Sunday, November 20, 2011

Some Commentary on The Parliamentary Library Paper on E-Health. It Could Have Done More To Help!

Last week we had a very interesting paper on E-Health released by the Commonwealth Parliamentary Library.
Here are the details:
RESEARCH PAPER NO. 3, 2011–12 17 November 2011

The e health revolution—easier said than done

Dr Rhonda Jolly
Social Policy Section
Parliamentary Library.
You may download the paper from this link:

I have now had the time to have a careful read and feel I should make some comments in response:
First it is utterly clear that the title is appropriate although I might have added to it to say ‘Much Easier Said Than Done’!
Second I am unclear who the audience is for this paper and just why it was written. (It is for the consumption of politicians, NEHTA, DoHA, clinicians or consumers for example or all of the above?) What follows from that is to ask the question what is expected to be done in response to the work and who is anticipated might do it? The paper does not seem to indicate if it was a response to a particular commission or request.
Third I suspect Dr Jolly does not remember the advertising campaign which instigated the idea of e-business from IBM in 1996. See here:
The idea rapidly then spawned all sorts of ‘e’s including e-Health and many others.
The e-business campaign was a huge and continuing push for a number of years and made e-something into common usage I suspect.
Fourth I think that while Dr Jolly has noted the progress in Europe she has quite underestimated the impact of the successful parts of the UK program for Health IT. Choose and Book, PACS implementation and GP2GP have been distinct successes and the (very basic) Summary Care Record is still being implemented. The failure has been in implementation of Hospital Systems and this is now being addressed thorough provision of more local autonomy and more pragmatic contracting etc.
I do not believe progress has stalled - it has been slowed and re focussed and has switched to a more grassroots approach. In this change there are lessons for Australia - some of which are already being noted and acted upon.
Fifth I agree with Dr Jolly the jury is still out on the United States but I would add that there has been considerable Standards driven progress and in the enabling of Health Information Exchange. I am hopeful but not confident the energy being applied in the US will lead to considerable progress in a reasonably short period of time.
Sixth Dr Jolly has it absolutely right when she writes:
“The SCFCA was astute, however, in noting that despite the conduct of various federal, state and territory e health projects, there appeared to be ‘a general reluctance’ to share information about the outcomes of these projects. So too, while industry was moving ahead with the development of technology, there had been little consultation with health professions and evaluation of pilots. All in all, the project process had been fragmented, with no information shared amongst project teams and opportunities for development lost. The answer, according to the SCFCA, was to develop a national strategic plan.”
What she missed is that this did not stop in 2000. It still continues to this day!
Seventh, while mentioned on a number of occasions I really think Dr Jolly has missed an opportunity to dissect the importance of governance in the e-health space and has not mentioned the need to strategic leadership at all as far as I can see. This is a fundamental key to e-Health success that we see in the US and elsewhere but which is simply absent at a strategic level in Australia in my view.
Eighth, while discussing the end on HealthConnect (page 29-30) Dr Jolly does not mention that there was a sudden defunding of the program after the Department of Human Services advised just how much an implementation would cost (over $1 Billion). The switch to a ‘change management strategy’ was a clear con to justify baling out of e-Health - no matter how it was spun!
Ninth Dr Jolly simply misses that the IEHR/PCEHR was a low priority for the Deloittes (now agreed) National E-Health Strategy and that the PCEHR was a fundamental distortion of what was recommended. This push for the PCEHR is analogous to pulling out the Mineral Super Profits Tax from the Henry Taxation Report while doing little else!
Tenth, Dr Jolly seems to fail to appreciate that Beverly Head is wrong to suggest the personal e-EHR is basic:
“Beverly Head, writing in Information Age in 2009, labelled personal e health records as the ‘cornerstone of all e health initiatives’. Only once these were in place, according to Head, would it be possible to develop other e health applications.142 While it could be argued that all aspects of e health are equally important, it is difficult to envisage e health working without this crucial component, and it appears this view has influenced the policy directions of Coalition and Labor Governments since the 1990s. - Page 37”
We needed all the source systems implemented and working before the PCEHR was added. The whole thing has been done wrong way around!
Eleventh it is good Dr Jolly recognises the ConOps was not reviewed as it might have been and fails to mention the sponsorship relationship between NEHTA and the RACGP.
Twelfth this paragraph says a great deal!
“It can be argued with regards to David More’s assessment of the papers released on the PCEHR to date, that there does appear to be an element of hastiness in the issue of a number of papers. On the other hand, there clearly is a complex array of questions that need to be addressed and to consider these in isolation risks criticism that vital aspects of the system and its implementation will be overlooked. However, as the legislative issues paper suggests that legislation will be introduced in the Spring 2011 sittings of federal parliament there is the question of to what extent the Government intends to attempt to reconcile the views expressed by stakeholders in preparing actual legislation.”
I suspect we are just ‘steaming ahead’ and will wind up with a ‘train wreck’.
Thirteenth I both agree with and reject this pargraph!
“Dr David More’s apprasial (sic) of e ehealth (sic) policy presents the former view. More has been a strident critic of Australian e health directions for many years.161 More is supportive of using information and communications technology to improve health outcomes but believes that the plans devised and directions taken by governments to implement e health plans have been at best misguided. While More has not put forward a comprehensive alternative strategy for e health, in a submission to the NHHRC in 2009 he noted his support for the e health future developed and detailed by Deloitte for the National E Health Strategy.162”
A great deal of my blog tries to flesh out what I see as problems and what I would do about them.
are recent examples.
The whole blog is essentially a statement of the strategy I would suggest with the evidence in a huge number of posts to support my view. The PCEHR is an evidence-free initiative as we all know!
Last this document really needed some clear suggestions or recommendations as to what could improve things given the scope of the research she has undertaken. This is really a great pity!
All in all, a useful perspective that may have been greatly improved by clarity on what the document’s purpose was a maybe even a phone call or e-mail to discuss some points!
All this said it is good that an alternative view was given a pretty fair hearing in this report. Time will tell how far off the mark I was!

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