Wednesday, January 23, 2013

NEHTA Achieves A Really New High In Irony. An Example Of Those Who Can Do And Those Who Can’t Teach.

This links appeared a few days ago.
The direct link is here:
The title of the document is ‘Making Sense of eHealth Collaboration’ A guide to getting started.
The date of the document is October 2013 - .pdf dated 8 Jan. 2013.
The document runs to an amazing 107 pages.
Those who provided wisdom were listed as follows:
Acknowledgement NEHTA would like to thank the following groups and organisations who contributed to the development of this Guide:

  •          Accoras
  •          ACT Health
  •          Australian Commission on Safety and Quality in Health
  •          Australian Medicare Local Alliance
  •          Calvary Healthcare
  •          Continuity of Care Reference Group
  •          Department of Health and Ageing
  •          Department of Human Services
  •          Hunter Medicare Local
  •          Identification, Authentication, and Access Reference Group
  •          Inner East Melbourne Medicare Local
  •          Mater Health Services Brisbane
  •          Metro North Brisbane Medicare Local
  •          NSW Health
  •          Northern Territory Consortium/NT Health
  •          Queensland Health
  •          Royal Australian College of General Practitioners
  •          St. Vincent’s and Mater Health Sydney

The Disclaimer and Security On The Document Are A Fun Read.
‘Disclaimer NEHTA makes the information and other material (“Information”) in this document available in good faith but without any representation or warranty as to its accuracy or completeness. NEHTA cannot accept any responsibility for the consequences of any use of the Information. As the Information is of a general nature only, it is up to any person using or relying on the Information to ensure that it is accurate, complete and suitable for the circumstances of its use.
This publication may contain links to websites that are run by third parties. Such links are provided for the user’s  convenience and do not constitute an endorsement or a recommendation by NEHTA for itself or on behalf of DOHA, of any third party products or services. These links are provided for convenience and in good faith but may not be or remain current. NEHTA for itself and on behalf of DOHA takes reasonable care in selecting linking websites but accepts no responsibility for the accuracy, currency, reliability and correctness of information contained in linked external websites. Access and use of any linked website is at your own risk.
Security The content of this document is confidential. The information contained herein must only be used for the purpose for which it is supplied and must not be disclosed other than explicitly agreed in writing with NEHTA.’
So it seems how to collaborate in e-Health is a secret!
Moving on.....
The requirement for the document is as follows:
“The requirement for this guide emerged from recognition that there was a need to:
• Bring together the vast array of guides and materials available
• Provide a common starting point for collaborative eHealth implementation projects
• Provide insights and lessons learned specific to collaborative eHealth implementations
As part of the development of this document, a number of representatives from eHealth project teams were consulted including teams from a range of Australian jurisdictions, acute and primary care settings, public and private institutions as well as both metropolitan and remote locations. The learnings and insights they shared were invaluable in developing this document. The authors note their contribution with thanks.” (Page 6.)
Note no sign of the vendor community or the MSIA or the AMA or the RACGP. Just who is intended to collaborate with whom in all this?
The rest of the document is a summary of the basics of well-planned e-Health implementation - none of which seems to have really been followed by DoHA and NEHTA (e.g. actually have proper governance and have a decent well considered business case as well as real stakeholder engagement)
For the last 20-30 pages there is a link of what look like some quite useful resources that are said to be available at the NEHTA web site. Sadly I could not find them which was a pity. A portal with all this material would be a good idea. I wonder is it I just could not find it?
All in all this is a document that might actually have helped DoHA and NEHTA about 3 years ago - especially if they have taken notice of it. Just goes to show how useless developing “shelfware” actually is! That said it seems that some of those mentioned above as contributors do have some real clues on how things should be done!
The irony that this document turns up so late in the day is hard to bear!
David.

8 comments:

Bernard Robertson-Dunn said...

David,

A few comments:

1. In a couple of places (pages 9 & 23) that document refers to something called a PCHER. It looks as though they mean PCEHR, but haven't done much of a proof read. Loses a bit of credibility there.

2. on Page 7 it states "The primary focus of the guide is for eHealth implementations that involve collaboration between different organisations from across the healthcare continuum. For the purposes of this guide, collaborative eHealth is defined as a solution that enables improved healthcare delivery between two or more providers through the use of shared information, amended clinical workflows and improved technology."

The guide is all about projects and implementing solutions. There is a whole body of literature that says you should understand your problem before implementing a solution otherwise the solution is almost certainly going to fail. I have not been able to find any reference in that guide, or anywhere else, that discusses the problems that eHealth is supposed to address, never mind the new problems that will arise when implementing eHealth "solutions". Enabling improved healthcare delivery is a goal, not a statement of the problems that arise when trying to achieve that goal.

And could someone please explain what "enables improved healthcare delivery between two or more providers" means? Why is healthcare delivery being provided between providers? Shouldn't they be providing healthcare to a patient? They might mean "improved healthcare delivery involving two or more providers" but t hat's not what they have said. Section 1.2 and credibility is dropping like a stone.

I'll say it again. They are throwing IT solutions at an undefined problem. All they will do is create new and bigger problems.

Anonymous said...

