Sunday, April 01, 2012

Health IT Vendors Need To Now Take Steps To Rebalance The Way E-Health Programs Are Being Delivered. Program Costs and Benefits Need To Be Better Spread Between Stakeholders.

This blog aims to make a really simple point. The point is that the influence of the Medical Software Industry (in all its forms) has somehow been sidelined over the last few years and the balance between the software providers, their customers and the Government agencies has got out of whack! The governance and leadership has been just awful and really needs to change. Additionally the costs and benefits of the program need to be better spread.
In the last week we have seen the clinical lobby manage to take some small steps to re-assert their centrality to the National E-Health Record System Project (NEHRS) (formerly the PCEHR) and its overall success.
This outcome was reported here:
and there was further commented upon here:
This has led to a situation where the clinicians have been essentially offered an uncapped level of funding to support the introduction of the NEHRS. Of course the mechanics and impact of this announcement won’t become clear until more details are provided, but it is clear the user lobby has had an impact.
A year or two ago we also saw the rather bizarre e-Health  PIP announcements where clinicians were paid (reasonably generously) to purchase and use software that the providers had agreed would be made compliant with some future to be determined at some time in the future.
This really now has the feeling of having been ‘money for jam’

Eligible Suppliers


To be considered an eligible supplier, software suppliers agree to participate in consultation processes with NEHTA to develop and implement secure messaging standards and specifications. The actual development of these standards and specifications by NEHTA, in consultation with the medical software industry, does not impact on a practice’s eligibility for payments through the eHealth Incentive.
The Department of Health and Ageing has advised NEHTA that practices should not be concerned if their supplier does not appear on the current listing but should recheck the website periodically. Practices are also reminded that they have until 31 July 2009 to comply with the secure messaging requirement and this timeline was developed with the particular needs of vendors in mind.
For further enquiries please contact NEHTA at 1300 901 001 or email your enquiries to pip@nehta.gov.au.
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As far as I know most GPs are using providers such as Argus, Medical Objects and HealthLink for their secure messaging and to date implementation of NEHTA specifications has been hampered by the lack of an End Point Location Service, a provider directory and NASH.
You can read here to see just where implementation of the NEHTA specifications is here:
So, the docs have been pretty well funded. What about the Software Industry as they respond to the deluge of NEHTA and Tiger Team specs and documentation and all the associated demands and pressure - created by nonsense ‘political’ deadlines. While I am sure some funds from the Wave 1 and 2 projects has helped what is needed is a much more robust and thought-out approach to assisting Industry to respond to Government expectations.
The Government claims it will save money and consumers will be better off - but nowhere does it say we will share the gains - at least in part - with the industry. Until this happens, with other lobby groups having their needs addressed, there should be a sensible quid pro quo.
According to the survey presently running on the blog there is a strong view the industry is being harmed by the ‘elephants in the room’ of NEHTA and DoHA.  All this needs to change and I cannot see a better time than the present to start making the point clearly and strongly to those who seem so fond of just assuming the world is all take and no give as far as dealing with Health Software Providers is concerned.
David.

7 comments:

Anonymous said...

Before turning to your overarching point it's worth noting that NO money has been allocated to doctors for PCEHR work as yet. While funding of doctors is inevitable despite the RACGP's attempts to talk themselves out of it, the Minister's speech was just a smoke screen and the AMA has called the bluff.

While it is true that the percentage of money software vendors -- even the relevant ones -- have received is a pittance compared to the money government has paid themselves in the Wave 1 and 2 projects and more broadly (NEHTA, Divisions, hospitals), how do you propose we 'share the benefits of the eHealth boom'?

If you believe in government funding private enterprise on a selective, merits basis, I think you'd have to conclude the vendors that have a seat at the PCEHR table are the correct ones at this point in time.

Who's feeling short changed and would their situation be any better vs their competition if government withdrew completely from eHealth?

Anonymous said...

“Who's feeling short changed and would their situation be any better vs their competition if government withdrew completely from eHealth?”

The Healthcare system, its administrators and practitioners should be feeling the most short changed at present, as the government intervention by DOHA and market perversions created by NEHTA have stifled if not killed innovation in ehealth that could have been creating value in the marketplace. Consider the amount of new systems and applications brought to the Australian ehealth marketplace pre and post NEHTA’s existence and consistent interference, and you’ll find Australia’s ehealth marketplace has been in 7 years of famine since its inception.

And while DOHA and NEHTA continue to redirect millions of Tax Payers’ money towards ineffectual documents, powerpoints and talk-fests, plus bespoke developed National Infrastructure software such as the PCEHR, NASH and HI Service, developed by expensive consultancies that cannot be licenced or sold elsewhere to support and nurture a broad and vibrant customer base, procuring with its own resources and not relying on or squandering tax payers’ funds, then you’ll soon come to the realisation that the ehealth industry and marketplace has been literally dying on the vine, with our government not solving problems but creating and/or prolonging them.

Governments should set the rules of the game and police those rules and let industry and the marketplace get on with creating value, innovating and playing the game, and minimise its interference and drag on the economy to the benefit of all stakeholders in the economy!

If this was the case in contrast to what we have in effect in Australia’s eHealth sector today, then guaranteed the situation would be soooo much better.

Anonymous said...

This is not new. DoHA’s, Medicare Australia’s and more recently NeHTA’s lack of appropriate engagement with, and compensation to, the software industry goes back decades.

The body that represents these companies, the MSIA, was formed in the late 80’s at the behest of Medicare Australia, so that it had one representative organisation to deal with, or, more generally, ignore.

The software companies have been seen by the health bureaucracy as a necessary evil and treated almost with contempt. At one MSIA AGM, in his presentation, Dr Brian Richards, the then DoHA CIO said, and I’m paraphrasing here, “you should all join the AIIA because they are the organisation that DoHA will deal with”. I recalled this when I read the AIIA’s statement on the PCEHR Senate report last week!! They still don’t get it.

Over the years, millions of dollars have gone to consulting firms (AIIA members) to tell NeHTA and DoHA what to do, yet 3/5ths of bugger all have gone to the organisations that actually deliver the product that makes eHealth work.

Until the software industry is treated in the manner it deserves, and that doesn’t always mean being paid to do something (though in a lot of cases it would help), then there will remain a huge disconnect between what is postulated as being possible and appropriate by the consultants and what can actually be delivered, in an appropriate timeframe, by the software industry.

Paul Fitzgerald said...

Whilst I agree with most of the comments here, I am always curious why so many remain anonymous. Is it that you are afraid of retribution?
I must say it does cross my mind from time to time when I have made a less than complimentary comment. :-)

Dr David More MB PhD FACHI said...

On the anonymous thing I think that its frequent use shows just how crook NEHTA and DoHA are to individuals and companies they think are not toeing their line.

David.

Anonymous said...

I posted comment #3 as Anonymous because they are my thoughts and may not reflect those of the company I now work for.

That should not prevent me from putting in my two bob's worth.

Anonymous said...

I would certainly feel that the industry in general would be better off without government intervention, unless you are a eHealth startup that gets a $5M gift as a wave site, or you are a consulting company.

The problem is that despite good intentions (You hope) it appears that government are pretty hopeless at developing solutions and even act against successful players out of some sort of sense of power, even though they are usually on the wrong track.

Government should regulate standards compliance when they are being used in the industry, but the wholesale "Creation" of standards in some grand plan is a joke. A very expensive, destructive joke.