Sunday, April 17, 2011

The NEHTA CEO Knows Things Are Moving At A Glacial Speed - Maybe He Should Tell The Minister Before She Is Embarrassed?

Peter Fleming gave a talk at the Australian Healthcare Summit a few weeks ago.

You can download a copy of the slides from here:

http://www.nehta.gov.au/component/docman/doc_download/1296-australian-healthcare-summit-23-24-march

A couple of the slides in the Health Identifier Service really ‘bell the cat’ on what the real timetables NEHTA has in mind for the HI Service.

Before discussing the slides it is important to keep in mind that the HI Service allegedly went live on July 1, 2010 (at a cost of approximately $90M) and that the funding for NEHTA is only thus far approved until June 30, 2012.

For the PCEHR funding to continue this means there will need to be an allocation in early May 2012 (Budget time) so the time to make a decision is shortening by the day - now close to 13 months.

What happens to both NEHTA and the PCEHR program seems to be linked, in the mind of the Minister for Health at least, to demonstrated outcomes and benefits from the PCEHR program before that date - otherwise the funding is apparently not going to be continuing.

What an astonishing mess that would be. Maybe all this is also going to become a 'change management strategy' as the HealthConnect program realised just how big and costly all this can be!

Let us no look at two slides from the presentation.

Slide 1. Adoption curve for HI in General Practice

Click image to enlarge

This shows the Adoption curve for HI in General Practice. The timeframes talked about extend to 2013 and beyond with only 30% of the population having an HI in use at the end of 2012.

Slide 2. Adoption curve for HI in Acute Care

Click image to enlarge

This slide shows the Adoption curve for HI in Acute care. Here hospital adoption is not really in full swing until 2015.

Allowing that some slippage is virtually inevitable how long is it going to be before all those patients who sign up for a PCEHR are going to have access to any useful content and how will anyone be able to tell if there is something useful or not without signing up?

Of course we still have no clear idea of just what digital identity credentials will be available for and used by patients to access the planned PCEHR portal and how secure that is going to be. Equally how far the National Authentication System for Health (NASH) is along has not been mentioned since the outcome of the Tender (won by IBM) was declared on March 1, 2011.

The HI Service is clearly not going to reach major levels of adoption until 2013 at the earliest, if that, so just how this fits with any real PCEHR capabilities, besides some cute mock-ups and story boards, being available July 1, 2012 is hard to know.

The time to confess this is a badly planned implementation fiasco and come clean with some realistic plans has well and truly arrived.

On a related topic there is at least one area in the Concept of Operations document that is a little economical with the truth.

On Page 108 we read (On the National E-Health Strategy):

“The Strategy identified a national Individual Electronic Health Record (IEHR) System as a high priority. The Strategy envisaged the IEHR as:

A secure, private electronic record of an individual’s key health history and care information. The record would provide a consolidated and summarised record of an individual’s health information for consumers to access and for use as a mechanism for improving care coordination between care provider teams. [AHMC2008]

Since the Strategy was originally developed, the term ‘PCEHR’ is now preferred as it better aligns with the recommendations from the National Health and Hospitals Reform Commission which recommended that a national approach to electronic health records should be driven by ‘the principle of striving to achieve a person-centred health system.’ [NHRR2009].

In 2010, the Government has invested 466.7 million in the first release of a PCEHR System.”

----- End Quote:

What the Strategy actually said was:

“R-2 Foster and accelerate the delivery of high priority E-Health solutions by vendors and care provider organisations in a nationally aligned manner.

R-2.1 Establish a national fund to encourage investment in the development and deployment of high priority, standards compliant and scalable E-health solutions.

R-2.2 Establish a national compliance function to test and certify that E-Health solutions comply with national E-Health standards, rules and protocols.

R-2.3 Adopt a nationally coordinated approach to the development of consumer and care provider health information portals and an electronic prescriptions service.

R-2.4 Adopt an incremental and distributed approach to development of national individual electronic health records (IEHRs).”

So the IEHR was a much lower priority and the concept was also based on a much more traditional and basic Shared EHR with consumer access as a peripheral component. Doing more to support providers was the priority and this has just been ignored.

Also, the IEHR and the PCEHR were and are very different ideas and that point is quietly just slipped over as well!

We really have reached the time for some frankness and transparency on a range of these things!

David.

12 comments:

Anonymous said...

Those adoption curves are ridiculous and can't possibly bear any resemblance to reality.

Looking at IHI adoption, it forecasts 10% of the Australian population will be using their IHI in general practice by July 2011, then a further 20% will somehow decide to use it by July 2012. This is despite the fact no health providers are actually using the service and because of the continuing holds on the service, no vendors have yet implemented IHI's, nevermind deployed IHI-capable software anywhere in general practice.

So the IHI service has been operational for almost a year, and the adoption rate has been zero. (Yes, some consumers have queried their IHI, but none have used it). We're to believe that from an adoption rate of zero for the past 10 months, it will accelerate to more than 275,000 per month for the next ten months - to reach the 10% adoption. Then accelerate to gain adoption at a rate of 370,000 per month. What absolute garbage - there are no drivers, incentives or even capacity within the systems and processes of GP's to support this adoption curve.

There is a point at which this deception by NEHTA executives is less about incompetence and more a question of self-serving negligence to justify their continued existence. NEHTA likes to play both sides - when it suits them, they're a corporation that can do what they like with government money, unaccountable to government. Likewise, when it suits them they're a government entity that can operate without any accountability to the industry they operate within.

So take your pick: bureacractic incompetence or corporate malfeasance.

Sadly, e-health in Australia is going nowhere and the sooner this is exposed and the PCEHR program falls apart, the better. NEHTA has delivered precisely zero, they will not be missed a year from now when they're abolished.

