Thursday, November 17, 2011

This Is Going To Wind Up Being A Pretty Large and Useless Mess I Suspect. Surely This Is Not The Way To Move E-Heath Forward?

The following appeared yesterday.

NEHTA releases final e-health Specifications and Standards Plan

Confirms move away from current development strategy to strategy involving the establishment of "tiger teams"
The National e-Health Transition Authority (NEHTA) has published its final Specifications and Standards Plan for the Federal Government’s $466.7 million Personally Controlled Electronic Health Record (PCEHR) project.
The document, based on the finalised PCEHR Concept of Operations paper released in September, outlines NEHTA’s plan for the project, which is scheduled for delivery by 1 July 2012.
The plan confirms that NEHTA will do away with its current development strategy which uses two separate but related processes — the NEHTA specification process and the Standards Australia Development Process — as it is too slow.
“The current NEHTA specification process is rigorous, with high levels of stakeholder consultation,” the plan reads. “There is often a considerable amount of time between the completion of the NEHTA Work Package Specification Stage and the start of the Standards Australia Working Draft Stage.
“This time lapse in the development lifecycle results in loss of applied knowledge, history and learning, and often results in considerable re-work and re-education being performed during the Working Draft Stage.
“This would make it difficult to manage variance between final NEHTA specifications implemented into lead sites and further specification and standards development.”
According to the document, the limited timeframe for the development and completion of the PCEHR project would be answered with the creation of five “tiger teams", initially proposed by the authority some months ago.
Tiger teams refer to a group of experts assigned to examine or solve problems associated with the PCEHR program including issues around clinical use, consumer advocacy and government policy.
Lots more here:
I have had a browse and I have to say what we have here are two older documents and a recently DoHA approved plan which is the subject of the article above.
The scope of what is being addressed by the so-called ‘Tiger Teams’ seems to be as follows (Page 23):

Tiger Team Formation

Tiger Teams have been identified based on the need to address a number of work bundles identified in the PCEHR Standards Requirements. Five Tiger Teams have been identified, with each team progressing one or more work bundles.
The teams and their proposed work bundles are as follows:
1. Continuity of Care
- Discharge Summary
- eReferral
- Event Summary
- Shared Health Summary
- Advance Care Directive
- Consolidated View
- Specialist Letter
- Consumer Entered Information
2. Medications Management
- Electronic Transfer of Prescription
- Electronic Medications Profile
3. Technical and Identification
- Identification
- Architecture
- Security
4. Infrastructure Services
- Secure Message Delivery and Business-to-Business Integration
- Repositories
- Portals and Portal Services
5. Clinical Informatics
- Foundation Clinical Informatics
----- End Quote
Now what is planned is that by the end of November (2 weeks away) there will be specifications and standards covering all this ready to be rolled out to the Wave sites so they can get ready to develop, implement and test by mid next year.
It is interesting to note just how infrequently ‘safety’ is mentioned in the document.
The time pressure is so desperate that we read:
“A work item proposal (scoping of work required) is submitted to IT-014-XX sub-committee and, once accepted, goes to the IT-014 Parent Committee for acceptance to then submit to the Department for formal acceptance and approval for the work programme.
Note: If the IT-014-XX committee is unable to participate, for whatever reason, the work item proposal will go directly to the IT-014 Parent Committee for consideration.”
Frankly there are not enough subject matter experts in the country to give them a snowflakes chance in hell - and the parent committee probably won’t have the depth needed in specialist areas.
Worse I am hearing from those involved that there all sorts of issues about recruitment of Tiger Team members, the lack of adequate notice to members is causing issues, that dates are already slipping wildly and that despite the deadlines at least one team is yet to meet.
Worse there is conflict between the solution teams and the management about priorities and there are issues about getting material through the NEHTA Architecture Review Board and out into the field even when reviewed!
I really have no idea who is kidding who here. This won’t end well in my view.
What will to come out of all this is a collection of half-done pieces of work which will be subject to rework and review endlessly and which will risk all sorts of un-expected outcomes.
This is not the foundation on which to build a national e-Health system!
As a final comment at least some of the documents referred to in the plan still seem to remain unreleased.
Who has seen these (Page 46)? I have not that I can recall!
[NEHT2011f] Business Requirements, PCEHR System, version 1.07, 7 June 2011
or this
[NEHT2011b] National E-Health Transition Authority 2011, High Level System Architecture PCEHR System, version 1.34, 2 June 2011.
Look pretty important to me. Of course a Business Case for the whole thing would also be a fun read!

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