A National E-Health Strategy for Australia is Coming! Can it Succeed?

Well, blow me down! I have just had one of my core suggestions taken up! We are to have a National E-Health Strategy developed!

The important parts of the tender are as follows: (Sorry for the formatting - useful comments are at the end.)

Part A. Information for Tenderer

Purpose of this Document

This document is a Tender Brief and has been prepared to provide information to assist prospective Tenderers in the preparation and submission of proposals for the development of a national e-health strategy.

Project Overview

On behalf of the National e-health Information Principal Committee (NEHIPC) the Department of Human Services is seeking suitably qualified and experienced parties to develop a national e-health strategy that:

· Provides a vision for and desired outcomes of national action in e-health over the next 5-10 years

· Identifies priorities and next steps for development and implementation of a national e-health system

· Provides advice on the governance arrangements needed to oversight and manage national e-health projects and infrastructure

Key dates for this proposal are indicated below. These dates are advised as a guide to projected timelines, only. The Department of Human Services will attempt to maintain this schedule, but reserves the right to vary key dates where necessary:

Tenders advertised	13 February 2008
Closing date for submission of Tenders	7 March 2008
Shortlisting completed by	11 March 2008
Interviews conducted by	14 March 2008
All tenderer A Tenderers advised of Tender outcome by	28 March 2008
Service/project commencement by	28 March 2008
Service/project completion	28 July 2008

Project Objective

The objective of this project is to develop a national e-health strategy through the identification of a national vision and goals for e-health. The strategy recognises existing and projected national and international efforts in e-health while also considering future developments in health service delivery. The strategy provides a practical roadmap for further national e-health development and implementation in this country, and allows prioritisation of existing and future investment in national e-health infrastructure and activities.

The strategy should:

Specify a vision for e-health in a national context to include discussion of:

· Models for health service delivery

· Enablers for improved efficiency and quality

· Consider population and demographic changes

· Workforce and skills

· Service delivery sustainability

· Physical transportation

· Emerging risks and influences

· Plan for change

· Identify drivers and influences of change

· International influences – vendors, products and standards

· National and jurisdictional legislation

· Identify key priorities, goals and practical strategies and initiatives to support the national e-health vision

· Identify options for next steps in national collaboration in e-health over the next 5 - 10 years, which leverages existing national and international investment and experience. This must include:

· A review of the scope, funding and timetabling of existing and future significant national and state government e-health projects and initiatives. This would be based on an audit commissioned by NEHTA within the last 2 years and direct consultations with jurisdictions regarding any more recent developments;

· Advice on priority areas for progressing national collaboration in e-health (in accord with health system reform priorities including desired outcomes and models of care) and the benefits to be derived from proposed initiatives;

· Analysis of international experience that may guide prioritisation and practical implementation of e-health initiatives in Australia;

· Advice on a practical pathway for optimal pursuit of national e-health priorities, including timelines and parties responsible for each milestone. Gaps in current effort, incentives to promote uptake and opportunities to harness learnings from existing programs and projects must be identified. The pathway should identify necessary action and responsible parties to deliver sharing and utilising health information electronically, including incentives for uptake and any possible sanctions.

· Provide options for strengthened e-health governance. This must include:

· An analysis of existing national governance arrangements for both e-health and information management under the Australian Health Ministers’ Advisory Council (AHMAC);

· Options for strengthened AHMAC governance arrangements in line with national e-health directions, including how any new arrangements align with other organisations and committees progressing the national e-health agenda;

Identification of governance structures needed to oversight and manage national e-health priorities, including e-health infrastructure and programs. In considering these structures reference will need to be made to the regulatory arrangements necessary for the effective and efficient operation of the future national e-health environment.

Scope

“E-health” is defined by the World Health Organisation (WHO) as ‘the combined use of electronic communication and information technology in the health sector.’ It refers to the health care components delivered, enabled or supported through the use of information and communications technology. Examples include clinical communication systems such as online referrals and e-prescribing, and electronic health records. E-health is identified as a key enabler of models of care delivery, patient centred care, supported self-care, remote access and monitoring, and health system sustainability.

The strategy should recognise existing national and jurisdictional efforts and investments in e-health by Australian, State and Territory health departments, the National E-Health Transition Authority (NEHTA), the Australian Health Information Council (AHIC) and the National E-Health and Information Principal Committee (NEHIPC).

