Monday, January 17, 2011

The Post of January 11, 2011 Has Really Caused Some Interesting Discussion.

You can read the blog (and all the comments) here:

There was what I see as a major theme from the comments and that was a deep sense of frustration with the status quo and a real concern about whether it could be fixed, and if so how. The germs of some very good ideas appear at the end. Who wants to add to them?

Gems of examples of this were:

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.

Friday, January 14, 2011 4:33:00 PM

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.

Saturday, January 15, 2011 10:53:00 AM

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?

Saturday, January 15, 2011 3:53:00 PM

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?

Saturday, January 15, 2011 10:54:00 PM

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 that’s 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 that is solid.

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

Sunday, January 16, 2011 12:10:00 AM

Anonymous said...

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..

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?

Sunday, January 16, 2011 3:35:00 PM

Anonymous said...

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

Sunday, January 16, 2011 5:50:00 PM

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?

Sunday, January 16, 2011 6:39:00 PM

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.

Sunday, January 16, 2011 9:04:00 PM

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 independent 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.

Monday, January 17, 2011 12:00:00 AM

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.

Monday, January 17, 2011 11:49:00 AM

OK kind readers, over to you to take this further. We have a forum for discussion that seems to work pretty well - so let’s use it - and hope the ‘powers that be take time to read’!


1 comment:

Tom Bowden said...

Tom Bowden here, in my view what is needed above all else is a sensible IT strategy, well thought through and then appropriate incentives and if necessary disincentives to make it happen.

In Australia I dont see a coherent health IT strategy in place and that is to me the heart of the problem. At one point it looked as theough the report by Deloitte might go somewhere, however the strategies before and since have left a lot to be desired.

I must say that the steps 1-7 outlined in the posting above are exactly what should happen; payment on results, nice simple and transparent. It deserves support. All other dreams and schemes should be put on hold.

The proposed formula is exactly what we have been advocating for some time. Does anyone have any ideas as to how we could build support for it? get it into place? Recently I heard Dr Pesce quoted as saying the most important way to push the e-Health agenda forward is to fix pathology messaging. Perhaps the AMA might be enlisted to help?