Sunday, November 15, 2015

AusHealthIT Poll Number 296 – Results – 15th November, 2015.

Here are the results of the poll.

Does The Australian Government Have A Clear And Well Understood Strategy For Australian E-Health.

Yes 6% (6)

No 85% (82)

I Have No Idea 9% (9)

Total votes: 97

Again a pretty decisive poll. We are a strategy free zone it would seem! This is, of course, a disaster and bodes badly for the future!

Good to see such a great number of responses!

Again, many, many thanks to all those that voted!



Karen Dearne said...

The National e-Health Strategy is still the one produced by Deloitte in 2008, adopted by the feds and all states and territories via COAG - and never implemented.

Instead, we got the PCEHR

Deloitte did an update on the strategy in November 2013 - but this is still a national secret, apparently, and has never been agreed or adopted

So readers are spot on, Australia is officially a no e-health strategy zone

Anonymous said...

Hi David,

I am having problems with your latest question. What exactly has NEHTA actually done? Its hard to answer because of that. I guess they are good for nothing?

Dr David More MB PhD FACHI said...

Have a look at the Annual Report to see the context of Mr Fleming's claim.


Anonymous said...

In his CEO report Mr Flemming said:

“the core of the national foundation work (has been) to be designing, building and operating the common identifiers, specifications and terminology to establish interoperability and connect healthcare providers and data sources."

A worthwhile work activity. He also said:

"The national foundations, the bedrock upon which a national eHealth system is built, have been delivered. The Healthcare Identifiers (HI) Service, National Authentication Service for Health (NASH), clinical document specifications and other national foundations are all operational.”

In other words Mr Flemming has confirmed that NEHTA has now successfully completed its mission and everything has been delivered. NEHTA is ready to move on after handing everything over to the Australian Commission for eHealth to provide ongoing maintenance and support resources for NEHTAs products.

Having participated in a number of Senate Estimates committees on eHealth I have to say from a politician's perspective I find Mr Flemming's report reassuring. Presumably readers of your blog will conclude likewise.

It has taken Australia a long time to get to this point.

Anonymous said...

The current status of NEHTA delivery of eHealth in Australia is incomplete. I would describe it more like "Having a car advertised in the paper and it even looks good as you walk closer to it. But when you try to take it for a test drive you realise the motor starts but won't move the car, theirs only 1 seat, not all the doors open and some metal body parts are actually plastic or paper."

HI's have only been issued to some organisations and some staff and used by only some patients. Authentication was changed half way through and doesn't work as expected.
"Yet all healthcare providers registered with AHPRA have an individual healthcare provider identifier.
The problem is that the HI service is so poorly designed, it is impossible to find them."
Terminology and classification has been neglected. Document exchange standards have no standard fully implemented to the point required for all to exchange data with meaningful use. No ROI has been published.

Sure, there are some foundations and a few facades but the eHealth house has not been finished.


Anonymous said...

Some of us in the house hear quite a different story from that described by .....Tim above in his colorful analogy. As politicians, we can only glean a limited understanding about how well the eHealth project is progressing by questioning NEHTA and Department staff at committee hearings. We haven't heard that it is not on track. If there are some genuine concerns it might be best for you and your colleagues to request a meeting with the Minister to voice your concerns.

Dr David More MB PhD FACHI said...

"Some of us in the house hear quite a different story from that described by .....Tim"

Just read the last 30-40 comments on the blog and I think you will learn that many e-Health experts think what is being done by NEHTA and the Department are over spun and under done!


Anonymous said...

Its not done, its not working and never will while we accept the executive summary that would do Sir Humphrey proud.

Australia bought into Snomed-CT, but done nothing useful with it since and has completely stuffed up wrt Medications.

SMD is an over-engineered bloated green monster that is a monument to the trendy technologies of its birth year. SOAP and xml encryption is so yesterday. Its also inefficient and over complex and had made a simple job complicated and resource hungry. Hardly a good foundation for a national program.

The Provider identifiers are deeply flawed with the requirements mis-specified at the start. No location specific identifiers and another overly complex system.

The clinical models are not in real use and CDA is also now out of fashion and yesterdays technology. The models themselves are lacking in real clinical utility.

The medication "CDA document" architecture fiasco is best forgotten and another mess. Really what were they thinking?

I could go on, but NEHTA have set the course of eHealth back a decade and added virtually nothing, They are a creature of Ronald Reagans id coming back to haunt us. "They are from the government and are here to help us"

The PCEHR will set the course of Health back another decade if its allowed to live. Its dumb and has no reliable data that could be used for decision support and does nothing to help health professions safely care for patients, which is the point of the whole exercise. Its a demanding deformed love child that is preventing the rest of ehealth get the attention it needs.

