Wednesday, October 26, 2011

Here is the AusHealthIT Blog Agenda Just So You Know! Ignore Any Other Rubbish You Read About This Blog and Its Perspective!

There has been a lot of nonsense being sprouted in some quarters about this blog. So I thought I would just make it clear where I stand on Australian E-Health and the present Government plans.
First I think that the use of terms like ‘e-Health’ and saying people are pro or con ‘e-Health’ is semantic nonsense. For what it’s worth I believe you can only form such opinions of particular individual initiatives and not the aggregate. In that context I think better secure e-Health messaging is good, supporting practitioner IT use is good, providing a consumer and professional portal is good and the PCEHR is an ill-conceived and wasteful initiative which has a very high chance of failing and which lacks any evidence to support its deployment.
People who talk of ‘e-health haters’ and ‘e-health lovers’ are frankly talking arrant nonsense and are clearly beyond rational debate.
Second I think that, on the basis of evidence from many, many sources inside and outside NEHTA that the organisation is in some significant degree of distress, is expecting too much of some hard working staff and has manifestly not delivered on most of its agenda. The latest evidence for this is the eleventh hour ‘pussy cat teams’ being formed to solve issues that should have been sorted ages ago. I do not blame NEHTA and most especially its staff. I blame Government and NEHTA senior management for failing to provide the appropriate governance frameworks and mechanisms that could have much better joined NEHTA with those who needed its help (jurisdictions, vendors, the private sector etc.)  and avoided the mess with which we now seem to be stuck.
Third I think most who are not, nor ever have been, practitioners in the e-Health domain really struggle to understand just how difficult and complex it is, and how naïve ill-considered initiatives can lead to disaster. We only need to see how badly the well-funded and pretty well considered UK National Program for Health IT went to be put on our guard regarding the risks of failure.
Fourth, as has also been found in the UK, large national programs have a propensity to stifle local innovation and damage emerging players in virtually any industry. We are seeing this right now with DoHA and NEHTA choosing winners and losers and the long term consequences of this I do not believe will be good.
Fifth we seem to have a situation where the tolerance of any form of dissent from a Government position can be commercially and personally exceptionally damaging as paid spruikers and lobbyists push the party line. I know of many competent people who have been cut out of employment and work for having the impertinence to suggest there might be another way to the to proceed different from the NEHTA tablets handed down from mountain of e-health truth!
Sixth I think it is just fraudulent for DoHA and NEHTA to be claiming they are implementing the 2008 National E-Health Strategy when nothing could be further from the truth. They have done what policy incompetents often do - cherry picked the recommendations and ignored much that was crucially important.
Seventh I am still amazed how such large sums of money and effort can be expended without a business case that explains the cost and benefits - with evidence - of proceeding down the present path.
Enough said - I want to see ‘e-Health’ progress, based on evidence of improved health outcomes and evidence of improvement in the whole health system being facilitated and enabled.
Also, on the positive side I aim to provide information and perspectives I find in my research in bite-sized chunks and allow those who want to comment and contribute.
Just doing ‘e-Health’ on an emotion, guess or a whim is nonsense but sadly there is a lot of this going around lately. I plan to continue to suggest we try to do things with a little more scientific and socio-technical rigor. Using technology to improve health outcomes and reduce risks is not easy but there are some who seem to think all you need is some spin and a populist plan and all will be well. Nothing could be further from the truth in my view.
I write this blog because I do actually care that we get value for money for the e-Health dollar and actually make a clinical difference. Right now I do not believe either of these goals are being reached as quickly as they might - by a very, very long way!
On a related matter I was asked by someone who is pretty close to the PCEHR what should be funded for 2012/2013 and on with the PCEHR Program.
My view was - in 2 minutes off the top of the head was:
If the PCEHR is to be ever useful the issues are investment is needed in:
1. Improving the information quality and sourcing of the health summaries.
2. Improving secure clinical messaging - using proven approaches.
3. Providing full integration with GP systems
4. Addressing and Fixing workflow issues and providing incentives for those who will lose out financially.
5. Sorting out the non-existent - as a practitioner - audit trails.
6. Actually doing some full function trials to show what works and what doesn't
7. Stop pretending a national implementation of anything is possible in 8 months
8. Stop all the pretence and actually tell the truth and consult honestly!
9. Work to stop the ‘hollowing out’ of the Health IT Vendor Community by the dominance of NEHTA and DoHA in the e-Health space.
10. Actually invest in some proper Project Governance and Management and develop real rather than political project plans!
The implication of this list is that the PCEHR Program needs to be fundamentally re-designed to actually work and deliver I believe! It seems a pity that there has to be an implosion, as seems inevitable, before anything is actually done.
This comment a few days from a NEHTA insider said it all - and confirms there are some very smart people in NEHTA who would like to do good - but who are just dreadfully managed!
Lagrimas de Luna said... (October 20, 2011)
David,
You are right to posit that Nehta is in considerable trouble. The scale of work required by next July is immense, and cannot be accomplished by anything other than a well-led, highly motivated and content group of people.
Instead of having a dedicated focus on delivery, the architecture office instead comes up with the monstrous work programme for which you posted a diagram on this site a few weeks ago. That work programme requires even more Enterprise Architects than they already have. It is a program of job creation for EAs, ensuring that the senior managers can write "I managed this many EAs" on their CVs. When Nehta is finally abolished, these cockroaches will pop up in the next incarnation of Nehta, or at Qld Health, as bureaucrats tend to do. Does anyone remember HealthConnect? I rest my case. Professional ambition motivates these people, not any genuine interest in delivering value to the community.
I learned some very painful lessons at Nehta about accountability and hostile work environments. If you are bullied, victimised or marginalised there is only one thing to do: RESIGN. If you complain, your managers shuffle their feet and can't maintain eye-contact, the HR department circles the wagons, defending the most blatant bullies. Worksafe is equally impotent, and at least one attempt to bring legal action against Nehta has foundered because the company has the resources to bring the full force of its taxpayer-funded war chest against those it perceives as its enemies.
What we are dealing with here goes well beyond incompetence. Nehta may have started with good intentions, but has become a malevolent organisation, whose leaders dismiss criticism as lunatic raving. The sad irony is that all of the "lunatics" are powerless to derail this train, which will crush its opponents, damage careers, waste taxpayer money, and fail to deliver meaningful benefits to health care.
I exhort the "little people" who are actually doing the work, to heed Monty Python: FLEE !
There is no one who could doubt the frustration, sadness, devotion to cause, intelligence and insight provided here!
This blog exists as a forum to allow discuss how we can do better in the e-Health domain in OZ and that is it!
David.

