Thursday, March 03, 2011

Silence and Compliance Looks Like It Is Being Purchased By NEHTA / DoHA. A Pretty Sad Situation for Our Democracy.

Amazingly, this morning, I had 2 e-mails from CEO’s of private e-Health companies in Australia within half an hour on the same topic.

Both had a pretty simple message.

They both felt that the management and delivery of e-Health in Australia was bordering on the disastrous but they both felt that the commercial cost of them speaking out - not only in terms of their own companies and the people who rely on them for a salary - with what amounts to a single funder of e-Health in Australia - would be personally and financially a risk that they were not prepared to take just yet.

Both, however, made it clear that they were reaching a point where they were going to go down with their ships shouting ‘damn the torpedos!’.

Over the last couple of months I have had a number of other senior players both in the private and public sector express similar sentiments.

This situation really needs to change, and I really believe those who are concerned about the strategies and directions being taken by DoHA and NEHTA should be able to speak honestly and openly without any threat of financial or other penalty.

We will only get the best solutions for our national e-health aspirations if the climate of apprehension and fear are publicly denounced at Ministerial level as being counter-productive and dangerous and steps are taken to sure it goes away.

I can say from personal experience that some NEHTA staff have the most offensive and nasty modes of behaviour on occasion and occasionally behave in ways well beyond what is acceptable in civilised society.

Given the dependence of so many small private providers of e-Health on continued governmental beneficence maybe the MSIA might think of developing some form of ‘code of practice’ to try and make sure there is more balance in the Govt / Vendor relationship.

Reading between the lines I suspect at least this substantial vendor has similar views:

Government funding distorts developments in e-health

  • VENDOR John Frost, HCN

JOHN Frost says governments should butt out of e-health project funding.

"The biggest impediment to the e-health success is government funding, because it undermines the development of genuinely sustainable systems," he says.

"Project funding creates a feeding frenzy where industry is chasing that dollar instead of building their businesses on stuff that makes a difference.

"People lose sight of the fact that e-health is not about standards, or software, or election platforms -- it is about patients, their safety and wellbeing."

The market leader in software for doctors, HCN's success comes from reducing potential for mishaps and providing systems that give doctors more time with patients, Mr Frost says.

Instead of funding pilots, government should fund outcomes. "A successful pilot for 200 sites is Mickey Mouse stuff," he says.

"If we do the development work for the personally controlled e-health record program, we won't just be rolling it out to a few hundred sites, we'll roll it out in 6000 sites across the country. And that will make a difference."

More here:

There is serious work to be done by both sides around all this to make things work. We really can’t let the status quo persist in my view.



Anonymous said...

Errr and how did MD become the market leader I ask you Mr Frost? I recall some significant govt intervention back in the day.... Maybe it is time to admit you are part of the problem as well and not just the answer

Anonymous said...

Well if Mr Frost would cooperate with other software vendors in the exchange of information new horizons will open up for all. Unfortunately, Mr Frost and his company have consciously practiced their 'frosty' attitude towards being non-cooperative almost as an art form to the extent that others have been forced to develop work arounds to access the information contained in MD's database. Pity the ACCC doesn't serve one to him in the national interest.

Tom Bowden said...

I think we should be grateful to John Frost for having the fortitude to take this stand. IMHO he is absolutely right, the best results in e-health are in environments where government sets goals, rules and the incentives/ disincentives but stays off the pitch. One-off funding for tightly specified projects has led to a series of dead-ends.

For the record, I have found John and his company great to deal with, business-like,fair and straight-up. I think it is a bit rich for a couple of annonymoids to use the cover of their annonymity to hurl rocks. Come on, be fair.

Anonymous said...

"HCN's success comes from reducing potential for mishaps". A bit of a sick joke? (Pardon the pun!) I think some still current and former customers of his would disagree. Vendors like his give some of the reasons for NEHTA to exist...

Anonymous said...

HCN may not be a paragon of health sector collaboration but John Frost has made some very valid points about how the government (including NEHTA, despits its ridiculour claims that it is not a public sector organisation) is managing eHealth. Funding policy for eHealth is a half-baked crock of rubbish that does not even attempt to deliver a sustainable commercial model for the sector (at any level, from vendors through to consumers) - while managing to achieve the most egregious waste imaginable in public spending programs.

