Wednesday, January 26, 2011

The PCEHR Seems To Be Still Lacking Real Detail! There is Still No Evidence That DoHA / NEHTA Know What They Are Doing.

The following report of a briefing held last week appeared today.

Bidders seek details on $467m personally controlled e-health record project

  • Karen Dearne
  • From: Australian IT
  • January 26, 2011 1:02PM

POTENTIAL candidates for the job of keeping the $467 million nationwide electronic patient records rollout on track want greater clarity on the sprawling work program.

The Gillard government is seeking a private partner to build an analytical and evaluation framework to monitor and measure progress of the personally controlled e-health record (PCEHR) as it is introduced over the next 18 months.

But bidders have asked for a list or directory of relevant activities being undertaken by the National E-Health Transition Authority to assess the scope of job ahead.

"It seems there are a whole lot of websites all over the place, but no-one’s actually got it all together," one asked Health in a series of questions and answers released yesterday to registered bidders. "Is that part of the tender?"

Another says there appears to be "many health providers, government departments and other organisations that NEHTA has been involved with, either peripherally or centrally. Is there a list that will enable the successful tenderer to properly evaluate and monitor it?"

In response, the Health department said it does not expect tenderers to have a "line by line" understanding of NEHTA’s program at present.

Bidders also questioned whether there was any other system on the same scale as the PCEHR in existence. Health replied: "There is no single solution in place that meets all of the requirements and specifications of the PCEHR program."

"(But) every single component of the PCEHR has been implemented successfully somewhere in the world. So the system components do exist.

"Some PCEHR infrastructure components have already been implemented in Australia, while others have been implemented overseas."

Health acting deputy secretary Megan Morris told an industry briefing last week the PCEHR would provide summaries of patient health information including medications, immunisation and test results over the internet via secure access.

"The government has adopted a combined approach of ‘top down’ initiatives and ‘bottom up’ lead implementation sites," she said. "We will create a national framework to guide development and impose uniform standards, including a national privacy regime and change and adoption framework.

More here:

http://www.theaustralian.com.au/australian-it/government/bidders-seek-details-on-467m-personally-controlled-e-health-record-project/story-fn4htb9o-1225994842659

You can visit the site and see the presentations here:

PCEHR Industry Briefing

On Monday, 17 January 2011 the eHealth Systems Branch, Primary and Ambulatory Care Division of the Commonwealth Department of Health and Ageing held an industry briefing in Canberra. The purpose of the briefing was to provide further information and clarification regarding the Request for Tender (RFT) for a Benefits and Evaluation Partner for the Personally Controlled Electronic Health Record (PCEHR) Program.

Informative presentations were given and attendees’ questions were answered by representatives of the Department of Health and Ageing and the National eHealth Transition Authority (NEHTA) regarding the requirements of the RFT, and the wider PCEHR Program. These are available below for download.

PCEHR System Overview - Speech Notes (PDF 39 KB)

PCEHR System Overview - Slides (PDF 870 KB)

PCEHR Work Program - Slides (PDF 3443 KB)

BEP Scope of Services and Tender Submission Requirements - Speech Notes (PDF 49 KB)

BEP Scope of Services and Tender Submission Requirements - Slides (PDF 231 KB)

Questions and Answers (PDF 18 KB)

Here is the URL:

http://www.health.gov.au/internet/main/publishing.nsf/Content/pcehr-industry-briefing

The Q & A Session was very revealing:

Question: Does a list or directory of NEHTA’s PCEHR Program activities exist? From looking at the website, it seems as though there are a whole lot of websites all over the place, but no one’s actually got it all together, and is that part of the tender?

Answer:

The Department does not expect that tenderers will have a line-by-line understanding of the program of work that’s being undertaken within NEHTA at present. The core documentation associated with the PCEHR Program has been made available to tenderers, and will be sufficient to enable the Department to undertake an appropriate capability assessment of tenders. Other documents that may be relevant have been identified by the Department and will be made available to the successful tenderer.

Question: There appear to be many health providers, government departments, and other organisations that NEHTA has been involved with either peripherally or centrally. Is there a list or directory of all of this activity that will enable the successful tenderer to properly evaluate and monitor it?

Answer:

The evaluation only refers to the eHealth sites and the build and rollout of the PCEHR Program. Wider health reform is a broader program, which is being managed by the Department of Health and Ageing on behalf of the Australian government. The PCEHR Program is only one stream of work within broader health reform. I provided details regarding NEHTA’s broader range of health activities and business blueprint in my earlier presentation and slides. The Draft Concept of Operations for the PCEHR Program is available to tenderers.

