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.