Sunday, August 25, 2013

This Is A Really Excellent Article On The E-Health Machinations Going On In Canberra. A Careful Reading Is Warranted.

This appeared a day or so ago.

Doctors and DoHA hold eHealth crisis talks

Published on Fri, 23/08/2013, 09:40:42
By Julian Bajkowski
The Australian Medical Association (AMA) has held crisis talks with the head of the federal Department of Health and Ageing, Professor Jane Halton, over the unprecedented walkout of clinical advisors from the nation’s decade long $1 billion effort to build a functional eHealth system.
Held on Tuesday, the meeting followed calls by AMA president Dr Steve Hambleton for Professor Halton to intervene and take a “personal focus” on why highly respected eHealth clinical advocate Dr Mukesh Haikerwal and several other medical advisors suddenly parted company with National eHealth Transition Authority (NeHTA) after a decade of attempting to make eHealth an everyday reality.
The situation that is emerging is that DoHA, assisted by contentious technology consulting and services firm Accenture, are poised to take on far more control and work to finally deliver software end-products to doctors and hospitals leaving an existential question mark over the future of NeHTA.
Dr Hambleton told Government News described the meeting with Prof. Halton as “extraordinary.”
“Clinical utility will drive this thing,” Dr Hambleton said. “If we can’t get it from NeHTA let’s get it from somewhere else. We have got a railway line … we just don’t have any trucks.”
“We can’t be driven by the techos,” he said.
The metaphor of rail lines, and the attendant headaches they have caused the Australian Federation, appears to be a highly prescient one.
It is understood that a major driver for greater federal involvement is that state governments, particularly those held by the Coalition in Victoria, New South Wales and Queensland are now far less willing and financially able to plough in the cash resources required to make a doctor-friendly front-end appear.
Ironically, the latest hiccup comes despite much of the back-end infrastructure for eHealth already being in place.
“It’s not a big jump. We just have to make it happen,” Dr Hambleton said.
Either way, the support of what some Canberra bureaucrats cheekily refer to as the “doctor’s union” is essential for any eHealth scheme to work because state and federal governments simply cannot, nor want to, compel clinicians to use it.
Relations between DoHA, NeHTA and the doctors have been strained now for some months over apparent difficulties in providing a usable system interface that provides what clinicians term “clinical utility” - or the ability for the system to be used for practical work by doctors.
A number of informed sources have suggested that reticence of the big states to keep ploughing long-term financial resources into NeHTA through the Council of Australian Governments has effectively left Prof. Halton and DoHA in control of the wider eHealth delivery agenda by default.
“It’s a pretty desperate lot that they are left with,” one government source said.
Much more here:
On the basis that Dr Hambleton is being accurately reported I have to say I am concerned he is being rather more optimistic regarding where we are in terms of the quality and utility of the present e-Health infrastructure than I am at present. However I really think he is spot on in the diagnosis that without  ‘clinical utility’ the whole effort is doomed.
I also agree strongly with the comment that without real AMA support and commitment the e-Health Scheme is doomed to fail.
The sooner DoHA and NEHTA face up to this fact the better for all of us and the less money will be wasted.
As a general point I think that there are some really useful and sensible things happening in e-Health - some of which I plan to write about during the week - but I have to say the Federal Government interventions have been by far the least valuable and evidence based and have cost the most. Hardly a great recommendation for Government intervention in what is a complex health / technology space that requires a good deal more understanding than is presently apparent.
I note in passing that other e-Health interventions from DoHA in other areas such as the AMT are also going badly at present with the Government just ignoring the expert advice they are receiving and leaving patient safety under increasing risk.


Anonymous said...

It's quite simple, yes Peter Fleming has been instructed to start dismantling NeHTA, ensure the assests are bundled up with our specs on a single website, there is no need for standards no need for clinical specifications, compliance conformance or accreditation, the Accenture consortium have clearly demonstrated they can and will provide all this for the department. We will insure that through the NEHRS and other exchanges vendors and various medical unions comply as they are clearly addicted to the departments payment schedules, as for clinical input, we have established an alternative and budgeted for. In regards to clinical safety ( to coin phrase from Mr Abbott - NeHTA will you ever shut up), there is no evidence the system posses any clinical safety risk, if in the future an issue arises we have processes in place to deal with this. Security is another area which we see no concerns, we have adopted banking strength security features, perhaps if doctors could be as efficient in accurate records things would improve much faster. We have listened and are removing our hurdles, assurances and remain confident that the minister will remain committed to dismantling any and all state control in health in Australia

Anonymous said...

yep, the bureaucracy wants all the control, as usual, and is blind and deaf as usual, as 'Anonymous' of 8/25/2013 06:24:00 pm, makes abundantly clear. Add a profit-driven 'big consultant' promising to make all the problems go away for them [DoHA], we are bound for a disaster.

