Quote Of The Year

Quote Of The Year - Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

Wednesday, November 07, 2007

The Aust. Department of Health and Ageing – Is It Australian E-Health’s Worst Enemy?

The Australian Commonwealth Department of Health and Ageing (DoHA) released its Annual Report for 2006-07 on October 30, 2007.

The report can be downloaded from here.

I was of course keen to see what was being reported for e-Health. I think it is fair to say the news is not at all good.

In the 2006-07 Budget, about $78.9 million was allocated to e-health implementation; but in fact, only about $37.4 million was spent during the period.

The precise figures are as follows – (See Page 150 of the Annual Report.)

Program 10.2: E-Health Implementation

Allocated: $78,972,000

Actually Spent: $37,408,000 – Underspend: $(41,564,000)

Budget for 2007 – 08: $40,041,000

It is worth noting that the Budget for 2007-08 allocation for e-health is now also only about $40 million) so effectively they've simply reallocated the money they didn't spend, after shaving $1.5 off the top.

This we now wind up with a situation where DoHA have effectively halved their investment for this coming year.

A review of the DoHA performance indicators in the e-Health domain makes really depressing reading and to be frank seems to me to be hardly accurate. (See pages 144 and 145)

Having a goal expressed as:

“Key stakeholders use electronic clinical communications to improve quality and safety in health

care.”

And to claim it was met on the basis of what follows is pretty cute in my view!

“The Department continued to work collaboratively with states and territories and non-government organisations, through its Broadband for Health, Managed Health Network and HealthConnect programs to provide and expand infrastructure that allows clinicians greater access to electronic clinical communications.

Broadband for Health Program take up by eligible general practices (including Aboriginal Community Controlled Health Services and Royal Flying Doctor Service sites) increased 3.6%, from 58.0% to 62.0%, and community pharmacy take up increased 8.2%, from 80.0% to 88.0%.”

As for Electronic Health Records we are told (Page 6):

e-Health

“The Department continued to provide national leadership in the electronic management of health information through a range of e-Health initiatives to improve the accuracy of patient records and other information available to doctors. For example, with our support, a Shared Electronic Health Record is being rolled out across the Northern Territory. Currently, over 12,000 people have a shared record, with their essential health information available, with their permission, to around 320 health care providers in hospitals, general practice and community care. Registered health care providers can create health profiles for their patients which can be viewed online, as well as medical event summaries and pathology results. They will also be able to access participating patients’ hospital inpatient discharge and emergency event summaries (Outcome 10).”

Last year there were 7000 people enrolled. At 5000 extra per year it will be a long while before the Northern Territory is covered let alone the other 20,000,000 of us!

With all this I thought it may be fun to go back a year or so and see what one could find.

DoHA Annual Report 2005-06

The ongoing chaos in e-Health is beautifully illustrated by the following from the Annual Report of 2005-06

“On 10 February 2005, the Council of Australian Governments decided to accelerate the electronic health records agenda. This became the impetus for the Department to realign its e-health activities. The Department disbanded the E-Health Policy Group and transferred its ongoing work to the E-Health Branch within the Health Services Improvement Division. The E-Health Branch has responsibility for all electronic health activities in which the Department is involved.”

That is two and two thirds years ago – Has anyone noticed an acceleration? I think I have noticed the opposite with a business case to COAG not even being due till 2008!

Even more amusing are the claims for the progress being made in 2005-06 with HealthConnect.

Support for Health Sector Electronic Clinical Communications

“HealthConnect is an overarching national change management strategy aimed at improving safety and quality in health care, through a range of standardised electronic health information for health care providers and consumers.

The Department put in place a number of initiatives during 2005-06. These include:

• the establishment of the National E-Health Transition Authority by the Australian, State and Territory governments, which is charged with developing the standards and infrastructure for health and medical information management systems;

• the extension of the Broadband for Health program. This initiative supports investment in secure business grade and advanced broadband connectivity for general practices, Aboriginal Community Controlled Health Services, and community pharmacies, and has seen a steady increase in uptake for the duration of the program; and

• the implementation of the Managed Health Network Grants, as part of the Broadband for Health program, which provide funding for collaborative local e-Health projects. Due to the pioneering nature of the project, uptake was initially slow, however, the Managed Health Network Grants have since had an overwhelming response and a large quantity of applications have been received.

As a result of the Department’s work, over 7,000 consumers in the top end of the Northern Territory now have a fully functioning electronic health record; in Tasmania over 3,440 consumers who have been admitted or discharged from hospitals now have their general practitioners notified electronically; and in South Australia, some 52 per cent of health providers are now connected via Broadband for Health.”

All one can say about all this is “whoopee do”. How many of these grants have yet to bear operational fruit – let alone be actually publicly evaluated over two years later! Of course we also have NEHTA beavering away in secret and yet to actually produce much except a lot of questionably useful documentation.

For the record we again had an underspend in 2005-06.

Program 9.2: E-Health Implementation

Planned Spend: $53,670,000

Actual Spend: $46,467,000

Variance: $ (7,203,000)

DoHA Annual Report 2004-05

On Page 5 we read:

A Health System Evolving Through Technology

“New information technology has the potential to greatly improve the provision of health services and reduce the number of clinical mistakes which unfortunately occur through human error. The HealthConnect system developed by the Department has the potential to set the world standard for electronic patient records.