The strategy should focus on those aspects of e-health which are both necessary and sufficient to establish robust and effective national approaches to the creation, communication, storage, use and analysis of information.

The national e-health strategy should be inclusive of both public and private health sectors, to guide the next phase of national e-health collaboration.

The strategy will articulate priorities for e-health that are measurable and grounded in local and international evidence.

The strategy will need to take account of the current and emerging issues in health service delivery facing government (Commonwealth, States and Territories), health care providers and consumers, in identifying priorities and governance arrangements.

The e-health strategy will address the dimensions of information, information management (for primary clinical purposes and secondary reporting, evaluation and research), information technology, communications technology, medical technology and all associated enabling infrastructure (such as policy and legislative frameworks). It must assess and leverage work completed to date or currently underway.

Period of Service

The period of service is to commence on 28 March 2008 and the contract period will be for 3 months, ceasing on 28 July 2008.

Extension of Contract

Subject to satisfactory performance and agreement of the successful Tenderer, the Department of Human Services reserves the right to extend the contract period to a total period of 6 months.

Background

Department of Human Services

The Department of Human Services, Victoria, on behalf of the Australian Federal, State and Territory Health Departments and the NEHIPC, is seeking suitably qualified and experienced parties to develop a national e-health strategy.

The Department of Human Services is responsible for a wide range of services to diverse client groups across Victoria. The principal function of the Department of Human Services is to ensure the delivery of a range of health, housing and community services.

The Department of Human Services’ Mission Statement is:

To enhance and protect the health and well being of all Victorians, emphasising vulnerable groups and those most in need.

Policy Context

In 1993 the Australian Government and the States and Territories, recognizing the importance of a strategic national approach to the development of health information management and information communications technology, signed the first National Health Information Agreement (NHIA). The NHIA between the Australian Government, the State and Territory health authorities, the Australian Bureau of Statistics and the Australian Institute of Health and Welfare provides the foundation for the development, collection and exchange of uniform health data and information and tools to support analysis, research and comparison at all levels of the health system.

National governance arrangements were established under the NHIA to oversee developments in statistical standards and other national information projects. Under the first NHIA uniform national data standards were developed and the National Health Data Dictionary, which contains metadata standards for a range of health services, was established.

In 1995 the National Health Information Development Plan was released, promoting the development of high priority health information and equitable cost effective service arrangements. In 1998, the National Health Information Management Advisory Council (NHIMAC) was established to advise Health Ministers on options to promote a national uniform approach to more effective information management in the health sector. In 1999 NHIMAC released Health Online: A Health Information Action Plan for Australia. Under Health Online national action plans were developed focusing on health information standards, telehealth, supply chain reform in hospitals and electronic decision support.

Australian Health Ministers established the National Electronic Health Records Taskforce in November 1999 to evaluate the potential of electronic health records for the Australian health care system. Based on the Taskforce recommendations, Ministers agreed in July 2000 to jointly fund a two year project to assess the value and feasibility of HealthConnect. The purpose of HealthConnect is to facilitate the adoption of common standards by all e-health systems so that vital health information can be securely exchanged between healthcare providers. HealthConnect trials have been operating in the Northern Territory and Tasmania since 2002. Trials commenced in North Queensland in 2003 and in New South Wales and Brisbane in 2005.

Health information management and technology governance arrangements evolved over this period with the establishment in 2003 of the Australian Health Information Council (AHIC) and the National Health Information Group (NHIG). AHIC and NHIG were established to provide leadership on information management and technology, and to coordinate advice to Health Ministers. The key role of AHIC is to provide independent advice to Health Ministers, via the Australian Health Ministers’ Advisory Council (AHMAC), on long term directions and strategic reform issues. NHIG was established to provide advice to AHMAC on planning and management requirements, and to manage and allocate resources to health information projects and working groups.

During 2005 and 2006, AHMAC reviewed its subcommittee and working group structures. As a result of the review, NHIG became the AHMAC Principal Committee on National Health Information Management (NHIMPC). In December 2007, AHMAC CEOS considered advice commissioned from KPMG regarding the scope and governance arrangements for strategic development of health information management in Australia. In January 2008, AHMAC agreed that the NHIMPC be reconstituted to take on a broader responsibility in relation to e-health alongside its existing focus on information management. Reflecting this broader focus the Principal Committee has been renamed the National E-Health and Information Principal Committee (NEHIPC), with the new structure and membership yet to be finalised.

