As part of developing a short document on National E-Health Strategies around the world I thought it would be useful to sort out the HealthConnect documents I have retained and see, when organised, the story that would be told.
Here is a print out of the directories I created.
HealthConnect - Organised
199306 - HCN Business Case
199910 - Health On Line Action Plan
200007 - A Health Information Network for Australia
200008 - Health On Line Summit
200008 - Research Report on EHRs
200101 - HealthConnect Update
200102 - HealthConnect Setting the Standards
200108 - Health On Line Action Plan V2
200110 - Health Supply Chain
200207 - Consent Review
200209 - HealthConnect Board
200212 - Tasmania NT Trials
200304 - Business Arch V10
200304 - Interim Research Report
200307 - HealthConnect Implementation Strategy
200307 - HealthConnect System Architecture V0.9
200401 - HealthConnect Project Plan 2003-5
200402 - Benefits Studies
200404 - BCG Report
200405 - HealthConnect Implementation Brief
200409 - Gap Report - EHR
200410 - HealthConnect Newsletter
200410 - Wooding - HealthConnect
200411 - Implementation Approach
200412 - Business Arch V19
200412 - HealthConnect Overview - Update
200501 - Benefits Realisation Framework
200501 - Legal Analysis for HealthConnect
200501 - MediConnect Evaluation
200504 - External Analysis HealthConnect
200504 - Lessons Learnt Summary Report
200507 - Changed Implement Approach
200507 - Formal Implementation Strategy Change
200508 - Abbott Speech - Abandons HealthConnect
200508 - More Implementation Planning Change
200510 - HealthConnect Conference (Confirming Essentially Zero Implementation Progress)
200512 - Abbot Concern Speech (So much spent – so little progress)
200512 – Last HealthConnect Newsletter
200606 - E-Health Newsletter (No longer even HealthConnect)
What is revealed is a seven year saga that ultimately led nowhere!
The waste of enthusiasm, hope and money ($200 million or so probably) is really a tragedy.
It is up to the new Rudd government to do much better that this. I certainly hope they will really learn from this history and develop a strategy and implementation approach that can really work.
They must also not let NEHTA try to repeat what has already failed – as they seem to be intending with their reported COAG submission.
As we move into 2008 – with a new government - I have great hope this may be beginning of a new e-Health era for Australia.
We will see!
Happy New Year to All!
David.
17 comments:
The seven year saga ultimately led, as you say, nowhere. Very few would disagree with you with one correction - it led to NEHTA.
$200 million is a fair estimate of resources wasted to-date by the Howard Government.
Unwittingly and ever so sadly, through no fault of its own, the Rudd government will most likely find itself trapped by the NEHTA Board and its silver-tongued CEO, and a combination of circumstances all coming together in obscene haste, viz. the BCG report, NEHTA’s response (unconvincing and pathetically shallow “we accept all the recommendations of the ‘independent review’ blah, blah)and the 'urgent' COAG submission now in preparation.
The real picture, with all its contradictions, lies in the body of the full BCG report - NOT in the Executive Summary which has been sweetly massaged for the ‘time poor’ reader in the expectation that the full BCG report will not be scutinised too closely.
You say “they must also not let NEHTA try to repeat what has already failed – as they seem to be intending with their reported COAG submission”.
Reading between the lines it is apparent you are about to see a repeat of the past.
We thought the same last week at our Xmas party. A few beers and prawns on the Barbie and we came up with a recipe for the Xmas Pud.
The Reinecke Recipe
1. Stick the Goal Posts in the ground = accept ALL recommendations from the BCG Review
2. Create false sense of 'security' = 'Things they are a changin' - "ALL recommendations to be implemented"
3. Divert immediate attention from the real issues = promote and focus on the SEHR as the hot topic of 'national' importance
4. Create a new Sense of Urgency = get the SEHR business case 'sign-off' by COAG early 2008
5. Deflect criticisms and concerns = frustrate expert industry critics with irrational response (return to 1, when bored goto 6)
6. Create confusion = push 'media coverage' building expectations around early SEHR delivery
7. Overwhelm decision makers (NEHTA Board)= swamp them with multiple documents (BCG, NEHTA response, media coverage, draft 'SEHR', proposal for business case, etc, etc)
8. Drive for a favourable SEHR decision quickly = push NEHTA Board for an early recommendation to COAG
9. Stick Goal Posts in the ground = business as usual
Section 3.1.3 Work-program contains some real EYE-OPENERS like:
# poor perceptions of NEHTA’s work progress correlated with a lack of knowledge of what NEHTA was doing
# from within NEHTA it was clear the work program was suffering from its isolation from real-world implementation
But the one that takes THE PRIZE is - - - - -
- - - Unique identifiers was the most common ‘top three’ priority with external stakeholders. Jurisdictions however allocated this a lower priority, possibly because, they felt it was already well underway and the focus could be shifted to the next goal, that of Shared EHR. - - - !
