Australia’s E-Health Control Freaks – Guess Who?

Honestly, sometimes NEHTA really takes the biscuit!

For the most recent example – see this ripper from ZDNet.

NEHTA gags stakeholder forum

Liam Tung, ZDNet.com.au

22 August 2008 05:48 PM

Australia's peak e-health body has held the first meeting of a new forum designed to address past failures to adequately engage government and industry stakeholders — but individuals in the group have been gagged from talking about details.

Established in 2005 by state health ministers, the National E-Health Transition Authority's (NEHTA) mission is to develop standards to better integrate Australia's health IT systems and improve clinical outcomes.

The group yesterday announced it had held the first meeting in of its so-called Stakeholder Reference Forum (SRF) which aims to improve the organisation's engagement with key stakeholders. The first meeting was held in Melbourne on 29 July.

The forum was partially a response to a review by the Boston Consulting Group published last year, which labelled the organisation's engagement with stakeholders as "ineffective", leading to a "cycle of criticism, defensiveness and isolation".

"We have put together a stakeholder forum as another conduit to provide input to the work program — consumer, clinician and informatician," a spokesperson told ZDNet.com.au.

Members, which include all state health agencies, the Department of Health and Ageing, and several other clinician stakeholder groups and consumer representatives, discussed the 'terms of reference' for itself and agreed upon holding two more meetings by the end of this year.

…..

The major priorities agreed upon at the first meeting were the development of an e-health business case for consideration by the Council of Australian Governments meeting in October this year, as well as devising a five-year plan.

The first major e-health implementations the group wants NEHTA to focus on are developing systems for electronic discharge summaries, pathology reports, specialist referrals and medication management.

However, members of the forum have signed a non-disclosure agreement that personally binds them when the SRF discusses confidential topics, including NEHTA’s finances.

"They have signed a confidentiality agreement and probably wouldn't be able to comment on specific topics discussed. However they would be able to comment on the fact that the forum exists and if it is valuable," the NEHTA spokerson said.

More here:

http://www.zdnet.com.au/news/software/soa/NEHTA-gags-stakeholder-forum/0,130061733,339291511,00.htm

I was lucky enough to have been sent some of the materials from the Forum and also a note that NEHTA has published some news about the Forum on their web site.

Most interesting were two things (let’s just forget the nonsense Terms of Reference for the SRF that has the NEHTA acting CEO as the co-chair on their own and makes it clear all service for your brief stay on the SRF is at NEHTA’s pleasure – so just shut up and listen!). First we have the membership list.

Three groups are cited.

First jurisdictions, second clinicians and third consumers. The third amused me:

Stakeholder: Consumer

Australian Information Industry Association (AIIA)

Australian Medical Association IT Committee

Australian Safety and Quality Commission

Consumer Health Forum (CHF)

Health Informatics Society of Australia (HISA) and Coalition for e-health

Medical Software Industry Association (MSIA)

Private Health Insurance Funds

I would contend this is just another example of how out of touch with reality NEHTA really is – I doubt if you ask them the AIIA or the MSIA would see themselves as consumers. They are technical peak bodies and should be separated from the admirable CHF. It is also interesting how few consumer interests are reflected – sure the CHF is important – but there are many more consumer voices than that who could help. Just ignored it seems.

Also why the list is headed “DHS HO Fax sheet v4” just eludes me! (see the .pdf)

More amazing is the suppression and spin of the minutes of the 5 hour meeting.

From the NEHTA web site we get the following:

Outcome statement of the Stakeholder Reference Forum

July 29 2008

Terms of reference

Members discussed the Terms of Reference for the new Forum and agreed that there would be three meetings this calendar year with this revisited for next year.

Members agreed to use teleconferences for the discussion of specific topics if required.

SRF members signed non-disclosure agreements that personally bind members when the SRF discusses confidential topics such as NEHTA’s finances.

Stakeholder engagement

While the SRF is a key consultation forum, it is not replacing direct stakeholder engagement. Members noted that NEHTA is committed to stakeholder consultation and will coordinate further round tables and forums as the e-health agenda progresses.

