ms Halton’s stamina so I get more tired as the day goes on and I find it harder to find papers. It is estimated by a Booz and Company report for release this year that as many as 18,000 Australians die each year as a result of adverse drug events. The most commonly acknowledged cause of these events relates to disjointed communications or unavailable information. Depending on how much time you have got I could give you a variety.
Senator FURNER—You could give me maybe some of that on notice.
CHAIR—Perhaps we could arrange a briefing because it is something you could take up to the minister’s office that there is a lot of information to be shared. There is interest there. We could arrange a briefing to get that information.
Ms Morris—Yes, that would be useful.
Ms Halton—I think the short summary is: medication errors; information which is not well transcribed; the whole question of quality and safety; the number of preventable deaths; all of these things, not to mention patient inconvenience, duplicate tests, the kind of being run around problem which particularly if you are sick you really do not have the time or energy for. And all of those things, not to mention preventive health—I could go on and on and on. But in every facet of the health system this will make a significant contribution not only to improved patient outcomes—and heaven knows we are all interested in that—but also in improved patient experience.
Senator FURNER—What about savings to the government and I imagine practices as well?
Ms Halton—The thing I know about health is there is no such thing as a saving because someone else will come along and spend the money. It is like there is no such thing as an empty hospital bed. What it enables you to do though is to spend the money that you do have more wisely and more efficiently—
Ms Halton—In other words, we can use the dollar that we have in the health system to deliver more services, to deliver better quality of care and therefore to improve outcomes. The department of finance will find that in evidence and then I will be on the fatwa list for not delivering a saving.
Senator FURNER—What will the department be doing in terms of the take-up rate of the IHIs with regard to a promotion of that leading in towards July 2012?
Ms Morris—I mentioned earlier our lead implementation sites for the personally controlled electronic health record. The approach with the IHIs is to push for early adoption in places where it can be linked to other things that are developing in the e-health space. To have the health identifier on its own is not going to do a lot in terms of an e-health outcome. You need to have the information attached to it, health information being sent electronically between providers. So, as I think Ms Forman said, one of the requirements for those lead implementation sites is that they do encourage their patients to take up the use of the individual health identifiers.
Senator FURNER—Other than that will you be doing any promotional material through marketing in terms of explaining to the public what is available?
Ms Forman—There is a communications approach that has been released by NEHTA along with a highlevel implementations approach. That does capture the concept of information that is required by all the people who will be involved in identifiers, including the consumer. But one of the things that we do need to be mindful of is that there is a point in time when that information is relevant and useful for each of those parties—consumers, healthcare providers, vendors—and we need to be really targeting them and making sure that information is available at the point where it is most useful. There is an approach being developed and information has been out there since the beginning of the healthcare identifier service. Certainly brochures are available in all the Medicare outlets and those have been taken up extremely well. There has been a lot of interest in those. The next stage would be to have that same information, more detailed information, available in the actual healthcare providers who are beginning to adopt the identifiers so that the patients understand how the process is working. There has also been a consumer hotline available through Medicare from the outset of the campaign.
Ms Morris—That was set up on 1 July, the day that the identifiers started being assigned.
Senator FURNER—In terms of ratings, how do we compare globally now with some of those nations that already have this magnificent system?
Ms Halton—It is interesting because, having had a conversation with some of our global colleagues in the last couple of weeks, there are a couple of very small European countries that are out in front. Scale—there is a whole series of reasons they are out in front. But the bottom line is we are more than globally competitive.
The danger here is that we do not keep in front of the wave. There is the whole e-timewarp, if you want to put it that way, that if we do not keep moving we will not stay in front of the wave. We will not be in the same position as some of the very small Nordics because they have a much smaller scale problem to deal with. We are trying to do this for a whole country. And 20 million people is arguably not that many but in terms of the rail gauge issues and all the other issues we are trying to deal with, getting this right and having it be flexible so we do not have to rebuild it every second year with all the costs that incurs is important.
We enable multiple players. We enable open source and all those sorts of things. Certainly my take-out from the discussions I have had with my international colleagues recently is that we are more than globally competitive if you take all of our like-minded reasonable comparators and, interestingly, we are not spending the same quantum of funding. I am loath to be too rude about our friends and colleagues overseas because if you look at what is happening particularly in the UK they have run up several blind alleys on this. They have spent an awful lot of money and not delivered in some cases. They will deliver and what they will deliver will be really good, but it will cost them more than multiples of what it will cost us by the time we are done.
Senator FURNER—Thank you.
Senator SIEWERT—I would like to go back to the identifiers. You filled us in on the early adopters. In terms of people starting to take up the identifiers, I appreciate the public may not have jumped at it, but have providers started taking them up?
