Tuesday, January 17, 2012

An Interesting Question To Contemplate. Does NEHTA Have Any Grasp of Commercial Reality?

A correspondent has just pointed out a very interesting quote from NEHTA in the Article in The Australian on 17/1/2012.
“Vendors "looking at different investment opportunities or where you can maximise your return, if you want to be early to market I'd encourage you to get involved in user- acceptance testing". Those looking to launch product sets between July and December should attend the masterclasses, he said.”
This is the last paragraph of the article which is found here:
PCEHR investing opportunities or maximising returns? How exactly does that work as they say?
As my correspondent wrote:
“- Investment opportunity?
- Maximise your return?
- Early to market?
I think all vendors understand what these words mean - do NEHTA and DOHA?
As we all know.
-Patients aren't going to have to pay for PCEHR access.
-GP's and specialists aren't going to pay extra for PCEHR features in their software.
-The government is explicitly turning off the tap on July 1.
As I am asked - and I have not a clue or the remotest idea of the “answer’
“Is there some other magic money fairy ready to bestow cash on the PCEHR vendors? What exactly is the market - and if the entire premise for why vendors are involved is because of this market - I presume there will be next to no vendor involvement (other than those from wave 1 and 2)?”
The answer is, as far as we all have been told, NO and to be more emphatic one gets the sense the position is ‘not a chance”!
It is transparently clear from this the NEHTA / DoHA axis are just ‘blowing smoke’ and have no idea what the words actually mean!
What a staggering appalling joke!
David.

13 comments:

Anonymous said...

Hi David,

Don't forget demand generation.

You only have to look at the recent telehealth tranches of money (which exceed money allocated to PCEHR) to form the opinion that government is far happier paying doctors to use technology than it is paying vendors to build it.

Or said another way, I wouldn't want to be a vendor standing between a GP and a revised eHealth PIP criteria, or a telehealth-like sign on bonus, or an extra MBS item number for PCEHR review/upload.

5 of the top 6 'GP vendors' have acknowledged this...the number 1 vendor didn't at last check but there's still time for them to do the couple of dozen man months worth of work to bring their stuff up to spec.

Anonymous said...

Evidence that the answer to your question is "No":

1. NEHTA has selectively paid a small number of vendors to implement support for elements of its work program, giving these companies a substantial advantage over their competitors in the market.

2. NEHTA has conspired with DOHA to assist a startup vendor to establish itself in the market - free of any competition - by not conduting an open tender process for a technology provider for the Wave 1 PCEHR Lead Sites.

3. NEHTA has told commercial software testing services that they can derive substantial revenue from software vendors' requirments to undergo conformance tests, without any evidence of a businsess model for software vendors that would support this (in fact, the model orginally suggested by NEHTA would have resulted in a large number of vendors going out of business).

4. NEHTA has a team that is encouraging software vendors to build and operate PCEHR conformant repositories - and other teams that are encourageing PCEHR progams to direct all their clinical document management to the national infrastucture provider.

NEHTA's approach to the market appears to be a mix of ignorance, mismanagement and outright market interference.

EA said...

One of the realities stems from the rate at which IBM is granted patents, some of which must be pertinent to Health IT. Accenture, and other clients of NEHTA, will be paying for use of others' innovations and the costs passed on to taxpayers.
So, there are $$$ to be made, but by NEHTA? What innovations have been claimed by NEHTA?
Most of the Health IT that has been developed in OZ has been in partnership with users, but without the users receiving any material benefit other than the sweat and good vibes. Most of the Health IT in use now is being run on constant modifications to suit users requirements, and, perhaps, even a bit of code-cutting on the fly. It ought to have been better, but there it is.
If NEHTA does, indeed, have a unique business model for developing Health IT, they may be sitting on a goldmine. If so, the principal partners would be very quiet about the detail of their intentions and achievements, their "secret weapon".
However, that all goes against the way all previous advances in health technology has progressed. That is, by intense and intimate linkage between human operators, as methods are tried on real people. It's almost impossible to bring out an innovation in health care without involving a lot of ordinary people. There has to be significant investment in the right kind of human capital, otherwise pain and suffering will follow.
If the support structure at NEHTA-DoHA is built on a future revelation that is supposed to capture the imaginations and loyalties of a vast array of human agents/operators/subjects then we are looking at a mass delusion.
A good book on the phenomenon is When Prophecy Fails.

EA said...

David, the new Minister may well look at NEHTA in July, or soon after, when another scandal races across the face of Health, and decide "enough is enough".
People in the industry may be well advised to be considering their options. If the tap is turned off, most of the budget left in the tank will be distributed to the big players who have secured their futures in rock-solid contracts (eg, what's happening in UK; MyKey in VIC; any other well-crafted PPP). That result, alone, ought to be enough to raise serious questions about due process, now, not when the horses have bolted.

