I think it is fair to say it has been a bad weekend.
As reported over the weekend we have had the following statement from the Council of Australian Governments (COAG) on e-Health.
“E-Health
COAG noted the progress of the National E-Health Transition Authority and agreed to the continued funding of $218 million (50:50 cost shared between the Commonwealth and the States) for the period July 2009 - June 2012 to enable it to continue its existing work program.”
The Commonwealth contribution is as follows.
E-health (NEHTA)
2009/10 - $28.7M
2010/11 - $39.2M
2011/12 - $41.0M
Total $108.9M
This is ½ of the total as the rest will come from each of the states.
As pointed out by a correspondent this is really very rapid growth from the 2007/08 financial years sum of $38.715M to approximately $82M in 2011/12.
The real increase in activity could actually be a little more than the figures indicate given all the consultants that can be replaced with more permanent staff now funding is clear for the next 3.5+ years.
If this is to be all the new money for e-Health ($30-40M extra per year over current spend at Commonwealth level and almost certainly flat to negative spend in the States (Mr Garling SC recommendations for NSW Health IT notwithstanding) then progress, if any, will be dreadfully slow!
What this funding of NEHTA for the next few years has done has ensured that its leaders feel vindicated in the way they have behaved – they have essentially been ‘patted on the head’ – and any real stimulus for ‘root and branch’ change has been lost.
There is also a bit of a problem in that without a co-ordinated national direction it is a little murky as to who will be able to get the full value out of the planned NEHTA spend.
More importantly what has been lost is the opportunity to put in place the sort of national strategy and national governance of e-Health. This will lead, almost inevitably, to waste and inefficiency in how the new money is spent. Of course that waste and inefficiency will be dwarfed by what will flow from failing to properly automate the health sector.
It is clear that without judicious, planned – but quite large – investment in Health IT that our health system is drifting towards the un-sustainable. Not getting going now in a serious and co-ordinated way will come back to cost us all dearly in the future. (much like not addressing Climate Change early means you pay a lot more to fix things up later).
With this expensive and large outcomes of this COAG meeting it is virtually certain that Commonwealth Investment in Health is going to exceed 10% of GDP, if not get close to 11%, especially as our economy contracts because of the “Global Financial Crisis”. Health IT can slow this growth – but only if you invest in it!
What has also been lost is an opportunity to commence planned co-ordinated investment in Health IT in a way that is designed to maximise benefit to all the actors within the health system.
Whoever decided not to fund and implement the Deloittes developed National E-Health Strategy for Australia – after so many stakeholders agreed we need such action – is to be utterly condemned.
Ultimately it is the Federal Minister who must take responsibility for this decision and she should be asking very hard questions to assure herself she has not made a major mistake which will cost a great deal to remedy both politically and financially.
Remember not only has the National E-Health Strategy been canned but also has the IEHR, which was the reason NEHTA was said to be mainly developing their infrastructure. Talk about ‘being all dressed up with nowhere to go’!
We now have a situation where there is confusion between the Deloittes Strategy and the NEHTA IEHR proposal. The Deloittes approach is correct – but because the waters have been muddied -neither have gone forward. That is a huge mistake in my view.
The only, and last, hope left is that the Australian Health Ministers Advisory Council Meeting (AHMAC), which meets at the end of the week (I am told), unlocks funds from the National Health Infrastructure Fund to get things going properly. I understand this fund is separate from the COAG funding.
As far as the future is concerned, if that last hope does not come off, I see only fragmentation and waste with worsening levels of quality and safety within our system. Sad that.
David.
20 comments:
Hi David,
I think you're right that AHMAC are meeting quite soon and certainly the DeLoitte Strategy was originally commissioned by the NEHIPC which is a subcommittee of AHMAC, so it makes sense that it would go back to AHMAC first.
Your hope of that helping to unlock funds from the National Infrastructure Funds is tantalising - after all what we need for progress on eHealth is a fund that can support the national coordinated rollout of infrastructure. Tantalising, but possibly only a dream - we shall see as the weeks and months progress.
On your other points that make distinctions between the NEHTA IEHR proposal and the DeLoitte's strategy, the sad point is that we don't know the difference because we have not been engaged in the process.
From my understanding (and I've only seen parts of one) the two strategies notionally combine. The DeLoitte strategy differs in that it describes a set of practical steps to take towards improving eHealth (with one possible step in the future being an IEHR) whereas the NEHTA IEHR business case is more a set of steps towards the 'silver bullet' IEHR.
However, I'm only surmising from snippets and conversations because neither have been shared publicly and the engagement process for both has been very limited. In particular, NEHTA have been staggeringly avoidant of any real engagement or discussion around their business case for the IEHR. But this is the pattern of NEHTA - selective engagement with parties in agreement with their particular views, but quick to disengage if you present any conflicting views.
