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.