Since starting the blog in March I have written getting on for a hundred posts and have seen interest in the blog and comments slowly increase over that time. It has seemed to me that, with the research and thinking that has required, I now need to crystallise what I am trying to say and make sure I am achieving clarity in the objectives I have for all this. In doing this I want that the reader be under no illusion as to my background, perspectives and views.
As to background, its pretty simple. I am (was) a specialist in anaesthesia, intensive care and emergency medicine who has been working one way or another for the last 23 years to improve the use of information technology in the health sector.
As to perspective I am operating from the following assumptions which I am convinced are true.
First, Health IT is a potential major enabler of quality and safety in the delivery of health services, but is not the whole answer to safer, higher quality health service.
Second, the possible added value in increased deployment of advanced Health IT throughout the Health Sector is very large and delay is resulting in a very large opportunity costs in terms of both lives and dollars.
Third, while health service delivery is an information intensive activity which is able to be successfully assisted with Health IT, failure to involve and work with all types of health professionals and other stakeholder in the planning for and implementation of new Health IT is a catastrophic mistake.
Fourth, the deployment and use of Information Technology in the health sector in Australia is presently largely inadequate, underspent and ineffective.
Fifth it is clear that personal identified health information is seen by the public as something they want to have control over and any plans or implementation approaches that do not recognise this fact are for all practical purposes ultimately doomed.
Sixth, and somewhat paradoxically, what is needed is a carefully developed consensus based National E-Health Plan, Business Case and Implementation Plan which is then delivered in local contexts which respond to local needs but which conform to a national overall Framework (this is especially important regarding the selection and implementation of systems).
Seventh, there is pretty common agreement that most Government initiatives at both Federal and State level have not delivered as well as might be hoped. Most would also agree that at present there is little in the way of Federal Government leadership or direction being provided for the E-Health sector.
Eighth, there is a very large skills gap at both user and Health IT levels which needs to be addressed nationally with some urgency.
Ninth the lack of openness and transparency regarding both HealthConnect and other major Health IT project outcomes and failures has limited the learning that has been possible from the mistakes made so far. NEHTA appears to be replicating this mistake at the time of writing (November 2006). It is vital all lessons are learned – especially from the projects that have not worked out as desired
Tenth, it is important to recognise that commercial providers of Health IT have expertise and skills which should be exploited but equally health organisations need to bring comprehensive project management and change management skills as well as business understanding to any Health IT implementation.
Eleventh, in the words of the late Milton Friedman as far as Health IT is concerned there is “no such thing as a free lunch” (i.e. you have to pay for value received).
Twelfth, it is clear, largely because of the way benefits from Health IT are not recouped by the users of the technology, that there be mechanisms to have those return the benefits they receive to those who do the work.
Thirteenth, it seems highly likely that the major payoff from Health IT is to be found only in very advanced systems which improve clinical decision making and minimise errors both of omission and commission.
Last, there are proven and deployable Health IT solutions which can be successfully deployed today with the right project and change management. It is important to get on with it.
My view is that right now there is a lot of unfocussed, uncoordinated activity going on (some good and some bad) and that it is the time to take a step back, work out, at a national level, what is needed and how best to get there. As a nation in 2000/1 we had some good ideas with HealthConnect but we then lost the plot and momentum by early 2005. We can’t afford another wasted four years.
In the blog I hope to alert and warn where I see mistakes being made and lessons we should already have learnt being repeated. Hopefully the assumptions above will point to those things which need to be assured before investments are made.
Overall I am hoping to foster the change from a heard of cats to a sleek shoal of fish all swimming towards real, practical and achievable goals.
David.
1 comment:
I bought a few shares in Symbion, just to get me a chance to ask a question at their AGM. I was intrigued by the brief mention in the Annual Report about their in-house expert system, trade-marked as MedSmart, which was designed to be an aid to their pathologists in interpreting laboratory results.
Symbion is a "health and wellness" conglomerate, a mixed business of pathology, imaging, medical centres, retail pharmacies and niche consumer products.
I was curious to know how their various IT systems were integrated, whether they conformed to national data standards and how they secured their remote access to the imaging system.
Since I was the only one to ask a question under the general business item, I kept it short and polite. I referred to MedSmart, as it was the only mention of IT in the AR, and asked "Who sponsors IT at Board level, and does the company have an investment target for IT?"
The Chairman replied that IT matters were shared across the Board, but the CEO (Robert Cooke) had the main responsibility. He said the Board had not set budget specifically for IT. Mr Cooke followed in reply. He said the company was on the verge of a strategic review of IT needs, and they would be having the first meeting on this next Monday (Nov27). He said they had various systems, some 'antiquated', that did not communicate with each other. He mentioned the 3 or 4 GP software packages they had to deal with.
On the way out, the Chief Medical Officer spoke with me, being enthusiastic about MedSmart. What he told was, in fact, alarming to my ears, but, unfortunately, typical of in-house medical software.
I wish Mr Cooke all the best as he struggles to bring all this together. I know how difficult it is to get GPs onto Medical Director, and he has a battle if he thinks he can get reluctant users to switch to something else.
But their biggest problem will be with their pathology section, that brings in 48% of their revenue. I don't know that they want to change their existing system, but whatever is otherwise intended, the laboratory system will have to export data by standard messaging, and that, I think, means HL7. Medical software, in general, seems to be designed to lock the client in. If it was routine to store all data in a form that enabled packaging and export without loss and corruption, most of the current vendors would lose their customers. As it is, the business model seems to be built around the concept that every enhancement comes at a steep cost. Worse that that, though, systems seem to have been designed to make addition of 'bolt-on' modules a difficult, if not impossible, task. Being locked into a product that can't be developed to meet emerging needs, and paying good money for "improvements" that only further locks in the client, is like being in purgatory.
I'm not keeping my shares, but shareholders would do themselves a favour by making vigorous enquiry about the plans for IT. As it stands, I don't think it is an attractive target for a big US health care company, say, Kaiser, to acquire. In my opinion, bits of it will have to fall off, until they know whether they are selling herbs and potions, or dealing with the life-and-death issues in the pathology business.
Perhaps significant parties in the company believe the prevailing mode of running pathology by maximising turnover is protected by divine gift. If so, they are in for a shock, as the changes in health insurance will drive cutting of costs, and the USFTA lets in the big HMOs. If Tony Abbott hasn't figured out how to bring the pathology industry under control, he should be moved onto another job.
PS. If Michael West reads this, he need't bother to contact me. It's all here. Most of it, anyway.
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