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Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"


H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Wednesday, August 01, 2007

A Problem that Needs to be Pre-empted and What a Strange Company NEHTA Is!

This article is a two-parter made up of two short comments:

The first comment is prompted by a number of e-mails I have received commenting on the unsatisfactory nature of the management framework put in place for the Boston Consulting Group (BCG) review of NEHTA.

One correspondent made the point elegantly if a little bluntly:

“Your own analysis ( See AusHealthIT Blog on 31/07/2007 ) agrees that governance is a major issue with NEHTA.

The NEHTA Board is the sole recipient of the BCG review material – and on the basis that this material will be highly critical (as we know many submissions are) – what is to happen?

Is the NEHTA Board simply going to acknowledge that there is a broad consensus in the Australian e-Health Community that the NEHTA Board has been crucial factor in NEHTA’s underperformance and then start fixing itself up in an open and transparent way and order itself to self-destruct? Yes, as sure as those things with curly tails are going to suddenly start to fly unaided through the air!”

A failure of the NEHTA Board to face up to the shortcomings of the entity for which they are accountable needs to be pre-empted.

Ideally this would involve full public disclosure (un-edited) of all the BCG deliverables associated with the NEHTA review. Recognising that this is a mite unlikely….

The second best way for this to happen would for the BCG to make public – with the agreement of the authors and their organisations – as much of the submissions it has received as possible so that everyone can be assured that due note is taken of all views (both positive and negative). This disclosure should also be combined with – at the least – a listing of the other information sources (interviews, research references etc) as well as a final summary of recommended outcomes and recommendations and the NEHTA Board Response.

It needs to be said, quite explicitly, that the NEHTA Board has created this conflict of interest and it is up to the Board to publicly and transparently fix it. No blame should be apportioned to BCG, except maybe to suggest that they should not have taken the engagement with the governance as it was. Even in the NEHTA constitution it was poor drafting to have the Board organise its own existential review.

Publication would allow all those with an interest to form a view as to how well the review has been conducted and how open and transparent the NEHTA Board has been in responding to the recommendations.

Associated with suggesting this as a useful outcome I would again encourage all who have made submissions to BCG to make them publicly available via the web – my web-site or yours is your choice!

Creators of submissions should recognise they are doing a favour to both NEHTA and the BCG by spending time creating submissions and that there is no doubt the submissions are fully owned and disclosable by the creators or organisations as they choose.

If the fundamental issue of existential conflict that exists in this review is not properly addressed (by full disclosure of all the BCG reports related to the review by the NEHTA Board and a written Board Response to the Review) I for one would be concerned we will never know what was really said.

On a slightly different but related tack I came upon the NEHTA Ltd Articles of Incorporation a few weeks ago. They are interesting in all sorts of aspects – especially the point that NEHTA Ltd Members are the six States, two Territories and the Commonwealth. I wonder how many other companies have these members – maybe a lawyer can let us know?

The document is found here.


1 comment:

Anonymous said...

Agreed - the NEHTA Board needs to face up to the shortcomings of the entity for which they are accountable. The BCG Review is a step in that direction.

I doubt the Board would simply “acknowledge that there is a broad consensus in the Australian e-Health Community that the NEHTA Board has been a crucial factor in NEHTA’s underperformance and then” ….. (as you say) …… “start fixing itself up in an open and transparent way”.

They know they have a far greater responsibility, both to themselves and their constituents.

Transparency should be paramount. Without doubt the Board will gain a great deal of respect from all its constituents if it made all submissions public. One should expect that all authors and their organisations would agree with their submissions being made public; perhaps, with the deletion of any commercial-in-confidence information, should there be any.

It is difficult to ‘blame the Board’ for much of what seems to have gone wrong. If anything the Board’s major shortcoming has been its members’ lack of experience in health-ICT and their inability to understand the need to balance that inexperience - by bringing onto the Board some individuals with relevant, mature, pragmatic experience gained in the real world of health-&-ICT.

In essence the Board’s role should be one of strategy and governance. The CEO’s role should be to advise the Board in the development and refinement of ‘its’ strategy. Once agreed the CEO should execute the strategy.

The CEO therefore needs to have a really good understanding of, and experience in, the health sector, in all its complexities and in the complexities of deploying ICM&T across the many domains that make up the ‘health industry’. Otherwise, the CEO will not be able to provide competent guidance and advice to Board, and to execute the Board’s strategies confidently and competently, in the knowledge that they are the ‘right’ strategies. Anything less will render the Board highly vulnerable.