Sunday, May 29, 2016

NEHTA Delivers Itself Its Own Scorecard. The Report Might Be A Tad Self-Congratulatory To Say The Least.

This popped up last week:

Evolution of eHealth in Australia - Achievements, lessons, and opportunities

The national eHealth program in Australia is now at an important turning point as it moves into a new stage under the Digital Health banner. It is timely to take this opportunity to review the significant achievements made to date, to analyse lessons learned, and most importantly, to use this information to inform the future of digital health in Australia.
Here is the link:
I thought it might be work putting the Executive Summary on line:

Executive Summary

The national eHealth program in Australia is now at an important turning point as it moves into a new stage under the Digital Health banner. It is timely to take this opportunity to review the significant achievements made to date in the eHealth agenda, to analyse lessons learned, and most importantly, to use this information to inform the future of digital health in Australia.
This report seeks to summarise what has been learned about implementing eHealth in Australia. It is a synthesis of information that has been accumulated over the
ten-year course of NEHTA’s work, and is enriched with reference to publically available literature, international examples, and interviews with a number of NEHTA senior and executive managers. The report provides a consolidated summary of key achievements and lessons learned from eHealth implementations and programs within Australia and internationally. It distils underlying structural, cultural, and organisational determinants of eHealth success, and also identifies the important implications and opportunities.
International comparisons
Analysing international experiences is critical in order to learn from both achievements and mistakes. In reviewing the experiences of Denmark, UK, Singapore, USA, NZ and Canada it is clear that digital health policy implementation has been strongly shaped by the type of governance structures and policy frameworks of each country, as well as local health, social welfare, telecommunications needs, and variety of stakeholders. Difficulties in digital health implementations have been experienced all around the world. Even the most advanced countries face challenges relating to interoperability, uniform coding of patient information, and dealing with privacy and security concerns.
Compared to other global electronic health record implementations, Australia’s national electronic health record is in its early stages. Australia is well positioned to move into an era of continued implementation – focusing on enhancing usability, patient and provider registration and better sharing of clinical information.
Achievements
Significant achievements have been made to date in the Australian eHealth agenda, under NEHTA’s leadership. These achievements have created a solid foundation from which adoption, usage, and innovation in digital health can flourish. With widespread usage, digital health can be expected to deliver significant health system and population health benefits.
Key achievements include:
·           Delivery of national eHealth foundations by NEHTA, such as the Healthcare Identifiers Service and standardised terminology. Importantly, the objectives for which NEHTA was established have been met. All the policy and foundations required to enable national interoperability between providers are in place. Unique identification of patients and providers, security infrastructure, terminology, and solution specifications are now all in use.
·           Delivery of the My Health Record System. On current trend, the rate of adoption of the system amongst providers and consumers is trackingahead of all comparable forecast scenarios. A significant proportion of all public hospitals and a growing number of private hospitals are connected to the system.
·           The contribution of a number of other notable eHealth initiatives such as HealthConnect and the Northern Territory My eHealth Record service.
·           The establishment of strong relationships and collaborative partnerships between policy makers, governments, vendors, healthcare providers, and peak professional bodies.
These achievements could not have been realised without commitment from governments, industry leaders, and critically, the leadership within NEHTA. This report describes the complex and trying environment within which this has prevailed.
What have we learned?
It is readily apparent from the eHealth experience in Australia and internationally that success emerges from highly complex policy, social, technical, commercial and political circumstances. Many factors impact the success or failure of eHealth initiatives, including the fixed characteristics of the setting where an initiative occurs, healthcare provider attitudes and behaviours, functional capabilities of the eHealth system being implemented, as well as policy frameworks.
Three themes were identified in the underlying structural, cultural, and organisational determinants of eHealth success. These themes are:
1       Multi-level tensions that complicate decision making;
2       Competencies that enable organisations and systems to do eHealth well; and
3       Cultural shifts that are necessary to realise the full potential of eHealth.
Theme 1: Multi-level tensions
There are underlying tensions that affect eHealth initiatives at the system, organisation, and program levels. These tensions can be thought of in terms of a continuum, where each end of the spectrum represents opposite approaches or mindsets. Systems, organisations, and programs can be positioned anywhere along the continuum between the two ends of the spectrum, at a position that reflects their values and interests. Tension arises because there is no absolute correct position – there are advantages and disadvantages at either end.
In developing eHealth policy, as with all health policy, there are choices to be made in the allocation of resources, time, and effort. Any choice involves sacrifice and opportunity cost. The trick is to find the optimal position for a specific initiative, at a specific time. This positioning will inherently require compromise. Identifying these tensions is intended to prompt strategic planning with the goal of reaching balanced and mutually beneficial positions.
The key multi-level tensions identified are:
1       Technology-led vs clinical community-led;
2       Centralised command and control vs. diffused power;
3       Directed development vs open, community-led development;
4       Market intervention vs free market; and
5       Participant in the health system vs. being a bystander.
Theme 2: Organisational and system competencies
A number of critical success factors that are common to many eHealth initiatives have been identified. These are the structural capabilities, and organisational functions and skills that enable organisations to successfully implement digital health solutions. By identifying these competencies, the intent is to encourage policy makers and organisations to invest in developing them.
The key competencies are:
1       Having a strategy, and then working to it;
2       Relationship building and collaboration;
3       Capacity to rapidly iterate;
4       Taking into account clinician and end-user experience;
5       Using structural adjustment and market alignment mechanisms;
6       Change management;
7       Measurement, evaluation, and benefits management; and
8       Implementation capability.
Theme 3: Necessary cultural shifts
Policy makers need to recognise that eHealth involves a significant change in clinical practice. Ongoing effort is needed to instigate and maintain meaningful usage of eHealth solutions until the point where using eHealth solutions and services becomes a part of normal ‘business as usual’ clinical practice. Experience shows that it is extremely difficult to introduce positive disruption by changing the way health care providers work in ways that take full advantage of eHealth capabilities – there are structural, attitudinal, and aptitudinal barriers.
What this review indicates is that in addition to the common barriers, there are a number of important cultural shifts across the health system that will have to occur in order for the full potential of eHealth to be realised. These are shifts that need to occur not only among governments, policy makers, vendors and healthcare providers, but also amongst the general public.
The necessary cultural shifts are:
Status Quo

