Wednesday, October 15, 2014

How Can It Be That The E-Health Community Is Being So Mushroomed By Government?

First a definition - to be Mushroomed is to be “Kept in A Dark Place and Fed Smelly Excreta”.

To me that is what is happening to the e-Health Community . We have all sorts of meeting where there are lots of e-Health research presentations but where is NEHTA and DoH explaining the big picture and what the future is? Pretty well absent I guess.

With the ONC in the US we have a weekly e-mail newsletter and in Canada regular, is slightly selfserving, material from Infoway. Here all we hear about is AMT and SNOMED releases and about publicity ventures when a dead duck is being pushed on unsuspecting allied health professionals, nurses or administrators.

No futures, no strategy, no analysis of practical success has been forthcoming. Just why might that be?  Emperor and nudity flicker to mind.

I really don’t think the cone of inactive silence is good enough. Do you?

David.

27 comments:

Anonymous said...

The people get the Government they deserve!

Anonymous said...

Best thing to do is put all you duck eggs in a bunker, turn the lights off, guarenteed a lot of nothing will happen but plently of verbal dung to feed the mushrooms

Anonymous said...

Inhave to agree David, the silence if deafening, with all the spin around teh eHealth Reference Platform surely NEHTA could provide some good news stories around the usage of and number of organisations using the traning service and just what it is being used for.

Anonymous said...

Much has been said, but no one in NEHTA or DOHA choose to listen so in the end people withdraw. The stakes are high for DOHA but there appears to no accountability in the public service these days despite the billion dollar price tag of this mess. The sooner the money runs out the better!

Anonymous said...

Media management rule 101 ---- NeHTA knows it has lost all credibility. Therefore it will not add fuel to the fire by saying something that will act as more cannon fodder for you lot. It will stay silent, keep its head low, take the money for as long as possible and try and remain an invisible target.

Anonymous said...

Will the Department repeat it past mistakes by attempting to dictate what eHealth solutions Primary Heath Networks are to deploy? We should hope not. Rather, PHNs should be given maximum flexibility to determine their own direction in regards to how they choose to deploy eHealth to meet their goals and objectives. At least that is my view. What do others think?

K said...

well, it's pretty much a choice - like all things in IT: you can have one great big mistake, or many little mistakes, all made differently.

Whichever you choose, the department gets to take the blame ;-)

The second, though messier, is the better way, because you might also get some scattered success (by accident!), and you can *gradually* expand that up.

Anonymous said...

You're dreamin'!

Anonymous said...

K (if that is your real name) is not wrong, however at this level you need a good solution architecture, a common reference model for diverse systems to be appropriately guided in how best to iintergrate and ensure a secure and trusted exchange of information, sadly the last four years the national architecture work has been left to hang on the vine. I can only imagine the trouble nehta must be getting itself into as they try and support implemtation, look at all the FAQ etc.... I feel for the ones looking to implement terminology. CEO wake up and save the game, clean up your team, they are all replaceable

Anonymous said...

October 16, 2014 10:40 PM exactly AND it will allow market forces to prevail. In parallel the Department - without meddling and interfering - should create a supportive investment environment which shares the risk, underpins the core investment required and rewards with a bonus when proof-of-concept is well and truly tried and proven. Does any one agree with me this time?

Enrico Coiera said...

"Building national healthcare IT systems involves defining a policy and standards framework that can shape the convergence of public and private, local and central systems into a functional national system. It is also about governments doing those things that only governments can do well, like supporting public sector institutions to join the NHIS, providing incentives for the private sector where the private business case for change is weak but the national interest is strong, supporting the development of public goods such as the skilled health informatics workforce essential to the success of any NHIS, and crucially, developing the legislative instruments needed to protect the privacy and legitimate interests of citizens. And government should avoid doing what it is not good at, like designing, buying, or running IT."
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2732241/

Bernard Robertson-Dunn said...

re Anon October 16, 2014 10:21 PM & October 17, 2014 8:47 AM.

"Will the Department repeat it past mistakes by attempting to dictate what eHealth solutions Primary Heath Networks are to deploy?"

Will they make the same mistakes? Don't know. Hope not.

Should PHNs decide on solutions? Probably not.
They don't have the problems. IMHO, it should be the organisations that have the problems that come up with the solutions - solutions that suit them. Which is what seems to be happening anyway. The PCEHR, because it doesn't solve any particular problem - at least no better than other systems do, or will, is a white elephant.

PHNs should co-ordinate, not dictate. Central agencies do not have authority, knowledge or ability to dictate. They try and use finance to gain authority but that is a bad tool to use.

