Quote Of The Year

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


H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Monday, September 08, 2008

NEHTA and Openness – Just What is the Problem?

In the last week there has been a lot of press commentary about the appointment of the new NEHTA CEO. All well and good but equally there have been some worrying comments from the old acting CEO as well.

The four that struck me were the following in discussion about the Stakeholder Reference Forums that have recently been conducted and the conflation of that with the planned IEHR.

From ZDNet we have:

“The Forum was set up in part as a response to a review by the Boston Consulting Group published last year.

Members of the forum signed a non-disclosure agreement which bound them from talking about specific topics, however some information was released.

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 wanted NEHTA to focus on were developing systems for electronic discharge summaries, pathology reports, specialist referrals and medication management.”

Full article here (Suzanne Tindal):


Next again from ZDNET we have:

“Howard said that the gag order was so that NEHTA could share more information, not less, and was in line with normal corporate standards. "NEHTA is a company that has responsibilities and the directors of it have liabilities that any company has," he said.

"It's about being able to engage with members and share budget figures, issues and taking feedback from that forum. There could be a point where we could discuss the inner workings of the company, which means they need to be covered by confidentiality arrangements."

A major challenge for Australia's e-health plans has been achieving consensus amongst state health agencies and medical providers on how to transition away from paper-based systems.

"Today that common vision does exist... Right now there is a focus on high value transaction services and standardising information so that clinicians can access it at the point of care," said Howard.”

Full article here (Liam Tung):


Then we have from the Australian Financial Review:

“The new NEHTA chief executive comes into the organisation as it prepares to submit a business case for a national electronic health record to the Council of Australian Governments next month.

Mr Howard has shepherded the business case through its final stages and Mr Fleming will be briefed on the contents of the document over the coming weeks.”

Full article here (Ben Woodhead):


And from the Australian we have:

Mr Howard said reports that stakeholders taking part in recent reference forums had been "gagged" were untrue.

"In fact, having participants sign non-disclosure agreements means we are able to share NEHTA's inner workings -- all the way to business cases, financial budgets and work programs - with them," he said. "Our intention is to give a greater voice and power to these parties.

"Naturally, NEHTA is a (not-for-profit) company, the owners are the governments of the nation, but there are directors that have direct liabilities just like any other company director. Managing those responsibilities means we have to have these constraints."

Full article here (Karen Dearne):


What is being reflected here in my view is a passion to keep secrets that is totally unjustifiable. I don’t give a hoot whether NEHTA is a company, a trust or actually part of the Government. It is planning to put a major funding proposal to Government (in the form of the Councils of Australian Government - COAG) and is claiming it therefore can say nothing.

This is just rubbish.

No one wants to see the detailed budget spreadsheets. However the public should be provided with the following.

1. A detailed description of what NEHTA is proposing.

2. A broad outline of any planned timetables and implementation plans.

3. Details of the Privacy Impact Statement that has confirmed the plan is privacy protective (Not a promise to do the work after it is funded)

4. In industry impact analysis (who are the winners and losers if the project goes ahead).

5. A broad outline of the projected costs and the value that will derive from going forward.

None of this is commercially sensitive. To provide such information would make sure there is the right amount of accountability, discussion and scrutiny of the plans. Briefing a few selected stakeholders in secret just does not cut it in my view!

Given the CEO change I am hoping for a dramatic improvement in openness very soon. The old way is just not good enough.

Final remark, – also given the CEO change - I would be very surprised if we see anything go to COAG before December 2008 at the earliest.



Anonymous said...

Nehta’s new CEO, Peter Fleming, has had plenty of experience in dealing with the frustrations of working in large complex organisations. Nehta is no exception, given its turbulent history. Regardless of political pressures and the hyped-up sense of urgency being pushed by so many, he is cautious enough to ‘take the foot off the pedal’ and ‘bring a pause’ to the proceedings until he is ready to move the organisation forward. He is also astute enough to seek the counsel and perceptions of some others from well outside the tent. After Andrew Howard’s handover it is to be expected he will then take the opportunity, and whatever time he needs, to consider and reflect at some length before stepping forward into the minefield.

It is to be hoped, that those who have criticised nehta in the past (often, quite justifiably) will now step back and let Peter Fleming provide the leadership required.

Anonymous said...

A good case can be made for any organisation, be it public, private, or political, to avail itself of advice and opinions from a range of stakeholders as it evolves its plans and strategies for the way ahead. The evolution of the process of thinking, strategising and planning should not be required to be made public to anyone; except those chosen by the organisation to be privy to the process. When the ‘process’ has reached a stage of maturation, ‘some’ of the plans and thinking behind them may well be made public for others, including yourself, to comment upon. Even so, probably much will not be made public - nor should it be. Consequently, Nehta’s approach is valid - provided at predetermined points in the process the non-commercially sensitive information, such as you enumerate, is made available for wider comment and input. There is no reason to believe Nehta will not do just that. If it does, one hopes you will be satisfied.

Dr David G More MB PhD said...

If this was near the beginning of the SEHR (or IEHR) process I would agree - but with the application for funds being made in the next few months after almost 3 years - the time has come to let the public know just what is being planned and why.


Anonymous said...

We're at the beginning of the SEHR process. That three years have elapsed doesn't mean we've made it off the starting line. If Nehta has the guts to implicitly admit that they have to start all over again, that's a good thing, not a bad thing.

And that might well be something that they're willing to say behind closed doors, but which they can't afford to say in public, for a variety of reasons.

Dr David G More MB PhD said...

It could just be the public are entitled to ask just why people have had salaries paid for 3 years if they have got no where as you suggest? A status report could hardly be a bad thing.

Just what variety of reasons justifies public officials not being reasonably forthcoming?


Anonymous said...

Plenty of organisations run into troubled waters. When that happens the shareholders revolt, the Chairman makes a statement and heads roll - sometimes that includes Board members' heads.

Now, two heads were basically responsible for Nehta's state of ill health today. The first was the founding CEO and his head has well and truly rolled out the door. The second head was the founding Chair who did not insist on Board and Executive accountability. Her head too has now gone.

There has been an interim period of calm. A new Chair (who well understands the process of good governance) has been appointed. So too has a new CEO - who has yet to take up his position.

In time - not tomorrow - the Chair and CEO may well decide to make a joint statement. They may well say Nehta needs fixing. They may well produce a status report. This is not the time to do so. Let them come to grips with the 'business' they have now (or are about) to inherit. It would be helpful to the Chair and the new CEO if you now refrained from jumping up and down like a yo-yo and gave them some time to look around and come to grips with the issues. They must then be allowed to come up for breath. In other words - be patient.