Wednesday, July 20, 2011

NEHTA Put On Notice By The Opposition - Lift Game Dramatically or Else!

Senator Sue Boyce spoke this morning at the “Third Annual Technology In Health Administration Conference” which was held at the SWISSOTEL in Sydney this morning. The Conference runs for two days and the program can be found here:

http://www.chilliiq.com.au/pdf/3rd_annual_technology_in_health_administration-brochure.pdf

There is press reaction here:

NEHTA fails to deliver e-health on time: Boyce

Liberal Senator for Queensland, Sue Boyce, has delivered a scathing criticism of the National e-Health Transition Authority and its work in the roll out of e-health projects

Liberal Senator for Queensland, Sue Boyce, has criticised the National e-Health Transition Authority’s (NEHTA) work in the rollout of e-health projects across the country, claiming it has repeatedly failed to deliver projects on time.

Addressing attendees of the Technology in Health Administration Conference in Sydney, Boyce said NEHTA constantly changed goals, plans and deadlines to ensure that tracking its progress is almost impossible.

“To be blunt I don’t think they’ve done anything much ... except waste a lot of money and a lot of time,” Boyce said.

“NEHTA loves a guiding principle, and a vision and a purpose and a mission it sometimes sounds more like a cult than a builder of anything.”

According to Boyce, NEHTA’s mission to articulate the end-to-end application of e-health solutions in Australian healthcare by incorporating interoperability and integrating technology has failed.

“At every stage, I believe, NEHTA consultations have begun too late in the process. Certainly, not in time to produce the ownership and the efficiencies so necessary to the success of such a complex implementation.”

Boyce notes NEHTA’s latest strategic plan in regards to the National Authentication Service for Health (NASH), in which it defines issues and concepts, plans and definitions but fails to address any sort of project completion detail.

“I’m all in favour of definitions — and standards," she said.

"Without agreed definitions and agreed standards, we cannot measure progress of any sort... But 15 years on and we are still sorting out definitions and standards.

“Naturally, there is concern that this again is nothing more than a figment of NEHTA’S delusion of progress.”

She cites the Federal Government’s allocated funding for NEHTA from 2005-2011, to which global advisory firm Boston Consulting Group in 2007 described as “a solid foundation on a very lean budget”.

“In an ominous warning for the future, the Boston Consulting Group also said that NEHTA had set ‘overly ambitious targets’ and noted that many stakeholders were dissatisfied with the national body because of a ‘cycle of criticism, defensiveness and isolation’,” Boyce said.

In its 2010-11 budget, the Federal Government allocated $466.7 million over a two-year period to develop a Personally Controlled Electronic Health Record (PCEHR), a system which every Australian will be able to “opt in” from July 2012.

Boyce criticised the system, which has been designed so that patients can access and control what information is included in their record as medical practitioners will not be able to trust what is contained in the record.

“A system designed for use by clinical professionals is an utterly different beast to the system that might be designed to help a consumer keep track of their basic health information and the health story,” she said.

“In fact some have argued in the strongest terms that creating a system to be used by consumers and clinicians is just a fundamental nonsense.

“In terms of system design and implementation, any system targeting both groups will satisfy neither.”

More here:

http://www.cio.com.au/article/394275/nehta_fails_deliver_e-health_time_boyce/

and here:

'Pause' PCEHR, says opposition

  • Fran Foo
  • From: Australian IT
  • July 20, 2011 1:03PM

THE Opposition has called on the Gillard government to hit the pause button on the $467 million electronic health records project until a "thorough assessment" on e-health is conducted.

The call comes less than 12 months from the roll out of the opt-in, personally controlled e-health record (PCEHR) system.

In a vitriolic speech, Queensland Liberal Senator Sue Boyce ironed out what she described as "failures" in e-health implementation over the years.

She gave participants at a health administration conference in Sydney a history lesson on public sector e-health initiatives since the late 1990s during the Howard era and vowed to share what "needs to happen next".

Senator Boyce was especially scathing of the progress and role played by the National E-Health Transaction Authority (NEHTA), the publicly funded body charged with implementing the PCEHR scheme.

