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Thursday, August 02, 2007

Dr Oliver Frank – Experienced GP and Health IT Expert – Provides a Submission to the NEHTA Review.

I had a nice e-mail from Dr Frank this morning providing more transparency as to what the NEHTA review is hearing – this from a GP perspective. I quote:


Dear David,


I am writing to say that you may put my submission on your Web site. As I said, it was written in a very short time that I had, and isn't quite as 'respectable' as one might wish in terms of elegance, research and comprehensiveness, but I agree that it is important to put as much out in public as possible to try to make the BCG review process as useful as possible.


--

Oliver Frank, general practitioner


255 North East Road, Hampstead Gardens, South Australia 5086


Phone 08 8261 1355 Fax 08 8266 5149 Mobile 0407 181 683


What follows is the view of NEHTA from someone who has been involved in GP Computing for many years. I quote:


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Subject: Submission to NEHTA review

Date: Wed, 18 Jul 2007 07:55:15 +0930

From: Oliver Frank

Reply-To: oliver.frank-at-adelaide.edu.au

To: nehta_review-at-bcg.com


I am responding to the invitation to send a submission. I am a GP and full time partner in a group general practice. I have been involved in health informatics since 1985.


My qualifications are MBBS, FRACGP, PhD.


A brief selection from my CV:


2006 - Board member and Deputy Chair, Adelaide North East Division of General Practice

2004 - Member, Quality Practice Committee of the Adelaide North East Division of General Practice

2004 Member, Quality Care Working Group of the General Practice Computing Group

2003 Member of Scientific Program Committee, Health Informatics Conference 2003 & RACGP 12th Computer Conference

2002 Representative of South Australian Divisions of General Practice on Generational Health Review of the South Australian health system

2001-2002 Chairman, RACGP National Informatics Committee

2000 - 2006 Representative of South Australian Divisions of General Practice on the Clinical Information System (OACIS) Enterprise Wide Steering Group of the South Australian Department of Human Services

1999 - 2002 Representative of the Royal Australian College of General Practitioners on the Management Committee of the General Practice Computing Group

1999 - 2007 Urban Divisions’ representative on the Informatics Advisory Committee of South Australian Divisions of General Practice Inc.

In answer to your questions:


1. NEHTA’s effectiveness in meeting its objectives during the two years since its inception, including:

a. The consistency of NEHTA’s current role and function with its objectives as laid out in the NEHTA constitution[1] – “Has NEHTA achieved what was intended for it?”

I believe that NEHTA has largely failed to achieve what was intended for it.

b. The appropriateness of NEHTA’s objectives, given the needs of e-Health development in Australia - “Was NEHTA tasked with the right objectives in the first instance”

NEHTA's objectives were reasonably appropriate.

c. NEHTA’s goals, strategies and work plan, including any gaps or overlaps with the work of other bodies

NEHTA's strategies and work plan have failed to produce very much useful output to date and therefore must be judged as poor.

d. Progress achieved in deliverables and outcomes, especially with regard to the development of standards and the establishment of core information infrastructure for e-Health.

NEHTA has delivered very little in exchange for resources that it has received. It has produced only one useable or potentially useable standard that I know of and it and it has established no core infrastructure that I know of for e-Health - in fact, it has actually retarded progress because various other players have been holding up projects while they have been waiting and waiting for NEHTA to produce what it was supposed to produce and that it said that it intended to produce.

e. NEHTA’s structure and governance arrangements

NEHTA's structure is poor. The State health CEOs and other non-informatics experts on the Board of NEHTA are the wrong people to be running e-Health developments. The medical and other health professions are not represented or consulted adequately or at all. I asked NEHTA to give me a list of GPs with whom it had been working. NEHTA refused to do so and I still don't know.

f. The consultation and communication process NEHTA has undertaken, including:

§ The engagement process that has been conducted

There has been no effective engagement process. For example, I attended the MSIA Round Table meeting in Sydney on 22nd May 2007, to which NEHTA had been invited. NEHTA did not attend this most important meeting at which the vendors and developers who supply the software used by 95% of health professionals in Australia were working out their role in the future of health informatics in Australia.

§ The completeness and quality of the content that has been communicated

The quality of the content that has been communicated has been very poor. A lot of it has been presentations by the CEO and others that are simply promotions for what NEHTA is going to do. Much of the content that should have been in formats useable by information professionals to build information systems has been in amazingly non-professional and incompetent text files, spreadsheets and the like.

§ The outcomes that have been achieved as a result of consultation

g. The funding for, and value for money achieved by NEHTA, including:

§ The balance of resources committed to different activities and objectives

I don't have a clear enough picture about this to comment.

§ The level and mix of sources of funding

Little has been achieved from consultation because there has been so little consultation by NEHTA! The value for money has been very low.


2. Possible roles for NEHTA or a similar entity in the context of future e-Health reforms, including:


1. Roles and responsibilities for existing players and/or potential new players, including NEHTA, in e-Health reform going forward In the future, the national organisation for the development of health informatics in Australia must much more involve the health professionals who are actually caring for patients. It will be important particularly to seek to involve those health professionals who also have knowledge, skills, experience and/or qualifications in health informatics. NEHTA's heavy focus to date on public hospital systems and public health systems, resulting largely from the composition of its Board, has been undesirable and inappropriate. The new national organisation for the development of health informatics in Australia will need to give equally as much attention to the informatics needs and realities of health professionals working outside public hospitals, where a lot of the gains from e-Health are to be made.


2. Priority next steps in delivering e-Health objectives

a. Help all health professionals to stop writing on paper.

b. Get all parts of the health system exchanging clinical information electronically.

3. Vehicles and sources for funding the next steps


Divisions of General Practice are well-placed, if properly resourced, to help to get GPs using electronic information systems more effectively. Other health professionals may need other vehicles or perhaps there should be created an organisation that helps all health professionals to increase their use of electronic clinical information systems – this could be a teaching arm of the new national organisation for the development of health informatics in Australia.


Commonwealth and States together need to fund these steps. The Commonwealth/State divides, tensions and cost shifting must be addressed and sorted out.

4. Potential governance models


Governments and the new national organisation for the development of health informatics in Australia will need to work closely with health professionals and their professional organisations.

5. Ongoing operation and maintenance of standards and infrastructure established by NEHTA


NEHTA has established only one standard that I know of that is of any relevance, and it has established no infrastructure that I know of, so asking about 'ongoing operation and maintenance of standards and infrastructure established by NEHTA' is hardly relevant currently.


In summary, my experience and opinion about NEHTA is that it was wrongly structured for its tasks, that it has conducted its business in a secretive dictatorial largely non-consultative manner, and that it has so far produced very little of any real use to the people, patients and health professionals in Australia.


I am happy to discuss any of this with you at any time.


--

Oliver Frank, general practitioner

255 North East Road, Hampstead Gardens, South Australia 5086

Phone 08 8261 1355 Fax 08 8266 5149 Mobile 0407 181 683


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Thanks for that Oliver!


David.


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