Tuesday, January 11, 2011

It Looks Like NEHTA Delivery Is Slipping A Little. We Really Should Be Getting Better For Our Money!

I was quite impressed a couple of months ago when I saw that NEHTA had announced a range of quite detailed plans with respect to implementation of the Health Identifier Service and the PCEHR.

It now being January, 2011 I thought I would see how things were going.

What did I find?

As far as sector plans on HI Implementation.

In Aged Care not much has happened.

http://www.nehta.gov.au/ehealth-implementation/sector-plans/aged-care

In the Primary Care Sector we were promised a finalised and published Sector Plan by December 2010. That has not happened.

http://www.nehta.gov.au/ehealth-implementation/sector-plans/primary-care

The same thing was also to have happened in the Private Hospital Sector by December 2010. Sadly nope too.

http://www.nehta.gov.au/ehealth-implementation/sector-plans/private-hospitals

As far as the efforts of the States and Territories:

http://www.nehta.gov.au/ehealth-implementation/state-a-territory

Tasmania has not been updated since October 2010.

http://www.nehta.gov.au/ehealth-implementation/state-a-territory/tasmania

In the ACT we have testing underway with Medicare. No update since November 2010.

http://www.nehta.gov.au/ehealth-implementation/state-a-territory/act

As far as can be told a kick off meeting has been held to get e-referrals underway and no more progress is noted.

http://www.nehta.gov.au/ehealth-implementation/state-a-territory/northern-territory

As far as Victoria is concerned the rush for PCEHR money is well and truly underway:

  • Func Spec (final) - December 2010
  • Tech Spec (final) - December 2010
  • Best Practice Guide - December 2010
  • Next phase planning artefacts - December 2010
  • Specification Requirements for P&CMS (initially iSOFT draft) - Withdrawn
  • Cost Estimates - Withdrawn

Sounds just a bit off the rails and as though NEHTA is not actually driving down there in Victoria. (I wonder what "withdrawn" means and who is taking over if anyone?)

See here:

http://www.nehta.gov.au/ehealth-implementation/state-a-territory/victoria

So overall none of the deliverables seem to have been delivered on time. Indeed as far as I can tell there is not a single public deliverable so far! We can all now quietly wait to see just how long it is before delivery does occur.

This is not the level of delivery and communication we should see from such a large and well-funded organisation.

Oh and by the way, in the interests of some form of accountability it would be good if NEHTA posted on each web page the date of last update. To have all this material and have no clue as to how old it is, is really ridiculous!

NEHTA are famous for obfuscating information releases, not actually saying when delivery is actually achieved (the HI Service is hardly doing much yet) and communicating what is actually going on. This is a modus operandi which will see them ultimately fail I believe, both organisationally and in delivery of anything that is actually usefully implemented.

David.

26 comments:

Anonymous said...

Let us hope that NEHTA does not tread the self-serving pathway by attempting to exploit the enormous tragedy unfolding in the Queensland floods by rushing out with a media statement claiming that NEHTAs work will make a difference to all those people whose doctors have lost all their medical records in this monumental catastrophe.

Anonymous said...

I wonder whether the Queensland flood situation will see the whole NEHTA initiative placed on hold. Significant immediate funding will be required for essential infrastructure replacement / repairs. Federal and State funding will need to be redirected from existing initiatives. Existing projects which are only in the planning stages and have been going for many years without delivering anything (i.e. NEHTA) will be obvious targets. If NEHTA was actually half way through implementing something (which they should have been), it would be a different story, but now the whole NEHTA project could easily be put on hold with little if any political ramifications.

Anonymous said...

That's a fantastic idea. I'll second that as it can only help us achieve some real progress. Otherwise we we have to wait 2 years for it to happen anyway and cost $467M in the process.

Anonymous said...

Let's look at it this way and see what conclusion we come to.

NEHTA has achieved very little yet cost the Governments of Australia hundreds of millions of dollars.

If NEHTA is closed down $400++++ million could be allocated to the impact of floods in QLD, NSW, VIC - a very big step forward.

In parallel DOHA has $50 million earmarked for eHealth projects with 90 tender respondents now in the pipeline and the National Health & Hospitals Fund also has earmarked $1.2 billion for Rural & Regional Australia in health & education. Both those tenders have now closed. So if Government progressed those two initiatives and did away with NEHTA it is highly likely eHealth will start to move forward quite quickly, and the Government will have another $400 million to redirect towards repairing flood damaged infrastructure.

