Wednesday, August 14, 2013

NEHTA Attempts To Explain Why Clinicians Are Bailing Out. E-Mail To Staff Has More Spin Than A Top.

Here is what NEHTA’s Staff were told this morning.
Dear Colleagues,
This announcement is to inform you that Dr Mukesh Haikerwal AO will soon be stepping aside from the role of National eHealth Clinical Lead and Head of Clinical Leadership and Stakeholder Management with NEHTA.
I would like to acknowledge the tremendous expertise that Dr Haikerwal has contributed to eHealth in Australia. For many years he has been a tireless advocate to turn the eHealth vision into reality, with the Personally Controlled Electronic Health Record system now being well established and moving into a new phase. Dr Haikerwal will no doubt continue to advocate for the transformative ability of technology to improve healthcare delivery and outcomes for all Australians, and indeed worldwide in his role as Chair of the World Medical Association.
Over the past months, Dr Haikerwal and I have been in discussions with the Department of Health and Ageing about the way NEHTA and governments engage with healthcare providers, peak bodies, consumers, vendors and other key stakeholders who are playing a role in transforming healthcare delivery through eHealth.
This discussion aligns with NEHTA’s shift in focus from designing and building national eHealth infrastructure to implementing and supporting adoption of eHealth. As we are reaching the conclusion of these discussions, Dr Haikerwal has advised me that he sees this as the right time for him to step aside from the leadership role with NEHTA he has held for the past six years.
Mukesh brought to NEHTA the advocacy for a clinically led national eHealth programme and built a strong network of clinical leads who are experts across the entire Australian clinical landscape. This network, together with the internal Clinical Unit Mukesh developed, were successful in embedding clinical perspectives and needs into the design of NEHTA specifications which directly support the uptake of eHealth systems which are being implemented today. It is this tireless effort in the years of design which has provided a solid foundation for years to come. Mukesh will officially finish at NEHTA on 22 August.
On behalf of NEHTA, I wish Mukesh the very best in his future endeavours and look forward to continuing our dialogue on eHealth in the future.
The Executive team are meeting next Wednesday to discuss changes to NEHTA’s structure that arise from Mukesh’s departure and other recent changes. I anticipate these changes will be finalised and communicated shortly thereafter.
Regards
Peter.
----- End E-mail.
What wonderful spin.  It is utterly obvious the PCEHR is just not fit for its intended purpose, and is conceptually a disaster.

It is clear that Mukesh and a number of other senior clinicians have become utterly frustrated with the total lack of responsiveness to clinical input and requirements, and are now realising there are some fundamental and almost impossible to fix flaws in the current NEHTA designed PCEHR.
Some other good people have also left as well I am told.
Shows just how wrong DoHA and NEHTA are getting all this in my view.
David.

24 comments:

Anonymous said...

I think the "Clinical Leads" are the drug company equivalents of "Key Opinion Leaders" who are seduced to support whatever Nehta wanted and had little idea about eHealth. They certainly failed in their role to ensure clinically relevant software was being designed/built. The trouble is that its all style over substance, but in the end the emperor has no clothes.

Anonymous said...

A shame really, as we have often seen Mukesh speaking out bravely about the problems and difficulties with the PCEHR, and listening to clinicians and eHealth folk. He made a lot of sense. I think yes – like the rest of us, he must have felt powerless against the spin, the self-serving bureaucrats, and the highly paid consultants.

Anonymous said...

What a debacle!

They can call a spade a spade now...

the POLITICALLY controlled electronic health record

given clinical opinion is such an annoyance to the self-serving bureaucrats and overpaid consultants!

Anonymous said...

Where exactly is the shame?

Dr Mukesh Haikerwal received far more from NEHTA and taxpayers than he gave, that you can be assured of!

Let's hope the resultant diminished funding now required by NEHTA and its descending trend continues all the way to Zero, and at an accelerated rate once the election is over and new government is installed.

Maybe the Clinical Leads have finally seen the writing on the wall and are getting out before they are embarrassingly pushed out by new governance as another motivation for their newly announced departure?

NEHTA's "Senior Executive Ranks" may be prudent in adding how to efficiently shut down and shutter NEHTA and liquidate its resources to today's agenda for how the organisation needs to be restructured, as a result of a negative outcome (for them) to the upcoming election fallout.

Anonymous said...

David Gonski won't be claiming credit for chairing NEHTA to this point. More than a smudge on his CV.

Keith said...



Anonymous (02:42:00 PM)said...
"Dr Mukesh Haikerwal received far more from NEHTA and taxpayers than he gave, that you can be assured of!"

I think that is quite uncharitable. I believe Mukesh earned the respect of all parties; he tried to obtain the best possible outcomes under the circumstances.

In judging the clinical leads we should remember that initially there were none. It was in one of the reviews of NEHTA (by Deloittes?) that they recommended the appointment of a small number of clinical and technical "leads". NEHTA responded by appointing about 50 clinical leads and zero technical leads. Maybe they couldn't get anyone to take on the role of technical lead, but I suspect that they believed that they (NEHTA) had all the technical expertise they could possibly need!

