Tuesday, May 24, 2011

NEHTA And DoHA are Really Spin Central - How Can The Public Take These People Seriously?

We have had some responses to Questions on Notice from the Senate Estimates session a couple of months ago and just before the next session next week!

Here are some selected highlights.

Senate Community Affairs Committee

ANSWERS TO ESTIMATES QUESTIONS ON NOTICE

HEALTH AND AGEING PORTFOLIO

Additional Estimates 2010-2011, 23 February 2011

Question:E11-066

OUTCOME 10: Health System Capacity and Quality

Topic: NATIONAL EHEALTH TRANSITION AUTHORITY (NEHTA)

Written Question on Notice

Senator Boyce asked:

a) There is in existence a document that outlines a plan to eliminate ‘Argus Connect’, a supplier of medical messaging software from the Northern Territory market. Is it true that the chief executive of NEHTA, Peter Fleming, initially denied its existence?

b) Is it true that when shown the document he then claimed it wasn’t a NEHTA document?

c) What proof can you provide to support his claim?

d) If the document is indeed a NEHTA document would its contents be sufficient to warrant an investigation by the ACCC?

Answer:

NEHTA has advised the Department that:

a) NEHTA is aware of the project plan prepared by Northern Territory Department of Health and Families (NTDHF), (and documented by NEHTA) pertaining to the Web Services Messaging Application, (WSMA), Project which did state that NTDHF would replace the Argus secure messaging systems in the Northern Territory, and would replace Argus secure messaging systems for the Shared Electronic Health Record Service (SEHR) with NEHTA specification compliant web services. It also stated that as part of the expected outcomes that future release of the NT WSMA project would replace Argus Messenger in all NTDHF sites for the same reason.

The WSMA Project is a NTDHF project initiative to replace non compliant messaging product with product that is compliant with NEHTA specifications for secure messaging.

It should be noted that the project plan is a joint document that reflects the NTDHF requirements for this project. The information contained in the WSMA project plan was supplied by the NTDHF.

b) In regard to the NTDHF project plan for the WMSA project as referred to in part a), whilst this document was co-authored by a NEHTA employee using a NEHTA template, the information contained in the document, including the project plan itself, was provided by the NTDHF.

c) The document itself clearly talks about the WMSA project being a NTDHF project and it also talks about the expected outcomes of the NT secure messaging project. This detail in the document clearly delineates the articulated desire by the NTDHF to move to a NEHTA specification compliant product. The project plan also clearly describes NEHTA’s role as providing technical expertise and knowledge transfer to inform and assist so that the NTDHF product is compliant with NEHTA specifications.

d) The desire by the NTDHF to move from a non-compliant to a NEHTA specification compliant product that would also address administrative and performance issues associated with the Argus Messenger Product would appear to be a legitimate strategy for a jurisdiction to adopt.

See here for background

http://aushealthit.blogspot.com/2010/02/major-trouble-seems-to-be-brewing-in-e.html

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Question: E11-067

OUTCOME 10: Health System Capacity and Quality

Topic: NATIONAL EHEALTH TRANSITION AUTHORITY (NEHTA)

Written Question on Notice

Senator Boyce asked:

a) Did NEHTA ever present to DoHA or the Minister an identifier or summary health record system based on the putatively stolen property?

b) How much did they spend on computer forensics, lawyers, the time of senior staff etc in the attempt to take control of the IP of the patent?

c) Did NETHA ever intend to make use of the IP of the patents?

Answer:

a – c)

NEHTA has informed the Department that this information relates to an on-going legal matter which is confidential and subject to legal professional privilege.

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Question: E11-070

OUTCOME 10: Health System Capacity and Quality

Topic: NATIONAL EHEALTH TRANSITION AUTHORITY (NEHTA)

Written Question on Notice

Senator Boyce asked:

In its mission statement, NEHTA talks of ‘working openly, constructively and collaboratively with consumers’. So why does the vast bulk of NEHTA’s work focus on stakeholders rather than consumers?

