Regular readers of the blog will wonder why I should be concerned by this claim of such huge net benefits. The reason is very simple. While I firmly believe there are major benefits to be harvested from the deployment and use of e-health – and I believe the literature makes it reasonably clear where they are to be found – such claims are simply unsupportable without very substantial additional evidence.
NEHTA talks of the model they have developed in the following terms:
Modelling approach used for the study
• System Dynamics Model:
- Increasingly preferred (e.g. NHS)
- 900+ variables, 300+ calculation nodes, 25 sectors
• National and international expertise engaged:
- Jurisdiction, consumer and clinician input
• Focuses on major e-health benefits, costs and relationship to demand, quality and safety as e-health initiatives are rolled out over a 10 year period
Additionally they cite a range of published evidence from CITL, RAND etc and claim that from 3400 papers published since 1980 that Adverse Drug Events can be reduced by 50% (or more) by using Computerised Physician Order Entry (CPOE) with effective interactive decision support – among a range of other benefits that have been identified for e-Health.
They also suggest that there are 500,000 years of life to be saved in the Australian Population over 10 years with the implementation of e-Health.
What is conspicuously absent from all the presentations is the ‘how’? We are not told any of the basics that are required to make this credible. Obvious questions are:
What is the strategy, transition and implementation plan to move from where we are now to this 10 year future nirvana? If you don’t have that properly understood, documented and agreed with stakeholders how can you make any sensible comments about possible benefits? This is serious cart before the horse material I believe!
What are the assumptions for the capabilities of the systems to be used in hospitals and ambulatory practice to achieve these benefits? (It should be noted CPOE is notoriously difficult and complex to implement in hospitals – to the extent that – when last I looked – no more than 5% of hospitals globally have such systems in place. They are also not cheap to buy and implement.)
How much will such systems cost and who is going to pay for them?
What is a realistic time frame for replacement of present systems with the new more capable systems assuming they are readily available?
Given the vast majority of patient care is delivered in the private sector just what incentives (from Government) will be required to get the private sector on board?
Do we have the doctors, nurses and pharmacists who are sufficiently well trained and skilled in IT to make the transition to the e-health way of doing things?
Who is going to capably manage and co-ordinate such a huge change management and technology implementation program?
Are the assumptions in the model regarding a Shared EHR strategy correct? Is that ultimately the right approach for Australia? There is certainly a case for a careful review of the options being deployed around the world.
So what do we have here? Essentially what we have is a model without a strategy for architecture, implementation, funding and subsequent benefits management. There is no point putting out a generic claim about a possible scale of benefits without laser like clarity on just what is being proposed – or the economic hard heads in Treasury will shoot you down before you get started. This is where my concern lies. We have a once in a generation chance to propose a major re-investment in e-health for Australia and for it to succeed we need a model of an implementable and stakeholder approved strategy and implementation approach. Without clear and totally credible answers to all the questions I pose above, this initiative will turn out to be an expensive waste of time and effort.
It is vital in all this that those managing this proposed implementation ‘under promise’ and ‘over deliver’. I see no evidence of that approach in all this.
It is all very well for the Financial Review to publish an exciting headline and it is always important not to let the facts get in the way of a good story but I really think a little more digging regarding the reliability of NEHTA’s numbers, the assumptions and risks involved, the underlying strategic assumptions and recognition that things are usually much more complicated than they appear in a proposed, and largely yet to be defined, project of this scale would have been useful.
I look forward to NEHTA’s release of the Strategy and Implementation Plan that the model assesses along with the model and its assumptions. I will not be surprised to find I am once again disappointed and that sadly it all turns out to be largely ‘smoke and mirrors’ which will get us nowhere.
A final point that should be made is that the NEHTA Benefits Case relies on the deployment of clinical decision support (CDS). That, CDS, is sadly not actually part of NEHTA’s work plan as currently published. If it is actually worth so much, focus is needed and fast! Whoops!
We will wait and see!David.
9 comments:
Those who understand, know how right you are.
Those who do not understand, do not know that you are right. Someone inside NEHTA has sufficient concerns to provide Julian Bajkowski with an early copy of the report. The bigger the claims that NEHTA can make the more enticing and seductive it is for the senior bureaucrats and their political masters. So, there is no reason for them to listen to the voice of reason, for what would they do if they did? They are trapped and have nowhere to go except wherever NEHTA leads them.
