I suspect there must be something in the water that reaches
For background on this project go to my post of late last year.
http://aushealthit.blogspot.com/2006/12/children-of-healthconnect-how-are-they.html
The Table of Project Activities says it all! What is described in the table is an absolute and incompetent disgrace which is even worse than some of the bungled HealthConnect trials of years gone by. It is chaotic and absurd in the way it is being organised and the table of activities shows those involved have no idea what they are doing. Just consider the following past and future sequences carefully.
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February 2006 - Functional specification drafted
July 2006 - Care Planning Trial commenced
October 2006 - Commenced consultations with NEHTA re standards and data specifications and local groups, e.g. Health Provider Index (ongoing)
November 2006 - Care Planning Trial Go Live
February 2007 - Consumer Reference Group and Stakeholder Reference Group formed
Mar/April 2007 - Tender documents released to market
March 2007 - Communications plan developed
May 2007 - Tender responses due
May 2007 - Interim findings of the Care Planning and Communication Trial due
November 2007 - Care Planning and Communication Trial concludes
Late 2007 - State-wide implementation begins
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When considering the program – what does one see?
First, essentially out of the blue, HealthConnect SA caused a requirements specification for Care Planning (which has not been disclosed) to be drafted. On the basis of this specification it seems a trial of some commercial software has been commenced. The trial went live, it is claimed, in November 2006. It is quite clear the selection process was neither thorough nor open given the time it took, the apparent absence of a tender and the non-publication of full evaluation criteria.
What is claimed (on the project web site) is that the Ozdocsonline was selected by the following process:
“Consultations undertaken with key stakeholders identified that, in order for the care planning and communication system to be effective, it must:
- improve health outcomes
- be simple
- protect patient privacy
- provide patient access and control
- facilitate communication and collaboration between the health care team
- be accessible at the point of care.
Based on these criteria, and following an assessment of existing care planning systems, the Ozdocsonline system was selected for the trial. “
Hardly the level of detailed requirements needed to determine the appropriate system for a twelve month trial.
But – whoops! – it seems someone noticed that the trial now underway (despite its use of both state and federal funds) is hardly the type of non-standard, non-integrated system or approach NEHTA (or anyone else who had a clue) would choose to sponsor without solid evaluation as to alternatives.
So what happens?
In February 2007, presumably after a little 'jawboning' from NEHTA or DoHA, suddenly we see the actual formation of some management and consultative committees and the beginning of consumer and stakeholder consultation. Bit late since the trial has already been underway for four of its twelve months.
Presumably the Communications Strategy mentioned for March 2007 is to provide ‘spin control’ for the impending mess!
One also has to wonder how much pressure was exerted to spend committed funds with such haste concurrent with the establishment of such a large team (16 people in total in the group as of March 2007).
What happens next should be fascinating! A tender for a longer term solution is to be issued in March 2007 – but this is being done in the absence of any input from an interim evaluation of the first half of the trial – let alone a completed evaluation of the 12 month effort!
The responses to the tender specifications (whose requirements are presumably based on gut feeling of what might work rather than evidence of what is actually working) and the evaluation report of the tender are to be completed at the same time.
There is nothing like planning for success! This is an excellent example of the saying ‘If you fail to plan, you plan to fail. ’According to the timetable the tender will get evaluated, a solution will be selected, consultations will be held and State-wide implementation will begin by late in 2007!
Oh, and also – in November 2007 the trial closes down and all the data vanishes, unless the unsuitable incumbent as far as NEHTA's standards (and common sense) are concerned gets retained on a permanent basis or practitioners start paying to retain their own information.
Even more amazing is the following from the Project Site
“The South Australian Care Planning Project will also need to undertake work to:
- Ensure the care planning system conforms, where possible, with the National e-Health Transition Authority's (NeHTA) standards for care plans.
- Ensure that the Health Provider Registry, developed and maintained by SA Divisions of General Practice Inc (SADI), includes allied health providers.
- Ensure the care planning system has decision support capability.”
Firstly – It is important to note that, as far as I know, there are no such things as NEHTA Standards for Care Plans (they certainly do not exist anywhere in the NEHTA Standards Catalogue), if indeed there are any recognized Australian Standards in the domain at all sanctioned by Standards Australia or the like. Second NEHTA is developing a National Health Provider Identifier which presumably will obsolete the local SADI effort – so just what is being planned here? Thirdly the vagueness of “Ensure the care planning system has decision support capability” is both vague and meaningless – especially given that addition of any really useful decision support to any care planning system is a major and complex undertaking which does not seem to be contemplated in this one-liner and certainly not in the time-frames proposed above.