Provisional meeting dates for AHMAC in 2008 are as follows:

· 6 March (Hobart)

· 5 June (Melbourne)

· 9 October (Adelaide)

Provisional meeting dates for the NEHIPC in 2008 are as follows:

· 16 April (Melbourne)

· 19 July (teleconference)

· 17 September (Melbourne)

· 26 November (Melbourne)

NEHIPC is chaired by Ms Fran Thorn, Secretary of the Department of Human Services in Victoria. The NEHIPC currently comprises a representative from each Australian jurisdiction (as its core membership) and a representative from the Australian Health Information Council, the Australian Institute of Health and Welfare, the Australian Bureau of Statistics, the National Health and Medical Research Council, Medicare Australia, the Australian Commission on Safety and Quality in Health Care, the Department of Veteran’s Affairs and the New Zealand Ministry of Health.

A number of standing committees and set for purpose working groups provide specialist advice to NEHIPC, and the Chairs of these committees/groups also attend NEHIPC meetings as observers. These currently include the:

· Statistical Information Management Committee (SIMC);

· Health Data Standards Committee (HDSC);

· National Health Performance Committee (NHPC);

· Population Health Information Development Group (PHIDG); and

· National Advisory Group on Aboriginal and Torres Strait Islander Health Information and Data (NAGATSIHID).

In 2005, Australian Health Ministers noted the need for further cooperation on significant national e-health projects including clinical data standards and terminologies, consent models, secure messaging, user authentication, supply chain and electronic health records standards. This was endorsed by the Council of Australian Governments in June 2005. The National E-Health Transition Authority Ltd (NEHTA) was established in July 2005 to support the adoption of e-health in the Australian health sector.

On 10 February 2006 Council of Australian Governments (COAG) agreed that:

From February 2006, governments will accelerate work on a national electronic health records system to improve safety for patients and increase efficiency for health care providers by developing the capacity for health providers, with their patient’s consent, to communicate safely and securely with each other electronically about patients and their health. This requires:

· Developing, implementing and operating systems for an individual health identifier, a healthcare provider identifier and agreed clinical terminologies; and

· Promoting compliance with nationally-agreed standards in future government procurement related to electronic health systems and in areas of healthcare receiving government funding.

(Better Health for all Australians, COAG Communiqué, February 2006)

Funding was assigned to NEHTA to progress three significant infrastructure projects in the development of e-health, namely to establish the Individual Healthcare Identifier (IHI), the Healthcare Provider Identifier (HPI) and to establish a national clinical terminology. These three initiatives form the building blocks towards a national approach to a Shared Electronic Health Records system. COAG further agreed that Australian Health Ministers would report back to COAG no later than 2008 on progress and next steps towards a national e-health records system and appropriate cost sharing arrangements.

In December 2007, both the Australian Health Information Council (AHIC) in its report e-Health Future Directions and the Boston Consulting Group in its review of NEHTA, recommend the development of a national e-health strategy. It is also one of the key tasks listed in the revised terms of reference for NEHIPC endorsed by AHMAC in January 2008.

And also this part is important.

Key project deliverables are:

· A draft and final strategy fulfilling the requirements articulated in 3. and 4. To include:

Ø A discussion and key recommendations concerning the National eHealth Strategy, the Implementation Plan and the recommendations on governance of the implementation plan

Ø A vision, implementation and sustainability plan for e-health in Australia and its role in the planning, delivery and management of healthcare in this country.

o A recommended “future state” of e-health in the context of its proposed role in the planning, delivery and management of healthcare across Australia

o A definition and assessment of the current status of e-health capability, nationally both public and private, as well as at a jurisdictional level, with an assessment of the current level of contribution e-health is making to healthcare delivery and management and the investment in place to support this.

o Concept architectures and designs including information to support decisions taken in developing these. This must clarify which major components should be managed centrally (national), which could be either central or distributed (jurisdictional) and what should be geographically/regionally based.

o Identification of the major initiatives that would need to be undertaken to develop an e-health capability that optimally supports the Australian healthcare system and how each initiative will impact health outcomes and healthcare delivery capabilities. Initiatives need to be clearly defined and include high level detail of how impacted business processes would work. Each initiative needs to be scoped with a high level project definition that identifies outcomes, resource requirements, timelines, costs, benefits, dependencies, risks and issues. Costs must be fully inclusive of establishment as well as implementation costs.

