The Australian Financial Review has published 2 articles on e-Health today.
The first is here:
This article reveals e-Health in Australia to be a headless chook and the Federal Health Minister is unable to commit to any real progress before 2012.
That a National E-Health Strategy is being developed somehow is not mentioned! The left and right hands clearly have no idea what each is up to and neither is the Minister!
The second is here:
This provides a discussion of the AMA’s cautious support of Google Health.
Both are must not miss bits of reading.
Sadly it is also pretty depressing.
David.
Are we saying that there is 'enthusiastic' support within the Australian health IT industry for Google Health?
ReplyDeleteBen Woodhead wrote "Health officials blame duplication and a lack of co-ordination between governments, as well as resistance from doctors and pathologists, for the failure to deliver a national e-health system."
ReplyDeleteWhat does this say?
It says the big picture top-down approach did not work? It says the multi-jurisdictional approach did not work? It says widely scattered multiple seeding projects did not work?
Why did these and other approaches not work?
It is not appropriate to justify a failure of such magnitude on:
- duplication and lack of coordination between governments
- resistance from doctors and pathologists.
In my humble opinion most of the projects failed because they were not set up to address the underlying problems that needed to be solved in order for the ‘application’ to gain traction and become embedded within the environment.
And if the planners and bureaucrats approach the problem(s) in the same way as they have previously done they will fail all over again.
Google isn't the only elephant in the room.
ReplyDeleteAn article in New York Times on Kaiser Permanente joining up with Microsoft for personal health records includes "The proliferation of personal health monitoring machines, from blood pressure machines to pedometers, could be included, along with records of diet and exercise routines". I've got 99 records on my own digital BP monitor, so do I get to include all of them in my PHR? Someone needs to tighten up the thinking behind the PHR concept before more government money goes down the drain.
Have a look at the systems used in the US by Veterans Health and Military Health. There is concern that VistA is being whiteanted in favour of Defence's AHLTA. Perhaps the best entree to AHLTA is from the Wiki article on CHCS (Composite Health Care System). The upshot is that Northrop-Grumman has bought into health records, and they boast of the largest enterprise-wide electronic health record (EHR) in the world. Since Northrop also operates a centralized database for the nation’s largest payer organization – the Centers for Medicare & Medicaid Services (CMS) - it's worth pausing to wonder if they've made overtures over here.
On the other side of the coin, a respected provider at Pittsburgh Uni has tendered for a major project in the UK ( http://www.e-health-insider.com/news/3702/newcastle_chooses_pittsburgh_for_ehr ). There seems to be a lot more to see about Epic, and this is a good snapshot - www.himssconference.org/docs/sphandouts/28.pdf
It seems the arguments around our EHR haven't got as far as centralised vs federated.
Emily seems to have drawn a very long bow!
ReplyDeletePerhaps she would like to point out whereabouts, in the article, is there anything written which links the ‘Australian Health IT industry’ with GoogleHealth in a way which suggests ‘enthusiastic’ support is evident.
What an odd thing for the Minister to suggest we need to wait a couple of months for the business case(s) to be done!! That doesn’t make any sense at all. Before preparing the business cases surely some strategic planning is required.
ReplyDeleteNo. No, not at all. It’s clear the decision has already been taken to set sail through uncharted waters, as soon as a business case has secured the money for the journey ahead. No map, no compass, full steam ahead.
In other words NEHTA (and probably DoHA too) has decided the EHR business case should be the top priority. The most likely reason is to try and position to counter the perceived wave of PHR’s coming from Google, Microsoft and some local players.
With the all pervasive nature of the Internet does it make much difference whether the PHR is a local product or one sourced from overseas?
ReplyDeleteNone of the solutions will be used unless they provide a slick, user-friendly interface, and inter-operable access to the most important clinical information which is relevant, accurate and able to be trusted implicitly. In short, nothing will take hold in the market that doesn't bind the consumer and their health service providers tightly together safely, securely and reliably.
Are there any PHR systems available today capable of doing that? Google and Microsoft don't think so.
David - there is a mention of the Deloitte Touche Tomatsu consultancy which I was intended (and presumably still is) meant to be developing a National ehealth Strategy not a business case for an EHR. So perhaps you are being unfair when you say there is no reference to the strategy being developed.
