NEHTA has Failed and Needs to be Fixed – How is this to be Done?

A little history first – sourced from Version 1.0 of the NEHTA Fact Sheet dated March, 2005.

“In April 2004, Health Ministers endorsed-in- principle the establishment of a national entity to drive these critical national health IM&ICT priorities.

Australian Health Ministers' Advisory Council (AHMAC) members felt that achieving progress in some IM&ICT priorities was so urgent that it could not wait for the entity's establishment. AHMAC recommended that a transition team be set up to progress these urgent priorities and simultaneously finalise the establishment of the new national health IM&ICT entity.

On 29 July 2004, Health Ministers reaffirmed the importance of IM&ICT to health sector reform, and endorsed the immediate establishment of the transition arrangements. This transition team is known as the National E-Health Transition Authority (NEHTA).”

From this it is clear that NEHTA was intended to have two roles. First to get on with some high priority activities and second to establish an entity to carry forward in the long term the AHMAC E-Health Agenda – as defined, presumably, by the Boston Consulting Group Report entitled “National Health Information Management and Information & Communications Technology Strategy” of April 2004 developed for the now defunct Australian Health Information Council (AHIC) and the National Health Information Group (NHIG).

This report was “intended to be a key input into a national strategic plan for health-related information management and information and communications technology (IM&ICT) that will be presented to the Health Ministers later this year.” i.e. 2004. If it was ever developed this plan has never been made public.

In July 2005 NEHTA became NEHTA Ltd an independent Public Company Limited by Guarantee. Around the same period it became clear that a review of the HealthConnect program had transformed that program into a “change management strategy”.

It can be safely inferred that NEHTA Ltd is the permanent entity that was to be established by the decision of Health Ministers in April 2004. NEHTA has thus transmogrified from a transition team to a permanent entity with funding that is committed to 2008/09 and 60 plus staff.

After two and a half years how close are we to some real and useful outcomes? The answer to this is not close at all. Nowhere is there any real evidence of a substantive transition either being underway or in any form imminent.

Where are the gaps?

First, the overarching National E-Health Strategy has yet to be developed – despite being urgently needed for two plus years.

Second, all urgency (or even a sense of urgency) has evaporated. It was so urgent in mid 2004 to get underway promptly that some corners were certainly cut. Now, two and a half years later, we find the key NEHTA deliverables are now due in 2008 or 2009. No one will be knocked down in this rush.

Third, there has been deep industry alienation and increasing concern as it is realised that much of what is offered by NEHTA is presently not practically implementable or clearly enough defined, and probably won’t be for another year or two at best.

Fourth, the guidance that was to be forthcoming for the jurisdictions on the standards to be adopted in Hospital computing has simply not happened.

Fifth, there has been no perceptible impact on GP computing from NEHTA initiatives to date. Indeed many GP initiatives that have been funded from the moribund HealthConnect program have been utterly non-NEHTA standards compliant (e.g. the SA Ozdocsonline Project and the NT P2P project).

Sixth, while the use of secure messaging within the health sector has been making some headway due, in large part, to efforts from providers such as Promedicus, Healthlink, Argus and Medical Objects, NEHTA has yet to offer any useful contribution to the space and has taken 10 months to move its draft documents to final status. While much has been made of the use of web services, after 18 months no web services specifications have been published and NEHTA has disavowed all interest in the structure of the messages to be sent. In the words of one messaging service provider I have spoken with, this is “about as helpful as a barnacle on a battleship”.

Seventh, NEHTA has continued with an approach of developing and announcing positions and policies while providing only minimal, if any, sound justification for the conclusions drawn and only very infrequently providing references to the international sources on which much of their work is so obviously based. This is especially so in the interoperability and the international Health IT Standards arenas.

Eighth, there has emerged considerable confusion about just what Standards NEHTA is working on and what is within the purview of Standards Australia. This has led to the alienation of a number of people who previously have been working well with the IT-14 Committee structure. To many in the industry, NEHTA seems to have abandoned the standards process altogether.

Last, NEHTA has had an excessive emphasis on technical and managerial matters to the exclusion of a real focus on its core reason for existence – the health sector and its needs for IT enablement and infrastructure. In my view, NEHTA simply does not ‘get’ the health sector and its priorities.

It seems pointless to go on. NEHTA as presently constituted and managed is a clear failure lacking the health sector and political skills to deliver the needed outcomes.

It is vital that substantial change is made to get the National E-Health Agenda back on track and that the “baby is not thrown out with the bathwater” i.e. the useful work that has been commenced – in areas such as Clinical Terminology – is not impeded.

Among the most important changes that are needed are, in my view, (ideally by June 2007):

1. Return of NEHTA to the public sector with full transparency and accountability. This would include release of all documents that relate to NEHTA decision making to ensure there is appropriate public input and comment on planned directions.

2. Installation of a new and broadly representative Board – which provides both expert and industry savvy oversight of NEHTA’s operations. The jurisdictional representatives should be demoted to being advisory only. This Board would report to AHIC and Health Ministers. A vital early act would be the development and publication of a clear definition of NEHTA’s role, powers, accountability and concrete performance measures.

3. Full public disclosure of the membership, skill and interests of all those who are involved in NEHTA advisory committees etc.

4. Development of a NEHTA Policy Review Process that ensures all work reflects a practical understanding and recognition of the needs and priorities of the Australian Health Services delivery sector as well as technical imperatives.

5. Development of a National E-Health Strategy, Business Case and Implementation Plan which clearly identifies the optimal approach to the deployment of Health IT in Australia to improve safety, quality and efficiency, defines the activities and investment required, and makes clear the responsibility and accountability of all the relevant actors (Health Ministers, Jurisdictions, Commonwealth Government, NEHTA, Standards Australia, Private Sector Actors etc).

6. A renewed push to rekindle support for the core messaging and security standards and give the sector an immediate path forward. NEHTA should be encouraged to continue looking at the medium to long term future, but if it cannot contribute to moving forward rapidly in pragmatic and practical directions from the present state, it should stand aside.

Unless such ‘root and branch’ review is undertaken and implemented it is likely the 2000-2009 decade will be seen as a wasted decade that set the Australian Health Sector back many years.

Happy New Year to all!

David.

ps Blog Updated 02/01/2007 8.00 am to clarify point 6.

D.