More here:

http://www.theaustralian.com.au/australian-it/government/pause-pcehr-says-opposition/story-fn4htb9o-1226098293789

I have been provided with a draft of the speech - which will provide some context - but probably be a little different to what was actually said - as these things usually are:

TECHNOLOGY IN HEALTH ADMINISTRATION CONFERENCE

SWISSOTEL 20-21 JULY, 2011

TOPIC: “A response to the current government's directions of E-Health:

A possible platform for the Liberal Party's intended direction.”

SPEECH

Senator for Queensland : Sue Boyce

It’s almost 15 years since Australia acted on the recognised need for a national, consistent e-health system so whilst there has been a good deal of progress towards one, I believe we—all of us: politicians, health professionals, taxpayers--are totally justified in asking the question: “Well, where the bloody hell is it?”

Many of you will already operate with hospital-wide or service-wide electronic databases.

I mentioned speaking at this conference today to a friend recently who does the day-to-day management of one of Australia’s largest liver clinics in one of Australia’s largest hospitals.

Her response was: “But my hospital already has an e-health system, what’s the big deal?”

Of course, as you all know the “big deal” is that almost every hospital—and I’ll get to ‘what is a hospital?’ later—every health service provider of any size already has a system, in many cases, systems.

All those systems just don’t talk to each other and they generally don’t involve any interaction with the reason that any of us are here—the patient.

So what I’ll be doing today is discussing the history of getting to the point we are now at and what, I believe, needs to happen next.

When my children were small, I used to equate “getting ready for an outing” with a giant juggernaut getting up a head of steam.

There would be the washing and dressing of children, the packing of spare clothes and of food, the finding of favourite toys—dozens of behind-the-scenes, time-consuming activities—until finally we burst out the front door “ready to go”.

Well, our e-health journey seems quite like that to me—except I’m not at all sure that we know where the front door is.

But I think it important that we do take the time to reflect, to observe and to consider where we’ve been, where we’re going and where it is we want to go.

And it seems to me that we may have neglected some of the most important things about good quality public policy.

The rationale of E-Health systems is that providers, provider organisations and patients can securely and efficiently exchange data and can, as a result, have the potential to unlock substantially greater quality, safety and efficiency benefits.

When the Howard Government came to power in 1996, various state and territory governments had already committed funding to a variety of E-Health projects. A number of rural health pilot projects were already underway.

Governments were enthusiastic about the potential of E-Health because it would alleviate some of the problems for rural Australians in accessing medical services and, hopefully, ease overall pressures within the health system—for example, E-Health promised to provide services which could keep an ageing population out of institutions and address some of the health inequity experienced by specific groups, such as indigenous Australians.

It also promised to reduce unnecessary duplication of services, waiting time for patients and clerical errors.

But it wasn’t really going anywhere at this point with doctors having little incentive to take it further as Medicare rebates were still based on face- to-face consultations.

One of the biggest barriers to further development were concerns about privacy and the secure confidentiality of patient records.

There was a reluctance to share information and E-Health was really no more than a few fragmented blips on the radar of our health system.

In 1999 the first steps towards implementation of a National E-Health policy were taken with the establishment of a National Health Information Management Advisory Council (NHIMAC).

In collaboration with the Commonwealth, state and territory governments and relevant health stakeholders, NHIMAC conceived a ‘grand plan’ for E-Health—Health Online.

Launched in November 1999, the main focus of the plan was a series of wide-ranging national action strategies.

In July 2000 this Taskforce proposed the HealthConnect project.

The project received funding of $128.3m over four years to ‘develop a secure national health information network’.

The first stage of HealthConnect, the Better Medication Management System (BMMS), was intended to enable the use of consumers’ Medicare numbers to create a personal electronic medical record.

This record was to have linked prescriptions for medications written by different doctors and dispensed by different pharmacies.

There were widespread concerns within the medical community about the BMMS, which later changed its name to “MediConnect”.

In particular, there was a strong view that the scheme was being developed in haste and without the inclusion of necessary privacy protections.

Live trials were conducted in Tasmania and the Northern Territory.

Then there was the Medicare ‘Smart Card’ which was to be an integral component of the HealthConnect strategy.

The card was to hold information such as the holder’s organ donor status and PBS expenditure data in addition to providing access to standard Medicare services—all accompanied by a photo of the holder.

The then Minister for Health and Ageing, Tony Abbott, was enthusiastic about the card, declaring that it would deliver significant health savings and substantially better health care.

The Opposition Health spokesperson at the time, Julia Gillard, was equally keen and urged the Government to ‘roll out’ the card.

