In the last week a paper developed by the luminaries of the Australian Health Information Council has been released , having been finalised in sometime in August, 2007. The paper purports to suggest the Future Directions in E-Health for Australia for the next five years.
The release of the paper was publicised on the blog a few days ago.
See:
http://aushealthit.blogspot.com/2008/03/ahic-future-directions-paper-now-in.html
The recommendations made are as follows:
“1.1 Recommendations
In considering its advice, AHIC recommends the following:
1. That a comprehensive national eHealth strategy be developed in consultation with the Jurisdictions, industry, the community and health services, and that this strategy encompasses the advice of AHIC contained in this document.
2. That AHMAC recognise that eHealth is the cost of doing business in the 21st century healthcare and that this will require continuity of investment, accepting that products and hardware will need to be continuously implemented and upgraded in an ongoing cycle of capacity building.
3. That AHMAC recognise that Jurisdictions have many of the necessary eHealth components already and that what is needed is an effective system of knowledge exchange that can accelerate implementation rather than develop new products when existing ones can be used.
4. That a time limited implementation function/ body that is responsible for “connecting up”, building upon existing work and integrating eHealth nationally should be established and funded by AHMAC.
5. That a core set of functioning components of an Australian SEHR should be operating across Australia by 2012.
6. As part of the implementation function/ body, that an implementation plan and resources schedule should be developed to deliver the AHMAC national eHealth Strategy. The processes should be flexible and adaptable over time to the changing/evolving nature of information management and information communication technology.”
Implicit in all this is that at present there is no National E-Health Strategy and that there should be one. On that we are as one!
The second clear implication is that NEHTA is not the implementation body to get e-Health improvement done. Again vehement agreement.
The third clear implication is that we need much better and safer systems throughout the sector and some certification / control of such systems is vital – again I agree.
With these things said the key problems I see with the paper are as follows:
First the perspective adopted that you can essentially ignore the whole of the ambulatory health sector is just amazing in its stupidity. The thinking about a Shared EHR all seems to forget it that the information that needs to be in it has to be provided by GP’s and Specialists in the field. I can see “general practice” mentioned twice in the whole document and “ambulatory” not other than in a reference. This whole document flows from a centralist, bureaucratic perspective that has been the cause of many of the problems to date (think NEHTA). Anyway AHIC should say we need a plan, and leave it at that – not then try and apply their perspective as they do in Recommendation 1.0.
Second, the depth of research for a paper aiming as supporting the implantation of a national strategy is really quite uncomprehensive and I would assess it as dangerously understating the current state of knowledge. Also, sadly the references there are don’t even appear to be linked to the text. There is good evidence out there that e-Health works in terms of quality, efficiency and safety and increasingly that it can also save money. To say it is just a ‘cost of doing business’ simply is not a good enough justification for the large investment that will be required.
Third, it is increasingly clear there are serious options available to the Shared Centralised EHR, considered here, which can offer substantial benefits, which have not been even mentioned. Patient held Personal Health Records are the most obvious and I am sure there are others.
Fourth, the timeframes suggested here are essentially fantasy. With the best will in the world serious Shared EHR implementation is a 5+ year project (2009-1014) at least.
Fifth, despite the claims of some, there is no evidence that just ‘connecting up’ a collection of random unsustainable initiatives is going to get anyone anywhere. This is ‘fairies at the bottom of the garden thinking’
Sixth has anyone recognised that decision support is something that ideally happens at the point of care on the basis of a full information set. This is simply not what a shared summary record provides – and no one plans to share full local EHR centrally as far as I understand.
Seventh, there just does not seem to be any recognition of the now crucial concepts of EHR enabled ‘rapid learning’ and other more innovative use of full – as opposed to summary EHRs – as is all that can be provided in large scale centralised systems.
See:
http://aushealthit.blogspot.com/2007/02/weekend-treat.html
Eighth, it is clear AHIC has simply no idea of what is involved in making even the outline of the environment pictured on page 24 reality. The complexity and effort in doing this is really quite something and I believe is a decade long project.
Last the claim they Australia is well advanced in e-Health is just internally contradictory and frankly Table 1 is a conceptual nonsense. If we are well advances it’s obvious a plan free approach works. As the whole point of the document is to recommend a plan one is forced to conclude the authors clearly recognise there are huge gaps which need to be addressed.
This paper needs to be considered as an artefact of another era (the secretive, non-consultative Howard era) and the Consultants engaged to develop the national e-Health strategy should give it the weight it deserves – not much!
David.
7 comments:
The AHIC paper “essentially ignores the whole of the ambulatory health sector”.
This is nothing new. They know that the information that needs to be in the Shared EHR essentially has to be provided by GP’s and Specialists in the field. They understand that very well indeed even if, as you say, “they seem to forget”.
No Government, no bureaucrat, no NEHTA, will do anything other than ignore the ambulatory health sector when it comes to developing non-centralist Shared EHR solutions. It is not in their interest to do otherwise. Supporting decentralisaion in the ambulatory sector does not fit with their objectives. This should not be too difficult to understand.
“No one plans to share full local EHR centrally as far as I understand” ….. of course not - but the bureaucrats do!
It is of little consequence that the timeframes are “essentially fantasy”. The objective is to set parameters which are not too far out in order to get the nod for funding approval in the next budgetary cycle - then add to it later and extend the timeframes accordingly.
It is a very shallow and superficial document. But what would you expect from a committee with such limited expertise at the coalface of healthICT.
I agree they will continue to ignore the obvious - so why bother to try and change them - Government, bureaucrats, NEHTA, health departments and politicians will only pay lip service to anything other than a ‘centralist’ style solution. They perceive that they cannot afford to allow any other alternative to establish itself in the market for that could lead to a shift in control and a shift in the balance of power from the centre to the periphery. From their perspective that must never be allowed to happen lest the consumers and their doctors become too empowered. Therefore, the centralist model must prevail. They do not share your views that “the centralist, bureaucratic perspective has been the cause of many of the problems to-date”. Surely you and your colleagues understand this simple fact. If this holds true, which it does, what do you think can be done about it other than SFA?
I agree. Government, health department bureaucrats, nehta and politicians will only pay lip service to anything other than a ‘centralist’ style solution. They perceive they cannot afford to allow any other alternative to establish itself in the market for that could lead to a shift in control followed by a shift in the balance of power from the centre to the periphery. From their perspective that must never ever be allowed to happen lest the consumer and their doctors become too empowered!!!. Therefore, the centralist model must prevail at all costs. Also, they do not share your views that “the centralist, bureaucratic perspective has been the cause of many of the problems to-date”. This is a simple fact of life that we all must live with.
I don't believe in the centralist view and I think you are right - that the bureaucracy is scared of losing power and control if those at the periphery become too empowered.
But what can be done about it? The power lies with the money and the money lies with Canberra. So what hope is there of having anything other than a centralist model? And more importantly how would we go about getting a decentralised model when those agin such a concept appear all powerful.
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