o Definition of all enabling work that will be required to support the implementation plan. This will include areas such as standards, legislative and policy frameworks. Identify any changes or development that will need to be undertaken to support the implementation, whether these are already underway (by whom) or who should be addressing them (e.g. information privacy, consent models, additional standards).

o Prioritisation of initiatives to align with current national and jurisdictional health priorities as well as a process to recognise those that will emerge from the National Health and Hospital Reform Commission (NHHRC).

o A high level implementation plan, including assumptions and dependencies, with associated investment, costs and benefits plans. The plan should include strategies and incentives to maximise the take up of new capabilities.

o An assessment of capability in Australia to deliver against the proposed implementation plan. This must, particularly, consider issues of workforce capability (e.g. ICT, health informatics, healthcare) and market capability in this country. Identify strategies to manage these issues and ensure that the Australian workforce develops appropriately.

o An assessment of supply and demand factors in the private sector market for e-health products and services with a particular focus on vendors’ willingness and ability to develop and market products, issues driving private sector health care providers’ to acquire and use those products, and recommended approaches to address any shortcomings identified.

o Proposed governance structures to support and oversee the strategy and the implementation of the plan, including roles and responsibilities

o Description of all enabling work that will be required to support the implementation plan. This will include areas such as standards, legislative and policy frameworks.

o Clear statement of all assumptions that underpin the recommendations and estimated costs.

Ø A high level communication plan regarding the national e-health strategy itself, to inform key stakeholders of the planned future direction.

Ø Presentations and support to briefings related to the e-health strategy as follows:

o Presentations of the final strategy to key stakeholder forums (5 expected including but not limited to the CIO sub-committee of the NEHIPC, NEHIPC and AHMAC); and

o Support to the NEHIPC for related e-health strategy briefings on the final deliverables

o Regular meetings with the project steering committee established to oversee the project. This committee will comprise senior representatives from the Australian Federal, State and Territory health departments.

o Consultations with experts and stakeholders in Australia, as agreed with the e-health strategy steering committee.

==== End of Tender Quotes. (The full tender is available at http://www.tenders.vic.gov.au/domino/web_notes/etenders/etdrpublishing.nsf?Open)

First – let me say it is great to see such an initiative being undertaken. However this is really not a request for the plan that is required I believe. Why?

Firstly, three, or even six months, is not anywhere near enough time to address the complexities that Australian e-Health will face in the next 5-10 years.

Second the idea of using a Current State of e-Health Assessment developed by NEHTA a year or so ago is hardly an ideal information base from which to conceive the future.

Third the documentation seems to ignore the vital fact that the major stakeholder in all this is the Australian population who have a right to more efficient, safe and evidence based care. It is they who need to be convinced investment in e-Health will benefit them. Right now the consumer has no idea why they need EHRs or e-Health.

Fourth the brief is not focussed on a clinical outcomes perspective. By that I mean that the vision should be framed in terms of how the health status of the nation can be enhanced through the use of e-health – not some vision of a technological ‘future state’.

Fifth the strategy documentation does not appear to include development of a specific implementation justification business case to demonstrate the value of implementation of the proposed strategy. A persuasive national business case is the only way the required funding will be made available.

Sixth the overall process and deliverables being requested has a distinct 1980’s Information Systems Planning feel, rather than the dynamic, persuasive and compelling strategy that is needed to energise the health sector to move forward.

Seventh, without clear Health Sector wide analysis of where benefit can be gathered proper prioritisation is difficult if not impossible.

Eighth, all the background information simply tries to deny and sweep under the carpet the mess we have seen over the last decade with shifting priorities, staff turnover, inadequate evaluation of trials and so on. This is not the way to start. An honest look back is vital, before trying to move forward.

Ninth, by doing a short form plan, which is wanted by Government to meet the Health Care Agreement agenda, we don’t get the plan we need. The smart thing would be to use this as a starting point for detailed planning focussed on real outcomes after that issue is sorted.

All in all, unless we can move this retro approach to E-Health Strategy to one more consistent with 2008 and beyond we run the risk of yet another failed planning effort – which would be a huge pity.

David.