Question: You mentioned that the evaluation of tenders for the second wave of eHealth sites is underway. When do you expect that the evaluation process will be completed, and when will we receive information about the size and location of those sites?

Answer:

The applications for second wave eHealth sites closed shortly before Christmas, and the evaluation of applications is still underway. The Department is endeavouring to have a short list finalised within the next few weeks.

Question: As part of the services of the Benefits and Evaluation Partner, will the Department be requiring any capability transfer back to NEHTA or the Department, and by June 2012 from the tenderer back to the Department? Also, are there any conflict of interest restrictions on subcontractors, or any other organisation that may wish to tender for other PCEHR Program work?

Answer:

Yes, the Department expects that the Benefits and Evaluation Partner’s capability will be easily transferable to the Department, NEHTA, and other PCEHR Program partners. There is nothing that would prevent an organisation from tendering for other PCEHR Program work. However, please note that the RFT for the Benefits and Evaluation Partner states that “the Department may, at its sole discretion, exclude a Tender from further consideration, where it considers that a material conflict of interest or potential material conflict of interest would exist if the Tenderer was successful in being awarded a contract” (see Part B, page B24, clause 8.12.2 of the RFT).

Question: Is there any other system or solution that is of the same scale as the PCEHR system?

Answer:

There is no single solution in place that meets all of the requirements and specifications of the PCEHR Program.

Answer:

Every single component of the PCEHR system has been implemented successfully somewhere in the world. So the system components do exist. Some PCEHR system infrastructure components have already been implemented in Australia, while others have been implemented overseas.

Question: In the RFT, it is stated that the successful tenderer will “where possible, consider state and territory eHealth activity which is of relevance to the PCEHR Program” (Part B, page B10, clause 5.2.2(d)). What does the Department mean by “where possible”? Does this mean that the jurisdictions may not provide the PCEHR system with full access to necessary medical information and eHealth summaries?

Answer:

The jurisdictions have been heavily involved with the Department throughout the PCEHR Program, and are a key party to the governance arrangements. It is expected that this level of engagement will continue throughout the build and rollout of the PCEHR Program.

Answer:

State jurisdictions need to make significant investments to enable the PCEHR Program to work. State jurisdictions are developing similar business cases and are allocating funding to their acute sector programs. These acute sector programs will establish links to the PCEHR system.

---- End Q & A.

My view is that all this leaves way more unanswered that actually addressed and I still have the sense the no-one at DoHA or NEHTA actually knows what they are doing. These slides and briefing go no way to assure me anything I wrote here is at all wrong:

http://aushealthit.blogspot.com/2011/01/clinician-controlled-electronic.html

If they were confident they had substantial and credible answers then we would have the PCEHR Concept of Operations available for review and discussion. Until that is released we know that DoHA and NEHTA are as much in the dark as they are keeping the rest of us.

At present all I can see that is going to be delivered by 2012 are a range of incoherent pilots which will take the rest of the decade to be properly delivered so as to provide any value to either providers or consumers.

David.

16 comments:

Paul Fitzgerald said...

And David, you are surprised, why? It would be fascinating to know who was actually at the briefing...I assume the usual suspects, but any insight?
cheers,
Paul.

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

I am just staggered a 1/2 billion e-Health program is being run like a 'chook raffle'. I had expected way better of Government - but they are serial disappointers!

Obviously no-one has a credible plan and we are about to see massive waste!

David.

Anonymous said...

David,

I can only say I'm staggered you "had expected way better of Government"? Why and on what rational basis have you based your expectations?

If you place any value on this man's statements, Reagan didn't only quote "Trust, but verify", he also stated "Government does not solve problems; it subsidizes them", and how fitting this statement applies to the poor state of Australia's e-health agenda, and the insidious and incestuous AHMAC/DOHA/NEHTA nexus, which are predominantly the same Bureaucratic incompetent incumbents.

Some questions begging to be asked from the above transcript, following on from this statement: "Every single component of the PCEHR system has been implemented successfully somewhere in the world. So the system components do exist. Some PCEHR system infrastructure components have already been implemented in Australia, while others have been implemented overseas".

Outstanding news!

Can we please have an inventory of:

* each component?
* where in the world has it been implemented?
* what national, or even better, international standards is the component conformant to?
* what direct or indirect benefits has the component contributed towards?

Answers to these four questions would clear Australia's very muddy e-health waters in a heartbeat, demonstrate DOHA's and NEHTA's expertise and competence with a clear signal their fingers are on the national and international e-health pulse, and provide an unambiguous strategic direction to the e-health marketplace for what's required, desired, funded and expected to resolve Australia's e-health malaise...