Will someone please tell the Prime Minister and the State Premiers.

Anonymous said...

Hey, stop deluding yourself. A whole lot of little pilots with a disparate conglomeration of multiple players under the 'direction' of DOHA will achieve nothing. That is simply a repeat of DOHAs simplistic mentality which resulted in a whole lot of itty bitty HealthConnect projects set up 5 years ago none of which achieved anything of note.

Anonymous said...

So what should be done? It seems to me you people want to dismantle NEHTA because you say it hasn't achieved anything worthwhile. You want to can the $50M million earmarked by DOHA for eHealth projects because you say that approach failed last time DOHA went down that path.

How about one of you oh-so-smart commentators come up with something constructively positive and tell us what you all think should be done. If you don't like this and you don't like that and you don't like something else what do you like?

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

I don't claim super smartness - but a very good 1st step would be to actually fund implement the 2008 Deloittes National E-Health Strategy rather than pretending you are and doing something totally different (namely doing the easy bits but not taking on leadership and governance issues!)

David.

Anonymous said...

2008 was 3 years ago. Get real. It wasn't funded then, it hasn't been funded since so it won't be funded now. Whether the reason is one of cost, or that the Government and the Department don't want to know, or they want to put it off because of other priorities like the National Broadband initiative - who knows.

But let's face the fact - the Deloitte strategy has gotten mouldy and they don't want to know about it. So ................. how about coming up with another suggestion that both they and the oh-so-smart commentators referred to above might all like.

Any other suggestions?

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

Sorry, keep your shirt on!

I believe the Deloittes work is as relevant today as far as what is needed as it was when released.

What is utter rubbish is that DoHA/NEHTA keep saying they are implementing it when they are not.

I suggest you go and read the document to see why. Basically they say NEHTA needs to be radically restructured, we need to lift our game with Standards and need to focus on the clinical coal face. All this is still spot on. See the current survey for some evidence of that!

Remember this Strategy was endorsed and supported by all Health Ministers - so what we have is NEHTA and DoHA ignoring ministerial direction. That is just amazing!

David.

Anonymous said...

Saturday, January 15, 2011 8:10:00 PM said "we need to lift our game with Standards and need to focus on the clinical coal face".

I agree. But how should this be done?

Standards evolve over time. The clinical coal face is elusive. So that all sounds like something on the never never.

Given that the Deloitte strategy, even if implemented now, could take years to deliver, surely there must be another way to get some runs on the board. Runs on the board, now, immediately, quickly, soon, NOW.

Or are we all just deluding ourselves?

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

Sadly, reality is that this stuff takes time, is complex and difficult and is fraught with risk.

We need to start - but start with a coherent plan that consumers, clinicians and Health IT experts are happy with.

The PCEHR is not that! NEHTA secrecy and DoHA incompetence add to the problem. There are some really smart people out there who could bring all this together - but Government needs to realise that they need some help!

Right now they are of in 'la la' land in my view regarding just how hard, how complex and how long it needs to take!

Sorry - the old line ' always time to do it again, never time to do it properly' rings in my ears!

Note Deloittes did have some specific 'quick hits' to address the impatience problem!

David.

Anonymous said...

Hey hang about there - it is irrelevant whether or not Deloitte had some 'quick hits' to address the impatience problem if the Government, DOHA and NEHTA don't want to acknowledge that and do something about it.

So how about stopping using that as an excuse - you are beginning to sound just like Government.

Why don't all those experts get together and find a way round the obstacles that everyone seems to be so mesmerized by?

Surely there is another way to overcome the roadblock that is frustrating the progress you keep demanding. Or is it that, as you said, "it is complex and difficult and fraught with risk" to the degree that it is just too scary thereby rendering everyone, including Government, NEHTA and industry impotent?

Isn't it time to face reality and stop avoiding the real issues?

Anonymous said...

We should take the cheap but realistic road of improving the quality of what we already have by insisting on standards compliance with the existing standards we have had for years.

This will increase the cost of software, but thats what needs to happen to fund the engineering work that needs to be done. Hacking together something for a trial for a pot of $$ is one of the problems. We need to build the foundations of a connected health system and stop trying to add the 14th story to a structure that has no foundations.

