All of a sudden there has been an outbreak of discussion in the GP_TALK e-mail discussion list regarding the role, scope and purpose of the National E-Health Transition Authority (NEHTA).
The discussion was prompted by a correspondent asking - is NEHTA meant to be an Authority that ‘manages a transition’ (e.g. to much wider deployment of E-Health) or is it a ‘transition authority’ which is to be replaced by another authority when its job is done (in 2009 or so).
The official view – from the main Government entry point is not hard to find.
http://www.australia.gov.au/405
“National E-Health Transition Authority
The National E-Health Transition Authority (NEHTA) has been established to accelerate the adoption of e-health by supporting the process of reform in the Australian health sector. To enable this to occur NEHTA will develop the specifications, standards and infrastructure necessary for an interconnected health sector. The development of the foundations for widespread adoption of e-health is NEHTA's core mission. www.nehta.gov.au “
However NEHTA seems to have moved away from this – now saying on its home page (dated September 2006):
“Welcome to NEHTA Limited, a not-for-profit company established by the Australian, State and Territory governments to develop better ways of electronically collecting and securely exchanging health information.
Electronic health information (or e-health) systems that can securely and efficiently exchange data can significantly improve how important clinical and administrative information is communicated between healthcare professionals. As a result, e-health systems have the potential to unlock substantially greater quality, safety and efficiency benefits.”
And that their “website outlines the work that is being done by NEHTA to deliver a secure, interoperable e-health environment.”
The key difference is a much narrower role focussed on facilitation and enabling rather than direct intervention and support. It seems that NEHTA no longer sees itself as having a direct role in accelerating the adoption and use of Health IT, and also that NEHTA perceives it has no direct infrastructure or implementation role. Clearly, NEHTA sees these roles as being for someone else! (This view is supported in the recent “Privacy Blueprint” where there is much discussion of what sort of entity will deliver identity services – making it clear it won’t be NEHTA).
This view also fits with the NEHTA work-plan which focuses on developing services for provider and individual identification and for clinical terminology which will be used by other systems. NEHTA also says it is developing specifications for Shared Interoperable Electronic Health Records although it seems this work has progressed little in the last year as nothing significant has been published recently in this area that I can find.
This is most likely because similar initiatives overseas (UK and Canada) have hit quite difficult times and the levels of complexity in developing such shared records are becoming much better understood (I plan an article on this topic in due course).
The change in emphasis is of very considerable concern.
The reason for the concern is that with the establishment of NEHTA a lot of planned activity by both State Governments and the private health IT sector was put on hold, awaiting NEHTA guidance, support and direction.
It now seems this is not going to come promptly or the strategic way expected and with the HealthConnect program in mothballs (if not formally dead) NEHTA has now become a “dead hand” on innovation and progress in e-health in Australia.
In the last few days I have been approached by and chatted to both academics and industry players involved in secure messaging, software development, standards development, e-Health consulting and supply chain reform. All are concerned at the loss of momentum, lack of communication and strategic uncertainty.
What needs to be done to ensure there is a crystal clear understanding by all stakeholders of what NEHTA is actually now planning? NEHTA must urgently and clearly articulate just what it will deliver and by when and more importantly what it will not or cannot do and leave innovation and progress to others.
The problem we all now face is that, with the inertia and confusion that has now been engendered by NEHTA’s changes in emphasis, it may take some time for effective leadership to re-emerge. One can only hope the revamped AHIC can provide the needed strategic leadership and rapidly regain some much needed momentum.
David.
1 comment:
Maybe one problem is that there are no broadly acceptable measures of the usefulness of IT in health care. HCN could point to sales of Medical Director; DoHA could use PIP payments; readers of Sydney's newspapers may want to look at Harmed in hospital: 500 errors a record.
IMHO, usage of MS-Access stand-alone databases for storage/analysis of clinical data is indicative. Therefore, NEHTA could commission annual surveys of clinical applications in public hospitals. A sustained decrease in dead-end usage of MS-Access would be a good prognosticator.
[Confession: guilty, as charged, on two counts.]
In passing, it's worth noting the significant change in career of Victoria's immediate past Privacy Commissioner. Paul Chadwick has gone to the inaugural Director of Editorial Polices at the Australian Broadcasting Corporation. Personal privacy is one of the key hotspots in IT for all services, especially health. But it is not a high priority in the media. So, here's a hope - Chadwick will be able to guide presentation by the ABC of the absolute needs of the main issues relating to privacy, and particularly as they impinge on identity registers.
I'm pretty certain that lack of public engagement is the strong suit in this government's lackadaisical approach. That's a hazard for strong business cases.
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