Tuesday, July 17, 2012

Please Pour Yourself A Large Steadying Scotch Before Reading. It Will Help The Pain.

The following appeared today.

E-health 'delivering on its rollout commitments' says Paul Madden

FUNDING of $135 million for the National E-Health Transition Authority will support a new work program over the next two years following its delivery of Australia's e-health foundations.

But the health department cannot yet provide any details of NEHTA's forward work plan allocated $67m in the recent budget -- a sum to be matched by the states and territories under Council of Australian Government funding arrangements.

Health chief information officer Paul Madden says NEHTA has "delivered" specifications for all foundation capabilities, including infrastructure and services.

Mr Madden said The Australian was wrong to suggest $1 billion had been spent on the national e-health program since former health minister Nicola Roxon unveiled her personally controlled e-health record vision in mid-2010.

The department insists the PCEHR program has been completed on time and within the original $467m budget, despite the slow launch and lack of many key components.

Mr Madden said $380m in COAG funding for NEHTA's work program during the period included e-health foundations that were "leveraged" for the PCEHR but would have been developed anyway, so this sum should not be included in any accounting of costs.

"The money that's gone to NEHTA historically and NEHTA's e-health activities started well before any announcement of the PCEHR," he said.

"They've been working on a whole range of things that were not necessarily (aimed) towards a specific individual e-health record (the original concept endorsed by COAG) and certainly not the PCEHR.

"These include the Healthcare Identifiers, the Australian Medicines Terminology and secure messaging.

"So, even if we hadn't developed the PCEHR, those expenses would have continued because COAG had decided to develop them."

Separately, the Gillard government has spent $777m on specific PCEHR-related activities since July 2010, including $352m in new forward funding.

Mr Madden said of the $234m allocated in the budget over the next two years, $161.6m was "operational funding for the PCEHR".

"It shouldn't be categorised as development, (our position is) we will operate this system and gain experience with it; there are no functional additions, there's no catch-up (included) -- it's to operate the PCEHR," he said.

This allocation will also finance NEHTA to provide some "specific support and testing arrangements" for PCEHR, on top of the COAG funding for its new work agenda.

Health lowered its targets for the number of consumers registered for a PCEHR in the budget to 500,000 by the end of the current financial year and 1.5 million by the end of 2013-14; originally, it targeted half a million participants by June this year.

Meanwhile, the National Partnership Agreement on E-Health, under which COAG funds NEHTA, expired at the end of last month.

Mr Madden said a new intergovernmental agreement was "still being developed"
There is a lot more here:
(Well worth buying a digital pass for the full gruesome details!)
Let us now consider what was promised two years ago (from a recent blog)
Here is the press release - (I have highlighted the important and not delivered bits in italics):

Personally Controlled Electronic Health Records for All Australians

Australians will be able to check their medical history online through the introduction of personally controlled electronic health records, which will boost patient safety, improve health care delivery, and cut waste and duplication.
11 May 2010
Australians will be able to check their medical history online through the introduction of personally controlled electronic health records, which will boost patient safety, improve health care delivery, and cut waste and duplication.
The $466.7 million investment over the next two years will revolutionise the delivery of healthcare in Australia.
The national e-Health records system will be a key building block of the National Health and Hospitals Network.
This funding will establish a secure system of personally controlled electronic health records that will provide:
  • Summaries of patients’ health information – including medications and immunisations and medical test results;
  • Secure access for patients and health care providers to their e-Health records via the internet regardless of their physical location;
  • Rigorous governance and oversight to maintain privacy; and
  • Health care providers with the national standards, planning and core national infrastructure required to use the national e-Health records system.
The full press release is here:
And later in the same blog Ms Roxon claims:
This extract from a 2010 interview is telling:
MELINDA HOWELLS: Nicola Roxon says half a billion dollars is a big commitment.

NICOLA ROXON: Governments of past have put off making the decision to do this and our focus will be absolutely on these stages and of course there is business plan for the stages that can come after that. This investment, however, will give the momentum to taking electronic health records that step closer to reality in Australia.
Full interview here:
All I can say is that I, for one, struggle to align what was promised and what then happened.

Let us all know if you can explain how all this can all be true.


Anonymous said...

OMG!!!! what is he smoking?

Anonymous said...

On time, on budget, but not on scope. Like delivering a car without wheels and an engine. But we have to have the petrol money to 'operate' it. It just won't go. Perhaps we can use the truck after all.

Anonymous said...


Keith said...

Paul Madden is clear about NEHTA's remit: to develop a set of specifications. This role clarity is muddied at times when NEHTA takes on other roles as it has with project managing the rollout of the PCEHR production system. This, incidentally, appears to have diverted resources away from its primary role as NEHTA boss Andrew Howard almost apologized to software vendors that defects in the test environment had not been fixed because NEHTA was focussed on the government's priority to launch the PCEHR on 1st July. Mr Madden seems to ignore those specifications that have not been delivered, at least not in usable form. One such is Electronic Transfer of Prescriptions, which on NEHTA's website is marked "for information only" as it awaits revision.
If NEHTA's responsibility stops at delivering a specification two important questions remain: what mechanism exists to ensure that NEHTA's specs are fit for purpose? And who or what drives their implementation and adoption? The HI system is a good example. It is a useful piece of ehealth infrastructure. It has been specified and implemented at taxpayer expense and rolled out two years ago. It could have been doing good for those two years. But take up has been pathetic. Why? Largely because It is quite onerous for health providers to obtain their HPI-O and HPI-I and because there is no obvious benefit in doing it. So instead of being thoroughly bedded down the HI system has been largely unused (except by a couple of state health departments?) for two years. There are plenty of other specs which have not progressed nearly this far and it seems absolutely nobody takes any responsibility.

Anonymous said...

It's a bit of deja vu for those who follow public service careers - this is almost identical to the defense of the ATO's much heralded, massively over budget, shadow-of-the-expectation called the Change Program. Madden and several of his key executives are the very same who had leadership of that debacle that cost taxpayers many millions more than it should have.

And here we go again -- Madden again in the hot seat of a national project that has failed to deliver to expectations.

Lucky he's not a doctor.