Quote Of The Year

Quote Of The Year - Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

Tuesday, November 21, 2006

A Do Nothing E-Health Minister – Incapacity, Inactivity or Just Bad Advice from the Department?

Its getting to the time of the year when the Health bureaucrat starts to think of all things Christmas and congratulate themselves on a year well spent.

How is the report card looking this year I wonder?

In this context I guess it would be about time to remind Minister Abbott of what he said to the Sydney Morning Herald on September 6, 2005 and to use that as a benchmark.



Abbott's patience runs out

Federal Health Minister Tony Abbott admits to "a great deal of slippage" with the Federal Government's $128million national electronic medical records program but says he is working to ensure that patients get benefits within 12 months.

"I will do everything I can to meet these deadlines and I will be disappointed if we don't," he says.

His comments come after he told a breakfast briefing at Parliament House that he was "sick of trials and studies and working groups", and wanted to see electronic health records making a difference in patients' lives by the middle of next year.”

What do we see 14 month later?

A Department of Health and Ageing Report Card

Well it has been a year of focused but quite secret activity. The E-health Program from DoHA seems to be divided into five areas:

1. E-Health Business Development.

The emphasis here is on Managed Health Network Grants for development of health networking. They were announced December 2005 and the funds must be spent by June 30, 2007. Sadly no winners have yet been announced so the spend fest is likely to be amazing.

The earlier Eastern Goldfields Regional Reference Site, where amazingly expensive broadband access was provided to practitioners. The viability of the network is now questionable without the government subsidy

2. E-Health communications

This provides access to the HealthConnect Archive which has been pretty stable since February 2006. The June 2006 E-Health Newsletter has been reviewed earlier.

3. E-Health Governance

Progress here has been that the Council of Australian Governments (COAG) has announced that:

“From February 2006, governments will accelerate work on a national electronic health records system to improve safety for patients and increase efficiency for health care providers by developing the capacity for health providers, with their patient’s consent, to communicate safely and securely with each other electronically about patients and their health. This requires:

• developing, implementing and operating systems for an individual health identifier, a healthcare provider identifier and agreed clinical terminologies; and
• promoting compliance with nationally-agreed standards in future government procurement related to electronic health systems and in areas of healthcare receiving government funding.”

The strength of this commitment was emphasised by the disappearance of the Australian Health Information Council which is meant to be the peak advisory body to COAG on such matters. Clearly E-Health governance isn’t actually happening as best one can tell.

4. E-Health Major Programs

There are four major programs:

1. Broadband for Health.

Giving practitioners broadband internet access – clearly practitioners can’t find the $40 per month to pay for it them selves (tax deductible business expense of actually less).

2. HealthConnect

Said to be as follows:

“HealthConnect is an overarching national change management strategy to improve safety and quality in healthcare by establishing and maintaining a range of standardised electronic health information products and services for healthcare providers and consumers.”

Not much change seems to be happening federally (I will review the State HealthConnect initiatives in a separate post) and no one knows, or at least I don’t, what the “standardised electronic health information products and services for healthcare providers and consumers” are.

As most know, the E-Health Implementation Branch (previously responsible for all this including HealthConnect) has been wound down, after Dr Brian Richards and then Tam Shepherd left. Now it is being led Lisa McGlynn (who is ex NSW Health – but not an expert e-health or technology I am told).

I am also told all the original staff (with any corporate knowledge of e-health which they may have built up) have moved on, and the incoming staff are all people who have never worked in health and know nothing about e-health or IT. Apparently the States and Territories can’t get any sense out of them at all now. Many commentators have suggested to me they think that this tactic is deliberate to wind down the branch to nothing.

3. HealthInsite.

An excellent idea and well implemented. By far the best initiative of DoHA. Pity they have not had a few more good ideas since this service began in mid 2002.


It is very hard to comment on NEHTA since it is a privatisation of Government accountability to ensure that if it does not work the Minister can't be blamed and that the truth will never be known as Freedom Of Information does not apply.

