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Monday, December 17, 2007

The Boston Consulting Group Lets NEHTA off the Hook!

The report of the Boston Consulting Group on their formal review of NEHTA (undertaken August - October 2007) was released this morning:

It can be found at the following URL – along with NEHTA’s response

www.nehta.gov.au/index.php?option=com_docman&task=doc_download&gid=421&Itemid=139.

The report makes six main recommendations which are intended to ensure the delivery of the national E-Health agenda objectives over the next few years:

1. Create a more outwardly-focused culture.

2. Reorient the work plan to deliver tried and tested outputs through practical ‘domains’.

3. Raise the level of proactive engagement through clinical and technical leads.

4. Accelerate resourcing through outsourcing, offshore recruiting and more creative contractual arrangements.

5. Reshape the NEHTA organisation structure to address revised work plan priorities.

6. Add a number of independent directors to the NEHTA Board to be broader advocates of E-Health, and to counter stakeholder perceptions of conflict of interest.

A press release ‘spins’ the NEHTA response to the Review!

----- Begin Release

NEHTA HERALDS E-HEALTH MILESTONES

and announces its action plan for adoption success

17 December 2007

Australia's e-health reform agenda took a forward step today with the release of an action plan by the National E-Health Transition Authority (NEHTA).

The Board of NEHTA also endorsed a business case for developing a national platform for personal electronic health records to be put to the Council of Australian Governments (COAG) early next year.

The NEHTA action plan outlines key areas for ensuring the successful adoption of measures to improve the electronic communication of critical health information.

"After working to build foundations for electronic health since the organisation was established in 2005, we are now in a position to begin to deliver some concrete applications of our work," NEHTA's Chair Dr Tony Sherbon said.

"The new Federal Government has signaled health reform and improvements in state and federal relations as major policy objectives," said Dr Sherbon. "Given also the government's emphasis on

the provision and use of broadband communications, NEHTA is well-positioned to play its role in advancing e-health as part of this new agenda," he said.

"The recent independent review found NEHTA had made significant progress on our goals to date and made a number of recommendations about NEHTA's future. The action plan we are announcing today flows directly from our acceptance of all the recommendations in the review," Dr Sherbon said.

Dr Sherbon identified the action plan as also being an acknowledgement of where NEHTA now needs to go in order to expedite e-health reform in Australia.

"We have come to a point where many of the foundations to enable e-health are in a position where we can now move towards implementation and adoption. Seeking funding to establish a national system of personal electronic health records is also on our immediate horizon. The action plan that we have released will assist this process," he said.

Dr Sherbon said the case for personal electronic health records was compelling. "The safety and quality benefits are manifold. We understand the issues of equity and privacy and firmly believe that

the approach developed by NEHTA will address these to the satisfaction of all our stakeholders and the Australian public."

NEHTA's Action Plan for Adoption Success and the independent review of NEHTA conducted by the Boston Consulting Group are available on the NEHTA website at www.nehta.gov.au.

----- End Release.

Three major things concern me about all this.

My first major issue is that the last paragraph of the executive summary identifying the need for a national Health IT Strategy has simply been ignored by the Board.

"In parallel, planning for the next phase of eHealth coordination and implementation needs to commence now or momentum could be lost. An eHealth strategy and eHealth policies need to be developed. Further analysis and debate by NEHTA and its members on the future vision for eHealth and the role of a central agency (as described above) is needed now to generate a plan by mid 2008. Regardless of the funding scenario and any future role of NEHTA II, we believe that the ‘transition’ NEHTA is tasked to support has at least another five to ten years to run."

I welcome all the recommendations, cited above, as far as they go - but feel they do not point to where the real work is needed - i.e. a National E-Health Strategy.

My second major concern is that while it is clear there have been a very large number of issues with the way NEHTA has operated - there is no apparent accountability for the mis-steps being accepted by the Board and Staff of NEHTA.

That said the BCG report's findings seem to me to accurately reflect the view of external stakeholders (Health IT experts, Health Providers and the IT Experts) but the impact is diluted by continual use throughout the report of the views of the NEHTA staff on the quality of the job they are doing. The staff and Board are hardly likely to be objective regarding their own performance!