An ‘opt in’ trial of the card was undertaken in Tasmania from January 2005, but few people were interested in participating--only about one per cent of those eligible.

While no clear announcement of the suspension of this trial appears to have been made, the Government confirmed in May 2006 that it had abandoned the pilot.

It announced instead that it would introduce an access card which would replace a number of welfare cards.

But less than six months later the Opposition revived the idea of a specific health card after Medicare statistics were released showing that more than 70,000 people had faked illness to gain government-subsidised drugs.

Privacy concerns were still dominant and there was also concern expressed about Smart Cards and about “Function Creep”: when customer or patient data stored for one purpose, such as medical records, is used for another purpose or the data shared with another party for a new purpose.

The function creep issue, far from resolved, has resurfaced in relation to the current Government’s personally controlled electronic health records proposals.

In 2004, a report to government by the Boston Consulting Group (BSG) advised that a central collaborative body was needed to help implement e-health strategies.

Partly in response to this report, later in the same year the National E-Health Transition Authority (NEHTA) was formed to develop better ways of electronically collecting and securely exchanging health information.

To this end, the authority has received various funding allocations in the period from 2005 to 2011–12 totalling $366.2 million.

And this is all mandated and funded by the Council of Australian Governments (COAG).

In 2007 the Boston Consulting Group reported that Nehta had laid down a solid foundation on a very lean budget … but unfortunately that was about as good as it got for NEHTA.

In an ominous warning for the future, the Boston Consulting Group also said, that NEHTA had set ‘overly ambitious targets’ and noted that many stakeholders were dissatisfied with the national body because of a ‘cycle of criticism, defensiveness and isolation’.

In BCG’s view:

“Where engagement did occur, it appears often to have been one way, with little acknowledgement of stakeholder requirements or suggestions, and little patience with their lack of pre-existing understanding. Two thirds of stakeholders said that NEHTA did not acknowledge or respond to their feedback when they had engaged.”

BCG also found that: “Two-thirds of external stakeholders complained that NEHTA was not transparent enough.”

It seems that every stage of development, NEHTA has faced the same criticisms.

In 2009-10, the Medical Software Industry complained bitterly and legitimately about being asked to participate after so-called consultation that lacked any real-world industry experience.

Most recently, health consumer organisations have been brought into the NEHTA tent but only after trenchant criticisms.

At every stage, I believe, NEHTA consultations have begun too late in the process. Certainly, not in time to produce the ownership and the efficiencies so necessary to the success of such a complex implementation.

NEHTA’s exclusion from the provisions of the Freedom of Information Act perhaps tells the real story.

The same criticisms are still being made … as are NEHTA’s somewhat redundant denials.

When Labor came to power in late 2007, it commissioned Deloitte to conduct an investigation into the state of E-Health and found that:

“Australia lagged behind comparable countries in e health development by years, or even decades.”

It would seem E-Health is an orphan child that everyone wants but no one wants to look after.

The Rudd government introduced its own E-Health national strategy and while it was framed in new terms, fundamentally the strategy echoed the previous government’s approach.

In early 2008 NEHTA began working on development of a secure messaging platform which will be integral to a national e health system.

It’s called the National Authentication Service for Health (NASH).

In its latest Strategic Plan, NEHTA, in dealing with NASH, has 10 separate headings:

6 of them are about defining terms, issues and concepts…

3 are about plans and

None are about completion.

In another section of 11 separate ’actions’ all were about creating… wait for it…definitions.

Now, I’m all in favour of definitions—and standards. Without agreed definitions and agreed Standards, we cannot measure progress of any sort—whether it’s Closing the Gap for indigenous Australians, the comparative performance in the jurisdictions of the hospital system, even the true level on unemployment or of homelessness.

The Australian Institute of Health and Welfare (AIHW) is one of my absolutely favourite organisations. The Australian Bureau of Statistics are OK, but they should have a bigger budget.

But 15 years on and we are still sorting out definitions. And Standards—well, as you will all know, there we don’t just have to deal with the COAG or the Australia-New Zealand morass, we have to interact with the international morass.

Naturally there is concern that this again is nothing more than a figment of NEHTA’S delusion of progress.