When the ex-Chair of DSTC resigned to become NEHTA’s CEO, industry watchers predicted many DSTC staff would quickly be absorbed into NEHTA. This has now happened, the funding for DSTC has dried up, and its CEO has now assumed his new post as CTO for NEHTA with many of his DSTC staff in place within NEHTA. As stated by Bajkowski “this hiring represents a coup, as it will ease NEHTA’s access to a vast repository of e-health-related intellectual property held in trust by the shareholders of DSTC after the group’s funding was terminated in 2005”. Curtain call ACT 1.
If anyone believes in the tooth fairy it has to be the 9 CEO’s of NEHTA’s Board and their political masters. It would seem to many we have been there before and we are going there again, unless or until someone in the bureaucracy or in the health IT industry takes note of what you are saying, and what you have been saying for a very long time. The power is with the money and the money is with NEHTA. How the money should be spent is the $30 billion enigma.
You concluded “We will wait and see!”
Everyone has been doing that now for a very long time.
They will continue to do so, for how can they do anything else?
Why should anyone change?
Well..at least there should be a choice about what happens next..have you seen any evidence of that discussion happening?
David.
Enigma! What enigma? Enigma means riddle. There is no riddle here.
1. NEHTA is conceived and announced.
2. The Chair of QLD-based DSTC becomes the CEO of NEHTA (Jun 2005).
3. DSTC is informed its funding will be terminated.
4. DSTC staff progressively move across to join NEHTA.
5. QLD-based Extensia is formed (Jun 2005).
6. The CEO of DSTC becomes the CEO of Extensia Solutions.
7. Extensia Solutions becomes Extensia Health Solutions (Dec 2006).
8. The CEO of Extensia Health Solutions becomes the CTO of NEHTA (Mar 2007).
9. QLD Director of Health becomes the Chair of NEHTA’s Board.
Is there an IPO on the distant horizon?
Will DSTC / Extensia shareholders be major beneficiaries?
Will NEHTA and its managers be major beneficiaries?
It won’t matter a diddly squat who provides the funding once the IPO is completed.
Is Government unwittingly funding the smoke and mirrors to which you refer.
How can they expect anyone to cooperate or trust them when they operate in such a dark cloud of secrecy?
For the sake of clarity, I presume that the reference to an IPO is an oblique reference to the scandalous history of the Health Communications Network?
Your presumption that my reference to an IPO is an oblique reference to the scandalous history of the Health Communications Network is not correct, although thanks for mentioning it.
Look at it this way. There is a lot of money involved one way or another. HealthIT is a very high risk endeavour. The smart thing to do is to hedge the risk, use other peoples money rather than your own - all the better if it’s Government money. As Kerry Packer might have said ‘they won’t miss it because half the time they don’t know when they’ve got it, and the other half of the time they don’t know what to do with it when the have got it.”
So, use Gov’t money, ideally without letting them have any control or ownership over the end result and go as far as you can before the wobbly bits cut in. Then rev the show up with lots of hype, suck in the hungry greedy investors on a sure fire promise of things yet to come through an IPO and lots of convincing marketing, fill your saddle bags with the investors money and hang around to see if you can make work what you sold the investors through the IPO.
If you can, go for another cut of the pie, if you can’t run like hell. I hope that clarifies it for you.
Back in Health IT for the first time since 1994 - seems like it was yesterday. We still seem to be pursuing the same Holy Grails. Nice analysis of NEHTA guys - David and others.
Good to see documentation on the "takeover" of NEHTA by the remnants of DSTC as evidenced by the uncritical support of OpenEHR. The savings are interesting as the Victorian Acute Health Budget is about $8 Billion per annum so a $30 Billion saving (over what period?) is basically saving FOUR Victorian Health Budgets. These proposed savings are good for publicity but, given about 80% of the health budget is salaries, REAL savings are only possible by reducing the health workforce. In other words, the savings are notional and reflective of savings in morbidity and mortality by managing clinician work practices. This is a costly and difficult but necessary change process but it won't save $30 Billion!
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