Quote Of The Year

Quote Of The Year - Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

Monday, June 23, 2008

Just Why are NEHTA’s Plans for the Shared EHR a Secret?

The following is adapted from the NEHTA web site (captured 22/06/2008)


Shared Electronic Health Record

NEHTA is working to develop specifications and requirements for a national approach to shared electronic health records. These records will enable authorised healthcare professionals to access an individual's healthcare history, directly sourced from clinical information such as test results, prescriptions and clinician notes. The shared electronic health record will also be able to be accessed by individuals who have received healthcare services.

Specifically, NEHTA will focus on developing:

  • Operating concepts for a national approach to establishing and maintaining shared electronic health records;
  • Policies, requirements, architecture and standards for a national approach to shared electronic health records; and
  • A business case to substantiate and validate the proposed approach.

For the health system within Australia to reap the full benefits from the IT, governments and healthcare providers need to make the case for undertaking further investment including the development of a national system of shared electronic health records. The case for the required level of investment depends on the credible quantification of the costs and benefits of providing such.


Dr Andrew Goodchild - Shared Electronic Health Record Design

Fact Sheets

Shared Electronic Health Record Fact Sheet 19/08/2006

Context and Strategic Direction

Standards for E-Health Interoperability v1.0 - 08/05/2007

Review of Shared Electronic Health Records Standards v1.0 - 21/02/2006

What this shows us is that it is over 14 months since NEHTA has published anything on the Shared EHR.

However we have had Dr Haikerwal running around the country spruiking the plans for having a new electronic record implemented over the next few years – following the receipt of funding from Council of Australian Governments which is to meet in October this year.



It seems, from the reports I have received, NEHTA has been conducting briefings about such a plan to a collection of clinical and consumer peak bodies. (The last one was on June 18 in Canberra).

The obvious concern is just what they are telling these audiences and what commitments are being made that have not been subjected to any technical scrutiny other than the NEHTA staff. The situation we have here is that NEHTA (a publicly funded organisation) is providing private briefings on topics where it has by no means the monopoly on expertise trying to get very substantial ($billions I would not be surprised) funding to keep itself in existence while having been reviewed by the Boston Consulting Group recently as a failed organisation – especially in the area of Shared EHRs (now somehow renamed Individual EHRs).

In the meantime we also have the following:

3 years away">Surprise, surprise - e-health records >3 years away

17 June 2008

The Australian Doctor website reports today that Australia “is at least three years away from introducing shared e-health records for every patient — despite $150 million being sunk into e-health programs over the past eight years.”

Federal Health Minister Nicola Roxon, when interviewed by the Australian Financial Review last week, refused to commit to a 2012 deadline for a national e-health record system.Clinical leader of the National e-Health Transition Authority (NEHTA) and ex-AMA president Dr Mukesh Haikerwal told Australian Doctor, “There is no element of the reform agenda that can succeed unless we have a decent underpinning by a robust e-health system.”NEHTA is believed to be looking initially at a minimum-quality data set - limited to information such as allergies, hospital history and medical conditions to ensure there is enough information “to treat the patient safely”.

For more see:


Worse we have a National E-Health Strategy being developed by Deloittes which NEHTA is clearly making bets on the outcome of. This is a governance and management farce. Either NEHTA or Deloittes are setting the direction for the future of e-Health. I know which is should be and it isn’t NEHTA!

Deloittes need to be allowed to finish their work – have it made public for consideration by all relevant stakeholders - and at this point NEHTA should be invited to consider how it can actualise whatever is recommended.

I believe both Ms Roxon and Mr Hockey (the Opposition spokesman) should be asking some hard questions of NEHTA right now as to just what they are up to and how they justify it. At the very least the public (and not just a select few) is entitled to know what they have in mind!



Anonymous said...

Just step back and have a long hard look at this in the cold light of day.

What is going on here? What is Dr Mukesh Haikerwal doing?

NEHTA appointed him as the Clinical Lead shortly after the BCG Report came down and some months before Ian Reinecke departed the scene. So in effect we have here an implementation of the Reinecke strategy flowing from the harsh criticisms of the BCG Review that NEHTA needed to engage with industry.

What we are seeing here is NEHTA, with the Department’s backing and support, preparing to pitch to COAG for funds to develop a national shared electronic health record. To bolster that support Dr Haikerwal has been charged with bringing together any and all peak medical and health related bodies to nod in agreement on the urgency and the need for a shared national EHR. A report will now follow and all the nodders names and organisations will be included in the Appendix to give credibility to the application for funds that engagement has been achieved and the entire health industry has nodded its approval.