Play it again Sam - - - - -
- - - Jurisdictions felt the focus could be shifted to the next goal, the Shared EHR because Unique identifiers was already well underway !!!! Play it again Sam.
All this takes one back to the BCG Report of April 2004 (5.2.7 Electronic Health Records). ….. Moving to an EHR will be a very large and complex undertaking.
… The difficulty in designing, implementing and managing a longitudinal health record cannot be overstated. ….. many building blocks need to be in place before an EHR is achieved …….. it is unlikely that the business case for EHR can be made without separate business cases for the major component parts in their own rights.
Hospital systems that would feed hospital data into an EHR will need cost justification on the basis of the benefits they deliver directly to hospitals. Therefore, the rollout of EHR will need to be tied to the independently cost-justified rollouts of some of the key systems components - the most significant of which are the hospital systems.
Play it again Sam.
As much as I hated the Howard government, I'm not sure that the blame for NEHTA is most accurately laid at the feet of politicians. It seems to me that the guiding philosophy of the management at NEHTA was 'publish or perish' - their annual report lists quite proudly their publications, as if what we wanted from them was to publish papers.
The problem is that NEHTA's true objective is not to publish papers (like an academic organization), nor can it simply set policy (the usual operating mode of the senior public service). We wanted (and still want) NEHTA to actually deliver outcomes, which is the key recommendation of the BCG report, and the thing that NEHTA is likely to continue to fail to understand.
Because it's not a problem that only happens in NEHTA - it's endemic through the public sector. Junior bureaucrats are trained to implement policy. Senior bureaucrats are trained to formulate policy. Neither of these activities is good preparation for delivering a service, and NEHTA's task is a very complex service-delivery scenario.
Combine that with the chilling reality of 'Yes Minister' being played out every day in the public service, and the ability of politicians to make things happen is severely limited.
I don't think that the failure of NEHTA was due to incompetence from the Howard government, or even from the leaders of NEHTA - there's a structural weakness in the Australian public service itself that I think is to blame.
If the Rudd government manages to make this work, it will be an impressive achievement (and bloggers who work to maintain the profile of these issues will have played an important role - thank you for this blog). But transforming NEHTA would be an impressive achievement outside the public service, where it would be much easier in many ways.
“It seems to me that the guiding philosophy of the management at NEHTA was 'publish or perish' - their annual report lists quite proudly their publications, as if what we wanted from them was to publish papers.”
When you fill an organisation up with a lot of PhDs, with no real world experience, and put in charge of them another PhD from Academe and no health experience whatsoever, the end result will be as you have so aptly described above.
I agree with you that NEHTA's task is a very complex service-delivery scenario. However, I doubt you will see NEHTA delivering useful and practical outcomes until NEHTA learns how to listen to, embrace, enrol and lead, health informatics experts so readily available and quite prepared to contribute. The current leadership lacks those vital skills.
As for the bloggers who maintain a profile on these issues I too say a heartfelt ‘thank you’ for this and past blogs. They have indeed played a very important role.
Your reader's reference to the BCG Report of April 2004 (5.2.7 Electronic Health Records)fills me with serious doubts about the BCG.
They were correct when they said "Moving to an EHR will be a very large and complex undertaking."
But they were wrong when they said "Therefore, the rollout of EHR will need to be tied to the independently cost-justified rollouts of some of the key systems components - the most significant of which are the hospital systems."
The hospital systems are NOT the most significant components. The most significant components lie in the Primary Care sector - not the hospital sector.
Is it any wonder NEHTA neglected the Primary Care sector. It didn't understand. BCG didn't either.
Is there any likelihood they do now? I very much doubt it. Others might not agree?
COAG would be doing the Australian health system, including the RUDD Government, an enormous favour if it told NEHTA's Board that before it comes to the trough for more money to develop a business case for an SEHR, or anything else, urgent or otherwise:
(i) the whole Board should take a cold shower
(ii) restructure itself
(iii) change the culture of the organisation for which it is responsible
AND
ensure NEHTA’s management:
(iv) delivers some practical, useful, proven outputs to satisfy ALL stakeholders
(v) get the domains as recommended in the BCG Review up and working - domains like eReferrals, e-Discharge, e-Prescribing, Pathology interoperability
(vi) focus, focus, focus on delivering UHI’s as the No 1 priority
(vii) OWN responsibility for the Medicare UHI project
(viii) put the SEHR ‘dream’ on ice until the domains are demonstrable.
Sorry, while I like to see all this enthusiasm without a plan that sets priorities among all the things that are needed, progress is unlikely.
NEHTA as it presently operates needs to be repositioned as part of a larger and better managed 'big picture' that delivers, in reasonable time frames, what is needed. This all needs to be done in the context of a workable and practical overarching framework.
David
David, you have been promoting this message for almost two years or even more ... "This all needs to be done in the context of a workable and practical overarching framework."
How right you are.