Long-time NEHTA critic, Dr David More, has said:

“... for almost 3 years we have been told NASH is coming and now we discover it was just a twinkle in someone’s eye and will now be designed and developed externally because NEHTA can’t quite work out how to do it ... Incompetence piled on deception adds up to me to a serious need for some management accountability to be delivered with some major resignations for having wasted public money”.

IBM Australia was awarded the $23.6 million contract on March 1, 2011, to deliver the NASH service by the end of June 2012.

The 2010–11 Budget allocated $466.7 million over two years to create a personally-controlled electronic health record (PCEHR) for every Australian who agrees to one—that is, for every Australian who agrees to opt in to the system.

Having a PCEHR will not be mandatory for an Australian to receive health care.

It is anticipated that those who choose to opt in will be able to register online to establish a PCEHR from July 2012.

The Government released a draft plan for the PCEHR in April 2011, the Draft Concept of Operations Relating to the Introduction of a Personally Controlled Electronic Health Records System (Con Ops).

The Con Ops suggested how the PCEHR system may look, what information it might contain, and how it might function and connect with existing clinical systems.

Consumers, medical providers and IT experts expressed dissatisfaction with the plan claiming it was ‘impractical, unsafe and waste of money’.

Some were unhappy that it had been largely developed ‘away from the public gaze and in secret’.

Again it’s a charge NEHTA denies but it can be said that many groups in the world of IT and E-Health have little respect for NEHTA, its output or its assurances.

Further criticism was that the Government’s intention to allow patients to decide who will access their records will mean that medical practitioners will be unlikely to trust the information contained in the records.

The AMA has argued from this perspective that as patients will be able to mask information, the promised improvements to health outcomes will not eventuate; indeed that records with hidden information will be more dangerous than no record at all.

Moreover, the peak medical body has labelled patient control as a ‘medico-legal minefield’.

In the pharmacy area, a recent study by a group of Boston researchers found that, in the American E-Health system, “electronic prescriptions” are as likely as handwritten ones to contain errors with the same error rate of one in ten.

This brings us to another fundamental problem.

A system designed for use by clinical professionals is an utterly different beast to the system that might be designed to help a consumer keep track of their basic health information and the health story.

In fact some have argued in the strongest terms that creating a system to be used by consumers and clinicians is just a fundamental nonsense.

In terms of system design and implementation any system targeting both groups will satisfy neither.

Another worrying sign for the successful take up of E-Health in Australia is Google's decision to terminate its Google Health platform, launched in 2008, at the beginning of 2012.

It’s a decision made, at least in part, because of poor consumer interest and take up.

This is clearly a problem as NEHTA has just let another contract this time to McKinsey and Company… this time for $29.9m. The task set is to improve take up and adoption

But whatever money is spent or however brilliant McKinsey’s may be there is no established evidence-based case for the benefits of a PCEHR.

As well, one of the key advantages for clinicians of the PCEHR and one of its key selling points trumpeted by NEHTA was the provision of “clinical decision support” but in its recently released ConOps document NEHTA now states that, and I quote: “The PCEHR system will not provide ‘clinical decision support services’.”

Given there are no planned incentives for adoption by health professionals and that many clinical organisations struggle to see much utility in the program… the risk that this whole change and adoption exercise will be a waste of $29.9 million is quite high.

Now let’s turn to consumers—you know, the people this is all about. The three highest priorities for consumers considering ‘opting in’ to the E-Health system are the ability to:

  • Arrange appointments
  • Request prescription repeats
  • Access a secure email messaging service to seek information and explanations related to their health care.

Well guess what under the NEHTA plan NONE of those three will be available for consumers.

During a recent Senate inquiry into the legislation establishing Health Identifiers, the benefits of a nationally consistent e-health system, especially for patients with complex and chronic health issues, were very apparent.

One of my colleagues, a midwife by background, was delighted that she would no longer have to carry X-rays around with her and explain her recent medical history and treatment to every health provider and every organisation that she saw.

She is very incentivised to use the system—for others with less complex needs or strong concerns about privacy; it’s much more difficult to sell the benefits.

Given all this, the position of the Opposition Leader and the former Health Minister Tony Abbott on the future of E-Health would seem the only sensible course.

He had this to say in the budget in reply speech of May 13, 2010:

Of course, there should be an electronic health record but hundreds of millions of dollars have already been spent to make this a reality and no more should be spent until it’s certain that we’re not throwing good money after bad.”

