A key theme in any discussion of e-health is how to foster adoption and use of Health Information Technology (Health IT). In the last few days a few reports have come together to remind me that this issue is not being addressed in a reasonable way in Australia, but that at least some hopeful signs are emerging elsewhere.
Firstly we have had the reports of the last few days, from both The Australian and e-Health Insider in the UK, of the apparently continuing problems about iSoft plc’s contracts and viability both here and in the UK. The essential messages seem to be that there were some distortions of the selection process by which iSoft has been engaged and not enough scrutiny of the future plans the company said it was assured of delivering in now well past time-frames. This is bad news both for the company and its customers despite all public announcements to the contrary.
On the good news side we have the news announced yesterday regarding the Certification Commission for Healthcare Information Technology (CCHIT) release of the most recent drafts of its functional and interoperability criteria both for ambulatory and inpatient systems.
The mission for CCHIT is to “accelerate the adoption of health information technology by creating an efficient, credible and sustainable product certification program.” These specification are evolving in a studied, obviously competent and purposeful way towards a vision of really excellent, clinically sound and valuable systems which, as they are certified, purchased and implemented, will make a real difference to the quality and safety of the US Healthcare System.
How are these two items linked? I would suggest they are linked through the lack of a national Health IT certification process in Australia than has permitted purchases by State hospital systems of software of poor quality that, it appears, lacks a future. We have seen issues in hospital software selection, cited here, in Tasmania, Victoria, NSW and Queensland (who are still being sued by a disappointed vendor as far as I know).
As far as ambulatory care systems are concerned we also have a situation where both functionality and interoperability between different system providers is hardly assured (to say the least).
CCHIT works by taking only the approved and fully implemented and tested standards, merging them with the priorities of the American Health Information Community and developing a functional and interoperability requirements that are required for certification. They also signal their direction well in advance to give the vendors time to develop what is required that they may not have at a particular point in time.
Having the CCHIT does two important things. Firstly it provides system developers with a clear set of system requirements and objectives. Secondly it provides system purchasers with an assurance, if they stick with the approved products, they will be purchasing competent systems that are being developed to meet real clinical and operational needs, and which have a future.
What is needed, to avoid further unwise purchases both in the private and public sectors, is for NEHTA to rapidly move to replicate the role the CCHIT is playing and for the Commonwealth to ensure there is a clear plan and clear strategic guidance as to the directions e-health needs to move in. This inevitably means resurrecting and funding an Australian Health Information Council like entity and charging it to provide the big picture directional guidance to both NEHTA’s certification arm and the software development community.
Very useful documentation already exists and could be swiftly tailored to meet Australian requirements. The time to get such certification and strategic direction setting capability in place is now to avoid further waste and “spinning of wheels” and to give the software providers confidence to invest for the benefit of all.
It will be the development of strategically and clinically valuable systems by commercially viable and confident software providers that will make Health IT adoption easier and be one further step to a better and safer healthcare system.
David.
2 comments:
An Australian agency for certification will follow the US model of public and private stakeholders, without transparency of process, inadequate declaration of financial conflicts and a well-oiled set of revolving doors.
Going by what's at HITSP I cannot see how the processes can be insulated from the influence of major software vendors.
However, if we adopted some of the British models for probity, we'd keep the carpetbaggers out of the loop.
Teki,
I must say that I am hoping any Australian Certification Agency would very much follow the usual Australian probity guidelines and not be captive by sectional interests.
We shall see.
David.
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