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Monday, May 26, 2008

NEHTA Seeks Our Patience but Does Not Explain What it is Doing!

Late last week a couple of reports of CeBIT’s e-Government Forum appeared.

First we had

NEHTA asks for patience on patient records

By Brett Winterford, ZDNet.com.au

May 21, 2008

The National E-Health Transition Authority (NEHTA), the organisation charged with steering Australia's efforts to unify patient records across the nation's healthcare providers, has asked for patience in the face of growing criticism of its progress.

Gil Carter, general manager of authentication at NEHTA, told attendees at the CeBIT's e-government Forum today that critics should consider the "wicked problems trying to be solved" when reading any adverse press about its efforts.

It is widely recognised that healthcare provision in Australia desperately needs a system that connects the disparate silos of paper- and electronic-based health record systems isolated within healthcare institutions in Australia. A unified electronic patient record, one which can be transferred between healthcare institutions, is the "glow on the horizon" for e-health, Carter said.

Carter said NEHTA, funded by both Federal and State governments, has contrary to media reports made some considerable progress on most of the key areas required to build such a connected health system.

Development of unique identifiers for healthcare patients has been allocated to Medicare as of December 2007, he said. NEHTA has also built a comprehensive framework for the development of "premium grade" digital certificates to ensure that records can be transferred securely, and negotiated for healthcare system developers to gain free access to the SNOMED CT standard for clinical terminology to ensure all institutions are "speaking the same language".

"We've done the strategy, the documentation, the standards and procedures," Carter said. "The focus of the next 12 months will be consultation and implementation."

Any lack of progress, Carter told ZDNet.com.au, was a reflection of "the complexity of healthcare".

Read more here:

http://www.zdnet.com.au/news/software/soa/NEHTA-asks-for-patience-on-patient-records/0,130061733,339289144,00.htm

Reporting on the same event we have the following from Computerworld

Govt gets serious about e-health implementation

NETA green lights e-health revolution

Darren Pauli 21/05/2008 16:47:28

The National E-Health Transaction Authority (NETA) will this year action its spate of electronic health projects, set to revolutionise the operations of Australian hospitals and clinics.

The authority is tasked with creating standards for healthcare across areas including electronic document management, pathology and patient identification and privacy. It is an independent government body which interacts with nine separate agencies, and state and federal government.

Speaking at the e-government CeBIT conference in Sydney today, NETA general manager Gill Carter said the agency has entered a phase of "serious implementation".

"Our work in personal e-health records is a five to 10 year transition from paper to electronic [media],"Carter said.

"The biggest benefit of e-health and [affiliate] projects is that people will have access and control over their own health information.

"We need to establish common standards, uphold privacy and work out what consumer access to health information should look like."

Common communication standards are top of the list for NETA, according to Carter, because they allow successful local projects to be deployed nationally.

Read more here:

http://www.computerworld.com.au/index.php?id=255536153&eid=-255

Looks from all this that the old NEHTA is alive and well!

What we have here is a classic case of blaming the customer (i.e. the health system) for being complex and slowing NEHTA down! – Diddums!

The speaker then goes on to say “We've done the strategy, the documentation, the standards and procedures” Well good!

And he then goes on to say "The focus of the next 12 months will be consultation and implementation."

The first step in consultation is to inform stakeholders where things are up to and what is planned. How about now sharing all this with the health sector and other interested stakeholders? It seems to me to be planning to move to any actual implementation without very considerable external review is fool-hardy in the extreme.

Review of recent presentations from NEHTA we discover a few more details about, as an example, the National Authentication Service for Health (NASH).

Gil Carter Presentation 15th May, 2008 Brisbane (Slide 7)

National Authentication Service for Health

Highlights

  • Smartcards for healthcare professionals
  • Digital certificates for devices
  • Enable trusted authentication, digital signing, encryption
  • Learns from previous experiences of PKI in health
  • Specify and build during 2008
  • Initial operations in 2009

So it seems we are to have Smartcards for every health provider (There are a few hundred thousand of those at last count) and digital certificates for all sorts of devices!

More the whole thing is going to be specified and built in seven months and be ready to operate in 2009!

Well I suppose it might happen – but I doubt it. The effort of reliably identifying every health provider, issuing a smartcard etc is going to be both expensive and time consuming. (The UK NHS took a few years as I recall to do something similar in the NHS). Worse still where is the business case justifying it is the right way to go and the pilot that shows it is practical and workable?

Reliable Provider Identification is both very important and non-trivial. The sooner the detailed plans are available for public scrutiny and comment the better in my view. “Bull at a gate”, unconsultative approaches make very little sense.

At the same session we discover Clayton Utz have undertaken a Privacy Impact Assessment (PIA) of the Individual Health Identifier. This work was begun in August 2007. Again – so where is this report? Especially since the outcome of the review “Identified privacy issues and risks, and made recommendations for mitigating them”. The industry, the sector and the public all have a right to know what is going on.

