Quote Of The Year

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

Thursday, December 20, 2007

I Wonder if NEHTA has a Plan “B” or Should They Be Out of the Loop?

As regular readers will know the NEHTA Board announced the following a few days ago.

“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.”

This led me to start thinking what were the possible outcomes of NEHTA submitting this business case to COAG, and secondly should they manage anything at-all?

It seems to me there are five reasonably possible routine outcomes – and the required one!

First, COAG could endorse the Business Case and provide the funding that is requested for the four year project.

This seems to me to be a very unlikely outcome – in part for the reasons outlined in the previous blog – see here – and in part because COAG would want, at the very least, to make sure there are regular milestones and conditional benchmarks applied to the flow of funds and other resources.

Additionally, if COAG has its wits about it, it may say it would like this project to be positioned within the context of a National E-Health Strategy to ensure all the necessary ducks can be properly aligned.

Second, someone on COAG may remember HealthConnect, and suggest that as well as the present Business Case, a review of previous attempts – along with more detailed planning – be undertaken to firm up the project details, benefits, stakeholder consultation etc such that after that work has been successfully completed more substantial approval may be forthcoming.

This seems to me to be a much more likely outcome.

Third COAG may approve, say, an initial twelve months of funding and other resources, set some milestones and benchmarks and look forward to a progress report in a year’s time. This seems to me to be very unlikely as COAG will recognise the political risk of starting something like this and then having to stop it if it does not look to be going well – exactly as happened with HealthConnect Version 1.

It also is likely there will be sufficient corporate memory in the Commonwealth Department of Health and Ageing (DoHA) that there would be resistance to a project of this scale and risk setting out without very considerable proof of concept work being done.

There would be a lot of problems if, at 12 months, things were not going well..as is more than possible

Fourth, COAG might say that it is not comfortable that all the necessary pre-work has been done and ask for a more detailed business case to be presented for the next meeting or two. Given the poor view of the Boston Consulting Group on the readiness of the Shared EHR proposal and the inadequate level of public and industry consultation that has been undertaken this seems quite likely.

So, one way or another, I suspect a good deal more work and consultation will be requested before approval is given.

Lastly, of course, it is also possible that COAG will say that this looks too complex, difficult and risky for now, and defer the whole thing indefinitely. Go back a develop a plan that addresses these concerns and we will consider it much later! This is not impossible, but given that all the State Health CEO’s have agreed to move forward, and have NEHTA come to COAG, it is hard to see the Ministers delivering such a firm knockback.

I am no prophet, and I am sure other nuances are possible, but if I were NEHTA I would not have embarked on this without a carefully thought out Plan B. Without such a plan this could turn very messy and many may find themselves embarrassed. I wonder if it exists and what it is? I find it hard to believe COAG will just wave something like this through without some considerable review and discussion!

If NEHTA does not have a decent secondary way forward – that avoids much of the risk and complexity of the apparently envisaged Shared EHR – E-Health in Australia could languish for a long while. To hear what NEHTA and those they report to really need to do, read on!

The big picture alternative, which I much prefer, is that totally new governance structures for Australian E-Health will emerge, NEHTA will go back to doing what it should do – enabling infrastructure improvements and Standards – and a major policy and technical implementation – managed by experts - will develop – all I can do is hope this is the real outcome of COAG.

This is the outcome we really need – and this is what needs to happen now! The NEHTA Business Case must be abandoned and better more strategic brains must take over! As they say those who “Fail to plan, plan to fail”. By pretending they can proceed without an explicit articulated plan and new governance, NEHTA shows itself for the techo driven, non strategic, organisation it is.

NEHTA is not the organisation to deliver the Business Case for ( and the actuality of ) the Shared National EHR. It is as simple as that! That needs to be a done by culturally richer, better resourced and much more competent entity.



Teki said...

Seems to me the health bureaucracy will look to AHMAC for direction to take with NEHTA. If that's true, then the NHIMPC http://www.ahmac.gov.au/site/membership.aspx#other
holds the key. So, why would that Committee recommend allocation of resources that were not compatible with the political agenda of the Chair, a DHS Secretary? In other words, why will AHMAC go anywhere near the IT mess in public (State) hospitals, when the States are all busy running their own IT projects? Will AHMAC put all the current projects on the same page and let them be assessed independently against a set of criteria that is not contaminated by managerialism?

Teki said...

It would be nice to know that the next direction for NEHTA is informed by observable facts, and that all those wonks, managers and bureaucrats holed up in that incestuous menagerie of committees "looking into" Health IT are made to confront some reality befoe they indulge in another round of taxpayer funded travel and accommodation.
Take this slice from the NHIMPC Annual Work Plan - "As the development and implementation of electronic health records (EHRs) become more prominent, it is important to understand the possible future for national health statistics. Since the establishment of NEHTA, NHIMPC committees (including the SIMC), statistical agencies (including the AIHW) and other stakeholders have been considering the effect that the EHR and related developments could have on health statistics in the future."
The people who write this stuff should be forced to acknowledge they don't know much about 'personal health records'. At one end of the spectrum is a tiny minority of citizens who have kept detailed records of their own health events. When the EHR is a reality, who, how and when are these books of record going to be transcribed into digital form? At another end of the spectrum is a large proportion of the elderly with complex medical conditions. When they move to another GP, all they have is a shoebox of pills. Somewhere in between is a male in his sixties with newly diagnosed hypertension. He has purchased a digital BP reader which has been a fount of reliable data. Some of the readings have been scribbled on loose bits of paper, but the result has been good control of the BP.

The NHIMPC Plan mentions identifiers once in another flick-pass to NEHTA. Yet a plan for national identifiers lies at the heart of reform. An article on the retiring State Coroner for Victoria (Graeme Johnstone) http://tinyurl.com/2b436j by Karen Kissane includes "Johnstone remembers most vividly an elderly man whose much-loved wife died because of a mistake in hospital. The wife was 68 and seriously ill but had seemed to be improving. Then a nurse who intended to flush her intravenous line with saline instead mistakenly picked up a vial that was packaged the same way as saline. The nurse injected her with potassium chloride and the patient died. Johnstone found that the injection hastened her death." We need to be counting, not just deaths due to error, but near misses. I suggest it is technically possible to track the physical locations of lethal vials and the number of times they are lifted out of storage and by whom. That death occurred, I believe, in a private hospital. So, it's likely that owners of private facilities will install their own systems of identifiers for employees years before anything much is done to create a national system of patient identification. But the conferences, ever-bigger committees and cut-'n-paste work plans will keep a lot of public servants busily employed.