IMHO, central agencies should co-ordinate and encourage collaboration. Unfortunately they are soft skilla. IMHO there are too many high energy, Alpha managers who don't understand that soft skills can often be far more useful. You only have to look at our PM and his "shirt front" approach to international diplomacy for a good example of a bad tactic.

And it's probably no coincidence that he and the redoubtable Ms Halton kicked off some of these dictatorial initiatives.

But to directly answer your question. Yes, I agree that the Department should get out of the way. At best they add nothing, at worse they slow things down and make things more difficult.

Anonymous said...

I agree with you Benard. Although when you say "it should be the organisations that have the problems that come up with the solutions - solutions that suit them" - I have to say that while that makes commercial / market sense I wish it were that straightforward.

Look at the Primary Care market - multiple small businesses all chasing their tails to make a profit, run their businesses and compete with each other providing 'patient care'.

By all means get the solution that works for them; many different solutions. Great - but that isn't the problem - the problem is getting all those software suppliers to those many businesses to put systems into place which will share information with the other suppliers, which will facilitate the sharing of clinical (health) information which can be used to build a comprehensive, reliable, trusted overview / record of each persons health status that other health providers can refer to with permission and as required.

Can Government help make that happen without meddling by creating an environment in which it can happen? Whereby those participating in 'that environment' all want to make it happen and are prepared to invest the time, energy and resources to achieve that end - let me repeat - without the government stepping in and meddling by telling those in the 'environment' what to do and how to do it - that requires real leadership backed by adequate resources.

Regards - Anon October 16, 2014 10:21 PM & October 17, 2014 8:47 AM

Bernard Robertson-Dunn said...

Anon October 16, 2014 10:21 PM & October 17, 2014 8:47 AM

Agree. It's an information problem.

And who has the greatest information sharing problem? Hospitals and specialists. Let them lead the way - which is what seems to be happening at the state and local level.


The Federal Government doesn't have a health information problem - at least not in the delivery of health services sense. It might in the national health and health funding senses, but it seems to be promoting a solution to one problem (individual health records) when in fact it has a different problem - health statistics.

Anonymous said...

who has the greatest information sharing problem? Hospitals and specialists. Let them lead the way.

Ahem - big hospitals - in 9 states and Territories have not done too well with health information systems over the last decade or so. Specialists are too busy making money to be bothered. Hospitals acquire 'systems' 'solutions' via tender and spend upwards of $80+++ million acquiring US based solutions like Cerner, Epic, Intersystems Trak, CSC, GE Health, All Scripts.

Do you really believe hospitals and specialists can lead the way and solve the problem?

Bernard Robertson-Dunn said...

Anon:

"Do you really believe hospitals and specialists can lead the way and solve the problem?"

They haven't so far. Should they? They have the greatest need, especially the hospital/specialist environment. Their solutions, driven by real problems, could then be extended gradually into wider areas.

Some of hospitals and hospital networks have developed ehealth and medical records - they are already heading in the right direction.

The big problems of patient and health care provider identification have been solved (something good seems to have come from the $1B, but it could have been done for a lot less).

Sometimes the only way to build a big system is to make lots of small systems and join them up. You might say "why not just build the big one from scratch?"

The problem is, you don't know what the big one looks like. You have to get there through evolution. And evolution is about making lots of little mistakes and learning from them. $1b is not a little mistake. And the people who make the $1b mistakes don't learn much, they just move on and make similar mistakes in other areas.

Andrew McIntyre said...

I don't believe that provider and patient identification has been solved. Patient identification requires a perfect match which is not that helpful. Provider identification is not location specific which makes it dangerous and useless for messaging. Practice identification would be useful but that is optional and so is pretty useless.

Medical-Objects is specialist centric because of its origins and we have widespread specialist uptake particularly in areas that have been established longer. On the Sunshine Coast virtually all specialists are online, because its an expectation from GPs and the fact that it makes their life easier and transfer of results easy and rapid.

Solutions that work are out there, but DOHA and NEHTA are guilty of oxygen theft. Better compliance (HL7V2) by receivers would make the job much easier and allow higher quality reporting but we have interoperability working, bandaids and all. At 27000 connected users its hardly a small pocket of activity.

The thing that would make it very easy to satisfy the wants of specialists would be Universal support for receiving compliant HL7V2 and support for html display using a compliant browser component for display (And not conversion to rtf as we currently see!!!) If that was in place we could improve the display quality and reliability, which is one of the big issues for senders.

Anonymous said...

