What Would Get My Tick for an E-Health Policy?

We are now just three weeks from the Commonwealth Election – so it is time for my E-Health Manifesto!

A week or so ago I published a small set of points that are apparently being recommended by AHIC to the Australian Health Ministers Advisory Council (AHMAC) as the basis for a National E-Health Strategy.

These points were (my comments follow each point in italics):

1. To develop a comprehensive national E-Health strategy in consultation with the Jurisdictions, industry, community and health services.

This one is hard to argue with except that it does not go far enough in the sense that we not only need the Strategy but we also need the compelling Business Case and the Implementation Plan that should be developed at the same time.

I also think we need to explicitly recognise the imperative for a holistic approach that covers both ambulatory, hospital and community care in both private and public sectors as well as public health and the ancillary services (labs, radiology etc) and allied health.

Of course the other stakeholders need to be involved properly in the sense of the IT Industry, the funders of the overall system and last but not least the community. It is, after all, the quality and safety of the care they receive that is the key reason for doing all this.

Also, it is also important we identify the ‘real’ stakeholders. There is the risk that some elements among apparent stakeholders may not have a solid mandate from their constituency.

2. That AHMAC recognises that E-Health is the cost of doing business in the 21st century, hence requiring continued investment

All I can say is well put. It is most important to also recognise also that those who receive benefit from the investment should be those who pay.

3. That AHMAC recognise that the Jurisdictions already have many of the necessary E-Health components already, and that what is needed is a system of knowledge exchange

This seems to me to be a bit of a sop to the Ministers who all (with the possible exception of South Australia – or so they seem to think!) have not exactly made huge steps in the last few years.

This is hardly a secret when we have the likes of Crikey suggesting that the Victorian HealthSMART project is so unpopular with financially struggling health services they are being offered long term loans to fund the needed Health IT investment – in the hope that all those who both provided and accepted the loans will be long gone before they need to be repaid. I wonder is it true?

Really what is needed is an honest audit of who is up to where, and how it is actually going. This should be part of any Strategy development process.

4. That a ‘time limited’ implementation function / body be established and funded by AHMAC to integrate eHealth nationally

In this context I am not sure just what is meant by integrate - is this meant to be NEHTA or is AHIC suggesting a role change for NEHTA.

My take is that we need to continue down the standards driven path but that those responsible to deliver that initiative need to be open, consultative, pragmatic, transparent and possess a deep understanding of the health system. To achieve this will take a good deal more than a throwaway line of two in the NEHTA Annual Report saying they plan to usher in a "more transparent and consultative approach”.

My policy would also ensure NEHTA is fully exposed to Freedom of Information accountability and I would insist on public disclosure of all reports paid for by NEHTA – including the review undertaken by the Boston Consulting Group (BCG).

If not fully addressed by the BCG Report I would also review the likely value that will flow from continuing with NEHTA’s work plan and adjust it in line with the Strategy mentioned above.

5. That the core set of components for a Shared Electronic Health Record be operating across Australia by 2012

6. That an implementation plan and resources schedule be developed to deliver the AHMAC eHealth strategy

The goals identified in point five and point six are really an extension of what should happen in point one. In addition there also needs to be an explicit benefits management and evaluation plan developed to ensure all parties are getting what they need and what they are paying for.

What is missing from this is the harder part. I would suggest the policy also needs to have the following drivers:

1. Local responsiveness in the context of a national strategic direction. There needs to be clear recognition that the top-down one size fits all approach is a prescription for disaster.

2. Prevention of wasteful, half baked, poorly considered non-strategic local initiatives.

3. Substantial clinician input and leadership where appropriate.

4. Recognition of the inherent complexity of the task (especially the Shared EHR development and implementation task) and the preparedness to walk before running.

5. More intelligent balance in the investments made across the hospital, GP, specialist, public and ancillary sectors.

6. Clear recognition of the importance of getting privacy and security right (and publicly acceptable).

7. Understanding of the importance of education in the use and deployment of Health IT.

8. More than lip-service acknowledgement of the difficulties of change management of any E-Health transition.

9. Recognition we need to fully and urgently address the state / federal / local divide. We need one coherent health system supported by a coherent E-Health system. All relevant legislation and regulation needs to be harmonised.

10. Appropriate support for research in the e-health domain.

11. Support for appropriate strategic consolidation and evolution of the clinical software industry where that makes practical and commercial sense leading to improved service provision in the health system.

12. A much enhanced (and dominant) role for Standards Australia in standards setting and an emphasis on international compliance and compatibility where appropriate.

13. Development of appropriate accreditation regimes for the quality, safety, standards compliance and functionality of all software used in patient care delivery.

Well, I think that just about covers it. Anyone who promises this can have my – sadly not very marginal – vote!

David.

Note: Useful Sites for the Week will appear later in the week. Too much on to let the election slip by!