Thursday, January 06, 2011

We Need To Set Some Expectations For the Three Trial Implementation Sites. Transparency and Frequent Progress Reporting Would be a Good Start!

Late last year (August 2010) we had an announcement that 3 sites had been chosen as lead implementation and testing sites for the planned Government PCEHR.

This was followed up by this release.

Applications Now Open For Second Wave e-Health Projects

Hundreds of thousands more Australians will join the e-health revolution as a result of up to $55 million from the Australian Government now available for the next round of innovative e-health projects across the nation.

24 November 2010

Hundreds of thousands more Australians will join the e-health revolution as a result of up to $55 million from the Gillard Government now available for the next round of innovative e-health projects across the nation.

Organisations are invited to apply to be one of the country’s lead sites to help introduce personally controlled e-health records.

“Currently 190,000 hospital admissions a year are caused by medication errors, and eight per cent of these are caused by inadequate patient information,” the Minister for Health and Ageing, Nicola Roxon, explained.

“E-health can improve patient care and save time for patients and doctors by reducing extra or repeat tests that don’t need to be done.”

“Of course, patients will ultimately control what goes into their health record and who can access their information.”

Applications are welcome from a variety of patient settings including from Divisions of General Practice, professional organisations, non government organisations, the private sector and others involved in the care of Australian patients.

The new e-health sites will join the first three selected sites in Brisbane, the Hunter Valley and Melbourne’s eastern suburbs, which are at the cutting edge of enabling Australians to use electronic health records. These sites—covering over seven per cent of the population—will be among the first to send hospital discharge summaries electronically to GPs and referrals using national specifications.

These sites will help lead the way for future planning of a secure, reliable e-health system, improving technology and identifying what works well and what could work better.

Organisations wishing to apply to be one of the next wave leading implementation sites of our nation’s e-health reforms should visit www.health.gov.au/tenders from 4.00 pm today. Applications will close on 23 December 2010 and the new sites will be selected in the new year.

The release is found here:

http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr10-nr-nr182.htm

The respective organisations put out some information as to what was happening and what they were doing:

First here:

GPpartners selected to lead on e-health records

17 August 2010

Brisbane will be one of the first areas in Australia to implement a plan foreshadowed in this year’s Federal Budget for building a national electronic health record system, following an announcement by Health Minister Nicola Roxon earlier today.

GPpartners is one of three Division participants which have received funding to work with the National E-Health Transition Authority (NEHTA) to plan for the establishment of a series of ehealth ‘lead implementation sites’ across Australia.

In addition to e-health records, these three sites will use health care identifiers for patients, providers and hospitals, and will be the first to electronically send discharge summaries and referrals using national specifications.

These sites will help lead the way in developing and informing future planning of the system, improving technology and identifying what works well and what could work better.

GPpartners Chair, Dr Henry Bryan said the Division was well-positioned to assist the government and NEHTA with the planning phase for the widespread adoption of electronic health records.

“GPpartners represents over 800 General Practitioners (GPs) and 200 GP practices, more than any other Division of General Practice in Australia, and we have many years of experience in developing e-health systems locally,” Dr Bryan said.

“We also cover the largest population of any division, but through our roll-out of the Health Record Exchange (HRX) system we’ve already demonstrated our experience in delivering similar projects of this size and scale,” he said.

The HRX is an electronic health record used by GPs to share patient information with other health professionals and hospitals across the GPpartners divisional area on Brisbane’s north side.

The HRX program has been operational for 4 years and is recognised as an Australian exemplar of community based shared electronic health records. The current license for the HRX software (Recordpoint) is supplied by Extensia Solutions Pty Ltd.

“GPpartners is grateful for this new opportunity to articulate its further vision for a truly advanced and connected, twenty-first century health system,” Dr Bryan said.

“We have formed the view that successful adoption of e-health requires ownership at a local community level with community-based care providers able to share patient information electronically across multiple care settings, including, but not limited to, the public health system,” he said.

