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Sunday, July 09, 2006

How to Really Fail at a Health IT Strategy.

To those of us in the Health IT community who genuinely care about health sector reform and the ongoing sustainability of our health services, it seems that we will need to get mobilised in order to try to change the directions that NEHTA is taking.

Before expanding on why I think this is so let me first say that I would really like NEHTA to succeed, but their approach however is, I believe, setting them up for failure before they start. A big call? I don’t think so, not after having been involved in and observed large scale Health IT implementations from all over the world for over 20 years.

How do you make a program like the one NEHTA plans fail? The things you do are as follows:

1. You don’t have a well considered, fully stakeholder consulted and clearly articulated program plan.

2. You don’t have a publicly persuasive and credible and robust business case supporting your plan.

3. You avoid detailed consultation with stakeholders, such as the software industry, on the impact of your activities so they are unsure of just what is happening and why?

4. You imagine grass roots clinicians (doctors, nurses and ancillary providers) will just accept what you offer when you choose to offer it.

5. You don’t have a well developed and open communication strategy that anticipates the information needs of your stakeholders.

6. You take advice from sources who are so unsure of their ground they seek anonymity.

7. You ignore, or redo, the work which was previously well done.

8. You have your implementation organisation operate with a culture of secrecy and non-disclosure.

9. You provide no clear outcome based indications of what will be achieved and by when.

10. You ensure the survival of the implementation organisation (NEHTA) by pursuing a non-transparent, complex, failure prone long term vision (if one actually exists), at the expense of the clear needs of the health system, which is to have decisive and doable projects undertaken promptly and focussed on assisting health care delivery.

The lessons of history are that clinical systems initiatives have never worked if the workers at the coal face - the doctors and nurses - are not convinced and keen to adopt.

I leave it as an exercise for the reader to work out how much NEHTA is doing right. My guess is that if even three of the above are not addressed, let alone ten, NEHTA will fail.

How many points do you think NEHTA has right on its present course?


1 comment:

Dr Ian Colclough said...

Dr David More is no novice in the highly complex field of Health ICT. For that reason alone his comments should not be discarded lightly.

He is critical of the direction that NEHTA is taking. Are his criticisms justified? Do they have substance and foundation? Why is he so vociferous?

At the outset he states emphatically that he “would really like NEHTA to succeed” and then points out that:
- a clearly articulated program plan does not exist (1)
- no publicly persuasive, credible, robust, business case exists to support a program plan (2)
- no clear outcome-based indicators exist specifying what will be achieved and when (9).

It is difficult, indeed almost inconceivable, to believe that this could be so.

Could the Federal and State Health Ministers have signed-off, in blind faith, on a pathway leading to the expenditure of hundreds of millions of dollars, without these basic fundamental steps being in place? Surely not; could they?

David goes on to point out, among other things, that NEHTA is operating within a culture of secrecy and non-disclosure (8) and avoiding detailed consultation with stakeholders such as the software industry on the impact of its activities (3).

There may be some justification for this. DoHA’s HealthConnect and MediConnect initiatives have attracted extensive adverse media coverage as a consequence of their high cost and the abysmal outcomes flowing from these projects. The Opposition too has voiced its concerns - 19 June 2006 Julia Gillard, Remarks to the ACT Chapter of The Australian College of Health Service Executives. (http://www.juliagillard.alp.org.au/news/0606/spad19-01.php).

Perhaps NEHTA’s Board and its CEO have opted to solve Australia’s e-health problems with a less than transparent ‘crash or crash through’ approach. In certain circumstances and environments such an approach can be justified. But is it an appropriate strategy for NEHTA to adopt in the health sector?

From every aspect (technical, organisational, cultural, political) the healthcare market is far more complex than any other industry. This has been well documented in the literature. Also well documented are the reasons for failure in large, complex, health IT projects.

David notes that NEHTA does not seem to understand that grass roots clinicians (doctors, nurses and ancillary providers) will not readily accept what NEHTA offers them when it chooses to do so (4). The corollary to this is that he is advocating that NEHTA needs to engage more closely with the grass roots of the industry – the healthcare providers. There are a number of powerful and effective ways that this can be achieved.

The way ahead for NEHTA will not be plain sailing. David raises a number of points that should not be ignored. On the assumption his concerns are valid it is to be expected NEHTA will publish ‘the program plan’, ‘the business case’ and ‘the outcome-based indicators with timelines’ to which he refers, without delay. This should serve to put Dr More’s and the Health Ministers’ minds to rest.

Dr Ian Colclough
Integrated Marketing & e-Health Strategies
Balwyn North VIC 3104
(m) 0412 059 392
(e) ihsipl@smartchat.net.au