The following is a summary of the issues that I plan to explore with the BCG. I plan to proceed based on the assumption that the BCG is now fully aware there is very considerable disquiet about the way NEHTA is performing and behaving.
It seems to me there is very little disagreement with the findings of the HISA and ACHI submissions and that the key issue is what is to be done to remedy the situation.
I offer the following suggestions as to what needs to be done:
1. The CEO needs to be replaced by someone who better understands both the Health Sector and Health IT and how the former can be assisted by the latter.
The culture that has been developed at NEHTA of organisational arrogance, secrecy and authoritarianism needs to be fundamentally changed in NEHTA is to have any chance of success – and the present CEO is not the one to manage that transformation – given it is clear from his actions he is of the firm belief he is doing the right thing and has all the answers (which he clearly doesn’t).
2. The NEHTA Board needs to be restructured to have enough technical skills to manage an organisation which has a focus on delivery of e-Health co-ordination.
3. The Australian Health Minister’s Advisory Council and the Council Of Australian Governments need to determine – with the BCG’s advice – just what the governance arrangements for e-Health in Australia. The ideal in my view would be a genuinely expert Australian Health Information Council (AHIC) with relevant clinical, e-health and technical stakeholders being the Strategy Development Entity with NEHTA being a strategy implementation arm. NEHTA should be restructured and renamed to recognise this and AHIC should be supported by a strategically focussed and expert secretariat.
4. AHIC needs to be charged with developing a National E-Health Strategy, Business Case and Implementation Plan which is agreed with Department of Health and Ageing (DoHA) and COAG for appropriate funding and support.
This plan needs to have (at least) the following attributes:
- Comprehensive Coverage of Whole Health Sector (Public / Private / Specialist / GP / Hospital / Public Health etc).
- Focus on Short to Medium Term Deliverables with High Benefits Impact initially.
- Recognition that the purpose of E-Health is to support improvements in the quality, safety and efficiency of the Health Sector.
- Ensure coherent long term outcomes and value through appropriate blend of Standards based and Point Solutions.
- Recognise who should pay for the technology are those that receive the benefits. Provision of appropriate incentives will be necessary and need to be factored in to the thinking.
- Delivery of the right blend of local autonomy and control vs. the need to national coherence and standardisation.
- Recognise there is no real place for a ‘command and control’ approach to management of change within the Health Sector.
5. NEHTA needs to stop pretending to be a Standards organisation and start genuinely working with Standards Australia in developing the Standards required for e-Health in Australia.
6. NEHTA needs to “spin off” the SNOMED-CT management and delivery functions into a separate public sector entity which is fully funded by the public purse.
7. NEHTA needs to be de-corporatized and moved fully back into the public sector.
8. All business case documentation developed by NEHTA needs to be comprehensively reviewed and assessed for quality, feasibility and validity. Each functional unit within NEHTA needs to be independently justified as being a sensible investment – recognising that is some cases infrastructure synergies need to be considered.
9. Each of NEHTA’s operational units needs to identify just who its customers and users are and develop a plan – which is reviewed at Board Level – as to how it will best engage with and serve them.
10. All NEHTA working documents and plans need to become subject to the standard Commonwealth Freedom of Information laws and rules.
If all these steps were taken it is just possible NEHTA could become an important and useful player in the Australian E-Health domain. Without changes along the lines outlined here – we will have another decade of failure and lost opportunity.