“In pursuit of that aim, we have partnered with Health Industry Exchange (HIE) and sister Divisions of General Practice to assist the government in developing the implementation plans for lead sites.”

“This announcement today means GPpartners can continue to build upon its pioneering work in the sharing of electronic health records for the benefit of all Australians,” he said.

Also selected to develop implementation plans were Melbourne East General Practice Network (VIC) and GP Access (NSW), situated in the Hunter Valley.

Release here:

http://www.gppartners.com.au/page/About_Us/News_media/press2010/GPpartners_selected_to_lead_on_e-health_records/

and here:

GP Access to take the lead on ehealth records

17 Aug, 2010

GP Access is pleased to confirm that is has been selected as a lead site by the Commonwealth Government to develop an implementation plan for electronic health records

Health Minister Nicola Roxon has announced GP Access is one of three participants to receive funding to work with the National E-Health Transition Authority (NEHTA) on establishing an ehealth lead implementation site, as identified in the 2010/11 Federal Budget.

In addition to e-health records, GP Access will be using health care identifiers for patients, providers and hospitals, and will be the first to electronically send discharge summaries and referrals using national specifications.The purpose of the lead implementation sites will be to:

  • Deploy and test national e-health infrastructure and standards in real world settings
  • Demonstrate tangible outcomes and benefits from funded e-health projects
  • Build stakeholder support and momentum
  • Provide a meaningful foundation for further enhancement and roll-out of a national electronic health record.

GP Access CEO, Dr. Mark Foster said the Division was well-positioned to assist the government and NEHTA with the planning phase for the widespread adoption of shared electronic health records.

“GP Access represents over 450 General Practitioners (GPs) and 151 GP practices; we are one of the largest Divisions of General Practice in Australia. We have many years of experience in developing ehealth systems locally and we have the highest uptake of broadband by GPs in Australia. Our success in getting GPs to embrace technology has been assisted by our employment of dedicated IT professionals who have the specialised expertise in General Practice information management & technology systems as well as experience in the wider health sector.” Dr. Foster said.

“We have already demonstrated our experience in delivering electronic health records through our after hours service which employs over 250 GPs and sees around 50 000 patients each year. Every patient that is seen in our after hours service has a record of their consultation sent via secure electronic messaging to their GP. The record is sent instantly so when the patient sees their regular GP for a follow up consultation, a complete record of their visit is stored on the patient’s file,”

“GP Access welcomes the opportunity to participate in a program that will demonstrate the potential and benefits for an advanced and connected, twenty-first century health system,” Dr. Foster said.

GP Access will be working with Melbourne East General Practice Network (VIC) and GPpartners (Qld), situated in the Brisbane metropolitan area who have also been selected as trial sites.

Release here:

http://www.gpaccess.com.au/news.php?action=show&news_id=266

and there was a mention of the success of the Melbourne East GP Network which can be found here:

http://www.megpn.com.au/

It has now been confirmed that after a hiatus for the election it is all running smoothly at the three sites:

Suspended e-health plans now on track

Josh Taylor, ZDNet.com.au

Workshops and the trial sites for e-health roll-out in Australia had to be stopped in the course of the election, but they're now back on track, according to National e-Health Transition Authority (NEHTA) CEO Peter Fleming.

In the 2010 election campaign, it was unclear what the Coalition was intending to do instead of the $466.7 million investment in e-health outlined by Labor in the May budget; the spend was expected by many to be reduced significantly. According to Fleming, this meant any projects that didn't come under the Council of Australian Governments budgets were put on hold while the outcome was determined.

"Anything that came under the $466.7 million the Commonwealth had announced we needed to be fairly quiet on. We were still working but not on that particular component," Fleming told ZDNet Australia.