What is worse is that a “Further PIA planned for final design of UHI Services (mid 2008)” and that no one other than NEHTA (and maybe the jurisdictions) know what the initial PIA said and whether the remediation plans were reasonable. The impact of what is going on here are way broader than that!

Someone really needs to get control of this steam train and make it accountable to its customers – the whole health sector and the public.

David.

8 comments:

Anonymous said...

You said "Someone really needs to get control of this steam train and make it accountable to its customers – the whole health sector and the public." These are strong words. Perhaps you are being a tad impatient.

It is only a few weeks since our ‘Dear Leader’ vacated his post. Even so some things do need to be done pretty swiftly. NEHTA is no different from any other organisation that has lost it way.

First up the culture needs to be changed and that means the organisation needs to be purged and to lose some weight before it can see its navel again. Only then will it be able to recalibrate its compass, unless of course the current thinking is that everything was hunky dory, a change at the top was all that was needed, so its now business as usual and full steam ahead.

Aus HIT Man said...

That NEHTA staff think everything is hunky dory seems to be reflected in the comments I cite here. Hence my concern.

The new Acting CEO - as his first act - should have ideally told his senior managers to say nothing in public until the new direction was determined and bedded down. It is concerning what was said was essentially we have done all the planning work so now it is full steam ahead.

David

Anonymous said...

Changing the culture will help but NEHTA also needs access to some new blood with creative strategic thinking and communication skills.

Anonymous said...

You are so right. That was a pretty dumb statement by the NEHTA spokesperson. NEHTA has many complex issues to have to deal with related to damage control, public and stakeholder perceptions, image, capabilities, and communication to mention a few before it can progress towards the obscure objectives of ‘delivering and implementing’ anything of much value.

At least Gil Carter got it right when he said “that critics should consider the ‘wicked problems trying to be solved’.

The issue here, however, is that a great many of the critics well understand the wicked nature of the problems. NEHTA on the other hand well knows the problems are wicked but it doesn’t know how to harness the dormant expertise which lies beyond its organisational confines to help it understand and solve the wicked problems which it is trying so hard to wrestle to the ground.

Anonymous said...

Change of culture? What change of culture. I discovered last week that there is a NEHTA eHealth Summit in Canberra in the week commencing 16 June, but ...

1. Only a few medical professional bodies have been invited (RACGP, RACP, etc)

2. No one else has been told a thing - even that the summit is being held at all

3. It is not mentioned on the NEHTA website.

NEHTA does not have an inkling of how to manage the cross-sector initiatives it is attempting.

What is particularly scary is that it has learned nothing from any of the comments and reviews of the last several years.

This is the legacy of Ian Reinecke (the subject of the most remarkable hagiographies)and the other DSTC refugees that run NEHTA!

Andrew Howard is a good fellow - but he has accepted a poisoned chalice.

Dr Ian Colclough said...

NEHTA has a very tough job ahead of it. We only need to witness the stop, start, turn around, nature of similar projects in other countries to well appreciate that there are many different approaches to addressing the same problem and whichever path is taken they are all fraught with numerous potholes and untold difficulties.

I am a strong advocate of constructive, objective, criticism. It should always be welcome and heard. In the past, ever so sadly, that was not encouraged and it has led to where we are today.

Understandably it will not always be possible for NEHTA to satisfy its critics but without open, two-way, lines of communication, it won’t even be able to try. What concerns me here is that NEHTA has an important role to play in the direction of ehealth in Australia and that if the critics are not careful their criticisms, not unfounded by any means, could undermine NEHTA’s very existence. Some may be content to see that happen, but I think it would be unfortunate for everyone.

If there is one thing I would like NEHTA to do, it is to focus, focus, focus, on the priorities. Gil Carter said that a unified electronic patient record, one which can be transferred between healthcare institutions, is just that - the "glow on the horizon" for e-health. Few would probably disagree with him. “Unifying patient records across the nation’s healthcare providers” ….. is very much a looooong term objective which could fairly be describe as Nirvana - a state to be aimed for and one which can be reached.

It is and should remain THE valid long term focus - the ultimate goal - nothing more. NEHTA’s focus for the foreseeable future needs to be on putting in place the foundations, the building blocks, piece by piece, with industry collaboration. If that is what NEHTA is trying to do that is goodness. It needs to get that message out there and it needs to implement a strategy which achieves those outcomes. If it can do that it will have achieved all that can reasonably be expected of it.

Anonymous said...

The Meeting on 18th is on the NEHTA view of the Individual Electronic Health Record (IEHR) , we hope they explain just what an IEHR is and how it differs from the recognised defined terms EHR and PHR.Who invented the term anyway?

Perhaps if we we keep renaming things it can substitute for activity?

There are meant to be supporting papers issued before the meeting. On past record this means the night before on laying on the table on the day!

Anonymous said...

We would all be a lot happier if NEHTA published:

1. its prioritised list of the top 5 or so building blocks

2. how and when it was going to put each building block into place, and

3. the modus operandi and model it will adopt for facilitating industry collaboration.

That would be a good start.