Foundation work is not sexy and there is not a lot of cool stuff to show but we need someone in control who knows that its the only way to build something that stays standing for any period.

The silly part is that it would be cheap to mandate compliance and provide some mechanism to support providers to pay a bit more for software thats solid.

We also need a little support for the proper standards process to proceed without interferance from an organisation that wants to lay down the law without having the ability to do it well.

Anonymous said...

Saturday, January 15, 2011 8:10:00 PM said "we need to lift our game with Standards and need to focus on the clinical coal face".

What can our local health industry software developers do to expedite this? Or is it all too hard from them too?

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

I believe that all of this is possible. But it takes real political commitment and real understanding of how e-Health can assist in improving health service delivery.

At the layer below you then need the leadership, governance, skills and funding - and a plan to deliver what is needed.

Its not rocket science but all those 6 ducks need to be aligned!

If any are missing you will flounder as I think we are right now. I can't put it more clearly.

Right now I don't see any serious political will to do it properly!

David.

Anonymous said...

David, Sunday, January 16, 2011 8:37:00 AM said "Right now I don't see any serious political will to do it properly!"

Properly ... mmm. Serious political will .... mmm.

Well, there is political will (apparently) just look at what Jane Halton and Nicola Roxon said at the eHealth Summit in December. Let's accept the fact that there is political will and there has been a serious allocation of funds. However, that doesn't suggest there has been any degree of competence shown in the commitment and distribution of funds - indeed in retrospect quite the opposite. But perhaps that wasn't evident at the time; at least not to the politicians and it still may not be.

As for doing it properly - who can say in such uncharted waters what is properly. Look at how many very large IT projects have floundered - is that because no-one was doing 'IT' properly? Probably - yes. eg. NABs recent fiasco, Qld Health's payroll fiasco, big projects, big vendors, big customers, but they didn't follow the rules for doing it properly. Consequently there is nothing to indicate that ehealth will be done properly whatever approach is adopted.

In fact doing something 'properly' is a falsity because as David reminded us above it is all too common to follow the 'always time to do it again, never time to do it properly' approach. That is exactly what happened with the Qld Health Payroll - no time for parallel implementation 1,2, and 3 - they went live, first up - impetuous impatient management followed by a disaster that will take years to rectify. So much for your desire to 'do it properly'.

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

I see what is being done by Roxon and Halton as ill-planned, ill-managed, ill-conceived and just plain political window dressing. Remember we never heard anything about e-Health until pretty much just before the last election and the biggest achievement to date has been a totally inconclusive gabfest!

To use another quote "they don't know what they don't know" and so are making a mess of it IMVHO!

David.

Anonymous said...

http://aushealthit.blogspot.com/2010/12/it-is-now-clear-pcehr-is-nothing-but-pr.html?showComment=1294261142728#c7950044238187712463

In the context of this current discussion John Johnston’s comment of Thursday, January 06, 2011 7:59:00 AM is very relevant.

In particular:
(a)Government initiatives encourage collaboration between parties with a common focus on a better patient result”.

(b)It is implementation experience that exposes strengths of the standard and identifies the weaknesses.

HOWEVER, all this is undermined by the fact that, as he says, “when the chips are down, the collaborative spirit can be overtaken by self interest.”

Furthermore your commentator of Saturday, January 15, 2011 10:54:00 PM asked:
-- Isn't it time to face reality and stop avoiding the real issues?

And another asked on Sunday, January 16, 2011 7:33:00 AM:
--- What can our local health industry software developers do to lift our game with Standards? Or is it all too hard for them?

Clearly the bottom line in all this is that the real obstacles lie NOT with Government but with the inability of the software industry to collaborate when the chips are down as John Johnston so succinctly expresses it..

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

To a point the comment made 2:00pm Jan 16 is true but I would suggest that this is because of the perverse ways the industry is incentivised and the lack of a proper e-Health governance framework that recognises who should be doing what and how they can be properly remunerated in a way that is sustainable and leads to industry growth and consolidation where that makes sense.

We really need a coherent industry policy that fosters the obvious outcomes we all seek while building industry capacity and capability.

There is a real 'chicken and egg' issue here and just going out to tender for a PCEHR is not the way to optimise outcomes overall I believe.