No one in their right mind would buy into a centralised government database, accessible by and saleable to whomever, with a miniscule likelihood of any real benefit. We've seen all this before, and sadly, DoHA has learnt nothing.

Please God, the GPs have had enough off being treated like fools.

Anonymous said...

Please God, the GPs have had enough off being treated like fools .....

Well, the AMAs President isn't helping with his plea to and misplaced trust in Jane Halton to “intervene and take a “personal focus”.

Is he blind to the fact that she has been heavily involved from the very beginning, that from a management / governance perspective she is at the heart of the root cause of the problem?

Has Dr Hambleton not read Jane Halton’s nonsensical mumbo jumbo that she has been regurgitating up to the Senate Estimates Committees over the last 6 years or so about eHealth, NeHTA, PCEHR? Indications are that he has not, or if he has he hasn’t understood that she does not talk eHealth sense; quite the contrary.

The AMA has sat on its thumbs for far too long despite cries from the eHealth industry to get more involved in supporting local software vendors. They have sat back and done so little because they too have not understood the problem. By default they have left it to NEHTA and DOHA and in so doing contributed to the current mess.

The AMA has been gullible and DOHA and NEHTA have exploited that weakness. So too the Clinical Leads. Now the big vendor / consultancy firms will step in, suck up more $$$, and perpetuate the mess still further with the promise of sorting everything out. Trust us - we can deliver.

Anonymous said...

I like others am aghast at the idea that my PCEHR data could be on-sold by the government.

At least they are telling us this might happen. Given the recent revelations of massive government surveillance of our on-line lives, its clear that most advanced nations, with governments of whatever persuasion, seem to think that we have no longer rights to any sort of privacy.

Am I worried that government will sell aggregated health data? Not really. Am I worried that some future government will correlate health data with other sources to track our behaviours - its a given that they will.

So, just as you should do nothing on your computer that you don't want anyone else to know, we are now in a world where you cannot put anything in your record that you don't want anyone else to know. Privacy breaches like this will be covert, but that does not mean that they are right.

And you a bet that this message, even though anonymous here is cached somewhere on a government system right now, and they know what I had for breakfast (not Dr. More's Wheeties though).


Anonymous said...

8/26/2013 01:01:00 PM The AMA and the RACGP have had an abundance of opportunities to lead the way - instead they have kowtowed to the bureaucrats and techno heads and been led by the nose to where we are today. It is basically too late for them to recover. Perhaps their only hope is to turn away from NEHTA and support the local eHealth software vendors to get some working solutions into place. Unfortunately that would probably be too hard for politically conflicted peak bodies like AMA and RACGP.

Anonymous said...

"Well, the AMAs President isn't helping with his plea to and misplaced trust in Jane Halton to “intervene and take a “personal focus”. "
Doctors overboard, anyone?

Anonymous said...

If it wasn't for the $1+ billion of taxpayers money wasted on this doomed scheme it would be almost funny to hear these generic managers carry on about how they are going to fix this mess. An eHealth revolution will happen, but this subject is not "the one".

It is an insult to people who have spent decades achieving real, if slow, progress in solving this wicked problem to suggest that these clowns at DOHA can somehow solve it, when all the evidence is that they are the cause of many of the problems. The AMA may have medical knowledge, but are clueless about how it could be solved and are naive to think the DOHA or NEHTA have a clue. The consulting companies can't solve it but are happy to please the clowns* (*for a price).

As much as we want eHealth all we have done is hinder the people with adequate knowledge in trying to solve it in their own time, at their own expense. In the end governments should insist on compliance with standards that have been developed by consensus and provide basic infrastructure like codes and identifiers. Unfortunately they even struggle with that.

We need to remove this roadblock to progress and allow eHealth to resume some organic growth, at the expense and risk of the innovators, not the taxpayer. Evolution may be slow and evolves from what works (which may not be the latest cool thing) but DOHA has again proven the failure of Intelligent Design, A wicked problem does not yield to generic managers demanding it just happen and they just don't get that.

Anonymous said...

Doctors overboard - yes more clinical leads have resigned over the last week. The biggest name to announce his imminent departure is former RACGP President Dr Chris Mitchell who oversees Change & Adoption at NEHTA. Rumour has it that Peter Fleming is desperately offering clinical lead contracts to anyone with a medical degree.

Anonymous said...

"Rumour has it that Peter Fleming is desperately offering clinical lead contracts to anyone with a medical degree. "

The other latest desperate act...all nehta executives are back to uni to get their nehta funded medical degree! Governance issue solved.