My third major concern is that we have NEHTA recommending a Business Case for a National Shared EHR to the Council of Australian Government – and the public has had no apparent input – other than by a discredited NEHTA Board and a few bureaucrats. This is hardly the new open, engaging and consultative NEHTA!

In summary, this report addresses some of the operational, cultural and engagement failures of NEHTA, while failing to firmly recommend the development of a national e-Health plan to achieve value from NEHTA's work. Without this NEHTA will remain an unguided missile operating without strategic context and at risk of continuing to underperform.

To let NEHTA escape without a clear articulation of the need for a National E-Health Plan is really very poor indeed.

I fear the whole BCG exercise has been an expensive piece of ‘window dressing’

David.

8 comments:

Anonymous said...

Don't you just love the yellow highlight on page 7 of NEHTA's plan for action which reads

.......... "NEHTA's Board ..... is very pleased to be negotiating partnerships with both public and private sector organisations."

You would have thought with 5 to 7 weeks to cobble a response together the CEO would have double checked the final proof and taken a bit more care over its release...... including correcting the grammatical error in para 5 ... "provided in as an attachment" ..... .

Now let's have a closer look at those partnerships, who they are with and what they entail.

Anonymous said...

My reading of the NEHTA plan for action says it looks like the plan is to rapidly expand activities - hi ho silver. This seems to equate to asking for more more money (despite a significant under spend this year) rather than curtailing 'to the back burner' some projects until it has proven it can deliver something really useful. Kevin Rudd where is your razor gang?

Anonymous said...

The BCG Review says that "NEHTA's first priority must be to continue the current momentum to deliver its COAG objectives - the creation of unique, individual and health care provider identifiers, and clinical terminologies" .............. that are 'fit for purpose', which means:
(a) Endorsed
(b) Tested and proven
(c) Accepted by stakeholders with an in-principle commitment to adoption.

That alone would make us very very happy. So that should be the absolute focus. If the identifiers cannot be delivered, adopted and proven to work, then everything else is irrelevant. The message here is Identifiers first and foremost and a strategic plan.

Anonymous said...

Even if NeHTA's brief does not include advocacy and policy formulation (see 2nd para of page 7 in the report), surely the executive has a responsibility to raise such issues with their board, especially if it is affecting their ability to work effectively? The workplan shows no sign of being informed by a clear position on advocacy and policy.

I am also of the view that advocacy and policy formulation should precede (or at the very least inform through a parallel process) the work of developing and promulgating standards in this area.

Anonymous said...

It's beyond belief that NEHTA’s senior management did not know they needed to engage better with external stakeholders. This just reflects their total lack of understanding of how to deal with the health IT industry and the sectors many stakeholders. It's no good pretending they have sufficient insight to be capable of implementing such a key recommendation effectively.

Anonymous said...

Far from it - it's not beyond belief at all. It's a perfect reflection of the way the CEO and his management view their stakeholders.

Even the BCG review reported that two thirds of stakeholders said that NEHTA did not acknowledge or respond to their feedback when they had engaged. This included words like ineffective engagement, defensive, isolated, lack of transparency. It all adds up to a senior management which is arrogant, aloof, pompous, bombastic, conceited, supercilious and vain. Is it any wonder they can't engage and never will be able to? They can't see their deficiencies because they have none. Checkmate.

Anonymous said...

Recommendation 3: Raise the level of proactive engagement through clinical and technical leads.

NEHTA’s response:
points to a “… culture change, …. additional resources, ….. open and transparent engagement, ….. increased engagement with the clinical community, ….. a network linking into all the leading clinical bodies, ….. more educational seminars and implementation guides, ….. new implementation partnership opportunities, ….. a business adoption team, …… increased engagement with healthcare consumer audiences…”

One cannot help but wonder in absolute bewilderment and amazement at all this lovely motherhood.

Did Dr Reinecke write this? Did he approve it? What an incredible bucket of wiz, bang, spin, plop.

Anonymous said...

You got it in one. It demonstrates that an ex Financial Review journalist hasn’t lost his skills at spinning the top. It also demonstrates that he has little or no comprehension and insight into the health informatics market and how to advance it. In summary, the Emperor has no clothes.

http://hca.gilead.org.il/emperor.html