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Monday, November 03, 2008

The Senate Estimates Chronicles – What a Horrible Performance from All Sides

On October 22 the Senate Standing Committee on Community Affairs conducted some hearings.

The following is extracted from Hansard.

The full transcript material from Hansard is found here:

http://www.aph.gov.au/hansard/senate/commttee/S11355.pdf

Page 20

Dr Allbon—I might add that there will of course be data development areas that are identified within that schema, and the extent to which further work and further agreements can be made between the states and territories would really depend on what they decide is a priority to do some further work on in that area. But it will be absolutely up to the political players or the policy players in that arena to decide where they want further work done.

Ms Halton—The other thing I would say about this, and I have experienced this over many years working in this field at varying levels, is that there is a real tendency particularly amongst the more junior officers sometimes to stand on their dignity a bit about what the definition of, say, an orange should be: ‘In Queensland an orange looks like this but in South Australia an orange looks like that and we’re just not going to agree on it.’

Senator BOYCE—Well, actually, ours would be the best!

Ms Halton—That is absolutely my point. Yours are the best, but regrettably someone else thinks theirs are the best, and you just have this absolute standoff about definitions. We are doing this in the e-health environment as well, and I actually recently said to a group of—and I am allowed to say this, with an apology—propeller heads—

Senator BOYCE—A group of?

Ms Halton—Propeller heads, the people who are down in the details. I said, ‘You’ve got two choices: you guys can come to agreement about what an orange is or we are going to decide what an orange is; what would you rather?’

Senator BOYCE—Was there a specific orange in this case?

Ms Halton—Yes, there was a specific orange in this particular case.

Senator BOYCE—And it was?

Ms Halton—I would have to remind myself exactly what it was, but it was a particular definitional issue which we had not been able to get resolved among the junior technical officers, and so the senior officers had basically said: ‘We have to have a standard definition. We are going to decide this unless you give us a universal recommendation.’ And then they did give us a recommendation. What the process we are going through at the moment has enabled us to do is effectively crash through some of that stuff, isn’t it, Penny?

Dr Allbon—Yes.

Page 140

Senator BOYCE—I have a couple of quick questions around e-health, for want of a better word. I was surprised, at the time that we did a related inquiry into the Patient Assisted Travel Scheme, at the apparent lack of interest in using e-health initiatives amongst the medical profession. You have a way of measuring your electronic communications by service providers—is that correct?

Mr Davies—We have very good data, which I think you are about to hear, on healthcare practitioners, particularly GPs, who are equipped with computers and who use computers for particular applications, if that is what you are looking for.

Senator BOYCE—Yes, that would be good.

Ms Morris—I can tell you from memory it is over 90 per cent, but I am not sure exactly.

Senator BOYCE—Ninety per cent have a computer and use—

Ms Morris—Use it for a range of electronic things. When you divide down what they are using them for, you get less for some functions that you might think would be useful in an e-health environment or require a bit more commitment to the use of electronic communications.

Senator BOYCE—I was thinking in terms of innovative use. Perhaps you might like to tell me a little bit about what you mean when you say you get less when you get down to things where you feel it might be useful.

Ms Halton—While people are page flipping down that end of the table, can I make a general observation. You would be aware that all of the governments funded the National E-Health Transition Authority some time ago, which is precisely around spreading e-health, if you can describe it in that rather generalist way.

Senator BOYCE—Yes, I was struggling a bit for another word. No-one seemed terribly excited by the idea, except at a very basic level, from what I could understand.

Ms Halton—Yes. It is probably important to understand that there are a whole series of things that you have to do to realise the whole e-health vision, and some of those are about putting in place basic infrastructure. There are things that we all know about, such as broadband and having computers on desks— the things that we understand as people who operate in the day-to-day environment. Then there are things which probably are not very well understood. I think I mentioned propeller heads earlier today. This is kind of the arch propeller head—real nerd city.

Senator BOYCE—The databases.

Ms HaltonRevenge of the Nerds! People worry about standards; interoperability; issues in relation to nomenclature, in other words, making sure when we describe a ‘right leg’ everyone is talking about the same thing; catalogues of medicine; and I could go on and on. Having got all of those things, what you need is the software and the ability to uniquely identify individuals—so Senator Sue Boyce is Senator Sue Boyce and nobody else—and we need to be able to identify practitioners and locations. When you have all of those basic components, then you can build a very large e-health capability, but what you do, even if you have those components, is start on some basic things—what software do you have on the practitioner’s desk that enables them to record, for every patient they have, basic information: name, date of birth, height, weight et cetera?

Senator BOYCE—But, as you said, this initiative did start some years ago.

Ms Halton—Yes.

Senator BOYCE—So I am trying to get a sense of whether we have gone anywhere.

Ms Halton—Yes, we have. We had a program that did that infrastructure thing—the broadband et cetera— and that went incredibly well. People connected, both doctors and pharmacists. What NEHTA has been doing is building the infrastructure—those nerd-relevant things which the public do not have any interest in, and nor should they—but you need to make the system workable.

Senator BOYCE—But people would have an appreciation of it through their own businesses et cetera.

Ms Halton—Some, not all. But that work is—and I touch wood when I say this—actually nearing

completion. We have done incredibly well. There is still some way to go on this, but it is pretty close.

Senator BOYCE—What is pretty close, sorry?