During 2004-05, the Department reviewed the HealthConnect program in consultation with a broad range of stakeholders including State and Territory governments, industry, and health care providers and consumers. This review led to the development of a new implementation strategy for HealthConnect, emphasising connectivity of new and existing health databases.

The Broadband for Health program achieved a big uptake in high speed, secure internet technology – as a precursor to HealthConnect – in community pharmacies, general practices, and Aboriginal Community Controlled Health Services. The National E-Health Transition Authority (NEHTA) was created in August 2004 with funding provided by the Australian Government and States and Territories, to develop national standards and infrastructure to assist the adoption of e-health throughout the Australian health sector.”

Further on we read – continuing the sense of chaos

Changes to the Department

The Department engaged a consultant in December 2004 to review the support provided by the Information and Communications Division to the HealthConnect project and other e-Health initiatives.

Following the review and consultation with key Departmental and external stakeholders, the Information and Communications Division was disbanded, with its ongoing work transferred to other areas in the Department, including the newly-established E-Health Implementation Group, Business Group, Health Services Improvement Division and Portfolio Strategies Division.

Further on we also read about the following

Major Achievements

  • “ In January 2005 all Australian Health Ministers agreed to an implementation plan to progress four priority areas in safety and quality improvement in public hospitals including:

- open disclosure;

- performance management;

- development of a minimum data set; and

- external review.

The National Health and Medical Research Council awarded 930 new research grants during 2004-05.

Revision of the implementation strategy for HealthConnect to align the program with national governance arrangements for e-health, including the establishment of the National e-Health Transition Authority (NEHTA).

Challenges

The revision of the implementation strategy for HealthConnect has meant that the Department has had to negotiate new milestones for HealthConnect with all States and Territories, taking into account the changes to the implementation strategy including the role of the Department in the development of HealthConnect.”

The report also has some great performance claims.

Look at this one:

Goal

Research and development work to test and evaluate the feasibility of the National Health Information Network:

- including health information management

Target: Undertake research and evaluation activities to determine the feasibility of implementing e-health record initiatives nationally and develop infrastructure necessary for proposed e-health initiatives to proceed.

Result: Target met.

Revision of the HealthConnect implementation strategy was based on research and evaluation of the feasibility of implementing e-health records undertaken during 2004-05. The National E-Health Transition Authority (NEHTA) was established by Health Ministers during 2004-05 to specify the standards and architectures of the national infrastructure to support this implementation.

Target: Develop infrastructure to support electronic health information exchange, including finalisation of the first full iteration of the HealthConnect design as part of the National Health Information Network.

Result: Target met.

Revision of the HealthConnect implementation strategy and the establishment of NEHTA made this target redundant.

Target: Development of standards and other building blocks, and the commencement of implementation of a Records System (storage) in one or more States.

Result: Target met.

The development of standards and other building blocks is being undertaken by the NEHTA, and the implementation of a records system has commenced in the Northern Territory.

Target: A high level of stakeholder satisfaction with the timely development and implementation of national strategies for electronic health records.

Result: Target met.

Revision of the HealthConnect implementation strategy during 2004-05, involved extensive stakeholder consultation, and a high level of satisfaction and engagement in the new strategy.”

Actually three targets were essentially flicked to NEHTA and the other one was essentially a non target!

For the record this also cost a bit and was underspent (again)

Administered Item 4: Information Management/Information Technology

Allocated: $27,709,000

Actually Spent: $26,075,000

Underspend: $(1,634,000)

Comment:

Frankly this is a catalogue of management neglect, incapacity and strategic emptiness. On any measure DoHA’s leadership of e-Health in Australia has been an appalling travesty and is to be condemned. (Petronius Arbiter would have been proud of the number of re-organisations we have seen! ). I really find this level of apparent ongoing incompetence in a major Federal Department scary and truly a threat to our ongoing prosperity – to say nothing of our health system

David.

3 comments:

Anonymous said...

Worst enemy or best friend? Is the glass half empty or half full? Perhaps this is good fiscal management as we only spent half of what was budgeted because we couldn’t in all honesty justify spending any more. The quality of submissions was not good enough.

You have frequently criticised many of our HealthConnect projects which you describe as having inadequate outcomes. On occasions your criticisms are valid. The outcomes are not guaranteed in many of these projects, in some ways they are more R&D projects from which we hope people can learn what to do and what not to do.

How much more critical would you have been if we had spent another $40 million and achieved more of the same inadequate outcomes you have so often criticised us for?

Anonymous said...

What a dismal depressing picture you paint. Plenty of deckchairs slip sliding away on the tilting deck. There is plenty of clamouring about the need for ‘national leadership’. Government has tried to provide that. Is there any alternative?

Aus HIT Man said...

Hi,

The problem with the HealthConnect Projects is that their outcomes were never made properly available to be discussed, reviewed and made to work better. No one yet knows what happened at South Brisbane for example.

My point however is a more general one. HealthConnect used to be a coherent plan for action. That was abandoned and now we have a lot of spin and an incoherent collection of minor initiatives from which little will be learned I believe.

Success will only come if there is a coherent plan and investment in that plan in a consistent steady and managed way. That the Department's leadership has not developed and delivered the coherence and leadership is the problem. Even a small fraction of the underspend could have funded the work needed to develop the plans that are needed to really make headway.

David.