While contributing to the recently released Health Information Society of Australia (HISA) Submission to the NEHTA Review, the Australian College of Health Informatics (ACHI) has also developed its own submission.
The submission can be found here.
In addressing the question of whether NEHTA is meeting is objectives the submission points out:
“When we consider each of the objectives in S3.2 of the NEHTA constitution, the report card is not very impressive. Some progress is seen in the work on clinical data standards and terminologies. However, it is the continuation of work already started on SNOMED CT, which only became official in May 2007. The implementation program is neither explicit nor transparent, which precludes any informed comment on actual progress on the ground.”
The report then goes on to say there is uncertainty as to where other major initiatives are presently situated saying “However, lack of information sharing (by NEHTA to the e-Health Community) prevents informed comment as to whether the R&D is sound and consistent with parallel developments in national and international standards programs.”
When asked to address the question of whether NEHTA was given the appropriate objective the ACHI report remarks:
“When a NEHTA was recommended following the BCG report in 2004, our expectations was that all the R&D done to date by a range of agencies would be harnessed into a national implementation strategy and plan, along with a compelling business case. A role of a NEHTA would be to coordinate the development of this plan as a matter of urgency and get down to the business of implementing and monitoring the success of the implementation plan.”
As is now well known, of course, this plan never happened, or if it did it was never made available to the e-Health Community.
ACHI is also moved to point out that:
“It would be fair to say that there has been little substantial progress during NEHTA’s tenure as a player in this standards and infrastructure domain. NEHTA has delivered a number of summary documents of existing work and re-badged plans for the future. These are general and basic documents not just to the Health Informatician but also to computer science students who have been asked to examine them for academic purposes. “
ACHI also notes that while there has been progress with SNOMED CT and some apparent work in the area of e-Health Benefits Realisation the actual cumulative progress is very hard to estimate.
Among other key points ACHI notes the lack of consultation or inclusiveness with the ACHI membership despite a number of offers and meetings.
I will quote the final Summary in full:
“ACHI believes that NEHTA has not achieved what it was tasked to do and is unlikely to do so if it continues as is. The reasons include the vagueness of what was prescribed in the constitution of NEHTA in the first place, the lack of a clinical or health focus, a poor communication and engagement strategy, a governance structure which emphasised the jurisdictions and hospital-based systems, a lack of emphasis on capacity building, a lack of quality monitoring and evaluation, and a lack of clear deliverables and key performance indicators (KPIs). The key factor is a lack of national direction, leading to a lack of a national vision for the EHR system, and therefore a lack of a national implementation plan, budget and support.
We believe that what NEHTA is supposed to be doing is very important but that NEHTA is not doing it well. Along with the HISA survey, we believe that this is a widespread and consistent view from informed stakeholders, whose support is essential to achieve the objectives tasked to NEHTA.
There needs to be a concerted shift to a program of systematic implementation and management of the change to the health system as the implementation gets underway. Capacity building and a safety and quality improvement culture is essential, with built-in data collection and monitoring processes and systems to provide the evidence of improvement to cost-efficiencies and health outcomes.
ACHI stands ready to contribute to the development, implementation and monitoring of this nationally agreed implementation plan for a national EHR system and e-Health program”
Where does all this leave us?
I would suggest that, with both the earlier HISA and ACHI submission virtually totally aligned on all the key points under review, fundamental change in the way NEHTA operates and the objectives it pursues needs to be very fully re-assessed.
It seems clear to me it is the clear expectation of the e-Health Community that fundamental and deep change is both underway and required.
For the NEHTA Board to continue in its mode of denial and obfuscation is becoming increasingly un-tenable. Definitive action to access the broad range of e-Health skills available outside NEHTA is vital and is required and sooner rather than later! Facilitated by the BCG, the Board should engage in an inclusive Strategic Planning Process to minimise any further waste of NEHTA work and get the overall direction of e-Health back on a track that has the vast majority of stakeholder support. Without such a process no one can know what can best be done with what we now have in NEHTA and how it can best be shaped to serve the National E-Health Agenda in the future.