Ms Halton—The basic standards which will enable inoperability—describing the right leg as ‘the right leg’ and making sure that the messages that come from one place can be reliably interpreted by the next place and that they are secure, because that is incredibly important. What we are doing now is talking about the beginnings of moving messages around the system so that business is conducted electronically. There are some obvious early areas which we are already working on—moving prescriptions around electronically. Not only will you get it produced if you have a hard copy off a computer, not in that spidery handwriting that pharmacists know and love but more usefully having it sent electronically to the pharmacy—

Senator BOYCE—To the pharmacist.

Ms Halton—where you want to go and collect it so that, when you get there, it is prepared.

Senator BOYCE—Yes.

Ms Halton—And then you can keep building layer on layer with that so that eventually what you end up with is a fully operating electronic health world. I say in electronic health: it is a bit like health itself. People say to me, ‘Jane, when are you going to fix health?’ Actually you never fix health. Health just continues.

Senator BOYCE—Incremental development.

Ms Halton—And this is exactly the same with electronic health. But what we are working towards is the first version of the universal electronic health record. That is the aim in the short to medium term.

Senator BOYCE—So you are saying that we can expect a quantum leap in the nearish future because all this will be bedded down. Is that what you are saying?

Ms Halton—I am always nervous about saying ‘quantum leap’.

Senator BOYCE—Yes, well, say something else then.

Ms Halton—Yes.

Senator BOYCE—Use another term for me.

Ms Halton—What I am more inclined to say is that people will start to see the benefits of the investment and the tangible difference it makes in the near future. Until now a lot of it has been, I think, invisible to patients. They know that the doctor when they go to the surgery has a computer on the desk, much more these days than there used to be, and they tap away on it. Do they really notice it? Does it really make a difference to them, that they are aware of? Once, for example, your discharge record is electronically transmitted from the hospital you are admitted to, to the general practitioner, that is when you are going to see a difference.

Senator BOYCE—Yes.

Ms Halton—When your test results are transmitted. When your mammography, which is done in one location, can be sometimes read at a distance by a practitioner because you might not have someone who can read it where you are. You have someone who can actually do the mammography, but they cannot read it, but if that can be read at a distance then your general practitioner has access to that. Those are the kinds of changes that we are talking about.

Senator BOYCE—We are about to get into a catch-22 where the sort of technology that you are talking about could assist a lot in regional and remote areas.

Ms Halton—Absolutely.

Senator BOYCE—However, the broadband and other connections in the regional and remote areas may well prevent that.

Ms Halton—To be fair, you know that the rather unfortunately called DBCDE—is that right?

Ms Morris—DBCDE, or ‘Debesity’, yes—instead of ‘obesity’.

Ms Halton—which we think, given that health—

Senator BOYCE—‘Debesity’?

Ms Halton—DBCDE.

Ms Morris—It is the opposite of obesity.

Ms Halton—No, I think it is worse than obesity.

Senator BOYCE—Debesity?

Ms Halton—Yes, the department of—

Ms Morris—Broadband, communications and the digital economy.

Senator BOYCE—Yes, sorry. Now I know who you are talking about. I thought you were talking about the opposite of obesity there for a minute. I was very confused.

Ms Halton—Well, maybe they are. I do not know. As you know, they are rolling out broadband—the whole strategy in relation to connecting the nation—and we are talking to them about the need to ensure that that capacity is absolutely available for health. We have been talking to them quite specifically—

Senator BOYCE—So it does not become a basis for institutionalised discrimination.

Ms Halton—Yes. Health is an obvious and early application for that capacity and we are very conscious that it has huge potential in the bush, and so we really need to make sure that that is available to people in the bush.

Senator BOYCE—Mr Cameron was going to give me some figures. Is that right?

Ms Morris—Despite a lot of page flicking, I do not think we have it.

Senator BOYCE—Okay. That is all right.

Ms Morris—But I will just say that we do have them and we will take it on notice.

Senator BOYCE—That is great. Thank you, because it is a huge and helpful area. I am happy to stop. I have one more question, but I will put it on notice, if you prefer.

These exchanges are really deeply disappointing. Both sides (the bureaucrats and the politicians), look quite unaware of any e-health vision, let alone how the work that has been done actually fits into the big picture. What I hear from all this is a lack of commitment to get things done on the part of the bureaucrats and a lack of sufficient insight on the part the their inquisitors to even know what the right questions are to hold the bureaucracy to account.

This impression is just confirmed when one reviews the 2007-8 Department of Health Annual Report.

The important section is found here:

http://health.gov.au/internet/main/publishing.nsf/Content/33F737C91421ADA0CA2574E3001D3470/$File/Outcome%2010%20Health%20System%20Capacity%20and%20Quality.pdf

I have no idea how the Department can claim so many successes and performance indicators being met when the real state on the ground is largely unrelated to their activity and much more related to the efforts of the dedicated to move forward despite the ‘dead-hand’ of the Commonwealth in so many areas.

This report describes no reality I can recognise! A true spin city!

David.

2 comments:

Anonymous said...

What can one say? - other than this is a perfect reflection of sheer incompetence arising though a total lack of any understanding on the part of the bureaucrats combined with a naive preparedness by the politicians to believe whatever the bureaucrats tell them.

This alone explains in full why $130 plus million dollars can be spent over the last few years by Ms Halton's Department with very little to show for it and no accountability by her or anyone in her department.

It is quite sickening to read your Chronicles from the Oct 22 Senate Estimates.

Anonymous said...

Your previous commenatator asked "What can one say?". The answer would have to be TRES TRAGIC.