We need good quality atomic health information that can reliably and securely be moved directly to anyone that needs it. Once we have the information we can use it to improve the safety and quality of care. We were on track in 2000, but we are now well off the track walking along the edge of a cliff. But the official report says all is well!!

Bernard Robertson-Dunn said...

"If there are some genuine concerns it might be best for you and your colleagues to request a meeting with the Minister to voice your concerns"

Do you guys not read the papers or the submissions to the various reviews/inquiries?

Have a look at the Australian Privacy Foundation's submissions and letters to Senators. They are available on the APF website. To save you the trouble of finding them these are direct links.

Letter to Senators (10 Nov 2015)

Opt-Out and the PCEHR, Letter to Senators (30 Oct 2015)

Health Legislation Amendment (eHealth) Bill 2015, Submission to Senate Standing Committee On Community Affairs (28 Oct 2015)

PCEHR/IHI Legislation, Submission to Dept of Health (24 Jun 2015)

Disclosure: I was the principle author of all those documents (I'm very experienced Information System Architect), supported by privacy and legal specialists. As far as I am aware all the submissions were all dismissed as non-genuine concerns.

karen dearne said...

Share your frustration, we said in this latest submission thst "consultation" with Health and NEHTA only ever went one way

Anonymous said...

Its clear that NEHTA and DOHA are a long way off being across the issues. I have not met one person from either organisation that is. That is not to say that the individuals are necessarily stupid, its that they do not have the breadth and depth of knowledge to understand the issues. Some are experts in a narrow field with no health experience, most are lacking in real world implementation experience, especially when you consider you are dealing with small business, most of the time. The Hubris is enormous despite their lack of knowledge. "Its just an issue of change management really". Rubbish its an issue of having a coherent plan!

Some of their solutions have come from big business IT where you have a data center and full time support staff, something most GPs will never have. They have almost no one, certainly no one in a management position that understands HL7V2, which powers all the real stuff now. There knowledge is so poor that that try and reinvent things that are working and in widespread use currently. There are attempts to make everything overly complex, which is a sure sign that they don't understand themselves.

With this complexity comes a cost, and given that nothings is working in any real sense currently the cost to actually make it work is far greater than they can possibly understand, its just not doable in fact. The NHS in the UK learnt this lesson after 12 Billion pounds of investment. At what point will we say enoughs enough??? Given that they are spending other peoples (Mine and yours) money they don't seem to care.

I am sure that we would have had 100 times the benefit with 1% of well targeted investment in improving the quality and reliability of what was already working to provide a base to build off. This is the cost of complexity, we have long been in the phase of diminishing returns and are entering the phase where more spending actually reduces the benefit of eHealth.

Anonymous said...

David - I (November 16, 2015 1:14 PM)have been following your readers comments for the last few days. They all make good sense. Even so,no matter how much sense they make it would seem, at least to me, that there is nothing they can do to influence a change of thinking. Probably the only thing that anyone can do is to just sit and watch until everything falls apart; which could be many years away.

Bernard Robertson-Dunn said...

"Probably the only thing that anyone can do is to just sit and watch until everything falls apart; which could be many years away."

There is a chance that when the population at large finds out the government is creating a huge database with (almost) everyone's health data and making it accessible via the Internet, they may just start complaining.

Especially when they are told that the only reason this is being done is so that when they do need a health record it will save a little bit of registration time.

Anonymous said...

I have a great sense of deja vue.

ACeH is a classic repeat of previous scenarios and absolutely no-one can do anything about it except complain; all to no avail.

HealthConnect lost its way and was an embarrassment to the Department and to the Government.

NeHTA was set up behind the corporate veil to close down HealthConnect and get DoHA off the hook and out of the line of fire.

NeHTA lost its way when it suddenly changed its focus and direction to embrace the National Health and Hospitals Reform Commission (NHHRC) afterthought (recommendation) that the way forward for eHealth was to develop a national Personal Controlled Electronic Health Record (PCEHR)

ACeH is being set up to close down NeHTA and get DoHA off the hook and out of the line of fire.

For those who can remember back to the 90's the very same scenario first occurred back in the 90's when the Health Communications Network (HCN) project was established by the Health Insurance Commission (HIC), and after great expense failed to gain traction before being passed over to the private sector, once again getting the Department (HIC) off the hook of political embarrassment.

ACeH too will lose it way because vested interests prevail to perpetuate the status quo and disregard many years of sound advice proffered by very many wise industry experts in numerous submissions to government.

Bernard Robertson-Dunn said...

Anonymous Anonymous said...

"I have a great sense of deja vue."

Is all this documented anywhere?

If I can get help I was thinking of putting it up somewhere, but I don't have the full story. I'd like to include the way NEHTA/Health went about System Architecture (they didn't), design (from an IT perspective, not a health information need) and implementation, followed by the mandatory creation of a highly attractive honeypot of largely useless health records.