Ms Forman—The overall approach that has been used is a fairly staged approach. There are enormous implications for improvements in clinical safety and the stakeholders are very mindful that we need to avoid introducing any new clinical risks. That partly goes to the requirements for testing software to make sure they actually handle and use the identifiers safely and that there are no consequent problems. The first stages in the rollout are to develop that software, ensure that software can do what it is supposed to do, and gradually introduce that into lead implementations and others to then look at all the things that need to sit around that to ensure that staff understand how to use the systems and that consumers know their roles.
Senator SIEWERT—I am conscious of the time. I think I may have phrased my question poorly. I understand where you are going with it. I was actually thinking about registering. I apologise for any confusion. I was going back to prior to the rollout. That is my poor terminology in terms of taking it up. I meant in terms of starting the process by registering, because that is a bit of an indication of how people are going to be forerunners in adopting the process as well.
Ms Forman—It is. Already 390,000 healthcare providers, individual professionals that are nationally registered, have received their identifiers. Organisational identifiers need to be applied for, and as Ms Morris said, only two organisations have gone through that process. We see that obtaining the organisational identifier is something we would expect an organisation to do as an immediate, when they are ready to start doing it; so we will probably see that happening progressively down the track. For healthcare provider individuals who have not received their number, there have been a small number who have applied directly to Medicare to obtain their number. I do not have that figure in front of me. It was quite a small number; only a handful.
Senator SIEWERT—Did they need to apply because they have not received it yet?
Ms Forman—That is right.
Senator SIEWERT—I understand that we have all been given our number.
Ms Halton—You can go in and get it if you want to.
Senator SIEWERT—No, I think I will wait. I have trouble remembering my pin number.
Ms Halton—You and me both. As I said, one very earnest Canberra soul has definitely got his.
Ms Morris—He had no idea who was behind him?
Ms Halton—He had no idea I was standing behind him listening.
Senator SIEWERT—Most of the other issues that I was going to cover have already been covered. I just wanted to go back to the question that Senator Furner asked regarding awareness raising. Is there a strategy for the rollout of the system where you will be raising awareness through the whole process and also engaging the community in the ongoing process of rollout in terms of consultations? It is a double-bang question.
Ms Forman—There is a strategy for that. In the communications strategy, NEHTA has outlined, with the input from stakeholders, the types of communications that will be needed and where they will be needed.
Some of those materials have been developed by the Privacy Commissioner, which is around guidance to healthcare providers as to how they can ensure that they are meeting the requirements under the Healthcare Identifiers Act. Most of the consumer information would be at point of care because that is where it is most relevant, so information available in Medicare offices but also in healthcare provider locations where they will be downloading and populating your identifier. At that point of care we will be having simple easy-to understand information for consumers.
Ms Huxtable—We have the personally controlled electronic health record and there is significant investment through that. The sum of $466.7 million has been announced for that interchange and adoption, which includes how to communicate effectively with consumers about their health records.
Senator SIEWERT—Is that included in that funding?
Ms Huxtable—In that $466.7 million, yes.
Senator SIEWERT—My last question on e-health is the issue around the funding of the various initiatives. Is that the responsibility of NEHTA or the department?
Ms Huxtable—There is a national partnership agreement between the states and territories under the auspices of COAG that provides funding to NEHTA in respect of its current work program, on the one hand, and on the other hand there is the Commonwealth direct investment through the e-health record money.
Senator SIEWERT—Is the e-health record investment through the department?
Ms Huxtable—Yes, that is right.
Senator SIEWERT—Will it be ongoing through the department?
Ms Huxtable—That is a Commonwealth direct responsibility. The expectation is that NEHTA will have a very important role, in terms of how that money is spent, but it will be through a contractual arrangement with the Commonwealth in respect of the specific e-health record.
Ms Halton—I think this is a really important point because the Commonwealth is essentially taking the lead and is directly funding this particular work in terms of the personally controlled electronic health record.
By definition, the states will themselves have to make investments to participate and to make sure that their systems integrate with that information. That is why this is our investment and we are looking for the states to do their part. That is why it is slightly different to the kind of combined investment through COAG, if that makes sense.
Senator SIEWERT—Yes, it does. Thank you.
----- End Transcript
Well there you have it for another six months.
A few fun facts emerge:
1. The State Jurisdictions are about to get hit with funding requests.
2. NEHTA is a contractor for the Department essentially.
3. This is all going to take a very long time.
4. DoHA / MSIA relations are not yet ‘tippy top’.
5. NEHTA is as secretive and non-transparent as ever.
We will get nowhere until this is fixed!
I leave the reader to draw their own conclusions about how this is all going - comments welcome!