It is a tragedy that the politicians and the bureaucrats do not seem to want to listen.
$200 million has been spent. What have been the practical outcomes?
When will they ever learn?
I felt that the BCG report contained some very sensible planning recommendations in the 'Decisions that need to be made' section.
The biggest problem with asking them to produce a plan is the likelihood that they'd spend ages developing one, and then fail to deliver on it because they got it wrong, because they have no implementation experience.
An implemented result (any result) would be a better step forward, I think.
Let me first say we all need to recognise that "to fail to plan is to plan to fail".
Second there is no need for a quality planning process to take more than six months and if it is not done we will be assured of ad-hockery of the present type into the foreseeable future!
I am totally fed up with the current wasteful 'Brownian Motion' we see and would like constructive change.
NEHTA is not the agent to deliver that constructive change as it has its main focus right now on organisational survival - given its lack of any real delivery so far!
Has anyone noticed the new open, transparent and responsive NEHTA yet? Let me know!
David.
Dear Dr Reinecke
The new open, transparent and responsive NEHTA will, we understand, take a little time to evolve. We all look forward to it as much as you do.
The first step in the process we suggest is getting together (in business jargon we call it having a ‘love in’). By that we don’t mean a ‘one-off presentation’ to stakeholders and interested parties. We envisage something more intimate and cosy where we can get together with you in small groups of 8 to 10 for an exchange of views, opinions, experiences and ideas - a sort of brainstorming ‘what if’ ‘Q & A’ session. We believe we can give you some insights and teach you some things about health IT and in the same way we believe you can teach us many things too.
How should this be done?
The first step is to decide that it is a good thing to do and then to make it happen. Who should the 8 - 10 people be who come together and sit with you in a circle for 3 hours or until everyone runs out of puff? And how many times should this happen? How frequently? And how will the next ‘group’ of 8 - 10 people be chosen? And should ideas, views and opinions be recorded so anything of value is not lost? And should there be some continuity between each ‘group’ such as 2 representatives from the previous ‘group’ being ‘elected’ to join in the next ‘group’?
These are weighty questions and should not be answered here, perhaps, save one.
The first ‘group’ of 8-1 0 people should be selected from a list which has yet to be compiled. At the end of the first group session ‘that group’ should nominate from the ‘list’ 8-10 people (+ reserves) to be invited to the next “group’ session and so on until the list has been exhausted. It doesn’t have to happen all at once. One meeting, every 2 or 3 weeks will suffice.
So, where to start? We would suggest that as this blog is widely distributed an invitation to interested parties wishing to participate in the ‘group’ sessions should be made via this blog site. A short simple 'Letter of Invitation' will suffice. Interested parties can then submit their names to the blog controller to be put on the ‘list’ and the process can then begin in earnest.
We invite you to join with us in helping to bring a more open and inclusive environment to the world of eHealth in this country.
Kind regards
E-Health stakeholders and practitioners.
What an excellent idea. If only it could be made to happen. Why hasn't anyone suggested this before?
I don't think we're seeing Brownian motion from NEHTA at all. I think they've been making a concerted, focussed and determined effort - towards objectives that are utterly irrelevant.
The wrong plan guarantees failure even more than a limited plan, with the limited plan that I advocate being "Actually deliver some kind of useful service."
I don’t disagree with you re:
(i) NEHTA efforts - except that they have lost their focus on the core issues and seem eager to wander off to graze in new pastures like the EHR and SEHR without getting their foundations securely in place. This is naive as it puts at risk whatever has been done to-date, and that is irresponsible and quite unacceptable. This is abundantly clear from reading Section 2 onwards of the BCG Review.
(ii) "Actually deliver some kind of useful service." It would be helpful if you could specify what YOU mean by that.
My perception is that NEHTA believes it has the foundation it needs for EHR and SEHR, because they have not had any regard for (as the BCG report nicely puts it) "Tangible outcomes".
As an example of 'some kind of useful service', I think it would be fantastic if NEHTA sat down with two organizations that are trying to work towards integration and help them turn that desire into a reality.
The key change is moving away from an academic/bureaucratic philosophy of "We've published a document, therefore the problem is solved" towards a service philosophy of "We've helped organization X integrate with organization Y, therefore we've made progress."
How true and how obvious. Your perception is well founded.
Unfortunately, sitting down with others ‘to work through’ difficult issues is relatively foreign to NEHTA’s senior management and is most unlikely to change to any degree (superficially maybe), until the culture changes, and that will be a very difficult thing to achieve. The letter to Dr Reinecke above seems to be a very good starting point indeed. However, changing from an ‘academic/bureaucratic philosophy’ to a ‘service philosophy’, more than likely cannot be done successfully by the current management for three reasons:
1. they lack the hands-on, grassroots, roll-the-sleeves-up experience,
2. their ability to inter-relate and communicate with people is quite deficient,
3. they would have done so a long time ago had they understood the problems and the market they are playing in.
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