It’s perhaps a pity that the Rudd Labor Government didn’t listen as they approved the development of the personally controlled electronic health record (PCEHR) system in 2010, and allocated funding to deliver this by July 2012.

Initial consultation processes showed that many supported the health identifiers strategy, but there were also a range of objections, mostly these centred on perennial questions of how the service would affect patient privacy.

As the Howard Government had discovered, the possibility of function creep was an issue of pivotal concern.

The Privacy Commissioner considering that the challenge in introducing individual health identifiers would be to ensure that they were not usurped for use outside the health system.

The Commissioner cited the Canadian Social Insurance Number which became a quasi-identification card:

“... Property owners asked for it on apartment rental applications, video stores required it as security for movie rentals, universities and colleges requested it on their application forms and pizza places even used it as a customer number for their delivery system.”[1]

In addition, while some had no objection to national coordination and collaboration in the e health work streams proposed in the National Plan, they questioned whether it had the capability to deliver the technical requirements for a successful e health system.

The Government responded to some of these concerns outlined in our Senate Committee Inquiry by revising proposed HI Service legislation to state specifically that the use of healthcare identifiers would be limited to functions associated with the delivery of a healthcare service.

Use of healthcare identifiers would be underpinned by national privacy arrangements and would entail transparent and accountable governance arrangements and the effectiveness of the HI Service would be evaluated after two years of operation.

The HI legislation passed both Houses of Parliament in 2010.

A functional E-Health system can securely and efficiently exchange data and, as a result, does have the potential to unlock substantially greater quality, safety and efficiency benefits.

NEHTA says this in its mission statement and… a note of warning … do not try to do this on one breath.

NEHTA will support the Australian health system by:

§ Improving the quality of healthcare services, by enabling authorised clinicians to access a patient's integrated healthcare information and history, directly sourced from clinical notes, test results and prescriptions using standardised clinical data formats and terminologies.

§ Streamlining multi-disciplinary care management, enabling seamless handovers of care by ensuring efficient electronic referrals; authorised access to up-to-date clinical opinions and patient healthcare histories via shared patient health records; and fast, secure mechanisms for directly exchanging important notifications between healthcare providers.

§ Improving clinical and administrative efficiency, by standardising certain types of healthcare information to be recorded in E-Health systems; uniquely identifying patients, healthcare providers and medical products; and reforming the purchasing process for medical products.

§ And while doing all this … maintaining high standards of patient privacy and information security.

I have always thought that when you hear words or phrases like:

“Streamlining multi-disciplinary care management”

Or

“Enabling seamless handovers of care”

Be very, very frightened for somebody is about to put their hand in your pocket, move you to another planet or at the very least, snow you while boring you to death on the journey.

This is one of the problems with the technological communications revolution. It is highly technical and complex.

This doesn’t stop the IT revolutions adherents and acolytes from speaking in tongues …. and I have my suspicions that more than a few involved in the field of E-Health are deliberately obscure so as to better evade scrutiny or evade an honest answer.

While such sarcasm can be fun it also carries a much more important message.

E-Health at its core is about better communications.

It would be good if its designers, managers, administrators and practioners not only remember this but make it their mantra.

In theory E-Health can do all the things attributed to it… in theory.

Unfortunately the record in practice is nowhere near as good or as glowing … which is a major reason the Coalition believes it’s time for a pause and for a thorough assessment of the real, the actual progress of the introduction of E-Health in Australia.

No doubt many of you will be aware of E-Health developments in the United Kingdom

The UK’s E-Health plan is an 11.4 billion pound program begun in 2002.

Its core product was the delivery of a patient care record system by 2010.

As of March 2011 they’d spent 6.4 billion pounds of the initial budgets.

But this is what the United Kingdom National Audit Office has said of this vast budget and its implementation … and a warning … this should give you sweaty palms and an icy sense of devaju…

“We have not had time to validate the Department’s assessment, but our initial view is that it risks presenting an overly positive position on progress.”

“… The core aim that every patient should have an electronic care record under the Programme will not now be achieved.”

“Based on overall performance to date ….. It’s unlikely that the remaining work can be completed by the end of the contracts in 2015‑16.”

"This is yet another example of a department fundamentally underestimating the scale and complexity of a major IT-enabled change programme.”

“… The £2.7 billion spent so far on care records systems does not represent value for money. And, based on performance so far, the NAO has no grounds for confidence that the remaining planned spending of £4.3 billion on care records systems will be any different.”