NEHTA work program

Members noted the current work program priorities are the business case for consideration by the COAG meeting in October 2008; development of the five-year plan; engagement of stakeholders.

Members noted NEHTA will be focusing on national e-health implementations in the priority areas of:

• Discharge summaries
• Pathology
• Referrals (including specialist letters and notifications)
• Medication management.

Members heard a presentation on the COAG-funded national Unique Healthcare Identifier service (UHI).

• There are three identifiers, one for providers, one for organisations and one for individuals.
• The current model relies on the ability of the consumer to provide information to the healthcare provider and that there is currently no consumer token.
• Data will be authenticated through national registration boards.

Members noted the progress to date on the COAG-funded program National Authentication Service and agreed more work was needed on authentication validation and this could be discussed at future meetings.

Members noted a presentation on achievements of Clinical Terminology, a COAG funded program to develop national clinical terms for e-health. Members noted most States have implemented the National Product Catalogue as part of the e-health procurement strategy.

Individual Electronic Health Records (IEHR)

• Members were briefed on the structure of the IEHR
• Members noted that the business case for COAG funding had been the subject of consultation earlier this year at consumer and clinician round tables
• The SRF stressed that the benefits case should be based on improvements to safety and quality of healthcare
• Members supported the submission of the business case to the October COAG meeting

Outcome Statements will be provided after each meeting, so that participating organisations can distribute them widely to their constituents. The Outcome Statement will also appear on the NEHTA website at www.nehta.gov.au. For further information please contact NEHTA on (02) 8298 2600

But hang on..I was also copied the following e-mail – which said in part:

“Dear forum members

My apologies to all - I may have caused some confusion by sending out the meeting notes with the word 'confidential' on them. Please find attached another version which does not have 'confidential' marking on them to allow you to use as briefing papers to your members.”

Guess what – they could not even get this right – the difference between the two copies was that the heading “Confidential” was removed. BOTH versions still have a CONFIDENTIAL statement in the footer.

What is even more amazing is that both these versions are quite different from the one on the NEHTA web site.

So the public is excluded from the actual minutes – short though they are - they are 3 times the length of the public version. Here is the original:

CONFIDENTIAL

Meeting No 1 of the NEHTA Stakeholder Reference Forum

Held at the Airport Hilton Hotel

Melbourne

On 29 July 2008

1. WELCOME

The meeting commenced at 9:35 a.m. with the Chair, Andrew Howard welcoming the stakeholder reference forum members and outlining the format of the day.

2. TERMS OF REFERENCE

Members:

a) Noted the terms reference.

b) Requested clarification regarding alternate attendees and were advised that this would be negotiated with the NEHTA CEO on an individual case by case basis.

c) Requested that consideration be given to changing the length of tenure.

d) Agreed that three meetings would take place in this calendar year but that the number of meetings would be revisited for the next calendar year.

e) Agreed that teleconferences would be held for discussion of specific topics.

f) Requested that the full membership list be published.

3. NEHTA WORK PROGRAM

Andrew Howard the NEHTA CEO gave a presentation of the NEHTA work program outlining the priority areas for NEHTA for the current financial year.

Members:

a) Noted the current NEHTA work program.

Members were advised:

b) That the priority areas of work in NEHTA are:-

• Individual Electronic Health Record business case for consideration by the COAG meeting in October 2008

• NEHTA’s 5 year Plan

• To proactively engage and support stakeholders

• To refocus the organisation

c) That NEHTA will be focusing on National e-health implementations in the priority areas of:

• Discharge summaries

• Pathology

• Referrals (including specialist letters and notifications)

• Medication management

d) That NEHTA is not a policy making organisation. NEHTA can raise issues to be taken to the Chief Information Officers Forum who may then escalate to the NHIPC

e) That NEHTA proposes to undertake memoranda of understanding with selected organisations in order to undertake pilot programs and to draw on lessons learned.

f) Of the governance and the environment in which NEHTA operates.

g) That the NEHTA five year work plan will be discussed at the next stakeholder reference forum.

A copy of the presentation is attached to this document for reference.

