Sunday, March 10, 2013

Here Is An Opportunity To Possibly Make A Difference To Australia’s E-Health Future. Grasp It.

After a little hunting around I have confirmed that there is definitely a revamp of the National E-Health Strategy being undertaken - as mentioned by the Pharmacy Guild President last week
See here:
Word is that there is a pretty tight deadline, given that - despite what the pollies say - we are rapidly running up towards a Federal Election on September 14, 2013. Indeed in the article cited it is made clear that there will be major electoral influences on the direction after that date!
The reason I am discussing all this is because of three things:
1. There are a lot of readers of this blog who have direct access to DoHA etc. who will have commissioned this work.
2. The overall readership of this blog has the best, on the ground, understanding of what is working, what is not, and what we should do next and what we should scrap / modify / defer.
3. Over the last year or two the quality and scope of comments on this blog has been genuinely spectacular in terms of wisdom, insight and practicality.
The bottom line is that those who bother to assemble and upload a few ideas, suggestions can be assured they will be assessed and considered in the now underway process.
For me the following issues are the key ones.
1. How can we make governance of the e-Health actually take notice of all relevant stakeholders and how can be put in place sensible, dynamic leadership of the overall endeavour?
2. How will we be able to assess of what has been done to date in the e-Health domain what has worked and needs to be sustained, what needs to be modified and what needs to be simply canned? Once determined how will these decisions be actioned? What will be the best way to preserve and extend the successful initiatives?
3. How can we obtain real engagement of clinicians in the development and shaping of what is done in the future to ensure investment is made to achieve real positive outcomes for patients rather than the token consultation we have so often seen to date?
4. How can we get in place a real focus on ensuring that all e-Health interventions are actually evidence based?
5. How can we prevent hollowing out of the private vendor community via re-design of procurement and delivery processes?
6. How can we re-energise, support, foster and re-empower the Health IT Standards development processes?
7. How can we best take advantage of what has and is being learnt about the issues and difficulties associated with e-Health implementation in the real world as well as the issues around usability, Health IT Safety around the world? (2 pages outlining international trends hardly cuts it!)
Enough from me. Over to you to let us all know what you think! Remember this is probably a once in a five year period opportunity - given the last revision was 2008!


Anonymous said...

Yes it might be time to update the old strategy but it also might be pertinent to ask - what happened to the old strategy? It sat largely ignored on the COAG shelf is my recollection, whilst some DOHA geniuses invented the PCEHR - never foreshadowed in that strategy, never signed off on by the states, and never asked for by the population.

So yes, respond to the new strategy request, but make sure you also make clear the new strategy needs to have a big fat layer of reality wrapped around it. Maybe a statement on the front page: "The federal government bureaucracy reserves the right to partially or completely ignore the contents of this document, instead making it up as it goes along, and always claiming nonetheless that it has the mandate of this document to do so because of a get out of jail clause hidden craftily on page 356 footnote 15."

Dr David More MB PhD FACHI said...

I agree that is largely what happened last time.. Maybe by providing quality input we can see a more reasonable outcome this time?

Always the optimist..


Anonymous said...

Do we know who's doing this work? I don't recall seeing any tenders for it...

Dr David More MB PhD FACHI said...

Kos Sclavos said it was Deloittes in the article I linked from last week.


Bernard Robertson-Dunn said...


IMHO, the existing eHealth strategy fails on a number of points.

Failure 1. There is no bridge between the goals/vision/outcomes and solutions. A solution should solve a problem. Solving a problem achieves a goal. The existing strategy does not identify what problems the recommended solutions are going to solve or how they will solve them.

For example, the section on benefits starts with:

“A higher quality and safer healthcare system:
The E-Health Strategy will enhance the quality and safety of care through improved decision support for care providers and consumers, and improved patient information leading to a reduction in adverse events and improved treatment effectiveness.”

The strategy does not explain how this will happen. The references used to back up the claimed benefits a) may or may not be relevant in Australia and b) may or may not actually back up the claim.

Other questions include: How will consumers use eHealth information? Will all consumers be able to manage their own health? Which and how many consumers will not have the background, education or capability to manage their own health? Blanket statements like this one are like wallpaper over a cracked wall. They give the impression of solidness but there’s nothing behind them.

Failure 2. eHealth is all about information but there is no analysis of the information that should be/will be included in new eHealth systems.

An analysis of eHealth information should have definitions of entities and their relationships. There should be diagrams that show flows of information between the major components of the system. The table in figure 5-14 Key Information Flows is a less than comprehensive set of words that don’t actually define anything.

How anyone can attempt to define IT systems without an understanding of the information and how it will behave and need to be managed is beyond me.

Failure 3. The whole point of using technology to better manage health information is that it will change the way things are done at the moment. This will impact many players in the health profession, some of whom may not like the change.

Nowhere in the strategy does it say: “this is the way that information will be managed in the future”. Neither does it say “by changing the way that information is managed, a number of new problems will be created – e.g. that information that is much easier to access must also be carefully controlled”. It also does not cover what happens when there are errors, disputes and other problems with the system and who is responsible and accountable for the performance of the eHealth system.

