The recent fracas over the care offered at Royal North Shore Hospital – and the recognition that it is only luck that has saved many other hospitals from similar pain and embarrassment – has had additional intensity created by the rather heated pre-election environment.
With calling of an election imminent, this recent set of issues led me to start to think what would I like to see in the form of e-health policy from the major parties – and what template might I use to assess their offering.
I will make an educated guess here. I think both parties are working on the area. Why? Because the present Federal Minister knows he is in a mess in the area – witness the speech reported here from August 20. A ‘mea culpa’ and I must do better if ever there was one.
Moreover we have had the Australian Health Information Council (AHIC) and the e-Health Ministerial Advisory Council (eHMAC) working away in great secrecy for a number of months now – and repeated suggestions of relevant e-Health bureaucrats that ‘big things are coming’!
On the Labor side we have a quite supportive policy platform but to date no policy specific policy announcements I have noticed.
What do I want to see to give a policy a tick?
1. Clear recognition that there is an urgent need to develop an overarching National E-Health Strategy, Business Case, Implementation Plan and Benefits Management Plan.
2. A revamped and fully functional governance framework for e-Health in Australia that makes it clear who should be doing what and what their accountabilities and responsibilities are. This needs to cover Consumers, the Commonwealth, The States and Area Health Services, GP Divisions, NEHTA, AHMAC, AHIC, eHMAC, NEHTA, Standards Australia, System Vendors etc.
3. A clear articulation that the purpose of the investment in Health IT is to improve the quality, safety and efficiency of the Health Sector and to improve Health Outcomes for the whole population.
4. Recognition that there is frequently a mis-alignment between where costs are incurred and where benefits are obtained that must be addressed to make significant implementation progress.
5. Recognition that the current levels of investment in Health IT are not sufficient to enable the improvements in efficiency and safety that the public expect.
6. Recognition that the inherently conservative nature of the Health Sector means that management of the introduction of technology needs to be undertaken in a consultative way that is sensitive to local needs (the mega top down system imposition is a disaster waiting to happen).
7. A understanding of the concern many members of the public have about the privacy and confidentiality of their health information – and a recognition this issue needs to be address ‘head on’
8. A clear articulation of a position that recognises there are entirely practical, affordable and useful Health IT solutions that are available today and that should be deployed in the context of the plan mentioned above as soon as possible.
9. A view that so called ‘rapid learning’ offers a major benefit for the public through dramatic improvements in the value that can be extracted from patient data-bases through secondary information use and that therefore there implementation as soon as possible is vital.
10. A real preparedness to recognise things have not gone all that well to date and that more effort and more leadership focus is required, while at the same time not initiating an endless series of poorly managed and underfunded trials which ensure that failure begets failure.
I leave it as an exercise for the reader to score each side and hopefully vote accordingly. (Note no e-Health Policy announcement from one side or the other equals a zero score for that side in my books!)
David.
3 comments:
The problem is not so much the Minister - for he is but a talking sponge - rather, the problem stems from his Department. So, no matter which party forms Government - the problem will remain - until such time as something is done about the bureaucratic ignorance and ineptitude prevailing around the highly complex issues called ‘e-health’. New blood, new ideas, fresh approaches, are all badly needed. Perhaps, with a change of Government we may see changes.
You have hit the nail on the head.
Without doubt the Minister and his
Department need to demonstrate first and foremost that there is “a real preparedness to recognise things have not gone all that well to date" - or more precisely that past attempts have failed -
and
"that more effort and more leadership focus is required, while at the same time not initiating an endless series of poorly managed and underfunded trials which ensure that failure begets failure.”
In regards to the first point - the Minister needs to invite comment and input from industry to explain to him WHY he and his Department have failed. That is the starting point.
In regards to the second point - 'leadership' is a difficult area and this has been well demonstrated recently by the shortcomings of NEHTA's leadership.
Finally, underfunded trials, usually terminated prematurely, mirrors a lack of understanding about how the real world operates and the political imperatives of bureaucrats to spread funds far and wide to give everyone a nibble.
Using words like revamped, clear articulation, accountabilities, responsibilities, specific policy announcements makes it so easy to criticise. What bothers us most is who is needed to put it all together? Who should be called upon? Designating committees like AHIC, eHMAC and similarly impressive sounding names doesn’t answer the question at all. Also, naming organisations and office bearers like AMA, President of …., doesn’t answer the question either. We need to identify individuals with the skills, insights and experience to do what you have been calling for. Who are they? Where are they? Before naming and structuring any committee find the right people that can be drawn upon. Is David More one such person?
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