In the most recent example of this, DOHA has announced that it has awarded a contract to McKinsey to undertake two reviews of health sector readiness to participate in eHealth. Several week's work for a couple of conmpetent consultants - for $1,550,000. At least one competitive bid from a highly regarded local team of strategic consultants (with a strong record in the health sector) came in at $400,000 - and was overlooked.

This is simply unconscionable. The difference between the two bids, almost $1.4m, should be paid to McKinsey out of the salaries of the bureacrats that approved this wanton waste!

Anonymous said...

If the "private e-Health companies" actually behaved in a normal commercial manner, adhered to standards, and kept their technologies up to date without demanding Government bribes, we would have a much saner e-Health sector.

It seems to me that the chickens that were set flying by the "private e-Health companies" via MSIA and AIIA are now coming home to roost!

What goes around, comes around.....

Anonymous said...

"If the "private e-Health companies" actually behaved in a normal commercial manner"...

Looks like someone needs a reminder of what drives private companies (I recommend reading some of the works of one Adam Smith). For good and for bad - these companies are and will be incentivised to maximize shareholder value. Don't shoot the messenger, but incentives in this market are not aligned in a way that maximizing shareholder value and adherence can converge. The private companies are behaving normally. there's a good chance you are reading this post on a iPhone, iPad, MacBook etc. - another perfect example how in the real world, companies can make gains while not being very open or standard conformant (although they'll deny that every morning, afternoon and night).

Anonymous said...

What we are witnessing is the wholesale destruction of shareholder value in the eHealth industry.

Under this current plan, there are going to be a few winners (the consultants, the snouts in the trough, the cronies, the bag men and the back slappers) but the small, medium enterprises, the risk takers, the inventors, the innovators are going to get crushed.

That is happening in the telco sector simultaneously with the NBN industry restructure. SME ISPs are being wiped out en masse or will be if the NBN gets up and creeps its scope.

Consumers are getting shafted too with the introduction of a carbon tax, the flood levy etc.

We're not quite seeing Kevin Rudd's promises being delivered are we?

What has happened to the NHHRC Reform Recommendations, the Primary Care Reform, the Preventative Health Reform.

All talk, all politics, no action except a whirlwind of targetted spending and pocket lining between now and 30 June 2012.


Anonymous said...

"non-cooperative almost as an art form to the extent that others have been forced to develop work arounds to access the information contained in MD's database."

I don't know that 'forced' is the right one is holding a gun to their head. Peddlers of these bolt on products are simply pursuing their own commercial interests and forging ahead under less than ideal circumstances with scant regard for the potential risks. The PCEHR is going to magnify this problem as we're seeing all sorts of monkeys now swinging through the trees with their weekends worth of government fundable code between their teeth.

If HCN doesn't want to publish APIs to their product, that's a matter for them and their customers...the hangers on and pundits don't get a vote.

No one is forcing HCN's customers to use their products, and arguably there are better and cheaper options for these folk to pursue, most of which are developed by vendors that are more forthcoming with sanctioned and supported access to their product.

Jim cocks said...

Anonymous (Friday, March 04, 2011 12:04:00 PM) makes the statement "No one is forcing HCN's customers to use their products, and arguably there are better and cheaper options for these folk to pursue, most of which are developed by vendors that are more forthcoming with sanctioned and supported access to their product"

Quite correct. The problems arise when the client wants to change software vendor but has to migrate the existing patient data. In this respect HCN are very unforthcoming, indeed at one stage they were encrypting access to their database tables. While there is a strong argument that the IP for the code itself and the business logic it contains remains with the vendor, the situation with patient data is less than clear - my understanding was that the GP actually legally owned the patient data.

This issue also arises when a GP migrates to another practice and requests that their patients data be made available to them from the records held by their current practice.

Add to this scenario the questions of privacy and data security, never mind the rights of patients to access their own data, and the data structures used, and the decision to move to another vendor is not simply based on licensing costs and functionality.