If the bureaucrats can refrain from tap-dancing around answering these simple questions (although undoubtedly complex in getting to the simple response), then we may just get somewhere and save a few patients lives in the process with improved interoperability of e-health information.

Otherwise, let's just reset our expectations a lot lower and continue to watch in amazement and continue to be staggered by the ongoing incompetence and ineffectiveness of Australia's e-health finest that government can represent, as tragic as that may seem.

Keep up the good e-health fight, but please keep the expectations bounded within some form of rational reality!

Anonymous said...

You and your readers don’t understand how this IT process business all works. You need to have had first hand experience inside the bastions of the bureaucracy to get real insight.

An idea pops up from somewhere – anywhere. The IT industry and consultants promote it widely. Well meaning high level bureaucrats get sold on the idea by external forces and from within the establishment. The Minister cautiously nods approval for a small step forward to investigate further. Reports are written, consultants advise, and the idea is promoted far and wide. Then suddenly it takes on a life of its own. EOIs are called, business plans created, everything on the run, the sense of urgency is palpable, tenders are awarded, funds are budgeted, projects established and bedded down into the annual five year funding cycle and take-off is assured.

The project gets bigger and bigger as time goes by. Cracks appear, cost overruns and high staff turnover become noticed, the originators move on, media gets wind all is not well, customers become disenchanted, the propaganda machine ramps up increasing the lies and hiding the truth. Meanwhile, quietly and unobtrusively a new idea is being brewed up from somewhere – anywhere. The IT industry and consultants promote it widely. Well meaning high level bureaucrats get sold on the idea by external forces and from within the establishment. And while the old project crumbles and fragments in the face of investigations to determine what happened and what went wrong, and how it can be fixed and put back on the rails, a new project slowly raises its head as a better alternative which will give the Minister hope that the old can be left behind and a new way forward can be followed. The deck chairs move, old heads reappear, and the cycle of self serving incompetence fuelled by na├»ve exponents of the new alternative begins all over again.

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

Superb summary - and not a word of a lie! It is all true and all very, very sad.

The only thing you might have gone soft on is the vested interests of the paid advisers to make their budget. The conflicts of interest around all this are not well managed in my humble view!

David.

Anonymous said...

Thank you. And yes, "the vested interests of the paid advisers to make their budget" creates a malignant environment designed to give some semblance of credibility to underwrite what everyone does and justify all the decisions that are taken.

Anonymous said...

I agree: "Superb summary - and not a word of a lie! It is all true and all very, very sad."

I still well remember the first Health Online Summit in 1998 in Adelaide which attracted lots of IT industry, consultants,bureaucrats & advisers! However there were only a handful of actual clinical care providers. It has gone downhill since then - produced 10s of kgs of reports and cost billions. Employed a lot of people, provided a fair bit of political mileage but done very little for improving actual health care.

I am fascinated by the ever expanding list of job vacancies at NEHTA - yet they actually seem to want to outsource most of the PCEHR activity! Makes me think they are not serious about it!

Anonymous said...

As an example of this cycle, have a look at the Review of the HealthConnect program - the review was conducted over 18 months ago but was only just published on the Dept of Health website days ago:

http://www.health.gov.au/internet/main/publishing.nsf/Content/pacd-ehealth-programevaluations

The business case for HealthConnect was premised on among other things reducing the incidence of adverse events by 10%. It was to cost $500m to $600m for a total benefit forecast by the government was $550 million annually.

Source: http://www.health.gov.au/internet/hconnect/publishing.nsf/Content/C50C3B807441ADBACA257128007B7EC4/$File/hcibrv1.pdf

The review just published is conspicuously absent any hard measures, either of a financial nature or any clear clinical outcome nature. All of the review findings highlighted 'lessons learned' - but totally failed to identify the failure of the HealthConnect program to deliver the forecast benefits.

Now we're off again on another wave of investment with a dubious absence of a business case and no clear measure of outcomes. I would argue that nothing fundamentally has changed in the approach to HealthConnect and the approach currently being taken to the PCEHR. They are simply the same concepts, same people, same approaches, same plans. Yet, somehow expected to deliver different outcomes.

If we can't honestly assess failure and learn from it, and we deliberately avoid defining what success actually is, then we can only ever hope to repeat our failures again, and again and again. Sadly, this is the story of failed leadership in Australian eHealth.

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

I reckon some of you are trying to do me out of a job! Again - spot on - those recent evaluation reports from some highly e-Health literate Commonwealth paid consultants really awed with their quality, depth and insight - NOT!