In reference to a regular changing of aims, plans and due dates by the managing authority the UK national audit office had this to say…

There is a lack of transparency, regarding the impact these changes have had on the functionality now being provided compared to what was originally expected.

So we are seeing a steady reduction in value delivered not matched by a reduction in costs. On this basis we conclude that the £2.7 billion spent on care records systems so far does not represent value for money, and we do not find grounds for confidence that the remaining planned spend of £4.3 billion will be different.”

"The Department of Health needs to admit that it is now in damage-limitation mode.”

Sound familiar?

Begs the question really doesn’t it … is our performance in the introduction of E-Health in Australia any better?

E-Health is a great idea, but great ideas frequently founder in the sea of reality, when words replace action, spin replaces substance and when the idea falls prey to incompetent implementation.

When that happens, other things also usually appear … blame, denial and obfuscation.

Unfortunately I believe we are already running well down the road of denial when it comes to an honest, tough minded analysis of our progress towards the introduction of a quality national E-Health system in Australia.

Let me tell you why I think that.

And let’s start with what NEHTA said it was going to do and by when.

Sounds simple …arrr but it’s not … NEHTA has constantly changed its goals, plans and deadlines so that tracking what it is doing, what it has done, and what it plans to do, seems like wandering through the very best of EDWARDIAN HEDGE MAZEs.

A stream of consciousness cult that believes in the power of peyote, for example, this is from their latest mission statement,

It is essential that NEHTA articulate the end-to-end application of E-Health solutions in the health system, incorporating a layered approach to interoperability with technology-specific integration. This is required in order to communicate ….”

To be blunt I don’t think they’ve done anything much … except waste a lot of money and a lot of time.

The latest work of creative writing-- NEHTA STRATEGIC PLAN REFRESH 2011/2012-- in listing the milestones to date says nothing about 2005-2009 … finally it seems they’ve admitted … nothing happened during those 5 long years except of course the expenditure of tax payer funds.

Nehta loves a guiding principle, and a vision and a purpose and a mission it sometimes sounds more like a cult than a builder of anything.

A stream of consciousness cult that believes in the power of peyote, for example, this is from their latest mission statement,

Take this from their latest mission statement:

It is essential that NEHTA articulate the end-to-end application of E-Health solutions in the health system, incorporating a layered approach to interoperability with technology-specific integration. This is required in order to communicate ….”

Communicate!!

You are kidding!!

But you will be pleased to know that while it may have been the year of the rabbit last year and now it’s the year of the dragon … Nehta has moved from the year of delivery to the year of implementation. … I’m sure they’re glad to move on as they haven’t delivered anything as yet.

And let me remind you that NEHTA also described 2009 as its Year of Delivery” and when I asked its head Mr Peter Fleming in Budget Estimates in May… what had NEHTA delivered in 2009, this is what he said:

“Certainly part of that process was changing the culture of NEHTA to be very delivery orientated.”

He also said the Health Identifier Service has been built and is available

But I ask is it being used?

When I also asked him how their 3 year plan of deliverables, 2009-2012, was going this was his reply;

“We are on track with that. Each one of those components is tracking to its critical path.”

Now whatever that means can anyone in this room tell us of one product that NEHTA has successfully completed that is in place and fully working?

Six years (+ 10s of millions of dollars) later and, by any analysis, there has been not one product or deliverable that meets that simple criteria.

All they create are words and I must admit great graphics, schematics and charts

We find in their Estimates evidence phrases like this;

“Possible methods of construction”

“Another document that is very close to being finalised.”

“Yet another layer of detail in terms of the design elements”

“Lead implementation sites.”

A recent on-line poll on an e-health blog scored NEHTA’s record on delivering Implemental E-Health Standards …. 73% of readers gave NEHTA a fail.

I can tell you that from a series of Senate Estimates hearings over several years the ability of this organisation to talk nonsense is monumental.

In the recent round of budget estimates hearings members of the Community Affairs Committee endeavored to get representatives of NEHTA to spell out exactly what they had achieved in the creation of finished components necessary to implement a national e-health system.

We didn’t get very far.

When we asked about the self imposed deadlines they insisted they were on track especially in regard to a fully functioning PCEHR being up and running by July 2012

But it’s simply not the truth.