Anonymous said...

Anonymous Jan 17, 2012 12:58 PM said:
4. NEHTA has a team that is encouraging software vendors to build and operate PCEHR conformant repositories - and other teams that are encouraging PCEHR programs to direct all their clinical document management to the national infrastructure provider.

Have a look very closely at Repositories.

Go to the Privacy Impact statement – Diagram (page 17) and the System Participants comment on the National Repository Service Provider (page 18).

Note the comment:
Registered Repository Operators - In addition to the National Repositories Service, the PCEHR System will have the capability to connect to other registered repository operators operated by a registered repository operator.

Examples of registered repository operators may include:
- DHS operated repositories holding Medicare history, PBS history, organ donor information and childhood immunisation information
- Pathology service repositories holding Pathology Result Reports
- Regional or State/Territory operated repositories.

David, can you or any of your readers please list no more than 8 repositories and indicate which are likely to be private sector repositories?

Anonymous said...

"DHS operated repositories holding Medicare history, PBS history, organ donor information and childhood immunisation information" ......

Well that's 4 repositories (Medicare, PBS, Organ, Immunization) - all Government owned and managed

5.Cancer Registry notification might be another Government NGO owned and managed

6.Prescription Exchange Service - owned and managed by PBS(DHS)?????
7.National Blood Products Repository - National Blood Transfusion Service
8.Pathology Reports - some years away - owned and managed by ?????
9.Radiology Reports - some years away - owned and managed by ?????

Can anyone see any private sector Repositories in that lot? I can't.

Anonymous said...

Both current prescription exchange services are privately owned but for how long? Both are losing cash hand over fist due to some stupid wording in the community pharmacy agreement. I know that one is looking to shut down if the system won't pay for itself shortly

Anonymous said...

Hang on a sec...the stupid wording you're referring to means that pharmacists aren't getting paid for scripts that weren't sent electronically from the doctor. This is the whole point of such systems...dramatically reducing the possibility of transcription errors by making the electronic copy the one with the actionable data.

What the script hub vendors would like to be paid for is scripts that turn up without an electronic duplicate, but never the less the script is typed in by the pharmacist and uploaded to the script hub at this point. A basically useless exercise in the case of a single script (while there's no value added services like real-time doctor shopping warnings happening), more utility in the case of repeat scripts but still fraught with the transcription errors and time eprescribing is primarily setup to improve.

Anonymous said...

"I know that one is looking to shut down if the system won't pay for itself shortly" ... If that is true it looks like an excellent example of how Government destroys private sector initiatives.

Anonymous said...

"If that is true it looks like an excellent example of how Government destroys private sector initiatives."

Hang on a sec (again)...are you farking kidding? 2 private sector businesses come up with a business model entirely predicated on government funding their customers for 100% of the purchase price of their service, and you reckon it's government's fault the businesses are failing? How much more of a leg up than 100% can a private business expect to get? It's a labor government but we're still a far way from living in a communist state. The reason they are struggling with low adoption numbers is the customers -- who again are not even having to dip into their own pocket -- don't see enough value in the products on offer. If you can't give your product away for free, there's something wrong with the product.

Anonymous said...

As a messaging provider I am quite used to the government trying to put me out of business. As time goes on however I see less and less reason to worry. It seems the more money they get to less competition they are. I am yet to see anything that worries me! Maybe they will defy the odds and deliver, I guess its possible. Surely it should have happened by now, but my level of respect for these pumped up God like eHealth executives has sunk to an all time low. They make Mayne health look like management geniuses.

Anonymous said...

Anonymous Jan 17, 2012 09:33 PM said "if you can't give your product away for free, there's something wrong with the product."

You obviously haven't looked very closely at the business models. They are not dependent on government funding for their sustainability. They know that Government funding could be terminated by Government at any time. Their sustainability is dependent upon moving aside the barriers to progress - addressing the problem of doctor shopping, finalizing NEHTA's long awaited specifications for ETP, etc. The Department's and NEHTA's paralysis in that regard is where the problem lies. Could it be because DOHA and NEHTA plan to develop a government owned and controlled ETP service - the son of MediConnect? How realistic is that? How much will that cost? What have they delivered so far? Remove the barriers and progress will follow overnight and software vendors in aged care, medical practice, community health and hospitals will all benefit including NEHTA. Maintain the barriers and everyone loses big time.

Jon Hughes said...

There are private repository operators in the market. Smart Health is one. When we know what a conformant repository is, we expect to be one of those. We have operated a shared electronic health record repository for twelve years and have done so by providing added value to our clients. We expect that this model will continue to work in the world of the PCEHR - but it will require NEHTA to stop interfering in the market.