David.

Anonymous said...

The "perverse ways the industry is incentivised" is certainly a major obstacle to progress. But this has been pointed out to Government and the Department on numerous occasions however they simply do not want to know. So how do you overcome that problem?

Anonymous said...

I guess you'd have to start by defining what exactly the "perverse ways" are, as you see them.

Anonymous said...

So easy to say - so difficult to do.

How about starting from this end.

1. What is an incentive?
2. How will it motivate people?
3. What sort of incentive does a health software vendor need?
4. What conditions should be tied to the incentive?
5. What conditions should not be tied to the incentive?
6. Who should receive incentives?
7. Who should not receive incentives?

That's seems like a good first step. We can expand later once we have some answers to the above. Does that sound reasonable?

Anonymous said...

It sounds reasonable but I doubt anyone will be able or prepared to to construct a sound set of answers to your questions 1 to 7 leaving this discussion thread in a state of perpetual limbo.

Anonymous said...

I am happy to have a go at these as they are the alternative plan.

1. What is an incentive?

It is income received after you achieve a goal. In this case its proven standards compliance. That may be compliance with eg an AS4700 standard. It should not be paid to do the work but only when the work is done.

2. How will it motivate people?

There needs to be a demand for compliance and that is best done by legislation that requires it. Its as important as having reliable medication that has been tested. At the moment the eHealth snake oil salesman are doing very well.

3. What sort of incentive does a health software vendor need?

An incentive that covers the costs of doing high quality engineering, with the alternative being going out of business.

4. What conditions should be tied to the incentive?

The condition is proper compliance testing, AHML would do as step one but that is only structural and needs to examine content as step two.

5. What conditions should not be tied to the incentive?

No contracts or commercial in confidence deals, and independant testing by a NATA accredited testing organisation.

6. Who should receive incentives?

The providers or users should be able to access a software subsidy to purchase software that complies with the standards. PIP is not that way as it needs to be money for the software purchase only.


7. Who should not receive incentives?

The incentives should be for proven compliance only, so no compliance, no money. The subsidy could be slowly withdrawn over years if the medicare rebates were increased to allow Providers to pay out of their own pocket, but more likely the full subsidy would require more difficult and complex standards compliance each year with a well defined roadmap. The US incentives are a bit pie in the sky and the danger is that everyone will fudge it to save face. The targets need to be modest, but significant.

eg July 2011-2012: AS4700.6/2 compliance with AHML for outgoing messages will each attract a $2000-3000 per provider software subsidy amortised to $0 over 5 years.

The amout needs to be more than they are currently paying for software and in effect be the cost, so that would need some fine tuning but thats a ballpark figure.

Now someone out there can cost that. Its $4000 per doctor per year for proper message compliance, with a steady increase in complexity over 5 years, sounds cheap to me!

After about 5-10 years it could be gradually withdrawn and the price of medical software would have found a level that allowed good engineering practices and the legislation would ensure those practices had to be maintained. New entrants to the market would have assured income for a specified level of function.

No need for NEHTA, Would result in a few AHML clones and the ability to progress a standard knowing that everyone supported the current functionality, rather than still having to dish out PIT to a significant % of applications. Should also apply to Government hospitals!!! Especially them when I think of it.

Anonymous said...

Monday, January 17, 2011 12:00:00 AM said "I am happy to have a go at these as they are the alternative plan."

I agree - it looks like an excellent alternative plan - albeit in its infancy.

After reviewing the responses above I think it an excellent first pass effort and the contributor of Monday, January 17, 2011 12:00:00 AM is to be congratulated.

I plan to take each Question & the above Responses and build on those responses as best I can and hopefully we will not be alone in doing so.

If we remain alone I think it would be fair to conclude that there is not much interest among industry proponents of ehealth to develop an alternate plan for approaching the problem of how to move forward avoiding the obstacles.

Thomas Beale said...

Why would anyone think the software industry would unilaterally cooperate to achieve a solution for the commons problem of shareable health information? Most of the business value for the incumbents is not from sharing data, but from keeping it inside the institution where they sold their solution. This is a commons problem and needs a central strategy. Getting the IT and standards approach sorted is a start; defining the approach to adoption (here is where the incentivising comes in) is another. In actual fact, the right approaches are mostly known, they are just not used.