7 comments:

Anonymous said...

Being anti-NEHTA is not being anti-e-Health.

I just find it hard to believe that NEHTA could of got it so wrong.

I just can't believe how they escape more scrutiny, it is an industry fact that we are screwed.

The toruble with the Senate questioning is they put up BS responses and the questioners do not have enough knowledge to nail them with follow up questions.

I read your blog everyday, and while I think you are a little right of Genghis in your criticism....at the end of the day this is going to be a failure, a mass waste of tax payers money and it will probably set the e-health cause back years.

If you are pro-ehealth, in my mid you have to be anti-NEHTA.

Napoleon

Sarah said...

You make some great points David. They need to be made and keep being made.

Though Napolean has to think again. How can you be pro-eHealth and anti-NEHTA.

The NEHTA Board is made up of the CEOs of the Health Departments and they are by far the major spenders in health IT. How would you be able to sell any product or service if you are not aligned with them.

It just does not make business sense to be anti-NEHTA.

Dr David More MB PhD FACHI said...

Sarah,

That is the dilemma that is destroying e-health innovation and initiative in Australia I believe!

David.

Anonymous said...

This is the crux of the matter: "It does not make BUSINESS sense to be ant-NEHTA" but it makes perfect logical sense to be anti-NEHTA and as a result most of the comments will be anon as DOHA are trying to make Nehta the only games in town when it comes to funding.

That strategy is high risk, as if DOHA get it wrong then they take the industry with them, which is what has happened in the UK.

An anon survey of eHealth vendors ratings of NEHTA would make the Gillard opinion polls look good!!

Anonymous said...

The real dilemma at the root cause of the problem is the attitude that "if we can't control you then we will destroy you".

Anonymous said...

government contributes 70% of total health expenditure so it's not surprising they want to exercise absolute control over ehealth

Sarah said...

DOHA does not want to destroy anyone or have absolute control of eHealth, but their approach is giving some people that impression. The affect of DoHA’s policy settings on the commercial health software market has not been considered by policy makers.

Actually they might do better with a rethink of their whole approach. Did you see what Steve Yegge wrote about platforms?

http://www.launch.is/blog/google-wake-up-call-take-platforms-more-seriously.html

While there are many talking points about a blog that went viral and was supposed to be private the questions Steve Yegge asked of Google could be asked about eHealth. Do we get platforms? And if we did, would it be a better way?

In Steve’s article he talks about the mandate Jeff Bezos issued at Amazon about developing interfaces.

His Big Mandate went something along these lines:

1) All teams will henceforth expose their data and functionality through service interfaces.

2) Teams must communicate with each other through these interfaces.

3) There will be no other form of interprocess communication allowed: no direct linking, no direct reads of another team's data store, no shared-memory model, no back-doors whatsoever. The only communication allowed is via service interface calls over the network.

4) It doesn't matter what technology they use. HTTP, Corba, Pubsub, custom protocols -- doesn't matter. Bezos doesn't care.

5) All service interfaces, without exception, must be designed from the ground up to be externalizable. That is to say, the team must plan and design to be able to expose the interface to developers in the outside world. No exceptions.

6) Anyone who doesn't do this will be fired.

7) Thank you; have a nice day!

Point 4 is interesting. Jeff Bezos didn’t worry about the technology whereas NEHTA specifications are right down in detail of technology. Should we be worrying about technology to that level of detail?

Btw a change of Federal government does not mean that NEHTA will close down. NEHTA is a COAG organisation and COAG will decide NEHTA’s future. Peter Fleming gave a good description of NEHTA’s structure at the recent Senate Estimate hearing.

And even if COAG closed down NEHTA the Health CEOs have had a taste of working together, which is a good thing, and having a body that did things they wanted; they are likely to want more of that in some form. They will not want to go back to the old way where people developed software in silos and interconnectivity was an after thought --- they can’t afford it.

The challenge is to have the CEOs work together more effectively and have a more mature conversation about connectivity.

Sarah