"Prior to the election being called we had actually started a series of workshops around the concept of operations for an electronic health record and also the architecture [and] when we went into caretaker mode those workshops had to be stopped," Fleming said. "But they've been reconvened, almost immediately as you'd expect, and the intention there is to get a very diverse series of views from all of our key stakeholders, document that and publish it for very wide input."

The work on the three test sites for e-health records also had to be halted.

"Because we've been in caretaker mode and the announcements [on the three e-health record trial sites] were made just before, we haven't been able to enter into extended dialogue on that," Fleming told ZDNet Australia. "We're now in deep dialogue with the three sites but more importantly we're bringing in external parties into that dialogue now."

With the Federal Government's investment in e-health now secured due to the Labor Party's return to power, Fleming said these three sites will serve as the catalyst for kicking off e-health around the country.

"What you can expect to see is a very strong focus on implementations. Firstly around implementation of the [health identifier] services in the foundation program and then around implementation of the next level of our work program, which is things like discharge referrals. And that will ultimately lead to the [personally controlled e-health record]," he said.

More here:

http://www.zdnet.com.au/suspended-e-health-plans-now-on-track-339305955.htm

As far as I am concerned there is only one problem. Since the releases and announcement that all was rolling on the silence has been deafening.

As best I can tell the last material that appeared was this report:

NEHTA calls for GP software proposals

  • Karen Dearne
  • From: Australian IT
  • November 19, 2010 6:00PM

MEDICAL software-makers are being asked to help "test and finetune" currently undefined specifications for the Gillard government's $467 million personally-controlled e-health record program, which is yet to be explained in detail.

The National E-Health Transition Authority has called for proposals from GP clinical desktop suppliers willing to join a panel and work alongside it and the three e-health implementation sites announced by Health Minister Nicola Roxon in August.

During the election campaign, Ms Roxon announced $12.5m in total funding for GP divisions in Brisbane, NSW’s Hunter Valley and Melbourne to act as pilots over the next two years.

NEHTA received an extra $300,000 to co-ordinate the project; earlier the three parties -- GP Partners, Hunter Urban and Melbourne East -- had been invited to develop "lead implementation site" proposals for which they were paid $100,000 each.

Selection of the sites raised industry eyebrows as there was no public consultation or tender process.

Lots more here:

http://www.theaustralian.com.au/australian-it/government/nehta-calls-for-gp-software-proposals/story-fn4htb9o-1225956723414

Now we all know there has been over a decade of trials and pilots of e-Health in Australia starting with HealthConnect and Mediconnect and more recently with some State based programs and various other initiatives e.g. Healthelink.

As a matter of almost absolute uniformity each trial has essentially gone nowhere and has typically resulted in a non-sustainable non-continuing outcome with either no public evaluation or an obfuscatory whitewash appearing a year or so after the project finished. (The only possible exceptions I can think of are some of the work in the NT and the Pen Computing tools developed in SA.)

What is needed with these three trial implementations is a total break from the past.

Where we need to start learning in the new era is with how the 3 lead implementations are being planned and managed.

We need an overarching statement of strategic objectives, impacts and expected outcomes.

Additionally, for each of these 3 there should also be a public project and resourcing plan, defined objectives, evaluation criteria, time-lines and all the usual expected material. Each project should also be producing monthly reporting publicly on progress against the plan and so on.

The best way for this to happen would be for NEHTA, who is being paid as project manager, to establish a section for this on their website and report as I suggest openly and fully as to how things are going, what is being learnt and so on.

If we don't see something like this then I will know we have the same-old, same-old and it will all go nowhere.

Who is betting on the old rather than a new open approach being adopted by NEHTA? We shall see!

David.

1 comment:

Anonymous said...

As you have so often said, what is needed (in addition to a change in approach) is a functioning governance structure. At present there is nothing like that visible and while DoHA continue to use NEHTA as the "delivery manager" it is highly unlikely that any reasonable form of program governance will appear.
The sooner the Australian National Audit Office undertakes a review of DoHA's management of eHealth the better.