A Curious Interview with NEHTA.

An interview with NEHTA’s CEO appeared in the Australian IT section last week. It can be accessed at the following URL:

http://australianit.news.com.au/story/0,24897,21848256-15319,00.html

E-health standards advance

Karen Dearne | June 05, 2007

THE National E-Health Transition Authority is pursuing software industry engagement through a growing relationship with the Australian Information Industry Association (AIIA), NEHTA chief executive Ian Reinecke says.

Dr Ian Reinecke says NEHTA remains engaged with the software industry on standards

"Most of the big players in health globally are members of the AIIA," he said after a successful vendor forum in Brisbane last week.

"Sheryle Moon, the new chief executive, has been really supportive of health as an agenda item for the AIIA, so we're making progress in that area."

….. (see the site for the full article).

This claim of a growing relationship with the AIIA really demonstrates that NEHTA has completely failed to understand the need to establish a meaningful and practical useful working relationship with the body where the true e-health expertise in Australia lies. This is not the first time that NEHTA has nominated AIIA as its way of engaging with the software industry. Is it any wonder that NEHTA was so roundly criticized at the Medical Software Industry Association (MSIA) Roundtable held a week or two ago?

The AIIA is the 'big end of town' and the peak IT industry body. It is inevitably a generalist. It has little or no understanding of the health sector. The broad picture presented by AIIA can be seen on their web-site.

“AIIA's mission

AIIA leads the ICT industry in Australia, with almost 500 member companies that generate combined annual revenues of more than $40 billion, employ 100,000 Australians and export more than $2 billion in goods and services each year.

AIIA sets the strategic direction of the ICT industry, influences public policy, engages industry stakeholders and provides member companies with business productivity tools, advisory services and market intelligence to accelerate their business growth.

If your company is serious about building your business, AIIA membership is a must. Our members have access to:

• Experience - AIIA has represented, led and connected the Australian ICT industry for almost thirty years.
• Power - ICT is a $90 billion industry, representing 4.6% of Australia's GDP.
• Representation - AIIA has almost 500 member companies employing 100,000 Australians.
• Connections - 6,000 ICT powerbrokers attend more than 100 AIIA events every year.
• Engagement - 300 ICT business leaders are our volunteers.
• Partnerships - 80% of AIIA's members are local industry companies.
• Commitment - AIIA's 7 full-time lobbyists work with government, industry and media to address the issues affecting the ICT business community.”

Clearly AIIA has no deep and focussed expertise in Health-ICT. (Indeed its election manifesto does not even mention the word) By comparison, the MSIA is a small dedicated association of about 100 members whose only role in life is Health IT. Their position and strengths in e-health should be clear from the following:

MSIA member's software accounts in Australia for approximately:

1. 95% of clinical desktops,
2. including 90% of Aboriginal health services,
3. 85% of practice management,
4. 80% of hospital PAS,
5. 100% of retail pharmacy,
6. 80% of private pathology systems,
7. 70% radiology systems, and
8. 50% of public pathology systems.

Put bluntly, NEHTA simply cannot afford to side-line this group – for if it does, nothing NEHTA wants to do will be possible – it is that simple.

Further on the article says:

"For the Cerners, the iSofts and others, when the infrastructure, standards and specifications are going to be available is a critical issue, because they are going to adopt them in their systems."

This is a fascinating remark, firstly because, according to the AIIA website (5 June 2007), Cerner is not a member of the AIIA! Secondly, I cannot imagine Cerner or iSoft (which has other worries right at the moment) being the least bit interested in NEHTA specifications. Can you? They will be interested in Global HL7 and CEN ISO Standards - that’s understandable, but NEHTA's? – hardly, given Australia is such a small part of their business.

We are also told that the use of SNOMED CT will be under a dual licensing model and that vendors that want to adopt SNOMED will need to get a licence from the SDO for access to the main parts of SNOMED that come from the SDO, and that, if they are operating in Australia they will also need a licence with NEHTA to access the Australian developed components.

This is just unwise and silly. The Australian elements are only usable in Australia. So why impose a license at all? Just make them available for anyone located in Australia to download. We are also not explicitly told that the licenses will be free and this, I think, should also be of concern.

Even more amazing is that we are now told that after three years of effort there is still a lot of development work yet to be undertaken on the medicines terminology and that NEHTA are also still trying to co-ordinate the various contributions from the Therapeutic Goods Administration (TGA) and the Pharmaceutical Benefits Scheme (PBS). Is it not appropriate to ask ‘why can't NEHTA manage to have two Commonwealth entities co-ordinate inputs?’ It might be because NEHTA, being a private company, is not part of Government, or it could be they are just not any good at what they are meant to be doing. Either way it is just hopeless.

There also seemed to be some confusion about how terminologies are used. Once developed the medicines terminology is meant to work wherever the medicines are referred to (i.e. in a message, prescription or EHR) and not be different in different applications. The fact that NEHTA is currently recruiting pharmacists on two year contracts suggests we won't see an Australian Medicines Terminology in use any time before 2009 at the earliest – with all the costs in inconvenience to user and software providers that implies.

It was also reassuring to note NEHTA thought the MSIA's working group on interoperability between clinical systems was "sensible"?. Sensible indeed! I seem to recall that defining the requirements for secure clinical messaging and interoperability was one of NEHTA’s core tasks. Now, it seems, they have vacated that space. I am left amazed and horrified. NEHTA should be co-ordinating all this – not commenting on it!

Finally, we are told that Australia is only a small part of the global E-Health Standards picture. So just what are we getting from the 60+ people that work for NEHTA? If we are just adopting and being consistent with global standards it seems to me “waste watch” needs to be called in as soon as possible.

I really wonder why this interview was given – could it be the pressure of the upcoming review of NEHTA's value and utility? On the basis of these comments, if I were them, I would be nervous if this is the best they can say in their own justification.

David.