While not wishing to be unreasonably critical (I am really keen there be ongoing development in the e-health space a quickly as possible) , it just seems to me this whole project is the wrong way to be going and is very far from what should be funded to further develop e-health. There is a real risk, I believe, that a serious waste of money and effort is occurring. I will happily publish here on the blog any reasoned explanation from the proponents of all this that can show I have got it wrong and that this is a well managed, strategically sensible, standards aligned, coherently planned, transparent and properly executed pilot and project.
Am I the only one who can see how silly and bizarre all this is, how poorly thought through it is, how it is lacking in any reasonable process, and how its chances of and substantive long term success are miniscule at the best?
David.
No-one should be surprised by the SA-HealthConnect fiasco.
ReplyDeleteWhat happened last week? NEHTA announced HL7 as the way ahead! It should have done that one to two years ago!
When the bureaucrats in Canberra keep throwing money at piffling ill-conceived and ill-planned e-health projects, such as the one you have just mentioned in SA (not to mention what’s going on in Tasmania and elsewhere), when you have to resort to writing an ‘Open’ letter to the Minister for Health, because the poor man seems to be totally oblivious to the pathetic mess that his Department has made and continues to make with its e-health-disconnet projects, and when NEHTA continues to befuddle its Board with what a great job it is doing telling the jurisdictions and the health IT industry what is required and how they should all do things this way or that way, and while NEHTA continues to remain virtually non-accountable (in any sense of good accountable corporate governance) as it continues dreaming into the future and muddling along without the basic fundamental documents you have repeatedly been calling for now for over 12 months ……………
………one has to ask …..
…….. “Why should anyone be surprised?”
This presents a classic opportunity for NEHTA to show leadership. NEHTA should speak up and say what is good about this project and why it supports it. Is not this the sort of leadership NEHTA has been set up to provide to help the jurisdictions to stop making a mess of themselves? On the other hand ‘silence is bliss’. NEHTA has much more important things to do than be distracted by one-off e-health projects being set up at the grass roots level in the jurisdictions to whom it has an obligation to provide e-health guidance and advice.
Maybe the reason behind Costello’s razor gang chopping $100 million from Abbott’s childhood obesity program is to act as a cattle prod to help the Minister focus on how he can better deploy some of the money his bureaucrats continue to fritter away on frivolous e-health projects. The quickest way to get real change is to have an election.
……… and if this brings about change …………
…….. “Why should anyone be surprised?”
I have raised my concern to HealthConnect SA that is unusual to have a Tender process overlapping a specific product pilot implementation. They did not see any conflicts in that approach.
ReplyDeleteI do have the feeling that the tender will be a little problematic as HealthConnect SA may have assumed the use of standards that have not been adopted, and are unlikely to have been adopted prior to the conclusion of its State-wide Care Planning implementation. I refer to "standards" around Electronic Clinical Decision Support and those around Care Planning. Ian Reinecke has always indicated that the adoption of an EHR approach will clearly precede any Decision Support/Care Planning implementation. The ubiquitous phrase that appears in all Government tenders these days appears to be "compliance with NEHTA standards". At the risk of being a little repetitive I urge the focus to shift back to Patient, Product, and Provider Identifiers so that we can move forward.
Patient, Product, and Provider Identifiers.
ReplyDeleteThis is so basic, it is fundamental to underpinning subsequent developments on the pathway ahead to achieving successful e-health outcomes. If this one task alone was developed and implemented successfully Australia would be in a phenomenal position to take an enormous step forward.
In parallel there is room for, and clearly there is a need for, other ‘activities and tasks’ to be undertaken, but they should not be permitted to divert resources or distract attention from the PPPIs.
For example, establishing standards is important; however, this should not be done in isolation from industry. It is essential that the standards exercise which NEHTA is attempting to undertake, across a number of domains, is conducted in tight collaboration with industry under the umbrella of a strategic plan jointly owned by NEHTA and the healthIT industry.
Such an inclusive culture is paramount to NEHTA’s success. It will contribute greatly to ensuring the preparedness and ability of industry to embrace and deploy standards which are practicable and widely used and which permit the implementation of commercially viable solutions.
Ian,
ReplyDeleteYou say "under the umbrella of a strategic plan jointly owned by NEHTA and the healthIT industry."
Can I suggest this is much too narrow. If a strategic plan is to work it must be fully inclusive - especially with clinicians and those 'on the ground' in the Health Sector.
David.
Anonymous said...
ReplyDeleteI'll also flag the insane tendering constraints for the evaluation framework for the Care Planning Trial (CPT). Sitting on these pre-tender meetings highlighted that the CTP was to be a trainwreck from the start - the tight timelines, pre-determined solutions and objectives gave the impression that the project was to happen no matter and under no constraints. Pre-ordained to be messy to say the least... Wonder if it was about acquiting monies in the bank?