K said...

"NEHTA responded by appointing about 50 clinical leads and zero technical leads. Maybe they couldn't get anyone to take on the role of technical lead, but I suspect that they believed that they (NEHTA) had all the technical expertise they could possibly need!"

Though there was never a technical leads program, NEHTA made systematic attempts to employ technical leaders, but all of them said no for various reasons. But there has been a policy of engaging known technical leaders for specific project and expertise advisory work, and this has happened a lot (some of those high priced consultants everyone moans about).

Terry Hannan said...

Despite the praise from Peter Fleming towards Dr Mukesh Haikerwal we should all try and create a proper ‘perspective’ of what has been achieved under his leadership. That is in e-health terms we must “measure what we do”.
One cannot question Mukesh’s enthusiasm for his position what can be questioned is the outcomes in relationship to ‘clinical computing’ and in particular the PCEHR.
Why did he not know that the PCEHR model was unlikely to work when existing knowledge over 30 years confirmed it as a potential failure?
Had he not read the existing literature on how system implementations fail or succeed? Was this a reason for the inability to establish clear arguments for effective implementation?
From first-hand experiences of attempting to communicate with him and the DoHA/NEHTA group, was very difficult. At times it felt as if they just ‘did not want to hear’.
There are many in the community who have been a part of significant collaborative e-health implementations and our involvement could have facilitated early incremental, standardised, interoperable, end user e-health functionality. Here are some of the lessons learnt from these projects.
DESIGN GOALS FOR COMPLEX E-HEALTH SYSTEMS:
• COLLABORATION:
• SCALABILITY:
• FLEXIBILITY:
• RAPID FROM DESIGN:
• USE OF STANDARDS:
• SUPPORT HIGH QUALITY RESEARCH:
• WEB-BASED AND SUPPORT INTERMITTENT CONNECTIVITY:
• LOW COST: preferably free/open source
• CLINICALLY USEFUL: feedback to providers and caregivers is critical. If the system is NOT CLINICALLY USEFUL it will not be used. [AMPATH Medical Record System (AMRS): Collaborating Toward An EMR for Developing Countries Burke W. Mamlin, M.D. and Paul G. Biondich, M.D., M.S. Regenstrief Institute, Inc. and Indiana University School of Medicine, Indianapolis, IN ]
So what is the legacy left behind by Dr Haikerwal’s departure with the other ‘clinical leads’ under his stewardship?
Sadly we are a long way off the pace in e-health reform with many clinicians, physicians in particular [Hannan T, Celia C, Are doctors the structural weakness in the e-Health building? Intern Med J; 2013; 43: October; **2013
• Editorial JAMA July 2013: Will Physicians Lead on Controlling Health Care Costs? Ezekiel J. Emanuel, MD, PhD; Andrew Steinmetz, BA] and there does not seem to be a ‘political’ solution on either side of politics for “‘e-health being the essential tool for improving health care”. [Paraphrase of Dick R.S., Steen E.B., Detmer D.E. The Computer-Based Patient Record:An Essential Technology for Health Care, Revised Edition1997.]

Anonymous said...

As a peripheral participant, I would've thought that those design goals characterise the clinical leads aims nicely. They were compromised by what could be done politically, and particularly by the timelines that were set above them. I wonder how much of their inability to engage was driven by things they had no control over.

I'm sure that they characterise their own involvement in terms of *how much worse it could have been*

Anonymous said...

When clinicians who have no practical experience and skills in healthIT get together with IT people who have no practical experience in clinical medicine it is folly to expect the two together to be capable of designing a solution which will work. Finding the combination of required skills and experience on both sides of the equation in the one individual is a necessary prerequisite. There are a handful of such people around but none of them have worked with NEHTA for obvious reasons.

Bernard Robertson-Dunn said...

IMHO, the root cause is a failure to understand that when you make a major change to a complicated and highly interrelated system, most other parts will be impacted and will also need changing.

It's a bit like taking a small car and putting a much bigger engine in it. Unless you also change the gearbox, the transmission, the brakes, the steering, the tyres and your insurance, it just won't work properly or safely.

By the time you've done all that, the little car isn't a little car any more, it's just like any other, bigger car.

From my perspective, as a researcher of failed IT projects, there are two major problems with the PCEHR.

The first is that it is not complete in itself. There are just too many things missing from the PCEHR, as an Information System, for it to be made to work, without in the mean time losing the trust and confidence of those who are supposed to be using it.

The second is that it won't work properly in the wider health environment without significant changes to that environment.

I could try and tell the powers that be, what they should have done differently, but for two things.

1. It's too late.

2. I've already told them in my submission re the ConOp. They just didn't understand then, I don't think they would understand now.

Anonymous said...

For god sake, it is a record keeping system, that is it...

Simple.