I think the IEHR Business case became the NEHTA business case - ie. the business case for their very existence.
The funding granted would seem to be only a tiny fraction of what would be required for the establishment of national infrastructure to support an IEHR, so I have to assume that we will either have another three years of zero progress, or there is some other game in play.
It is a pity that all these strategies are not open to debate and discussion. Then we might have a level of public, industry, academic and clinical support that would actually encourage government to make the kinds of real investment required. Instead we just end up with the same old rhetoric.
Frankly - we all need to demand greater honesty and transparency from those involved. Will it happen? I fear not. Its up to Roxon and no evidence I have seen suggests she gets this message.
Many thanks for the thoughtful comment.
David.
It is rather presumptuous of you to suggest a decision has been taken "not to fund and implement the Deloittes developed National eHealth Strategy for Australia". As far as I can see there is no evidence to suggest such a decision has been taken.
Given there was an e-Health funding decision from COAG a day or so ago I would have expected a suggestion in that announcement of "more to come" if it were true. So I don't see it as presumptuous - given I have made it clear I am still hopeful, but by no means confident, of other sources.
David.
$46 million over the next 4 years was announced in the 2008-09 Federal Budget for the establishment of the National Rural and Remote Health Infrastructure Program (NRRHIP) which amalgamates Rural Medical Infrastructure Fund (RMIF) and the Rural Private Access (RPA) Program. As this will be split into multiple small grants it won’t make a dint in the eHealth funding you seem to be calling for.
Bill Ferris, a venture capitalist and Chair of the Advisory Board for the $10 billion Health and Hospital Fund would not entertain anything other than what the Infrastructure Fund is intended for - eg hospital upgrades, medical equipment, research facilities - eHealth and IT infrastructure would therefore need to be included in the Fund’s Charter. Has Legislation to create the fund passed the Upper House where Labor lacks a majority?
You appear to be calling for both a commitment to spending on an IEHR (as Australia has started calling it) and establishment of a strategy for e-health. Surely the latter must come before the former. Spending on NEHTA has so far not yielded an e-health strategy. How can more spending on NEHTA yield one?
Not quite! I want the Strategy that has been developed by Deloittes funded and the IEHR is a small part of that - down the track - after other more urgent things have been done. Keeping in some functional form, but not doubling, NEHTA is also part of the Deloittes approach.
David
Commentator (Monday, December 01, 2008 8:55:00 PM) said that the funding granted (under COAG) would seem to be only a tiny fraction of what would be required for the establishment of national infrastructure to support an IEHR.
That sounds like a reasonable assumption. So, in order to be better informed, the following questions need to be answered:
A. What is the anticipated cost of the Deloitte Strategy over 10 years? ($T)
B. What major program costs comprise the total - $T? ($Pn, $Pn+1, $Pn+2, etc)
C. What estimates, formulae and assumptions have been applied to arrive at the cost of each major program? (e, f, a)
We also need to know what funds, State and Federal, have already been budgeted under various programs underway in State and Federal jurisdictions. ($S, $F)
What proportion of %S and %F should be offset (deducted) from $T?
You might be quite shocked by what little is left of the total $T after you have deducted a significant % of the monies already allocated and budgeted for e-health projects by the States, the Territories and the Federal Government (which includes DOHA and Medicare Australia).
As your correspondent said on Monday, December 01, 2008 8:55:00 PM … “Without access to the Strategy Document it is unclear how the two strategies notionally combine” .
You said “The Deloittes approach is correct …… ” - which suggests you have full knowledge of the Deloitte Strategy document!
You said that what you want is to see the Strategy funded so that ‘more urgent things’ can be done. This sounds like you want to keep NEHTA on hold in some functional form (in some kind of limbo) which, you state, is also part of the Deloittes approach!
It’s time for some answers and straight talking. The bureaucrats are doing what ‘The Hollowmen’ do best - muddying the waters - confusing the issues - deviating from the main game. Just like pre-NEHTA when HealthConnect fell apart.
It’s time. It’s time for some hard, fast, transparent answers. What are they?
What funding is needed to implement the Strategy?
What is required to keep NEHTA on hold?
What do you mean by “some functional form?”
How would that impact NEHTA’s workplan?
What are the implications for NEHTA’s staff and consultants?
Why not implement the Deloitte Strategy by using NEHTA to do so rather than isolating NEHTA and thereby undermining its viability?
A few comments:
1. I don't know how much, if any funding will be made available to implement the Deloittes Strategy.
2. That said I know the broad outlines of what they are suggesting and believe it is as I explained a blog or so back. I also think it is pretty close to what is needed.
3. Part of that is to keep NEHTA's projects (IHI, SNOMED, NASH etc going forward at maximum pace - hence I want a "functional" delivery of that work as I believe does Deloittes. I am not about or suggesting putting NEHTA 'on hold'
4. I also believe - and I am not sure at all about Deloittes - that NEHTA needs major reform, better governance etc - as I have been saying for years - and I have not changed my mind. The BCG said that also - ages ago.
