Sunday, September 14, 2014

Plus ça change, plus c'est la même chose - How True This Is. I Am Amazed.

I spotted this a day or so ago and just could not believe it!

Advancing Health IT with Congressional Asks

by Alex Cohn, Institute for e-Health Policy Intern with the HIMSS Government Relations Office
Each year, a work group of HIMSS volunteers develops the organization’s “Congressional Asks” – formal requests to Congress to accomplish specific goals to advance health IT.
As the process goes, the HIMSS Public Policy Committee reviews, and the HIMSS Board of Directors approves, these Congressional Asks. A vital component of the HIMSS activities during NHIT Week, the Congressional Asks
  • represent essential messages presented to Congress during the annual HIMSS Public Policy Summit Day, Sept. 18, on the Capitol Hill; and
  • provide important issues and guidance used by HIMSS and many other organizations throughout the year.
This year, HIMSS focused on three very different, yet essential, topics within health IT. Our top three  2014 recommendations for Congress – the Congressional Asks – follow.
Ask #1: Minimize Disruption in our Nation’s Health System Emanating from Federally Mandated Health IT Program Changes.  To minimize disruption of healthcare to patients and avoid an undue burden on providers, Congress should require the Secretary of HHS to publish a review, evaluation, and recommendations on the five-year roadmap of all mandated, HHS-administered health IT requirements and program changes affecting patients and the operations of providers, payers, and/or health IT vendors.
Ask #2: Fund the National Coordinator for Health IT to Achieve Interoperability, Improve Clinical Quality, and Ensure Patient Privacy and Safety. Positively transforming our nation’s healthcare system requires, among other things, widespread, secure, interoperable exchange of health information. Congress should fund the Office of the National Coordinator for Health Information Technology in FY 2015 at sufficient levels requested in the Administration’s FY 2015 Budget Request.
Ask #3: Expand Telehealth Services to Improve Patient Access and Outcomes and Decrease Healthcare CostsTo expand access to quality care, help control costs, enhance secure interoperability of health information, and improve quality for rural and underserved populations, Congress should pass legislation that enables the nationwide realization of the full benefits of telehealth services.
Full HIMSS Post is here:

In summary what is being asked for is that Government stops springing surprises (like the PCEHR and a whole lot of standards and regulations) on the e-Health Community, that the focus be on safety and clinical information exchange and to see if teleheath - especially in remote areas can be supported.

The similarities of the analysis of the issues and what needs doing is just amazingly congruent with the situation in OZ!

Sounds like an agenda most in Australia could wholeheartedly support.

Seems like Government is hard to cope with all over!



Anonymous said...

On its own Government doesn't know what to do. It needs and seeks advice from external parties to develop its policies.

The external parties are the big consulting firms who develop their views based on the sales pitch of the larger vendors.

The vendors and the consulting firms pitch their messages at Government through various bodies which they have managed to infiltrate.

Best if Government got right out of the picture and left the whole business of eHealth to market forces - in that way vendors can develop, sell, succeed, grow, expand, take over or be taken over, or die.

Bernard Robertson-Dunn said...

re: "Best if Government got right out of the picture and left the whole business of eHealth to market forces - in that way vendors can develop, sell, succeed, grow, expand, take over or be taken over, or die."

I beg to disagree. If left to market forces, vendors would be free to develop solutions that didn't work properly, were of doubtful quality and which caused confusion, harm and death. It is quite likely that health care professionals would soon sus them out and not use them. Not unlike the situation with the PCEHR and other so called electronic health record systems.

A better comparison would be manned spaceflight where government sponsored organisations like NASA to lead the way. Even then there were occasional deaths.

Unfortunately, in Australia, the comparison with NASA fails for two reasons:

1. Health is about medicine, biology and psychology, which are much more difficult than the physics, chemistry and engineering of spaceflight.

2. The people in NASA in the sixties were much more competent than you'll find in NEHTA, DoH or any comparable Health organisation today, public or private.

IMHO, Government cannot get out of the picture; it needs to be a lot more clever than it has been so far.

Andrew McIntyre said...

The government (and government in general internationally) have a poor record of providing solutions and plotting direction. There is plenty of evidence for that.

Left to vendors alone inter-operability suffers as larger vendors use their market power to advantage themselves by ignoring standards and trying to snuff out emerging competition. We have certainly seen that.

Currently the government has become such a big spender that they dominate the market, but as an uneducated consumer their spending has distorted the market in perverse ways. The end users are best placed to buy what they want, but the governments role is to ensure that applications are safe and the best way to do this is by insisting on standards compliance.

Standards should be developed by vendors by a consensus process and if standards were enforced vendors would take an interest in contributing to innovation/standards.

Standards compliance testing is relatively cheap, particularly if done without NEHTAs input and we used to have AHML which was good value, but was destroyed by a complete lack of support by government. We need more than AHML provided but it was a good start.

Providing sound governance is very cheap, but it would increase the cost of software, which would be worn by users, but it would also advantage users. If the government wants to spend money then it could support users paying more for better quality software.

I don't think its like NASA as we already have people producing software and those people need to be able to innovate, while complying with existing standards in a very high quality and safe way. When done by government all the spending is going in hundreds of million dollar chunks and all we are doing is rewarding large companies who can convince the public service they have all the answers, and clearly they do not. Innovation does not come via large consulting firms.

The end users have an expectations that the software they buy must be complying with standards when they are not and this must change. I suspect that the less the government directly spends on anything but compliance the better the long term outcome. I doubt the US model is getting value for money for this reason.

Anonymous said...

There is also a reticence, even a fear, within the public institutions of buying any system that is not a big name in health care. There are many companies in Australia providing excellent products that comply with standards at competitive prices, but tender processes are distorted by the biases of the evaluators.