At a recent round table discussion about “Cloud Computing” involving senior technology managers from the industry, Mr. Paul Madden, CIO with the Commonwealth Department of Health and Ageing said the following in response to questions:

Asked what sort of timeframe are you putting on your journey to create an E-Health system?

Mr Madden replied

“… I guess that's something that's going to start as a real production thing from July 2012 and start to grow rapidly from there.

Do you think we'll see all the services and all the work that you have just outlined done in this decade -- by 2020?

Madden: There will be strong examples of it, and we are already seeing examples of how the business community, including some of the medical professions, are starting to interface and demand different computing services. Will it be ubiquitous across the next decade -- I doubt it, but I think we'll have made great inroads.”

So despite all the verbiage promises, guarantees and money we won’t a functioning system till at least 2020!!

The table of contents to NEHTA’s latest strategic plan includes a section includes an interesting section entitled “NEHTA”S NEW MANDATE” …

But nowhere in the document is it mentioned again and despite their love of the merry go round of definition … they provide no definition of this new mandate…

Perhaps that’s hardly surprising as all the money runs out as of June 2012.

In all the copious timelines that litter their publications anything after June 2012 … is just listed as the future … even though NEHTA doesn’t have one itself after that date.

I’m thinking that perhaps they’re taking into account the Mayan calendar that stops in 2012. Or perhaps they should be told that the movie 2012 wasn’t a documentary.…

Thank you.

----- End Speech.

I think it is fair to say the e-Health program in general from DoHA and NEHTA is particular are now on notice as far as the Opposition is concerned to do a great deal better job or face some considerable extra scrutiny and accountability down the track. That can only be a good thing in my view.

These people have clearly put the whole Australian e-Health effort at risk with the remarkably poor way they have conducted themselves. In 2008 Deloittes provided a very reasonable way forward and had that been followed I think we would be in a better place right now.

The risk is now, of course, the 'throwing the baby out with the bathwater problem'. The only way to avoid that is a careful assessment of what is good and what is not in the calm light of day and then sensible planning to move forward.

I hope that is what happens finally!

David.



7 comments:

Anonymous said...

Three cheers for Senator Boyce:

Hip, Hip, Hooray!

Hip, Hip, Hooray!

Hip, Hip, Hooray!

Fantastic!!

Now could we please have Ms. Halton, Mr. Fleming, Hon. Ms. Roxon and Mr. Gonski front a committee of "accountability" for Australia's "e-health scandal" anytime soon -- just as the Murdoch's are facing their chickens coming home to roost.

Anytime now or before June-2012 and before another Tax Payers cent is wasted on more e-health "inaction" and obfuscatory distraction would be fine.

EA said...

Got a slightly different view.
If ever we have a functioning NASH, a barebones SEHR, the necessary independence and auditing, with data for public health & billing & clinical trials (from public & private, after bedding down APPs) feeding into AIHW, ASQC and NPHA, then who would lose out?
Function would transfer from DoHA with the necessary funding and budgets.
Filleting NEHTA would leave Jane Halton with the enormous burden of managing the above (admittedly skeletal) transactions, and the pay-grade.
So, how is the relationship between Sen Boyce and Ms Halton?

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

On the basis of Senate Estimates over the last few years they are not close..

David.

Anonymous said...

RE: EA (6:35:00 PM)
I fear Mr W. Smith (EA) may have been spending too much of his time at the Ministry of Health (DOHA) and Ministry of Disinformation (NEHTA)… May explain his/her slightly “different view”!

“If ever we have a functioning NASH” – “Ever” and “Functioning” are two rather large assumptions for the long awaited, and very expensive, NASH. Where is the business case for this e-health building block again, and what metrics are stated and ‘published’ to demonstrate it is actually functioning, successfully??

“… a barebones SEHR” – ah the ever present SEHR hammer; and again, where is the ‘business case’ for this ‘solution’, and where in the world has it provided any proven track record of ‘clinical benefit’ to substantiate its inordinate costs for implementation, ongoing operation and attainment??

“…the necessary independence and auditing” – and where exactly does this ‘independence’ originate from, and what about it makes it ‘necessary’, and what (content) exactly is being ‘audited’, and for what purpose, for who’s viewing, and for how long??

