Sunday, February 24, 2013

The Calling Of An Election In September May Really Impact Developments In E-Health.

As readers will no doubt be aware the Prime Minister astonished the National Press Club audience by announcing an Federal Election for September 14, 2013 a good six months ahead of the time when such an announcement was required to be made. Despite the PM’s suggestion that this step would result in clear air for six months before the election campaign begins what has happened, not surprisingly, is that we are now in the midst of an eight month election campaign.
As we move closer to election day we can expect an increasing focus on just how the Labor Health and e-Health reforms have worked out. There are others well qualified to speak on overall Health Reform but in the e-Health domain we have already seen some considerable movement.
Dr Andrew Southcott (Member for Boothby in South Australia) is the Opposition spokesman on Primary Health and E-Health and it is interesting to see how his concern with present directions and execution is hardening.
Just over a year ago (21 February 2012) he told The Australian the following.
“Opposition e-health spokesman Andrew Southcott said the Coalition supported the concept of shared e-health records, but had concerns about the way the system was being implemented.
"Labor's implementation of the PCEHR since taking government in 2007 has received enormous criticism from industry for the poor management of the program's development and progress," he told the house last week.” [1]
Later in 2012 he told The Australian.
“Opposition e-health spokesman Andrew Southcott said that given "almost $1 billion of taxpayers' money has been spent or allocated for this in the past two years, it would be prudent for the Australian National Audit Office to examine the PCEHR program".
IT projects were "notorious for costing a lot more than expected and delivering a lot less than expected, and this seems to be in that category".
"I think we've had very poor ministerial oversight of this project," Dr Southcott said. "The infrastructure is not ready, the National Authentication Service for Health, which provides user verification and system security, is not ready, consumers could not register online and the GPs' software is not ready -- I'm told one of the largest GP providers won't have software ready until next February.” [2]
By mid-February this view had modified” to become the following.
THE federal government's controversial eHealth system to get the nation's medical records available online has had a dismal uptake from the public and the medical profession.
The scheme has been compared to the government's bungled roof insulation system by the Coalition's eHealth spokesman, Andrew Southcott, who called it ''Pink Batts on steroids''.”[3]
In the interim we have also had indicate the need for a careful review before further investment in undertaken.
One has to conclude, from these statements, that an Opposition victory in September will result in major change if not outright cancellation of the Personally Controlled Electronic Health Record (PCEHR) Program. It also seems highly likely the Program will become a point of Opposition attack - a fact that I am told is ruffling some bureaucratic feathers in Canberra.
As far as the Government has been concerned the level of public discussion has gone remarkably quiet over the last few months with virtually no public commentary or announcements in the last six months.
Two late breaking pieces of news have been the admissions at Senate Estimates in mid-February that only about 52,000 citizens had registered for a record - below the 500,000 who were expected by June 30, 2013 and some really rather left field news that a tiny US Company (MMRGlobal) is claiming it has patents over key aspects of the PCEHR. NEHTA and DoHA are said to be investigating the claims at the time of writing.
Overall, it seems to me that yet again what we are seeing are comprehensive failures of leadership and governance in the e-Health Domain. In my view most stakeholders have not been effectively engaged and persuaded regarding the Government’s plans
This short quote from a very recent paper by Professor Michael Georgeff and Dr Stan Goldstein for the ACHR tells the sad story of the derailing of the National E-Health Strategy which was meant to guide what happened but has sadly been sidelined. [4]

The National eHealth strategy and PCEHR

The National eHealth Strategy developed by Deloitte in 2008 [The National eHealth Strategy. Deloitte Touche Tohmatsu, September, 2008] laid out an approach to the implementation of a more digitally-enabled healthcare system. Three steams of activity were key to that strategy:
·         Build the basic infrastructure: connectivity, Individual Healthcare Identifiers, provider directories—the digital roadways and railways
·         Focus on high priority solutions: complete solutions that support chronic disease management, telehealth, and medications management
·         Invest in change management: assist stakeholders to manage the transformation to the digital world
However, somewhere along that path, the shared health record took centre stage under the name of a Personally Controlled Electronic Health Record (PCEHR).
A shared information repository is a key part of the basic infrastructure that governments need to provide. But a data repository—such as the PCEHR—is just infrastructure. As we have tried to emphasise in this report, it is the “apps” that count, not the data! It is the business processes and solutions that sit on top of the PCEHR and the rest of the national infrastructure that will make the difference to health care.”
What we have been left with is a lot of money being spent on a Program which lacked evidence for its approach and more importantly lacked the bi-partisan support which is so important for large scale multi-year IT Programs.
It is really hard to see how this can work out well between now and the election in just seven months time.
References.
[1]
[2]
[3]
[4]
Collaboration and Connectivity: Integrating Care in the Primary Health Care Setting.  January 2013 ACHR - To be released 2013.
David.

15 comments:

Anonymous said...

David you are correct, my mail out of Canberra is that the Coalition intends to make ehealth, and the PCEHR a major attack piece when the election gets in full swing later in the year.

I have been advised that a significant review will be undertaken by the Coalition (if elected) with the view that involves greater discussions and significant involvement from a variety of smaller software vendors, industry groups, privacy advocates, medical advisors and practioners, infrastructure and security vendors, to cast an eye over a mainly academic system rather than a practical one that has end deliverables and outcomes, not hypothetical milestones, outcomes and promises.

Interesting to see what happens over time.

The PCEHR has definite benefits for all, but pure data alone is not the answer... Privacy Paul

Bernard Robertson-Dunn said...

The PCEHR may have "benefits" but do citizens and healthcare professionals value those benefits? And are they prepared to pay the costs?

AFAIK, that debate has never happened.

Even the Deloitte "strategy" was all about technology and solutions, not about how to improve management of health information - and the problems that technology solutions will create.

