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Monday, June 04, 2007

The AHIC Survey – Will they Hear What they Need To?

Last week the President of the Australian College of Health Informatics (ACHI) was sent a survey which had been developed for the Australian Health Information Council out to ACHI members for comment. The survey – which was developed by the Nous Group (www.nousgroup.com.au) - had the following introduction and process description:

The Australian Health Information Council (AHIC)

eHealth future directions

stakeholder survey

Purpose of survey:

In its role of providing advice to inform national policy direction for health information to the Australian Health Minister’s Advisory Committee (AHMAC), AHIC wishes to look strategically at the development of the national health information program out to 2013. Part of this process will be a summit on June 18 (evening) and 19, involving AHIC and the National Health Information Management Principle Committee (NHIMPC).

To ensure we cover as much ground as possible at the Summit, it will be useful to have a systematic analysis of:

· what’s worked and what hasn’t up until now

· where Summit participants and your constituencies (if relevant) stand on the health policy imperatives moving forward

· what should be in place by 2013 (or before) in terms of eHealth infrastructure and specific IT and communications tools to serve those health policy goals, and

· what might be the right model(s) moving forward.

The findings of this survey will be collated and presented in advance of the summit.

Process

The survey provides you with the opportunity to highlight the issues of most importance in your or your jurisdiction’s view. We will be conducting a phone interview with as many of the Summit participants as possible over the next two weeks, based on this survey.

If you are able to partially complete the survey before your phone interview it will help us to focus the discussion on the most important issues that you have identified.”

Those who feel they can add useful contributions over the next week or so can – by downloading the survey from here and providing a response to the Nouse Group or the AHIC Secretariat of DoHA.

I dutifully filled the questions in the 25 or so questions and sent it back to Professor Liaw for him to formulate a full response with the input of others or ACHI’s membership.

After mulling for a day or so I also decided to try and respond – in my own terms – as to what I thought AHIC should be considering at the June meeting. This resulted in the following e-mail to the consultants involved.

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Hi,

I was sent a copy of your AHIC survey being a Fellow of the Australian College of Health Informatics. I have filled it in and sent it back to Professor Liaw so he can integrate my comments with the others. I felt however it would be useful if I made a few higher level points.

My first point is that I feel that the survey, by talking about building blocks and the like has missed the essential fact that without a co-ordinating national Strategy the building blocks are not going to get anywhere on their own - they are not self organising.

There is a core need to develop a National e-Health Strategy, Business and Implementation Plan that is based on stakeholder consensus and is practical, needs orientated and implementable in a sensible time frame. Lives are being lost in droves as the strategic dithering continues. Solving this is actually urgent despite the relaxed approach being taken by DoHA and NEHTA to actually delivery of outcomes.

My second point is, that the background to possible approaches really does not fully address the nature of the strategic choices and options that are available in a satisfactory way. Not mentioning the almost certain need for a hybrid of what has been done overseas (and not even mentioning the very successful Danish and Dutch initiatives) leaves the reader poorly informed

My third point is that it is my view the Health / Medi Connect trials have been virtually uniformly dismal disasters which have been much too positively spun by DoHA. The secrecy around the lack of outcomes and the waste of money has been alarming and I know as I have seen many of the full reports - not just the obfuscatory summary.

My fourth point is that is it now virtually the Health IT Community consensus that NEHTA has been a severe constraint on progress of the e-health agenda.

My fifth point - having worked in this area since 1983 - is that this is a very complex problem - and that the complexity extends far beyond technical issues into areas of innovation diffusion, consumer trust and a range of other non-technical issues.

My sixth point is that without bringing the inherently conservative clinical community fully on board anything attempted is doomed.

My seventh point it that this is the fourth time we have seen attempts to set a direction and each attempt has been crucially flawed due to inadequate consultation, lack of holistic understanding of the health sector etc. I for one do not want to see yet another repeat.

My eighth and last point is that strategic execution in the public sector is very failure prone and this needs to be addressed carefully if any useful outcome is to be achieved.

A search of my Health IT blog will provide a lot of background on all these areas (address below)

I hope this helps - I am happy to chat if it would help

Cheers

David.

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Of course I missed a couple of points I wanted to make… (and so a second e-mail)

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Hi Michael,

Thanks for the response:

There is one more I overlooked that woke me in the middle of the night. That is that the benefit flow from the implementation of e-health accrues not to the technology users but rather to the those that pay for health services. This means there is a negative incentive to adopt the use of the technology despite the fact there is overwhelming evidence that Health IT deployment improves safety, quality and efficiency.

This is recognised all over the world and thus in the US the payers are now funding systems to get the benefits - witness the $6+Billion Kaiser Permanente is spending.

If incentives for adoption are not properly addressed any plan will fail.

Sorry for missing it out.

Cheers

David.

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Sadly there was another key point I mentioned in my survey response but also left out of my e-mail – the issue of addressing the dysfunctional Federal / State divide and the impact it is having on e-health.

Anyway I think I have now got the big 10 points I want to see made. If you have others please let me know and I will pass them on.

David.

1 comment:

Anonymous said...

Agreed all 'round - with the comment that the late arrivals, your points 9 and 10, are actually the most important.

1. There cannot be a sustainable business model for delivering eHealth without a fair return to healthcare providers for their use of eHealth tools (with flow-on to their technology providers), and

2. Unless blinkered state and regional health bureacrats and IT managers are taken out of the implementation loop (or at least their influence is substantially diminished), state and national solutions will remain decades away. In some states, these folk still believe that public health patient information cannot legally leave the state health system or be made available in neighbouring states!

Regional and state health IT management is one of the strongest reasons there is for national management of health services.