Back to the Drawing Board For NEHTA!

Well the deadline has now passed for submission of comments regarding NEHTA to the Boston Consulting Group (BCG) NEHTA Review. (Friday, 27 July, 2007)

As we were told when the review was announced “The findings of the review will be provided to the Directors in the first instance. A General Meeting of Members will be called within two months of the review being completed, to consider and vote on the future of NEHTA. The review process is planned to conclude before the end of 2007.”

Being sensible about timing this means, practically, that the review will need to end by about the third week in December. Allowing for what will be a discussion and review process around the BCG findings and recommendations this means their work must be completed by early November, 2007 at the latest I would imagine. So we can conclude that at most there will be about four months elapse until the fate of e-Health in OZ is largely determined.

In thinking about this short time window, I have been trying to work out how I would like to see the suggestions in my submission be actioned.

In my thinking I have been lucky to have the opportunity to browse submissions that have been submitted by other interested parties. One of these, from the Health Information Society of Australia (HISA), I know is going to be made public in the next few days – after circulation to key HISA stakeholders, who, fairly, deserve a “first-look”. At this stage I am not sure of the plans for the others.

Without breaking any confidences I think I can safely say there is an amazing degree of consensus among my submission and the others I have browsed that change is needed. Without overstating the situation it would seem to me that a “New NEHTA” is clearly needed and if this is not delivered the confidence we all have in the way our public policy processes work will be severely dented.

It has also been re-assuring to note that the themes of this blog around the need for openness, transparency and two way communication are also very much unanimous as was the recognition of the need for a “plan”.

So while my suggestions for root and branch change at the Board and executive levels of NEHTA still stand there are some directional issues that I think also need to be addressed.

One issue, that I did not emphasise in my submission but that was picked up by others, is that there is the need for much enhanced investment in e-Health education if we are to take advantage of the opportunities offered by the emerging technologies and increased investment. It must be realised that there is a ‘chicken and egg’ problem here for without an agreed and funded national e-Health Plan who would venture to build a career in the area?

Second it is clear virtually everyone is as confused as I am about who should be doing what with whom in the Australian e-Health space. The alphabet soup of AHMAC, AHIC, NEHTA, the Jurisdictions, DoHA, Treasury, DCITA and Standards Australia’s IT-14 Committee seriously need a summit to define borders, roles, functions and responsibilities. It would be a great plan if the BCG could bring such a summit together and even better if we could get all of these bodies to operate in open, transparent and co-operative ways. Additionally this melange has to work out, for everyone’s sake, how it is going to interact and work with the private sector – be they service or Health IT providers.

No wonder we are seeing the level of paralysis that presently exists, and the likely waste of valuable resources, when there are so many with ‘fingers in the pie’.

Sorting this issue out really needs to be some sort of prelude to development of the National e-Health Plan.

Third there needs to be careful consideration of the directions to be taken in two key areas. The first of these is just how much national vs. local infrastructure is needed to get the majority of the benefits we hope to achieve. (This goes to the issue of how much local autonomy vs. central prescription is appropriate when ultimately we want ‘joined up care’.) The second area is just what are the priorities for both standardisation and functionality (at what location) that will best serve the national need. Just how complex do systems need to be to get 80% of the benefits?

Last the ‘elephant in the room’ of who will pay needs to be addressed squarely – with an understanding of the issues around benefits misalignment well and truly on the table.

All these issues will ideally be explored and discussed as the BCG consults and explores options.

There is not long to work out your views and contribute them to the relevant parties if given a chance.

David.