Dr David More MB PhD FACHI said...


Start here:



Anonymous said...

Today's PulseIT article paints a picture of panic leading to confusion and chaos. It seems the Department is now inviting PHNs to push the voluntary opt-in approach to the PCEHR's My Health Record while at the same time promoting its preferred Opt-out option.

Rather than wait to evaluate the outcomes from the Blue Mountains and Far North Qld trials the Department appears to be wanting to have its cake and eat it. Let's do it both ways unless Opt-out doesn't come up with the goods. We know the Opt-in approach didn't but let's not give credence to that - let's just keep pushing harder.

The philosophy being - let us not put the project on the back burner and start listening to the expert advice from industry which we have rejected and disregarded for so long. No, let's push our broken system harder until something gives way.

Bernard Robertson-Dunn said...

Let's be fair here. The opt-out trials are only a test of the registration process. Health has improved the usability of the system by making registration easier. The opt-out approach may not be successful if people learn that having a health record that is pretty useless but which is a high risk to privacy breaches.

If it is unsuccessful then they will have to rely on opt-in, so why not push that now, anyway?

The fact that registration (either ease or total numbers) is totally irrelevant to usefulness is a separate issue.

What is a much more meaningful metric but which is neither measured nor acknowledged as important is the usefulness to health professionals.

The report in PulseIT is important because the RACGP is probably the most critical in the user group. That group will either make or break the system.

Unlike opt-out, which forces Australians to have a health record, it is impossible for the government to force health professionals to use it. Apart from maybe insisting that they put data in, the government can't insist on GPs using the system, especially when they already have local eHealth record systems that more than meet their clinical needs.

Dr Ian Colclough said...

Bernard Robertson-Dunn said... it is impossible for the government to force health professionals to use it. Apart from maybe insisting that they put data in, the government can't insist on GPs using the system, especially when they already have local eHealth record systems that more than meet their clinical needs.

Yes, indeed Bernard and that has always been the case.

That is why in my view the arguments for having a shared, common, easily accessible, secure, trusted, personal health record have never stood up to intense examination of the logic, of the business case, of why and how it will be used and by whom.

Notwithstanding that, I am a strong proponent of the argument for developing My Personal Health Record in a way which meets all and more of the above criteria.

Where I differ with what has been done to develop the PCEHR is in the way they have gone about approaching the problem, in designing, developing, testing and deploying the system. It seems to me the people behind the PCEHR lost their way when they ceased asking the hard questions.

People like you have that skill in abundance – wicked problems will not be solved unless the hard questions keep getting asked up to and well after the hard answers have been found. Why ‘well after’, because there is a high likelihood that when the hard answers have been found some of them will inevitably be wrong necessitating more hard questions; and so the cycle repeats itself.

Dr David More MB PhD FACHI said...


They could have stated by asking themselves what is it that is needed, who is it for and who might benefit from it? I doubt the answer would be anything like what they have inflicted on us - which goes to the ignorance and incompetence of most of those who conceived and designed this monster!


Bernard Robertson-Dunn said...

Ian, David,

The question they asked themselves was:

"How can we reduce data fragmentation?", and developed a system that tries, but fails to do even that.

In fact they have increased the amount of data fragmentation by creating yet another repository that is not complete, not accurate and which overlaps other data repositories. Everything in the PCEHR exists elsewhere, but not everything is in the PCEHR.

The question they should have asked is: "what data do health professionals need in order to make better decisions?" (David's questions are a breakdown of my question) The quick answer is: Relevant patient data combined with a broader set of data that covers latest treatments, guidance, advice, available pharmaceuticals, available and relevant test facilities, other possible providers of specialist health advice etc, etc.

A dumb database of unreliable data just doesn't answer that question. All it does is throw potentially huge amounts of data at the poor GP who has to sort through it all. They are only likely to do that the once before ignoring it.

Anonymous said...

David said - They could have stated by asking themselves what is it that is needed, who is it for and who might benefit from it?

Yes that is a very basic place to start - a simple as one can get.

I think if you look back over earlier documents you will find lots of people asking those questions including government. The problem with asking such simple questions is that they end up with simple answers and stop - that's not good enough. I agree with Ian and Bernard, once they had got over asking simple questions they had to ask the hard questions and keep asking them. They didn't and they haven't and I suspect they don't want to because they know what the hard questions will reveal.

Dr David More MB PhD FACHI said...

I look forward to anyone providing any evidence that Government considered what was actually needed in e-Health. They had a 2008 Strategy but just took its lowest priority need - misunderstood it and then proceeded to spend a $B+ implementing a misunderstanding!

What a farce!