Results of the HISA Survey of NEHTA’s Performance – The Beginning of the End for “Old NEHTA”

Today (Tuesday August 7, 2007)HISA is making public the results of its membership survey on NEHTA’s performance over the last (almost) three years since its initial instigation by the Australian Health Minister’s Council early in 2004.

The core finding from the survey (which attracted over 180 responses) is found in the conclusion. It reads as follows:

“That NEHTA's performance is not matching expectation is the major and consistent outcome of this comprehensive opinion survey evaluating the first two and half years of NEHTA's operation.

The survey is well-designed and broad-based with a good response rate and with significant effort provided by the respondents to consider and convey the issues and to provide suggestions for improvement. It cannot be easily dismissed as a factional view. This is a consistent view from informed stakeholders whose support will be required to achieve the high level objectives for health system change that were intended from NEHTA coming into existence.

Issues related to the level and manner of engagement with the health community and the style of operation and leadership were repeatedly identified. The difficult task that NEHTA has is to take the highly intelligent and independently minded members of the Australian healthcare system and get them to do something that will often mean more work, and deliver little value directly to them, at least in the short term. The hallmark of leadership in this type of environment is the ability to engage, listen and bind this diverse group together with a common purpose.

This is the critical task for NEHTA, the task at which, according to the feedback from this survey, it is not achieving. It is not really a question of technology, most of the critical technology problems have been solved to a large degree. It is an ability to engage the Australian healthcare community in an agreed plan and involve them in the standardisation process, ensuring they are the final owner and driver of the outcome.

Australia does not have the resources to engage in a UK, NHS style “top down” approach to delivering eHealth. Nor would it be the best use of those resources if we had them. We need to intelligently leverage the rich resources that we have, engage with vendors and clinical participants, decide what problems need to be addressed locally and what nationally, and most importantly bring the Australian eHealth community along on the journey.

There is no doubt that there are some talented and open people within NEHTA, but their contributions appear to be blunted by isolation from the broader Australian eHealth Community. The results of this survey are starkly clear, in spite of the talent within NEHTA, it is not performing to community and stakeholder expectations. It needs to better engage, listen, and leverage the broader talent pool in Australian eHealth. In doing this, it needs to be a participant and in some cases to lead in galvanizing both the eHealth and broader healthcare communities together in the common goal of delivering a safer and more efficient healthcare system for Australia through the application of eHealth systems and processes.

It would be better to resolve these important issues around engagement and style within the existing structures to avoid a repeat of the hiatus that occurred with the formation of NEHTA.

There is close co-operation between HISA and the Australian College of Health Informatics (ACHI) with all ACHI Fellows also members of HISA. There is a strong view from the membership of both organisations that Australia is not moving fast enough to improve health information systems and that Australia lacks an agreed and resourced plan to address this to realise the benefits that are now becoming well accepted internationally. HISA stands ready and able to contribute and support the development of this national plan.”

The full report can be found here.

What will be interesting from now is, with some really hard and credible data available as to NEHTA’s performance, is what will happen next.

On the basis that this is only one of five different submissions to the BCG review which have provided very adverse, and very similar, commentary that I am aware of, one can only hope that major change will eventuate.

The threads of:

1. Not loosing any momentum that is presently underway.

2. Developing a new plan defining who does what with whom and who is responsible for which outcomes.

3. The need for a radically different management style and approach for the current NEHTA.

Are vital. Are all present in all the submissions I have seen!

All these points, and much else, is crucial. Let us hope the outcome of the Boston Consulting Group’s NEHTA Review accurately reflects these messages.

The BCG needs to be very clear that NEHTA has spent / is planning to spend almost $200 Million by 2009 (The COAG funds $130M + operation expenses of approximately $15M + pa for four years). This is a very large sum of money and how it has been spent needs to be very carefully reviewed. (For example does NEHTA actually need a quite palatially fitted out suite on
Level 25, 56 Pitt Street, Sydney NSW 2000?) (Chatswood, Macquarie Park etc would have been as good)

Just look at how the Royal Exchange Building portrays itself!

“With frontage to three streets this prominent corner position enables the Royal Exchange Building to take advantage of excellent natural light and good harbour views to the north-east particularly from the upper levels. The high rise floors present magnificent northerly and easterly views including Circular Quay, the Opera House and the Botanic Gardens. To the west the aspect is no less spectacular enjoying expansive views of the City and beyond creating an evocative backdrop particularly at sunset.

The central CBD location is only a short distance from Wynyard Railway Station and the bus ferry and rail transport at Circular Quay. Equally close in all directions are some of Sydney's leading international five star hotels, and a wide selection of Sydney's finest shops restaurants and entertainment. “

Nice spot if you can afford it – for more amazing information on how money is being wasted go to:

http://ebuilding.com.au/56pittstreet,sydney/jadehttp.dll?EBDWebsite_002

Let us also hope DoHA recognises the appalling conflict the NEHTA Board finds itself in – being the recipient of a consultant report which is very likely to suggest their oversight of NEHTA has been highly unsuccessful – at best. They should take the management of this project back to the Department itself and so free the consultants to do their job fearlessly and honestly.

I must say the work presented here re-assures me I have not been wasting my time pushing for major change in NEHTA.

Wait now for the “Empire to Strike Back”. The attempts at spin, backdoor attacks on the credibility of all those involved, denial of the validity or the survey and claims of bias on the part of the authors will be fascinating to watch.

I suspect we will also hear claims – we are doing great, this all just takes time so give us more time (duration unspecified) and we can prove how wonderful we really are!

In order to counter all this one should ask the following question. Just how many commercial vendors have actually signed up to use the NEHTA’s patient and provider identity services and what will this service cost into the future when the initial funding is used up? I think the answer is none and no-one knows.

Another issue, now it is clear that major change at NEHTA is warranted is the status of all those staff hired on two and three year contracts. Some will surely be in areas now seen as not strategic or useful. Even if there are 20 of the 100 or so staff who have to be paid out (given $250,000 per person in total employment costs would be usual for a two year contract) that could be $5.0 million paid, after the event, on wasted staff.

Further, longer than six month, recruitment by NEHTA should obviously be deferred until clarity is available.

I commend the survey to you for a very close read – it is really good to see the truth out once in a while!

David.

Press Commentary is now available:

1. MIS Australia

2. Australian IT

D.