Sadly NEHTA is not an outsourced e-Health Government strategy - or the Government would have had an outsourcing contract with all the usual performance hurdles and rewards.

The NEHTA Directors must be hoping some concrete results will be delivered soon since the organisation now has over sixty staff and, as yet, it is hard to see that much has been delivered other the FUD (Fear, Uncertainty and Doubt) on the part of all the other actors in the E-Health space.

My view is that unless there are some really useful and practical outcomes within the next six months (i.e. having been in action for just on three years (Authorised by COAG July 2004)serious questions will start being asked. The opportunity cost of all this inactivity is really astronomical in terms of patient suffering and lives lost.

5. E-Health Strategic Policy.

This section comes direct from the DoHA web site

“Information regarding e-Health strategic policy and how it is being implemented is found in this area of the website.

Strategic policy alignment takes a strong focus on the monitoring and analysis of trends and technology, in order to drive the Australian Governments' e-Health agenda. The work involves the provision of advice on Departmental, other government and independent e-Health related activity and the establishment of appropriate regulatory frameworks to enable e-Health nationally. Much of this work is linked with the National E-Health Transition Authority (NEHTA) work program. Further information about NEHTA and the work program can be found at the following site: www.nehta.gov.au

Page last modified: 21 April, 2006”

Sadly there is not a word about policy other than it has been passed to NEHTA, and can be understood as a work-program!

What does this all amount to?

I would contend it amounts to a virtually total abdication of central government involvement in E-Health. We have seen no significant concrete progress and the National E-Health Strategy, Business Case and Implementation Plans remain non-existent and the relevant Federal bureaucracy seems to have essentially imploded.

I hope next November I can write a happier report. I suspect our Health Minister must be very disappointed and frustrated in the progress made in the last twelve months!



Lisa said...

Excellent rundown David. It's a disappointing picture indeed.

PS Only discovered your blog recently, but imagine I'll be reading every post. Excellent work.

Teki said...

If Tony Abbott has been reading about the other HealthConnect he may not be lining up outside the Treasurer's door to ask for another $10m, let alone some real money.

Kaiser Permanente's problems are discussed at Healthcare Giant Faces IT Nightmare.

A search on 'epic kaiser mumps' turned up some interesting commentary, eg., this thread.

UK doctors are asking hard questions, GPs revolt over patient privacy ,too.

Dr Ian Colclough said...

An Invitation to the Minister for E-Health.

David More’s report card focuses on the Health Minister’s remarks as reported 14 months ago in the Sydney Morning Herald in September 2005: “I will be disappointed if …..” ….. patients don’t get benefits from the Government’s e-health initiatives within 12 months.

Without doubt Tony Abbott must be very disappointed indeed, and he has every right to be so. He is a politician, not an expert in e-health. He has a tough and complex job to do in managing the vast array of politics swirling around one of the most extraordinarily complex of Ministerial Portfolio’s.

He must be very concerned that so little has been achieved and that so much has been spent in the process with nothing much to show for it. It is reasonable to ask ‘For how much longer will he allow this to continue?’

David asks if the problem is one of “inactivity” or just “bad advice”. If the root cause is ‘inactivity’ it would be a lot easier for the Minister to rectify the problems than if the root cause is ‘bad advice’.

If the latter, how is the Minister to know that he has not been getting ‘good advice’? He is not experienced enough nor qualified to know if he is getting bad advice about e-health. If this is at the root of the problem(s) it must be addressed first and foremost and fixed before the Minister can, with confidence, do anything useful to advance the e-health agenda in Australia to the benefit of all patients and their practitioners.

Tony Abbott is a very open-minded and competent Health Minister. Discussions with some ‘captains’ of industry in health-IT have convinced me that the Minister would benefit enormously from a carefully constructed round-table of ‘real’ experts (pragmatic, astute, and successful, with lots of nous). A working round table of frank and open discussion, maximum attendance 10, Chatham House rules.

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