Anonymous said...

the PCEHR is "a mainly academic system rather than a practical one "

The PCEHR is anything but 'academic' - academia is concerned with evidence, reason and research and academics have pointed out from day one that the PCEHR is based on none of these.

The PCEHR is an evidence-free zone, a fantasy arising out of a folie a deux between a gullible bureaucracy and a rapacious consultancy industry that will say and do anything to get the millions it needs to sustain its bloated self.

Follow the money trail and you wont find 'academics' at the end of it, so choose your words wisely.

If by 'academic' you actually mean 'evidence free thought bubble' then I agree.

E

Terry Hannan said...

I have written on this topic her and in other places. The Opposition was going to review the NEHTA/PCEHR regardless of its success or failure. The latter being the most obvious. The "concept" of a record for each person in the community may be/is correct however the model is entirely wrong and its attempted implementation is a contradiction to established models of such large implementations. If the model is wrong the cultural changes and resistance to its implementation will guarantee its failure. I currently work on a committee of physicians who have NFI about e-health and have NO idea what it means. This is ONE structural fault in the current e-health policy. Also where are the regular ongoing evaluations of what practiioners have in place in terms of "e" and what is going to the dynamics of care delivery with the attempted impostion of the current and possible new government models?

Anonymous said...

The PCEHR is an evidence-free zone, a fantasy arising out of a folie a deux between a gullible bureaucracy and a rapacious consultancy industry that will say and do anything to get the millions it needs to sustain its bloated self.

The finest description of the PCEHR I have ever seen.

K said...

"The PCEHR is anything but 'academic'"

In that it's not concerned with outcomes, but experimentation (it is actually research itself), it is academic. And also in the fact that if you check the credentials of the thought leaders, you will find many with strong academic connections.

"The PCEHR is an evidence-free zone, a fantasy arising out of a folie a deux between a gullible bureaucracy and a rapacious consultancy industry"

But no, you missed the clinical leads, who actually had really strong influence over the kind of system we ended up with. They're the ones with the fantasy. And now that the depth of their fantasy is starting to become evident, they're starting to turn against the outcome (witness M Haikerwall last weekend). You can be sure of this: whatever happened is *not their fault* - it was bad implementation, that's all.

Anonymous said...

" a rapacious consultancy industry that will say and do anything to get the millions it needs to sustain its bloated self."

Not to mention a lazy bureaucracy that manifestly failed to deal with or listen to the local SMEs via the MSIA, who would never have delivered such rubbish for such an exorbitant price, pocketing millions.

When will we see bureaucratic performance indicators linked to involvement of local SMEs rather than the easy pitch to their mates and excellent relationship managers in the rapacious international consulting firms that export the money overseas and don't employ or contribute to the local industry.

As soon as the slush funds dry up they will leave and it will be the local industry that picks up the ball.

This bureaucracy has wasted more than the money being "given" to Victorian Health on this one failed portal alone, and unlike the schools program it didn't help local industry at all!

Well Minister, how about that for a summary of your department's engagement with local SMEs.

Anonymous said...

"When will we see bureaucratic performance indicators linked to involvement of local SMEs"

You know, if you're going to shill for the local industry, you should at least have some sophistication.

It may well be that the local industry could have done a better job for less money, but I don't think that the governments job is to line the pockets of the local industry - it's to get outcomes for the taxpayer.

And it would be quite wrong to think that the local industry haven't been able to get their snouts in the trough. ePIP, vendor panels, wave sites, etc. There's never enough money to make everyone happy, but these things are real.

Anonymous said...

"It may well be that the local industry could have done a better job for less money, but I don't think that the governments job is to line the pockets of the local industry - it's to get outcomes for the taxpayer."
And those outcomes would be what? An exorbitantly priced piece of garbage that neither provides value not useful information to clinicians or patients!

Anonymous said...

"An exorbitantly priced piece of garbage that neither provides value not useful information to clinicians or patients!"

But using local industry would have made no difference to the outcome? (except possibly reducing the amount of money spent - though it was spent mostly on local contractors, of course).

Dr David More MB PhD FACHI said...

A key theme of this blog has always been that the NEHRS / PCEHR was badly conceived and badly designed. This fundamental problem has largely led to the issues we see emerging now.

Had the initial conception and design been more clinician and patient need focused there may have been a much better outcome.

As E put it (and I agree +++++)"The PCEHR is an evidence-free zone, a fantasy arising out of a folie a deux between a gullible bureaucracy and a rapacious consultancy industry that will say and do anything to get the millions it needs to sustain its bloated self." Wonderfully put!

David.

Cynical Taxpayer said...

The opposition will do a review. That will take 12-18 months. Will sit on the findings for say another 12-18 months. We wait till the next election for a mandate to do things differently. Will ignore the key parts of the review and go down some other path with no lessons from the past considered. That is how it has been no matter what side of politics you belong to. Health is a tough area to keep the people happy - throw IT/IM into the mix and industry end up being not happy as well.

Anonymous said...

Wrong concept
Poorly specified
Badly delivered
Failed to engage
Bloated consultants
Wasted money
Missed opportunity
Lip service review
Back on the treadmill
Unhappy everyone (except consultants)
Oh dear!

Anonymous said...

You forgot

Pay consultants to produce Lessons learned

just before back on the treadmill

Anonymous said...

The problem is government trying to do things they know nothing about, rather than adding a touch of regulation around what people are actually doing to improve public safety.

Governments can't do new things, there we are they have their review. Just pull the pin and focus on making sure that standards that are in use are done well. If private ndustry comes up with solutions that work and are in use they can look at ensuring they are done well also. We have wasted enough money, its time to cut the losses and let the industry go back to solving real problems, rather than competing for the splashes that fall from this very smelly trough.