It will be the rest of the people working in eHealth that have to pick up the pieces to restore credibility to what is a vitally important domain.

Anonymous said...

Monday, April 18, 2011 7:00:00 AM said "So take your pick: bureaucratic incompetence or corporate malfeasance."

The truth is that it is a combination of both, with the former leading to the latter; and the more it continues without a forensic enquiry the worse it will get.

The more money they throw at the NEHTA model in its present form the more they perpetuate the modus operandi and destruction of the nation’s ehealth future.

If you pause to scrutinize Recommendation R-2 you will see it says “to foster and accelerate the delivery of high priority E-Health solutions by vendors and care provider organisations”

Further the only immediately useful ‘application’ that I can see which is mentioned in the recommendations you have listed is an electronic prescription service.

When one combines this with R-2.1 “Establish a national fund to encourage investment in the development and deployment of high priority, standards compliant and scalable E-health solutions” one has to ask:

- why, after all this time have NEHTA and DOHA not taken immediate steps to support the two e-prescription exchanges (MediSecure and the Guild’s eRx system) to support their rapid deployment “in a nationally aligned manner”?

This fact alone demands a forensic enquiry.

Bruce Farnell said...

I agree wholeheartedly with Anonymous - Monday, April 18, 2011 7:00:00 AM.

We should then ask what the NEHTA board are doing allowing this deplorable state of affairs to continue. They are failing in their responsibilities in at least the area of corporate governance of ICT.

AS8015, the Australian Standard for Corporate Governance of ICT, defines Corporate Governance of ICT as "The system by which the current and future use of ICT is directed and controlled. It involves evaluating and directing the plans for the use of ICT to support the organisation and monitoring this use to achieve plans. It includes the strategy and policies for using ICT within an organisation."

What is the NEHTA board doing? Are they simply being misinformed - or are they asleep at the wheel?

Anonymous said...

The NEHTA Board are doing what they have always done, that is they take advice and guidance from the CEO and the Board members get additional advice and guidance from their Departmental Heads whilst the DOHA representative (Departmental Head) provides advice on national priorities.

From a Board perspective if the input seems reasonable and a recommendation is made and put to the vote a motion is passed and seconded and everyone moves right along.

It's called good corporate governance, informing the Board and supporting the CEO to carry out the Board's wishes.

Who would know whether the Board is asleep at the wheel or whether they are being misinformed. Board minutes are not available for public scrutiny - in fact, nothing and no-one is available for public scrutiny because that is what was intended when NEHTA was first established. Surely you know that by know - snookered.

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

I think I am suggesting this 'modus operandi' is one of the things that must change for e-Health in OZ to succeed!

David.

Anonymous said...

"I think I am suggesting this 'modus operandi' is one of the things that must change for e-Health in OZ to succeed!"

Sadly it the whole 'modus operandi' of health management that has to change!

To have a greater than $AUD100 Billion industry governed by politicians to meet their short term needs has been an absolute disaster. It means that whole focus of senior health management is to meet political expediency with no focus downward at all in regard to long term planning for the betterment of health and wellbeing of the Australian public.

e-Health is just one example of a myriad of botched and misdirected health 'reforms' which have included chaos in regard to manpower management and an absolute disregard for proper strategic management iccluding financing of capital expenditure or even research.

Any other industry would have sacked their board by now!

It is us taxpayers that are paying the price, now and for a long time into the future - not only financially but probably also with are access to standard of healthcare.

Sorry about the rant but it really is getting past a joke lately!

Anonymous said...

I think most sensible people would agree with Anonymous Monday, April 18, 2011 6:38:00 PM.

It is quite inexplicable why DOHA has not taken steps to ensure these e-prescription exchanges are implemented as a high priority. It seems this one act alone could overcome an enormous number of difficult issues and bring much needed momentum and energy to the market.

Anonymous said...

At least one member of the NEHTA Executive have a qualification as a Corporate Director so you would assume that they know what they _should_ be doing if nothing else.

Anonymous said...

These people are a danger to society. They are consuming a huge amount of resources and diverting the attention of the average consumer of eHealth away from things that work and have a future.

The reality is that they are destroying the potential of real players, replacing real innovation with a glossy fa├žade, behind which there is nothing of substance.

They over complicate the simple pieces while ignoring the parts that are actually complex and need to be done well. This is a sure sign of incompetence as someone who actually gets it makes it look easy, someone who does not hides their lack of ability with unneeded complexity. This is seen in SMD and modelling of the various documents. They have not tackled any of the hard stuff, but make the easy stuff so complex!!!

I am so over NEHTA, Its time for an eRevolt.

Anonymous said...

Hahahahha ... I can't help laughing at the way you say "I am so over NEHTA, Its time for an eRevolt."

That's a joke if ever I heard one. You make it sound so easy but what are you going to do about it? There's not much you can do about it. You just have to grin and bear it dear chap. You don't have the money, the political power or sufficient muscle to take on NEHTA, and even if you did you would have to take on all the jurisdictions and DOHA and Medicare and the Federal government.

And anyway, if by some slim chance an eRevolt of some kind happened it would fizzle out very quickly as you and your like get swallowed up by a big black hole of your own making. Then you'd start complaining all over again.

Has it not yet dawned upon your tiny little brain that this whole ehealth NEHTA thing cannot be changed by your piddling little revolt or is that too hard for you to contemplate?

Anonymous said...

Its OK, don't worry yourself to much, they are already shooting themselves in the foot and their aim is not very good so a head shot is just around the corner :-)

Anonymous said...

"Has it not yet dawned upon your tiny little brain that this whole ehealth NEHTA thing cannot be changed by your piddling little revolt or is that too hard for you to contemplate? "

Watch this space!

Achieving change in the e-health revolution will occur despite NEHTA!