This document is very sloppy and poor quality despite the shiny orange e-health paint job veneer. Just one example here is how it describes the national Nehta work on Specialist Letters: (see page D.9):
"Specialist Letter package to facilitate a national approach to the implementation of an electronic clinical referral and specialist letter (i.e. 'e-Referral') infrastructure to support private, national, state and territory healthcare services reforms.These reforms are aimed at improving the safety, effectiveness, timeliness, efficiency and equity of healthcare by facilitating the flow of health information in a secure and private manner between authorised healthcare providers and service providers "

and the table indicating "who is doing what in eHealth n Australia" (page 21) has some glaring omissions. E.g. I don't think Northern Territory Health (who are leading the country in many e-health initiatives) would be very happy with their row in that table - totally missing e-medication management, which they have implemented across their state, and on which much of the national work has been founded! Meanwhile Fred IT get a guernsey for eMM instead!!

Here is their definition of an eHealth system: " An eHealth system is defined as an IT system that is implemented – such as eReferral"

Oh dear - why bother with these extremely silly documents! The rest is like telling health services how to suck eggs in terms of implementing IT systems in healthcare.

K said...

Hi Bernard.

Twice, out of perhaps several thousand times, PCEHR is mis-spelt as PCHER (for which we can surely blame the MS Word autocorrector - hate that thing). I do not think that this is very much credibility at stake.

Your wider point, NEHTA is not empowered by DOHA to do anything but provide IT solutions. You think people who work for it don't know this? These decisions are taken at the ministerial level, not by NEHTA.

But this is a common problem: management elects to use IT solutions as a trojan horse for making more meaningful change. At least that way, when the actual changes turn out to be ill-thought out, IT can take the blame.

The appropriate response to this, of course, is to shoot the messager. As you are doing here.

Anonymous said...

I agree - DOHA's PCEHR project could have benefited from the steps and advice laid out in this guide. But typically the last step in their project is to develop the guide on how to do it.

And have you noticed in this document how e-health is often equated to the PCEHR - like no other health initiatives exist. Well perhaps they don't now that all the money has been sucked into the PCEHR hole.

Bernard Robertson-Dunn said...

@K

The misspelling of PCEHR occurs in diagrams, so it might not be MS word. And I agree that not much credibility is at stake here, but it is the sum of all things, small and large, that results in credibility fading away.

re: "Your wider point, NEHTA is not empowered by DOHA to do anything but provide IT solutions"
I didn't actually say that. What I said was that the guide is all about solutions.

and re: "The appropriate response to this, of course, is to shoot the messager. As you are doing here." I thought I was shooting the message.

Government is very good at saying things like: If we implement this solution we will enable/achieve/facilitate/improve some outcome. And they do that without explaining how that will happen.

They are also very good at saying: So, you don't like our solution, that means you don't want to enable/achieve/facilitate/improve the stated outcome.

And before someone points out there are lots of words about problems in the guide, most of them are about implementation problems. Where business problems are mentioned it is phrased as - you had better make sure that your project is solving some business problem. What the document doesn't do is provide a guide to identifying and detailing the types of, or specific, problems that eHealth might be able to address and how they might fit into the broader information based strategy that has been previously developed. That;'s because such an information (as opposed to technology) strategy doesn't exist.

It always amazes me that the Information Technology industry pays such little attention to information. My guess is that this is because the big money is spent on implementation projects and the technology being procured. In comparison, thinking about information is both cheap and critical. And it should happen well before any business case, never mind implementation project. That's the IT paradox.

Grahame Grieve said...

Hi Bernard

"It always amazes me that the Information Technology industry pays such little attention to information"

While I generally agree, I do not think it is quite so simple. Information is slippery, where as technology is solid. You can get agreement and measures of success around technology so much more easily.

Now, let's imagine that you have been tasked to get several institutions to exchange data. For a variety of reasons, some parts of some of those institutions don't think that that investing in this exchange aligns with their business goals. Some of the others think that it woud *if it worked* but it won't work. The institutions have different information systems and policies that do not align. And you have no authority to re-align business priorities, practices, or to force change in existing information systems and policies. (or worse, you think you have some influence, and then you discover that your overall sponser doesn't intend to back you the way they promised).

That's a pretty common case. In fact, when is not the case? I've seen lots of suggestions for how to go about that - but you can't fault people for doing what they're paid to do.

What you can do, in practice, is create loose and complicated exchange structures that allow for deviations in practice. And lots of policy words around adoption and conformance to, umm, "encourage" uptake. At some point these things become surrogate goals in place of the real ones, and no one realises until too late.

And all the while. of course, the nay-sayers predicting failure contribute to it themselves. While you're right about the difference between disagreeing with the goal and the methods, in practice there's a gray zone between them. But the nay-sayers can take heart in this: they are more likely to be wrong than right.

But where does "who dares wins" fit into this paradigm?

Bernard Robertson-Dunn said...

@Grahame

I didn't say anything was simple.

However I do agree that information is slippery and technology is solid. Not only that, but the cost of acquiring technology is much easier to quantify (but not necessarily, the cost of maintenance and support). The value of information is not only slippery, but changes with circumstances and time.

The first thing that senior managers and project managers need to do is acknowledge those facts and proceed with that understanding. However, it seems to be in the nature of senior managers and project managers not to like such uncertainty. They prefer nice fixed time and cost estimates (with maybe an allowance for "risk". I've put risk in quotes because there are various interpretations of the word. The most useful to me is that risk means uncertainty. Senior managers and project managers seem to prefer "the probability of something going wrong" definition. ISO agrees with me.)

re: "But where does "who dares wins" fit into this paradigm?"

Do adventurous things but proceed on the basis that you still have a lot to learn and decide. So take a step by step, act and review, learn and grow approach. Don't do big bang projects based upon guesswork and/or blind faith in IT solutions.

My 0.02c

Anonymous said...

It reads to me as though this is NEHTA's handover document...