5. Given my druthers I would implement the strategy by absorbing NEHTA's functions (and some others) into a new, better governed, more accountable, non private entity.
6. My view of urgent things is getting basic applications, messaging and standards based systems operational in case that is not clear.
I hope that helps.
David
All I can say is thank goodness for this blog. How else would all the e-health workers out here find out what is happening. This blog and all the comments and discussion at least give us some insight into national and other intiatives. Please keep it going.
Understand this. Deloitte has delivered the National E-Health Strategy. NEHTA and its Board of Governance are giving the Strategy full consideration. On 29 Nov COAG authorised NEHTA to drive eHealth forward in Australia until 30 June 2012. NEHTA has now secured the funding it needs to cover that period. NEHTA is now in a position to implement the Deloitte Strategy where and when appropriate and practicable to do so. An announcement to that effect should not be too far away.
Dead wrong!
The Deloittes Strategy does NOT report to NEHTA. It reports of the Australian Health Ministers Advisory Council (AHMAC) via the National E-Health Information Principle Committee (NEHIPC).
An area of consideration by the Strategy was what to do with NEHTA - as essentially recommended by the BCG and AHIC.
If you think otherwise you are badly misinformed.
David
David, it seems to me that what has caused you to despair is actually the outcome of deliberate policy decisions, not wilful neglect. In QT today, the PM was challenged by Peter Dutton to reflect on a promise made by Labor that they would, if necessary, bring hospital governance to a referendum if the current split approach failed (again). The PM defended their stance and said "nothing has changed".
There is a new AIHW report on projections of disease burdens. The prevalence of diabetes (type 2) will increase by 400% over 20 years, largely driven by obesity. So, a government can, at this stage, throw their hands in the air and refuse to spend in order to prevent a few medication errors when a vastly greater cost will accrue from what people are choosing to put in their mouths.
Nicola Roxon in QT, after the above episode, answered a question on the COAG funding formula. Just at the moment she mentioned DoHa's "waist watch" initiative, Joe Hockey's bulk obscured the view. Ms Roxon mentioned the tape measures being given out by DoHA, and the PM must have made a comment about his own waist size. There was a bit of jollity about that. But, surely, the government could be challenged to put up data that shows DoHA's tapes will cause people to lose weight. Or not, if the PM himself cannot be a leader in fat reduction, despite being in possession of a tape measure. And from where would they get the facts and figures to prove their case? From GPs desktop software? That's laughable, but it seems Ms Roxon does not want to know about failed interconnectivity just yet.
I didn't suggest that the Deloitte's Strategy reported to NEHTA. I did understand it reported to AHMAC and NEHIPC.
What I did say was that "NEHTA and its Board of Governance are giving the Strategy full consideration." Indeed they would be very stupid not to; very stupid indeed.
If NEHTA's Board likes what it sees in the Strategy it may, with the appropriate level of political support, believe the Strategy should be implemented in full. If so, NEHTA will need to cut its cloth accordingly and it may well do so. That is what I meant when I said "NEHTA is now in a position to implement the Deloitte Strategy where and when appropriate and practicable to do so."
Surely that line of thinking (as a possible outcome scenario) is not too difficult to get the head around?
Sorry,
It is not a matter of what NEHTA likes in my view..it is what it will be told to do by Government. Government actually controls it 100% remember!
Already that getting NEHTA under control process is underway - take it from me by the way NEHTA has behaved over the last 2 years they have lost any moral authority in my view.
Another, new, organisation will have to implement the Deloittes strategy and NEHTA will have to do what it is told I believe.
I follow what you are saying - but NEHTA needed to start being a team player at least 18 -24 months ago in my view to survive as it is. It just didn't because of a CEO we all now want to forget.
David.
David - Tuesday, December 02, 2008 7:36:00 PM in reply:
Para 4 - I concur 100%+.
Para 3 - perhaps NEHTA can become (organisational and management and Board changes notwithstanding) that new organisation to which you refer, alternatively, and I will not argue against it, there may well be considerable merit in putting another supervisory overarching organisation on top of NEHTA.
Para 2 - I am unable to accept that current management should be held accountable for the period prior to the departure of the founding CEO - whose name shall not be mentioned here. New management is in place and the jury in all fairness is still out on that score.
Para 1 - Government controls it 100% - I agree. What is politically expedient will be a significant determinant of the final solution.
Hi,
Happy with all except your comments on Para 2. There are still too many in NEHTA who have not got what their new management is telling them and what their clients demand. Six months from now it could be different. I hope so!
We will all see. The Pathology comments report today certainly reflected a much better, but still needing to evolve, approach.
David.
Post a Comment