IMHO, any new strategy should address the following areas:

1) There should be an explanation of just how the proposed solutions will deliver the claimed benefits;

2) The strategy should cover non-IT system issues such as accountability, responsibility, dispute resolution processes, etc;

3) There should be evidence that the strategy is underpinned by a good understanding of the information issues in scope of eHealth; and

4) There should be a recognition that eHealth systems will disrupt and bring about change in the health profession and the wider community. Some of these changes will be intended and result in benefits, others will be less than welcome and will need to be carefully addressed. The strategy should detail what the issues are and how they will be handled.

The existing strategy follows exactly the same path as that of all failed IT projects that I have seen and studied. To plagiarise/paraphrase a comment made about a well known English actor and comedian: An incompetent manager’s idea of what a useful strategy is like.

And one last rant. If they are going to develop a strategy, then it is probably a good idea to actually implement it, not something else that some manager thinks is a good idea.

Anonymous said...

It's frustrating that the Government departments hire expensive consultants or consulting firms (via tender) who then ask the industry members for information. The consultants are paid but the industry members are not. It's not fair on the industry workers, vendors, academia and researchers who are asked to contribute information and discuss with the consultant but are never paid for their time and effort. So the people with the least amount of experience and who do the least amount of work get paid more than those with the greater knowledge and larger contribution.
--- Tim C

Anonymous said...

If a "vendor" comes knocking for info, you can always respond with "No Solicitations Please!".

If they persist, easy to ask what is their "Willingness to Pay" for your time and contribution. If zip, tell them to "Bugger Off!".

The sector needs multiple and many circuit breakers to cease the recurrent senseless and dirctionless madness that has been the eHealth Circus for approaching Two Decades.


Anonymous said...

Guy Sebastian caught out by stalled patent probe
SINGER Guy Sebastian has weighed in on allegations of patent infringement by the Gillard government's National E-Health Transition Authority.

Anonymous said...

Seriously, has Fran Foo given up all pretence of being a serious journalist? I can understand Guy Sebastian being so gullible as to be sucked in by this - he's not exactly the sharpest knife in the drawer. But Fran should know better.

Useful questions would be:
1. When was Guy first approached?
2. What real legal status does this have - what is the actual amount that would have been donated had a licensing agreement been signed yesterday?
3. Is this just another flavour of an attempt to prosecute patent claims via the media?

Surely the job of our media is to ask these questions and inform us, not to blindly repeat media releases from an organisation whose previous media releases have been found wanting?

In short, this looks like a way to gain free publicity but doesn't in any way change the status of the patent claim.

Anonymous said...

"My management team has been in conversations with Robert (Lorsch) and his organisation and how they're going to be involved in my foundation, which I have some really great plans for," Sebastian told The Australian.

In time Sebastian will find quite painfully he has been conned by masters of the art. His foundation will suffer, his reputation will be damaged, and he will kick himself for not having undertaken a forensic due diligence investigation on MMR before getting involved.

Finally it's 99 percent certain he wasn't so naive as to approach MMR, rather he was approached either directly or indirectly introduced, and the seduction plan implemented to snare him into MMRs spider web. It's a cruel world out there.

Bernard Robertson-Dunn said...

There is a report in Pulse+IT today
MediSecure disables dispense notifications over duty of care fears

In the past, a doctor had no way of knowing if a prescription had been filled, but with automatic dispense notification capability, GPs can easily find out, another source said.

“There is an argument that because a GP could credibly identify whether a patient did or didn't pick up their pills, it could be argued by a patient's lawyer that the GP should be held liable if the patient didn't pick up pills and something happened as a result,” the source said.
End quote

In other words, the doctor now has access to more information about a patient, therefore the doctor should take more responsibility for treating that patient.

The PCEHR provides doctors with more information about a patient - what does that mean with respect to duty of care?

This falls under my Failure 3 - The whole point of using technology to better manage health information is that it will change the way things are done at the moment. In this case, potentially change the scope of duty of care.

IMHO, this is something that an eHealth strategy should raise as a potential issue, and recommend steps to resolve it.

Anonymous said...

Given the state of the Budget and the money poored down the drain over the last 20 years my advice to an incoming government would be to get out of the "Government Innovation" wasteland altogether and just say we will be requiring compliance with existing consensus standards in 12 months time or else.

Government programs cannot create working standards and filling the trough with Taxpayers money just attracts the low life (but well dressed) scavengers.

They should fund Standards Australia with NO strings attached, fund education and academic research and just try some simple governance. We have had the masters of the universe trying to sort it all out and they have failed. Only vendors can progress this, and the stick of standards compliance will bring them to standards meetings if they know they are going to have to comply. The public service cannot direct this, no one can innovate with a Gant chart based timetable. Its time for the government to empty the trough and use some cheap Australian Standards Compliance policies to clean up this mess. Nehta has created nothing of value and never will. Its time to pull the pin and get us all out of the weeds.