“…with data for public health & billing & clinical trials (from public & private, after bedding down APPs)” – data for public health; data for billing; data for clinical trials; well where to start with this smorgasbord of data options and targets, as the kitchen sink was amiss, and anyone of these is a substantial challenge in and of themselves to accurately analyse and suitably service with ITC in a cost-effective manner to achieve any real benefits, and we’re getting all this from “public & private, after bedding down APPs”; God complex must be resident somewhere in Mr W. Smith’s delusions to have any “Fatal Conceit” that control over “Public & Private” and the “bedding down” of ‘their APPs’ is in anyway shape or form conceivable, controllable and achievable??

“…feeding into AIHW, ASQC, NPHA” – again, what exactly (content), for what purpose (objectives), for what benefit (tangible and intangible), and who exactly is paying for this steady flood of ‘newly and magically acquired’ health information into Government funded and operated, and some that don’t even exist yet, “sinks”?? NPHA – need to ask the ‘Soviets’ how centralised “pricing” worked for their efforts to achieve economic efficiencies in their poster-child of an efficient and effective economy!

Anonymous said...

RE: EA (6:35:00 PM) Cont.

“…then who would lose out?” – Maybe Mr W. Smith should think a little harder about the winners and losers in his proposed scenario, and think a little deeper around who is funding his/her pipe dream and delusional scenario along with the “opportunity cost” for the resources and funding consumed by this fantasy that may well be used for greater benefit in many other countless and imaginative better ways.

“…Function would transfer from DoHA with the necessary funding and budgets” – ah, the Bureaucratic fatally conceited mind at its finest! What ‘Function’ exactly, and transferred from DOHA to where exactly, and what about ‘its’, whatever it is, ‘funding and budgets’ makes it necessary, and what other “functions” lose out with the consumption of ‘necessary’ funding and budgets, by ‘whatever it is’, and for 'whatever how much it sucks out of the economy', and don’t forget the long forgotten tax payer in your calculation of ‘losers’ in your fatally conceited equations!

“…Filleting NEHTA would leave Jane Halton with the enormous burden of managing the above (admittedly skeletal) transactions, and the pay-grade” – ‘Filleting NEHTA’ what a delightful idea and suggestion, as long as it is as close to the bone as possible, and the ‘enormous’ amount of ‘fat’ that it is carrying and dispersing is additionally discarded from the morsel of meat (value) available to be salvaged; and ‘Jane Halton’ should only be left with the ‘burden’ of defending her unconscionable behaviour and atrocious performance record overseeing DOHA’s and NEHTA’s e-health incompetence and ineptitude, let alone managing anything else or managing period ‘going forward’, and ‘the above’, whatever it is, (admittedly nonsensical and incomprehensible), and whatever ‘transactions’ are supposedly described and associated, need not have any ‘pay-grade’ associated with this dysfunctional proposal!

Statements like these from Mr W Smith (EA) are evidence of “lazy and condescending thinking”, lathered in immeasurable amounts of conceit with the magnitude of pretence for having all the answers that clouds and interferes with any possibility for having the slightest semblance of any clarity of thought. Inevitable really with too much exposure to the Ministry of Health (DOHA) and/or the Ministry of Disinformation (NEHTA).

Here’s hoping Sen. Boyce holds Ms Halton’s -- and her cohort of partners in e-health “crime” -- feet firmly and protractedly against intensely heated fires!

And for Mr W. Smith (EA), if you’re gainfully employed either directly or indirectly by NEHTA and/or DOHA, please resign and free-up your salary drag on the economy for the benefit of the long-suffering Tax Payer.

Terry Hannan said...

Re Sue Boyce,

(Rewritten) Beware of wolves in sheep’s clothing from the Opposition. Do they understand e-Health better than the Government? What will they do with the present e-health plan when re-elected? Pull it down?

A senior opposition party member on health, has stated publically over morning tea, “You (docs) have it all wrong. It is nothing to do with patients. It is all about the money and getting re-elected.” Terry Hannan

Anonymous said...

Terry Hannan asks “Does the Opposition understand e-Health better than the Government”.

Michael Wooldridge the Tony Abbott failed to understand e-Health when they were in Government. Julia Gillard did seem to understand when she was in Opposition. Nicola Roxon as Minister is on par with the Opposition.

The only constancy is the Secretary of the Department of Health and Ageing who has led DOHA during both Liberal and Labor Governments. Therein lies the rub. The advice the politicians have received has failed to serve them well and failed the nation.