ReplyDeleteProfessor Angus is waiting to see if the AHICs charter is going to be renewed!!!!!!! Why bother to renew it. What a wasted space that bunch has been. They had a wonderful opportunity and fluffed it totally producing nothing of substance at all. Isn’t that what you said would happen? The membership of Angus’ committee was flawed from the outset. They have the wrong people doing the advising. It’s just been a repeat of the same old, same old, drop the hanky, pass the parcel. When will they invite new fresh blood into the game?
ReplyDeleteSorry, maybe I was not clear enough. I meant that the minister was not seemingly explicitly saying there were plans underway and that was what she was waiting for. Her comments did not seem to reflect awareness of the Deloittes work to me - but maybe I missed it. As all readers know I see the plan as key to getting the act back together.
ReplyDeleteThe central point that there is apparent disarray remains. Ms Roxon says that explicitly towards the end of the article.
David.
It's such pity the PHR doesn't seem to feature to the same degree as the EHR. Could this be because all the commentators quoted in the article' who wished to remain anonymous' come from the public health-hospital world?
ReplyDeleteIf the PHR was given more focus with an electronic feed from the desktop like Healthe and HCN announced recently we might see more energy and focus coming from private sector involvement, provided of course Government was prepared to support such initiatives rather than set up projects which competed with them.
I see a major problem with your (June 11, 2008 8:42:00 AM) suggestion. None of the PHR solutions available have as yet been able to demonstrate a really compelling offering. If people are convinced they need a PHR they will probably subscribe provided there is no financial penalty for porting their information to another provider if they choose to!
ReplyDeleteWhere’s the database?
ReplyDelete“Where is the database?”, “Why is it taking so long?” were the muttered comments from the table when the topic arose in conversation. I remained quiet in the background waiting for the subject to change. The saying “You can lead a horse to water but you can’t make it drink”, springing to mind. Gone is my enthusiasm to support this group of clinicians servicing a major health outcome area across a very large health organisation. They and I are frustrated and disappointed, …yet again.
Not that I didn’t go in aware of the risks, others had spoken of the politics, the history and the disengagement already dividing this group of specialists, surgeons, physicians and nurses. Still I thought, here is a chance to contribute to an area with high and growing demand. Funding is available and there appears to be clinical and corporate support. Sure there is the typical naïve view that this a database project, but already some have identified that this is really about clinical audit and quality, patient mortality and morbidity.
Halfway through my term and the project is well over the edge. Corporate support has diminished, but the considerable funding remains available. All would still be ok if only the clinicians weren’t there own worst enemies. The project has become another battleground for point scoring and posturing, for the ego of the clinician and the unit. There is no leadership, no direction, and no agreement on the basic data that models the service; there is no respect for professionals of the same or other fields. There is just the expectation that “someone” will build this “simple” database, and the oft demanded question “Where is the database?”, “Why is it taking so long?”
The actual work required to create, operate, populate and maintain a clinical registry, for that is what is needed, is far greater than a mere database. The database could be created tomorrow, in fact there have been a number of them created before, but they have never been used. Why? For the same reasons this one will not get created. It’s not about the database. It’s about agreement on a common set of data that consistently models everyone’s activity. It’s about agreement on a common set of rules that everyone can follow to be comfortable that data collected and information produced is used fairly, transparently and equitably. It’s about accepting that changes may be needed to collect data consistently and to reassure colleagues that gaming isn’t occurring. It’s about accepting that for others to create IT systems for you, they may need to know in microscopic detail how you work, or the IT won’t. It’s also about accepting that customising IT increases cost and risk exponentially and that changing practices to work in a similar manner to others to minimise the customisation is essential.
You have quoted someone in the past as saying “There is never enough time in health to do it properly, but there is always enough time to do it over.” Well history is about to repeat, this group have blown their opportunity. I see IT people and government people taking a lot of blame for the lack of any progress over the last 20 years. Perhaps it's time clinicians themselves take a good look at their own contribution.
For now, I’m off to look for another job, maybe I’ll find a group of clinicians who can work as a team and have respect for each other and for other professionals.