1. Engage and speak with the stakeholders after agreement then follow the bouncing ball -

2. Work out what records need to added
3. Work out how the records need to be classified
4. Work out what sources and formats that the data and records are coming from
5. Work out the access controls, permissions and audit trails
6. Work out what reports need to be generated
7. Work out the registration process

Bingo and there you have a PCEHR based on solid RM principals

Clinical + IT + Standards + Frameworks + Government = Failure

Keep the bloody thing simple.

I know many people that could build a working model in a month.

Deploy across complicated tiered server environments in 6 months

Total Cost best estimate = $20M

No consultants involved.

Anonymous said...

Dear 8/15/2013 04:56:00 PM if it is all so terribly simple and straightforward would you please explain why in the UK, Canada and USA such a simple, comprehensive and easy to use system has not yet been developed and widely deployed; rather we have numerous examples of bungled failed projects and Australia is no different. I'm sure you have an explanation for that and we look forward to reading it.

Bernard Robertson-Dunn said...

It's not just a record keeping system. That's why it's so difficult.

It's a disruptive system that will change people's behaviour in unpredictable ways.

As has been said before:

To every complex problem there is always at least one simple, obvious solution - that is wrong.

Anonymous said...

Firstly - Anonymous - 8/15/2013 07:07:00 PM - Simple answer why they failed in four parts.

Part 1 - They did not engage with ALL stakeholders across the health data continuum to ascertain impact on work practice, data collection methods and understanding the various types of data including the following;

1. overt data collection
2. automatic data collection
3. generated data
4. acquired data
5. ephemeral data

Part 2 - They tried to be all things to all men instead of developing a data framework and model

Part 3 - Government, bureaucrats and highly paid self interest consultants pandering to political whims

Part 4 - They failed to educate stakeholders and provide guidance with change management practices

That's why they failed.

There are RM systems that have been designed, developed and deployed for 450,000 contributors (and service millions of view only users) in the US government, across every populated continent, across multiple and different server tier environments that house, archive and manage Billions of records.

Nobody wanted to look at these as politics and lobbyists played a hand.

@Bernard the PCEHR is a record keeping system as it is a collection of data (records) that has originated from different sources, that should be displayed in an informative, interactive and logical manner to the user.

Something the current PCEHR interface does not do.

Bernard Robertson-Dunn said...

I didn't say it wasn't a record keeping system. I said it wasn't just a record keeping system.

Anonymous said...

Bernard, if it is more than a record keeping system, can you please explain what you mean by "more"?

Anonymous said...

Well said Bernard - sums it up perfectly. "To every complex problem there is always at least one simple, obvious solution - that is wrong.".

Your perceptive comments on this blog are consistently invaluable.

Bernard Robertson-Dunn said...

re: "Bernard, if it is more than a record keeping system, can you please explain what you mean by "more"?"

As I said: It's a disruptive system that will change people's behaviour in unpredictable ways.

A record keeping system is a tool. It is a powerful tool and like most powerful tools it can be misused.

What really matters is who is allowed to use it? who does use it? how it is used? what are the processes and procedures for when it is misused, or its contents are inaccurate? and finally, do people trust it a) as a record keeping system and b) that it is being used appropriately?

And most importantly, is it a tool that, by using it, results in improved health outcomes?

Anonymous said...

“You will never understand bureaucracies until you understand that for bureaucrats procedure is everything and outcomes nothing” Thomas Sowell

Anonymous said...

As you sow you shall reap. The mgt and clinical leads have bullied staff or failed to protect staff from bullying by others. A truly toxic workplace. Fleming and others should be sacked.

JeanneMarine said...

Anonymous said...
"When clinicians who have no practical experience and skills in healthIT get together with IT people who have no practical experience in clinical medicine it is folly to expect the two together to be capable of designing a solution which will work. Finding the combination of required skills and experience on both sides of the equation in the one individual is a necessary prerequisite. There are a handful of such people around but none of them have worked with NEHTA for obvious reasons"

In fact there is a professional group that is expert in the design of clinical information systems and has extensive experience in working and collaborating with clinicians and defining their information requirements. The profession is Health Information Management. See what they do at http://www.himaa2.org.au/

Anonymous said...

8/19/2013 04:26:00 PM .... in fact there is a professional group that is expert in the design of clinical information systems and has extensive experience in .......

Mmmm. Unfortunately they lack the commercially pragmatic experience so vitally necessary to keep the altruistic well intentioned system design enthusiasts heads out of the stratosphere and their feet firmly planted on the ground. Finessed business acumen, political skills, vendor management and many other skills are not evident in the organisation. Good, decent and enthusiastic people though they may be.

Anonymous said...

"Finessed business acumen, political skills, vendor management and many other skills are not evident in the organisation."

Results and historical records show this is a chronic problem across healthcare and especially eHealth organizations entirely.

Which is just another component piece of a much larger dysfunctional health sector problem!

The Boffins are the very least of the problems to say the least...