Tuesday, October 12, 2010

This Multiple Bites of the Cherry Approach Will Be an End of Us!

The following very illuminating report appeared in The Australian today.

Three-month testbed delay for health project

A THREE-month-old draft Healthcare Identifiers Service implementation plan has been reissued almost unchanged by NEHTA.

But a project plan is still some way off.

National E-health Transition Authority public affairs chief Heather Hunt says the material and timelines provided in the HI implementation approach and communication strategy were "only designed to show the public that the service will be adopted incrementally, rather than overnight in all locations".

The first deadline nominated has already been missed, with the final technical specifications due to be provided to IT developers by October 1 -- three months after the start of HI operations on July 1 -- still not available.

A Medical Software Industry Association spokesman told The Australian yesterday: "No, we do not have the specs, nor have we been given a draft, which we were expecting for review prior to the final specifications being published.

"We haven't seen a draft which includes the latest changes that were contained in the HI legislation and regulations". Changes included a new category of identifiers for third-party IT service providers.

Ms Hunt said the 45 pages of material released last week was "not a project plan, but a high-level document developed to give information to sector stakeholders who are going to be impacted by the HI service".

"While it contains approximate timeframes, that is for context only," she said. "Actual project plans will be managed by jurisdictions, the private sector, aged care, primary care and many other participants in the rollout. More detailed sector plans are being prepared."

More gruesome reporting (with the associated spin from NEHTA) is found here:


The first point to be made is that, of course, what NEHTA has provided here is not actually anything that could in your wildest dreams be described as a full implementation plan.

I made this point, among others, a day or so ago here:


However as I read the comments from NEHTA I realised that not only don’t they have properly formed plans for the so called ‘early adopter’ implementations, but even more worrying there is no real plan as to how, in any level of detail, the full e-Health picture is going to emerge.

This is more than a fussy academic concern. If you accept that the strategic direction being pursued by NEHTA - at the very top level - is to use various styles of secure messaging to deliver discharge summaries, pathology and radiology results and requests, electronic transmission of prescriptions and other clinical summaries then surely we need a coherent plan about how all this is going to be brought together.

I also suspect that if we are to reach the desired outcome of having vendors provide a client to be used by clinicians that integrate all these functions with the other expected functionality the GP systems, then having NEHTA just tossing out specifications at random times over the next few years and hoping the vendor community will just seamlessly respond then we are all dreaming.

What NEHTA, or someone else, if you are concerned at their apparent lack of capacity in delivery in this area, must deliver is a coherent implementable plan as to how this is to be done together.

Integration with the HI Service seems to me to be just one of a series of steps and projects NEHTA is expecting the vendors to just undertake over the next few years, for the good of all at a real cost to them. This really has no chance of working I believe unless we stop the sort of silliness we have seen here where old documents are just expectantly re-issued and none of the underpinning technical work and planning - to say nothing of funding and staffing - has been done.

Going at this in a piece meal fashion is really just not good enough - but it seems it is just this we are faced with. Additionally, of course, NEHTA is not offering any actual funds or staff to help.

I have to say if I was a software provider in this market I would be seriously considering selling out rather than being just randomly put upon as NEHTA takes its own time to decide what it wants next.

What should happen is that RACGP / NEHTA vision for the future which is described here:


should be analysed for the components that need to be brought together and a plan developed to have this achieved in a series of planned, co-ordinated steps where there is a logical flow and progression of capabilities.

Clearly right now this has not been done and ‘ad-hoccery’ is the order of the day. (Of course it could just be secret and we have not been told - but from achieving an outcome point of view that is just as bad!)

It seems to me to be doing one part of an overall vision in some sites and another part in other sites - without getting a single full capability site up, working and proven - is a recipe for long term problems.

Given we know where we are aiming to be, actually undertaking this is a properly planned and led fashion should not be too hard - but we shall see.

Demanding that we have an implementation organisation and plan - as advocated here:


To address this issue makes really good sense to me!


No comments: