Wednesday, February 01, 2012

The Medical Software Industry Association (MSIA) Recommends Major Changes To NEHTA and the PCEHR Program.

The MSIA Submission to the Senate Enquiry on the PCEHR Bills was released yesterday.
It would be fair to say they are pretty “unhappy campers”
Press coverage appeared today.

MSIA doubts e-health record delivery deadline

The industry body argued the project lacks accountability, transparency and timely delivery.
The Medical Software Industry Association (MSIA), whose members include Cerner, Cisco, iSoft and Microsoft, has delivered a scathing criticism of the National e-Health Transition Authority’s (NeHTA) handling of the government’s national e-health record project.
In its submission (PDF) to the Senate committee examining the Personally Controlled Electronic Health Record (PCEHR) Bill 2011, the industry body said issues of accountability, transparency and timely delivery still needed to be addressed.
MSIA referred to NeHTA’s recent “pausing” of the implementation of primary care desktop software at a number of the PCEHR’s lead implementation sites and said the actions had taken industry by surprise.
“No one in industry has been informed of what the issues are, when we may know the size of the problem or which of the many complex programs are incompatible with the build of the National Infrastructure,” the submission reads. “A failure to adequately inform stakeholders, be transparent, or to provide any timeline is consistent with NeHTA behaviour during the past few years.
All the details are found here:
The link to the full submission is found here:
The Executive Summary goes as follows:

Executive summary

The MSIA welcomes the opportunities that eHealth and the PCEHR provides for the medical software industry and Australia.
However, as with any large projects there have been a large number of challenges for all involved, but primarily a range of issues pertaining to accountability, transparency, and timely delivery.
Today, 24th January, an article in The Australian “E-health key trial halted by specifications glitch” caught many in the industry by surprise1. While a pause may be necessary, and a review of issues probably essential, no one in industry has been informed of what the issues are, when we may know the size of the problem or which of the many complex programs are incompatible with the build of the National Infrastructure. A failure to adequately inform stakeholders, be transparent, or to provide any timeline is consistent with NeHTA behaviour during the past few years. It does not make for trusting relationships, or inspire confidence in a way that allows industry to make decisions to invest in, and engage with processes in which NeHTA is involved.
This submission is to both provide information that accurately represents eHealth and PCEHR readiness and provides a range of recommendations for the Inquiry’s consideration.
The Recommendations are as follows:

Recommendations

The PCEHR BILL:

1. Add a more detailed description of the roles of all participants to aid understanding and uptake.
2. Commit to a date to publish “Rules” to allow adequate time for those who may be of risk of breach to be fully aware and compliant.
3. Increase Advisory group to include representation from research, secondary data and aged care experts. Ensure Advisory group reflects the 60% of health care delivery that is not provided by government or government agencies.
4. Make a provision that includes the taking of technical advice from the informatics community, Standards Australia and the software industry associations to ensure future changes and developments are appropriate, safe and timely.
5. Review the conflicts for the proposed System Operator in the various roles held :- as partial funder, system operator and as NEHTA Board Member
6. Review the ‘government furnished data’ liability issues, for example incorrect IHIs, incorrect PBS and MBS information, and incorrect AMT and SNOMED updates. Consider how the potential of such issues to act as disincentives, at worst, or to skew market and patient take up at best.

Healthcare Identifier and Patient Safety Issues

1. Action as an immediate priority, change requests to the HI Service that are deemed to have a potential clinical safety impact.
2. Action as an immediate priority, a government funded field study of AMT Mapping with at least 2 of the market-leading medication terminology vendors exchanging medication data.
3. All patient and clinical safety assessments and reports that have been funded either through NEHTA or other government agencies should be made publicly available immediately to provide confidence in the system. It seems unusual that the Australian Department of Health and Ageing has not required such reports of its manager of the PCEHR (NeHTA) to ensure the safety of the Australian public.
4. Review urgently all the issues in the MSIA White paper on the Healthcare Identifier Service and ensure changes are made to ensure the service can be used safely.
5. Review urgently the issues in the McCauley& Williams paper (Appendix 5). Consider a “consenting adults” model where software that acts in a parasitic way is tested with its “host” for all Conformance Compliance and Accreditation processes. Where such inherently unsafe software has been used there should be a post deployment review to ensure that patient safety and identification has not been compromised.

The PCEHR Program:

1. Reduce the scope of the 1 July 2012 release of the program (Release 1) by deferring elements that are not sufficiently mature or not sufficiently reviewed to ensure patient safety (for example, Australian Medicines Terminology, Health Terminology (SNOMED), Consolidated View, etc.).
2. Clearly define the scope of the national infrastructure partner relative to other software systems, including local PCEHRs and conformant repositories, to facilitate planning and investment by the software industry and healthcare providers.
3. Support the PCEHR program with sustainable, recurrent funding that supports the long-term viability of eHealth across the health sector (consumers, healthcare providers, healthcare provider organisations and technology providers). The National Change and Adoption and Benefits Evaluation Partners have provisionally identified national savings of several billion dollars a year from full operation of the PCEHR program; a modest percentage of these savings must be re-invested in the sector if the PCEHR program is to be successful.

Other Issues:

1. Make NEHTA accountable for its services and activities - NEHTA should be subject to federal FOI legislation (it is 100% funded by taxpayers and is for all intents and purposes a public entity).
2. The Auditor General (through ANAO) should conduct financial, information technology and efficiency audit of NEHTA as soon as possible.
----- End MSIA Text.
These recommendations deserve the most serious consideration by the Senate Committee. While I might personally have liked to see more emphasis on the leadership and governance issues which I believe are the ‘root cause’ of the present problems in Australian e-health the MSIA have clearly highlighted the absurd governance conflicts that surround the Department of Health Secretary as NEHTA Chair, PCEHR System Operator and Head of the Department of Health!
This full submission is worth a very close read!
David.

14 comments:

Paul Fitzgerald said...

but will anybody listen? there are presumably too many egos at stake here for anyone to admit that they made a mistake...

Anonymous said...

Was i the only one to hear Mukesh say (paraphrased) 'If industry doesn't support this then no governement in the future will ever pick eHealth up again and invest in it' ? - So listen up MSIA and others - if you keep kicking them you will have no industry to represent. There are some very very clever people (like Mr. McCauley) whose knowledge is invluable but I think you need to learn how to 'get along'with and work with NEHTA if you and others want an industry in which to sell your solutions and skills in the future.

Dr David More MB PhD FACHI said...

The problem is that these people and been blindsided, ignored and abused for years by NEHTA and frankly they don't think what NEHTA/DoHA is doing is on the right track.

The attack on the industry has already damaged a lot of it and we have already seen a hollowing out of skills and capacity.

Do you imagine they would be so angry without good reason - I don't. If NEHTA does not fundamentally change then there is just no point trying to get along with it!

David.

Andrew Shrosbree said...

David,

The culture of secrecy at NEHTA has lead to this dark impasse. Communication with people outside NEHTA is specifically forbidden in employees' contracts. The result of this "zero-leaks" policy means that the work being done is not subject to incremental, on-going scrutiny by the private sector.
Peter Fleming should issue a directive to his staff: that the culture of secrecy is to be discontinued. Let everybody talk openly about what NEHTA is doing, let the press and bloggers jump all over it, encourage discussion and debate. Let the communications department fight the fires that break out. Is the "raising of public expectations" really such a bad thing, Peter? So what if somebody or some team falls short. They are only human, the software industry will understand. If one of your employees speaks out of turn, just issue a simple statement saying that the person was either misquoted, is over-exuberant and to set the record straight, here is what that person should have said. There you go: rumours are quashed, NEHTA staff get to engage with the outside world like trusted professionals, the organisation earns a reputation for openness and frank communication.
Let NEHTA people talk to non-NEHTA people. Apples and oranges -they are all just fruit. The paranoia and recriminations whenever something "leaks" would disappear instantly. Lower the drawbridge, because opening the doors of engagement would do wonders for staff morale; the little fires that would break out could serve a positive purpose and most importantly, NEHTA's progress would be put under widespread scrutiny outside the sterile and controlled environments of the Tiger Teams and Stakeholder Forums.
I ask the NEHTA board this simple question: has the culture of secrecy served you well? Of course it hasn't. The staff are too scared to ask hard questions at staff meetings. Your company is reviled and ridiculed by the very industry it is supposed to support.
In my capacity as an entrepreneur I had firsthand experience of how hard is is to foster cooperation between vendors, so I have always supported the need for NEHTA's existence.
Having worked at NEHTA for over two years I know how ineffective the current communication policy is proving to be, how it makes NEHTA staff feel under constant assault, both from their own company's policies and from the health care community. It's a very stressful environment.
Do I want NEHTA abolished? Absolutely not. The company is filled with talented, dedicated and smart people.
Do I know and understand what is broken?
You bet I do.

Dr David More MB PhD FACHI said...

Andrew,

I think the problem is that 'management' don't get it and can't / don't see what you see. I am not at all convinced the change in policy you seek - which is right on - can ever happen in the current circumstances with this management.

I believe serious reform will probably have to be imposed from outside to get to where we both think they should be!

David.

Anonymous said...

That is a very strange argument. If NEHTA disappeared tomorrow, the need for health IT would still be there. The industry would still be there - despite NEHTA's best efforts to kill it off by picking multinationals over local suppliers.

It still remains to be seen if the multinationals are keen to stay in this market once the big NEHTA/DoHA-deployed projects shut down, given all the "unique" requirements being mandated. Why would the big US firms modify their products to suit the tiny Australian market?

That's why a local medical software industry has grown up - and with very little government investment, apart from the IT funding for GP desktops. And the industry developed looooonnnggg before NEHTA arrived.

There's a case to be made that the hundreds of millions have been pissed away by NEHTA. It's a disgrace.

If just some of the money had gone to the software developers and the folks who need their stuff, I'm sure we'd be in a much better position right now.

seriously, who can foresee what useful role NEHTA might play in e-health in future?

"Getting along with NEHTA" - what an absolute joke. I fear Mukesh has been drinking too much of the imported water

Anonymous said...

Since when has government been able to innovate? Those talented people should be employed outside government and the government should regulate what is actually in use in the eHeath environment, rather than try and dictate what should be in use, as history tells us they can't get that right. With Nehta around innovation is dead. After 10 years of wasting huge sums of money its time to try something else.

Andrew Shrosbree said...

> Since when has government been able to innovate?

Apart from small successes like the Manhattan Project and Arpanet, I share your lack of faith in government.
But that misses the point. NEHTA has a valuable role to play in acting as an arbiter between competing parties, such as the secure message vendors.
Almost no progress was made in interconnectivity before NEHTA came along. How about the ability of clinical desktop systems to exchange a simple patient record? The same. There was very little progress in these areas despite the direct involvement of people who supported the ideal, such as Magennis, Veil and McIntyre.
Much as it galls me to admit it, there is no finer example of market failure than the inability of doctors to exchange data securely. Participants in the private sector consistently failed to look past their own selfish ambitions to achieve standardisation.

Anonymous said...

Actually, Andrew, I dont think that's correct. Bunch of secure messaging standards were all set to go at Standards Australia before NEHTA came along and changed all the requirements.

As for acting as arbiter?

No, it picks "winners" and locks the rest out

Anonymous said...

Well I think if people implemented the existing standards well this would change, thats the point. Rather than encourage better quality and compliance with existing standards and slowly improve interoperability there is this push to replace everything, and what they replace it with is not up to the task, as the people designing it have no real experience on the ground and don't understand the existing standards at all. They are not smart enough to create anything of this complexity from scratch, nobody is. They need to allow existing standards to evolve and compliance improve.

Anonymous said...

I think that the software industry was more involved in developing standards and implementing them before nehta came along. Nehta has sucked up all the money and what do we have now - most electronic messaging is still using the same old hl7 v2 variations or other non-standard specs that were around years ago. Do any messages use the AMT or Snomed I wonder?
No doubt nehta has some clever people there but they are probably getting the blame and the sack now while the execs are still paid the big bucks. We have learnt one thing g from the lead sites specs fiasco - that this will all be repeated for the main event n July 2012- at least we know what we are in for. Vendors will have lost faith and will wait and watch while the whole fiasco is repeated on a bigger scale. Such a shame and wasted opportunity.

Anonymous said...

Its all about people and leadership I am afraid, always the hardest to fix as it takes real cohones.

The problem is a simple one, albeit there are actors and participants in eHealth.

Consensus and agreement across the industry, with whatever body coordinates ehealth standardisation, needs to be the key goal. Unfortunately, the current leadership personalities involved in Government, NEHTA and Industry, in general, are woeful, short-sighted and ego-ridden.

Without some cleansing of the leadership bloodstock there can be no change - I would recommend a change in leadership personality in eHealth Government areas and NEHTA as a start point. They should be changed very quickly; shortly followed by some on the MSIA/Industry side, they are tainted too much.

Without significant people change at the top we will see no real progress only effort wasted followed by failure and mistake after mistake...Its all about people and leadership...we haven't got any good ones in those key areas.

Anonymous said...

Good submission from the Msia, I don't agree with all aspects of the pack, but in the main they are on track. I just hope that the Senate will be able to really examine the key personalities from Doha or Nehta closely enough...there are some serious issues that need exposing and folk held accountable to.

Juanita said...

I really enjoy reading these comments and find them extremely illuminating. You provide the Australian HIT industry a very useful and important service David
Juanita