3. STAKEHOLDER ENGAGEMENT

The NEHTA CEO advised that it is NEHTA’s intention to continue an increased level of stakeholder engagement and that this will take the form of project reference groups and roundtable discussions. Members were also welcome to call NEHTA at any time to discuss a particular issue.

4. UNIQUE HEALTHCARE IDENTIFIERS

Miro Percic – Project Manager Unique Healthcare Identifiers provided a short overview of the unique healthcare identifier service . This included the key design elements, NEHTA’s implementation approach and the current status of the project.

Members were advised:

a) That COAG has made a commitment to the project and funded NEHTA to develop a national unique healthcare identifier service.

b) That there are three identifiers, one for providers, one for organisations and one for individuals.

c) That the current model relies on the ability of the consumer to provide information to the healthcare provider and that there is currently no consumer token.

d) Data will be authenticated through national registration boards.

Members noted that there were policy issues which would impact the implementation of the UHI service. Recommendations related to the these issues were made by the SRF for consideration by the Board and NEHIPC.

5. NATIONAL AUTHENTICATION SERVICE

Gil Carter – Manager Identity Management provided the context of the National Authentication Service.

Members were advised of :

a) The National Authentication Service aims.

b) The phased build approach.

c) The relationship with Medicare.

d) The incremental timelines.

Members agreed that more discussion was required on authentication validation and that this would be discussed at future meetings.

6. INDIVIDUAL ELECTRONIC HEALTH RECORD BUSINESS CASE

Roger Glenny- Manager Individual Electronic Health Record Business Case provided a presentation on the business case.

Members were advised that the business case had previously been discussed in clinician and consumer forums held earlier this year.

Members were advised:

a) Of the core components of the business case

b) The key aspirational targets

c) That the business case is not just about funding but also about build and operation of service.

d) That the benefits case is based on the improvements to safety and quality of healthcare which would result in macro-economic benefits.

e) That the case was initially developed by jurisdictions and then in consultation with Deloittes.

f) That there is a governance structure included

g) That at the core of the business case is that IeHR services will be accessible to all.

Members discussed the business case structure and the implementation requirements. There was continued support for the business case to move forward through the COAG process. It was agreed that further discussion was required on some aspects of the business case. This will be discussed at future meetings.

7. AUSTRALIAN MEDICAL TERMINOLOGIES

David Hislop – General Manger Terminology Services provided a short presentation and overview of NEHTA’s Clinical Terminologies project.

Members were advised that:

• Australia’s National Product Catalogue version 1 has been released.

• Western Australia, Australian Capital Territory and New South Wales have implemented a procurement system utilising the National Product Catalogue.

• Significant development of the Australian Medicines Terminology (AMT), including establishment of documentation of editorial rules for reliable and safe terminology is 99% complete.

• Business case is being put forward for funding for AMT for five years.

• Maintenance aspect of AMT will be where new products are input and old ones are retired.

• NEHTA is not funded for training purposes but will run a workshop around adoption approaches.

The meeting concluded at 3:35 p.m.

--- End Minutes

Really NEHTA remains out of control and it seems the new Acting CEO has made not one jot of difference to the openness and transparency of this deeply dysfunctional organisation. The spin, as illustrated here, is as rampant as ever. Clearly the meeting was not anywhere near as clear cut in its views as the ‘pseudo’ public minutes try to imply.

As a comparison – even more important meetings of the American Health Information Community – chaired by the equivalent of our Federal Health Minister – are open publicly with webcasts, transcripts and full meeting submissions provided. We seem to run a pretty faulty system here as far as openness, transparency and consultation I must say.

See here for a recent example:

http://www.hhs.gov/healthit/community/meetings/m20080729.html

NEHTA clearly has no clue what public communication and consultation is!

I also wish I could share – but can’t for obvious privacy and defamation reasons – the horrifying e-mails I have been sent recently describing the destructive organisational climate and culture that exists within the NEHTA organisation. Three separate former employees have now been in touch over the last month with awful stories. This is many more that I would expect if an organisation of less than 150 people was working well and just being unfairly defamed !

Anyone thinking of joining NEHTA should be very cautious indeed in my view, as, from what I am hearing, the organisation is pretty close to imploding under the weight of its flawed culture.

David.