New Norm
Digital health technology is a supplementary aid that improves efficiency – care providers could cope without it

Digital health technology is necessary for best practice care and public health – care providers rely on it
Implementation of eHealth an end in itself
eHealth an enabler of action on clinical and public health problems

Standard ‘workup’ model of care
‘Integrated care’ model with emergent coordination underpinned by eHealth solutions



Data generation is an administrative task with marginal clinical utility, that must be absorbed into standard clinical practice

High quality data is a prerequisite for high quality care, and its generation comes at a cost of time and effort
‘Document’ paradigm view of clinical information

Information assimilation
‘eHealth’ means discreet clinical information systems (i.e. standalone software programs)
eHealth infrastructure, services, and specifications comprise a platform for innovation
The goal of implementation is to embed eHealth with minimal disruption to clinical and administrative workflows


Workflows must be positively disrupted in order to realise potential benefit

Conclusion
Important implications and opportunities arise from these findings which are relevant to future digital health implementations and policy. NEHTA has endeavoured to incorporate these lessons into its work, which will assist with ongoing and future digital health planning in Australia.
- -- End Extract
The thing that struck me as I read through the document was that the document should have been written 3-4 years ago - in order to guide the way NEHTA interacted and worked with the Health Sector. Most of what is discussed here is common knowledge and has been well discussed on this blog for the last few years. Had this work been done before the PCEHR was designed it might have been that the global lessons might just have yielded a very different and more useful system.
I was amused to see HealthConnect being claimed as some sort of success - given it was an e-Health initiative that when Mr Abbott discovered how much it might cost suddenly turned into a ‘change management strategy’!
The document also somehow fails to explain why two previous critical reviews of NEHTA were largely ignored with the consequence of the PCEHR Review ultimately recommending it be disbanded!
Additionally there are also a range of references to NEHTA work which are still not publically available despite the recognition that secrecy and obfuscation has been a major contributor to NEHTA’s fate! As an example is this: Deloitte, “The national PCEHR system: relationship to the 2010 national IEHR business case,” Australian Government Department of Health and Ageing , Canberra , 2011.” I wonder what is still secret 5 years later!
This document needs critical and clear-eyed reading by all incoming staff in the new Australian Digital Health Agency - along with the alternative view provided by this blog and its contributors!
In many ways this feels a little like an attempt to re-write history.
David.  

1 comment:

Bernard Robertson-Dunn said...

If eHealth is a technology problem, then NEHTA can justifiably claim some successes:- e.g Healthcare Identifiers Service (although I can't comment on its contents, accuracy coverage etc) and a large centralised database into which health care practitioners can put health data (from which patients can delete potentially important information, possibly to their detriment).

However, if the aim is to reduce health care costs or improve health care delivery, there's not a lot (approaching zero) of evidence of success.

In fact there is anecdotal evidence that the overheads of data coding and data entry is increasing healthcare costs for no return i.e. GPs who spend time and effort inputting data are the ones that are least likely to get anything out of the MyHR.

The more people who have a MyHR and the more GPs who have to spend time taking data out of their eHR systems and putting it into the MyHR and then managing and correcting the MyHR data, the more costs will increase.

And all that is in the context of government surveillance and privacy risks.