Note DoHA got the reports in 2009 (or earlier) and it took a whole 12 months to create .pdf files for release!

David.

Paul Fitzgerald said...

David, surely you know by now how hard it is to create a pdf file (yes, I know that's a tautology or oxymoron or something!)
I am feeling a sense of deja vu....A number of years ago, I presented to a new Minister of Health in NSW - after the presentation highlighting some of the benefits of eHealth, he said "why aren't we f**king doing this stuff?" A few months later, when one of the hospitals actually signed up to do something, I suggested we get them some positive press, rather that the extreme negative press they were receiving at the time, I was told "you don't understand, we can't be seen to be spending money on computers, when we need to pay for more nurses!"...Yes, Minister, a very brave decision, Minister!

Anonymous said...

Two words come to mind: "Corporate Welfare"

http://en.wikipedia.org/wiki/Corporate_welfare

Anonymous said...

David,

I can only say I'm staggered you "had expected way better of Government"? Why and on what rational basis have you based your expectations?

If you place any value on this man's statements, Reagan didn't only quote "Trust, but verify", he also stated "Government does not solve problems; it subsidizes them", and how fitting this statement applies to the poor state of Australia's e-health agenda, and the insidious and incestuous AHMAC/DOHA/NEHTA nexus, which are predominantly the same Bureaucratic incompetent incumbents.

Some questions begging to be asked from the above transcript, following on from this statement: "Every single component of the PCEHR system has been implemented successfully somewhere in the world. So the system components do exist. Some PCEHR system infrastructure components have already been implemented in Australia, while others have been implemented overseas".

Outstanding news!

Can we please have an inventory of:

* each component?
* where in the world has it been implemented?
* what national, or even better, international standards is the component conformant to?
* what direct or indirect benefits has the component contributed towards?

Answers to these four questions would clear Australia's very muddy e-health waters in a heartbeat, demonstrate DOHA's and NEHTA's expertise and competence with a clear signal their fingers are on the national and international e-health pulse, and provide an unambiguous strategic direction to the e-health marketplace for what's required, desired, funded and expected to resolve Australia's e-health malaise...

If the bureaucrats can refrain from tap-dancing around answering these simple questions (although undoubtedly complex in getting to the simple response), then we may just get somewhere and save a few patients lives in the process with improved interoperability of e-health information.

Otherwise, let's just reset our expectations a lot lower and continue to watch in amazement and continue to be staggered by the ongoing incompetence and ineffectiveness of Australia's e-health finest that government can represent, as tragic as that may seem.

Keep up the good e-health fight, but please keep the expectations bounded within some form of rational reality!

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

Hi..I keep hoping things will get better and more rational - no luck so far.

BTW there are some things that have not been done anywhere I can think of - e.g. the proposed template service and an indexing service for 21 million people's records (yes maybe for NZ but that is 1/5 the size!)

David.

Anonymous said...

It's interesting that the level of expectation is so low!!

On the ABC news site today there was condemnation of a negative report about generic drugs with the argument being:

---------------

"I think that any claims that they are unsafe, in the main, are untrue."

Dr Hambleton says generic medicines are proven equivalents and also work to regulate the price of brand-name drugs.

"Generic medicines in this country are registered," he said.

"You cannot get them on to the market unless they are proven to be the equivalent. We can have confidence in our regulators.

-----------------

If we expect our regulators of medicines to be competent then surely we can expect the regulators of eHealth to also be equally competent as non-compliant eHealth data is at least as dangerous as bogus drugs when used to make decisions about patient treatment.

Its time we stopped accepting such gross incompetence and demanding some intelligence from regulators, perhaps by getting more able regulators as the current ones are clearly out of their depth.

We need some regulation and standards compliance which is the business of "Governance" What we currently have is unprintable!

Anonymous said...

I've been waiting on HealthConnect as a researcher for so long I'd almost forgotten about it! The same with the OACIS health IT network in SA- years of development, unbelievable $$ and only several sites so far.It was started by a medico who could program and snowballed (to hell, I'd say). People must be trained to use it and nonclinical researchers are not trained. Will this be the same with the national one? SA is still only releasing data from its old hospitals database, not the half billion OACIS. There is still no fathomable way the new national system will integrate with the monster that has been created here. Any news anyone?

Terry Hannan said...

These comments have prompted me to publish a public comment made by an eminent very vocal politician over cups of tea at an AMA meeting several years ago. He told a small group of doctors "you have it all wrong. It is not about patient care, it is about the money and getting re-elected." Also in a HL7 meeting I attended in Canberra a senior bureacrat stated, "this has nothing to do with patient care.!" Terry Hannan