Healthcare Provider Identifier - Individual and Healthcare Provider Identifier - Organisation are no substitute for the Provider Number in real clinical systems. Providers work in multiple locations and if messages are to be accurately and securely delivered to them then the providers need to be linked securely to a location. I cannot believe that with all the effort and dollars that was put into the IH that this simple fact was not recognised.

Anonymous said...

NEHTA - AKA "The smartest guys in the room" have been told - years ago that that provider identification was fatally flawed because of the lack of attention to the need for location specific identifiers.

However at that point it was a case of the equivalent of a "ministerial" where the minister says "you have to make it work" because it was to late to go back and so much money was spent. This reminds me of the NASA administrators dictating that things which defied the laws of physics had to be done. Minister these buffoons have failed you big time. When you understand how fatally flawed government designed eHealth actually is you understand why pulling the pin is the only sensible path for government to take. I think Tony Abbott had an idea of how hopeless the eHealth program was 7 years ago, he was right and given the budget situation putting a stop to this waste is a good option for everyone but NEHTA and DOHA.

Anonymous said...

Thank you all for this illuminating discussion which brings me back to my initial proposition above on October 17, 2014 8:47 AM.

Anonymous said...

"Anonymous said...
Healthcare Provider Identifier - Individual and Healthcare Provider Identifier - Organisation are no substitute for the Provider Number in real clinical systems. Providers work in multiple locations and if messages are to be accurately and securely delivered to them then the providers need to be linked securely to a location. I cannot believe that with all the effort and dollars that was put into the IH that this simple fact was not recognised.
October 17, 2014 8:57 PM"

Read the manual....

How can I link a health care provider to an organisation in the HPD?
The HPD shows the organisations where individual healthcare providers work. These links can only be made by the Organisation Maintenance Officers (OMO) of the organisations.
If you’re an OMO, you can link a health care provider’s entry in the HPD to your organisation’s entry by:
logging onto HPOS, selecting Healthcare Identifiers link and updating information under the ‘My organisation details’ link
using the web service if your practice management or patient administration software has the functionality—contact your software vendor for more information

http://www.medicareaustralia.gov.au/provider/health-identifier/#N101C6

Eric Browne said...

I agree with Andrew McIntyre and others that Bernard's assertion that "the big problems of patient and health care provider identification have been solved" is way, way off the mark.

Firstly, NEHTA/DoHA/DHS's HI Service is inadequate to meet many of the patient and provider identifier requirements for the exchange of health and healthcare information.

Secondly, there is very little implementation support for either the HI-service or the national identifiers themselves in existing clinical systems.

Thirdly, to my knowledge, there has been no attempt to audit the uptake of the HI-service and the national identifiers, nor to determine how much it might cost or how long it might take to get to the stage where we have widespread uptake and support for these nationally unique identifiers. Let alone have in place identifier systems that actually meets our needs.

K said...

Right - the way HPI-O, HPI-I, and the HPD work are clear an reasonable. Individuals do not become different people when they move to different institutions.

The problem is the expectation that HPI-I is a workable delivery address for that individual, because messages are not delivered to an individual, but to them as an agent of an institution.

I think that some people wrongly equated HPI-I with provider number, and expected to be a functional replacement. Quite a few people, early on, and the problem with waterfall development of specifications across a distributed community is that by the time you realise your error, it's too late to do anything effective about it.

Anonymous said...

At this point, thanks to all, we have teased out an important clarification around one of the great muddles created by DOH & NEHTA.

A muddle which is fundamental to the future success or otherwise of all clinical data exchange and the PCEHR. Dare I ask anyone to nominate another muddle for discussion.

David, the foregoing thread and associated blog should be brought to the attention of the Auditor-General VIC should he be appointed to investigate the Not Extremely Helpful To Anyone entity, otherwise known as NeHTA.

Dr David More MB PhD FACHI said...

If I hear of or anyone alerts me to such an Audit I will have a lot of links ready :-)

David.

Bernard Robertson-Dunn said...

Gee, there was I thinking that something of value had come from spending $1b. Obviously I was wrong.

Even worse, the thing I was wrong about is fundamental to the whole national eHealth initiative.

And it seems to hinge on the lack of (at least public) information models. (ERDs and DFDs for the technically minded)

SNAFU.

Thanks for the corrections guys, it's been most informative.

Anonymous said...

...... and thank you for your stimulating contributions Bernard. This is a good example of different opinions being scrutinised and turned over and over until questioning, flexible, open minded, problem solving minds reach a common point of understanding whence the fundamental truth is permitted to emerge to the satisfaction of all. Well done.