Answer:

Consumers are a key stakeholder group and are a high priority in the implementation of NEHTA’s work program. In 2007 NEHTA established a Stakeholders Reference Forum and a range of Reference Groups to seek stakeholder input on the NEHTA work program. Consumer involvement is prevalent across these reference groups. Specific consumer engagement activities are also undertaken on particular projects such as the healthcare identifier and personally controlled electronic health record (PCEHR) projects.

NEHTA has advised that since the announcement of the PCEHR system in early 2010, consumer representatives have been involved in 39 forums including stakeholder working group meetings and roundtable discussions held to progress design and delivery of the PCEHR system. On 20 January 2011, NEHTA established a Consumer Reference Group to assist with discussions on PCEHR related issues.

In addition to these forums, NEHTA has established a web portal, ehealth collaborate, to allow consumers and other stakeholders to contribute their ideas and feedback.

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Question: E11-073

OUTCOME 10: Health Systems Capacity and Quality

Topic: eHEALTH

Written Question on Notice

Senator Boyce asked:

Can the Department provide the evidence that supports the approach being adopted with the PCEHR as opposed to other approaches to eHealth?

Answer:

The proposed approach for Australia’s national personally controlled electronic health record (PCEHR) system has considered the lessons available from early regional scale implementations and larger scale international systems to develop a model specifically targeted to Australia’s healthcare context.

The PCEHR system takes a combined approach to interoperability - one which is tailored to support the Australian federated, multi-layered, public and private health system.

Australia’s approach is based on leveraging existing systems and distributed sources of health information as a basis for populating a consolidated view of an individual’s health information. It is built on the National eHealth Strategy principles, the foundations for information exchange currently being developed through National eHealth Transition Authority and the introduction of the healthcare identifier service.

This is consistent with international experience where an evolutionary rather than a ‘big-bang’ approach is being found to be more effective in lowering risks and costs and increasing uptake by consumers and providers.1,2 In contrast, the same analysis has shown that approaches relying on localised organic growth, can lead to limitations on the information that can be captured and shared for the benefit of broader health outcomes.

The national PCEHR system will comprise a secure network of systems that will provide access to consolidated and summarised health information drawn from multiple source systems for individuals who choose to participate.

1 Coiera, E. Building a national IT system from the middle out. J Am Med Inform Assoc. 2009;16:271-273.

2 Devlies J, De Moor G, De Clercq E, Vandenbeghe A. Health Data Exchange, Health Data Sharing and Decentralised Clinical Data Collections - Recommendations from a Belgian Expert Group. In: De Clercq E, De Moor G, Bellon J, Foulon M, Van Der Lei J, editors. Collaborative Patient Centred E-Health. Amsterdam: IOS Press; 2008.

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Question: E11-074

OUTCOME 10: Health Systems Capacity and Quality

Topic: eHEALTH

Written Question on Notice

Senator Boyce asked:

Now that the PCEHR is approved and being implemented why is it that the public cannot review the business and benefits cases that you claim have been developed and approved by Health Ministers?

Answer:

The National E-Health Strategy released by Health Ministers in December 2008 outlines the expected benefits and the steps for developing a national electronic health record system.

The business and benefits case referred to is not a Commonwealth document and was developed through a multi-jurisdictional process. Any decision to release the document publicly would require agreement of all jurisdictions.

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All I can say is that reading non-responses like this just turns the brain to mush!

It is clear there is an absolute determination to minimise openness and transparency and that there are some of these answers which sail pretty close to being just untrue.

As an example I know there does exist a Business Case for the PCEHR that was prepared by NEHTA and given to Treasury to justify the $477 Million over 2 years in the Budget before last. It should be available to the Senate, if they ask, in my view.

It is also clear the evidence base for the PCEHR does not exist as neither of the two papers cited in any way recommend the implementation of a PCEHR - given the term did not even exist when they were written!

When I was young and naïve I believed behaviour of this sort would be promptly exposed and corrected - now I am older and maybe a little wiser I am just resigned to the abuse Government meets out to all of us!

I leave it as an exercise for the reader to find the other little pieces of economy with the truth!

David.

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