The argument will be posited that there is no need for technology input at this stage.

So far we have momentum building with no strategic analysis and hence no strategic planning of any kind to underpin all this activity. The Deloitte consultancy will be massaged in wherever it seems to fit when it becomes available. The argument will be - there is no time to wait - we must get on and do the job with what we already have to work with.

And if the stories in last weekend’s Australian that ‘chaos reigns at the top of government’ are anything to go by the Government and Minister Roxon will have no option to do anything other than support this pathway.

Many are predicting a repeat of years gone by is well on the cards.

Anonymous said...

Hard questions indeed. But what difference will it make?

NEHTA is fighting for its life and as it now has to report to DOHA this simply means the department has built its reserves and soldiers back up to what they were, or perhaps even bigger than they were, when it lost them all at the time NEHTA was established about three years ago. So the writing is on the wall and there doesn't seem to be much you can do about it except complain - but who's listening.

Anonymous said...

This again encapsulates most of what is wrong with NEHTA.

NEHTA should not:

1. Be run by academics (especially through the wholesale recruitment of the former academics employed by the DSTC)
2. Be planning to develop or build anything (that’s what industry does and the public sector has proved time and time again that it cannot do)
3. Be defining minimum datasets (that’s what Colleges, Professional Associations, the AMA, AGPN, etc can do)
4. Be specifying technical frameworks (that is what industry, through IHE, is doing)

Talk about a WOFTAM! That’s our taxpayers dollars disappearing in smoke – and an obscene amount of dollars at that.

A case in point - over a year ago, NEHTA proudly announced that its budget for two national identifier projects (the IHI and HPI) was $98 million (yes, you read correctly!); earlier this year, NEHTA announced that it had contracted with Medicare Australia to develop these two identifiers for $51 million (yup, another chunky sum). Two questions:

1. Why would it cost Medicare Australia $51 million to develop two identifiers that it already has laregely developed?

2. What happened to the $37 million left at NEHTA? Supervision fees?

These sorts of numbers give new meaning to the expression "public profligacy".

Anonymous said...

Mukesh Haikerwal said recently that the Primary Health Reforms will fail unless they are comprehensively underpinned by IT. Absolutely correct.

So why on earth is he buzzing around like a flee in a bottle stirring up support for another humungous EHR project, at this time. Past experience strongly points to approaching the problem by putting the building blocks together with ‘bite-size’ steps?

NEHTA’s team of horses is chafing at the bit to break out. NEHTA is being opportunistic and irresponsible and Mukesh, as NEHTA’s Clinical Lead, has an onerous responsibility not to allow NEHTA to throw caution to the wind. Maybe he is powerless in that regard, maybe he is being paid to ‘just do it’, and not to give advice on what should be done. If so let us hope someone educates him fast and let us hope - he listens.

Anonymous said...

The Deloitte eHealth strategy is available online. Perhaps you should ensure that they receive a good response.


Anonymous said...

More importantly let us hope the Minister starts listening before the snowball starts well and truly rolling down the hill. One it starts rolling it cannot easily be controlled.

Anonymous said...

Andrew Howard is caught between a rock and a hard place. He is meant to be in charge. He doesn't want to demotivate his troops. In fact he needs to remotivate and freshen them up and give them some hope that all is well and all will now move forward under his new leadership.

It isn't on his agenda to chop people and resources. But that assumes NEHTA was heading in the right direction all along - and it wasn't. It was out of control. So he needs to be giving it a new sense of direction and if that means chopping staff and projects and resources and downsizing and re-engaging with the outside world differently, so be it - that's what he should do.

It will be interesting to hear from him when he comes up for air.

Anonymous said...

It's not a strategy (Deloitte's reference above) its a Survey of attitudes and ideas. It's quite amazing how many surveys get undertaken in the area of ehealth, how similar they all are, how many consultants get employed to do them, and how consistent is the expected outcome.

Anonymous said...

I am at a loss. Surely it can't be that hard?

Having said that using unique fax numbers as a personal ID some said was a great idea and what happened to that, no one signed up!

Another one hits the dust...

Anonymous said...

Who uses unique fax numbers as a personal ID? and why bother - who has a fax these days? Isn't that rather a prehistoric approach or is the fax coming back into vogue? Surely secure email is better!

Anonymous said...

It might be worth asking who in Australia provides an online SEHR today?

If no-one does how would we go about getting one unless we developed it?

And, if we did have to develop it why shouldn't it be developed by NEHTA and the Government?

Or put another way, is it a commercially viable proposition for anyone else other than a Government entity to develop a SEHR?