An Interesting Week for Australian Health IT

It has been an interesting week for Australian Health IT. First big bit of news was that there seems now to have emerged some concern from our political masters, at least on the opposition side, that Australia’s progress with e-health leaves a good deal to be desired.

As reported in the Australian a few days ago, in an article colourfully entitled “E-Health on Life Support says Labor”, Ms Julia Gillard delivers a withering attack on the performance of the government in the e-health arena.

Among other things she points out:

"We have to face the fact that a national e-health system is at least a decade off"

"Responsibilities have shifted, programs have changed names and the plethora of committees and advisory groups continues to grow," she said.

"In Senate estimates, we learnt that Human Services Minister Joe Hockey had made the decision in May - unannounced - to scrap the Medicare smartcard.

"We also learned that HealthConnect no longer exists as a program, leaving only three small initiatives running in South Australia, the Northern Territory and Tasmania.

"Indeed, HealthConnect has disappeared from the Health Department's lexicon, and there is some revisionist history at work."

The only legacy after four years and $200 million spent on HealthConnect was a "lessons learned" report in 2005 that identified a lack of "the underlying infrastructure and connectivity" critical to a successful implementation, she said.”

The lack of apparent co-ordination between the planned Services Access Card and the NEHTA Individual Health Identifier initiative were also strongly criticised - seeming as they do to duplicate each other's function to a large degree.

Of course she is right… the whole thing has deteriorated into a visionless fiasco. I only hope when, at some time in the future, Labor comes to Government these comments will be remembered and something constructive and properly considered be done.

For a little good news, in contrast, we also learned this week that, despite some delays and difficulties the UK NHS Connecting for Health initiative is actually making some significant progress. This is very good news and offers just a tiny sliver of hope for us south of the equator! It is worth reproducing the summary of the report made by iHealthBeat.

“Report Notes Achievements, Delays in NHS IT Program
by Colleen Egan, iHealthBeat Associate Editor
June 20, 2006

The United Kingdom's National Health Service has been under scrutiny since 2002 when it launched in its National Program for IT, which was intended to modernize the NHS' computer systems in an effort to improve care quality. The National Audit Office in a new report looks at the IT program's advances and shortcomings, and makes recommendations for future progress.

According to a report, which was issued last week, the massive IT program's "scope, vision and complexity is wider and more extensive than any ongoing or planned health care IT program in the world, and it represents the largest single IT investment in the UK to date."

The report, "The National Program for IT in the NHS," which was submitted to the House of Commons last week, assesses the state of the IT program, including:

• Progress being made in comparison to the program's original plans and costs;
• Steps being taken to implement the program;
• How the IT systems have been procured; and
• How the NHS is preparing to use the systems.

Schedule and Budget Status

The main goal of the IT program is to "improve services rather than reduce costs," and availability of the IT program's services have "largely exceeded contractual goals," according to the report. As of April 2006, the "Choose and Book" electronic scheduling system was being used for 12% of appointments, and the electronic prescribing program is being used at about 15% of physician offices and pharmacies. In addition, 80,000 active users and 168,000 staff members have registered with the NHS' e-mail system, called NHSmail.

Despite progress on some aspects of the IT program, other components have been postponed. For example, the National Data Spine was up and running on time, but some parts intended to enhance functionality have been delayed, according to the report. Also delayed are the first phases of the NHS Care Records Service, which will make certain parts of a patient's medical records available to caregivers.

The IT program is working to control costs by fostering "vigorous competition" among vendors and by using its buying power to negotiate reduced prices, according to the report. For example, NHS will renew its license for Microsoft desktop product prices for the "lowest prices in the world," according to the report. Overall savings from these types of agreements are estimated at about $1.6 billion.

The report estimates gross spending on the IT program over the 10-year timeframe (2004-2005 to 2013-2014) will be about $22.8 billion. However, Lord Warner, the minister of state for reform who is responsible for the program, in May estimated the total expenditure on NHS IT over 10 years at close to $36.8 billion.

Moving Forward

As the NHS proceeds with the IT program, the report states that successful implementation hinges on three areas:

• Making sure IT suppliers deliver on time systems that meet the NHS' needs;
• Ensuring that NHS organizations participate in implementing the program's systems; and
• Getting the support of NHS staff and the public to use the technology.

The report recommends that the NHS and the Department of Health focus on communication, training, management and evaluation as the departments further their IT plans. For example, the Department of Health and NHS Connecting for Health, which is an agency of the Department of Health, inform NHS organizations and staff as to when certain parts of the IT program will be delivered, and NHS organizations should tell members and staff how the implementation schedule will affect them, according to the report.

Also, NHS Connecting for Health should "continue its strong management of suppliers' performance" to make sure vendors are delivering components of the IT program on time, a process that includes imposing contractual penalties, the report states. In addition, the report recommends that the Department of Health, NHS Connecting for Health and the NHS develop training and development programs for staff and commission studies to evaluate the impact of the IT program and the experiences of organizations that have implemented the technology. ”

I hope our Government is watching and seeing how far they are slipping behind to the cost “in both blood and treasure” of the Australian population.

David.