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Sunday, December 14, 2008

Australia’s National E-Health Strategy – An Obvious and Disappointing Hoax.

OK, I have now had 24 hours to consider how to respond to the document released by the Australian Health Ministers Advisory Council (AHMAC).

The report is available for download here:

http://www.health.gov.au/internet/main/publishing.nsf/Content/National+Ehealth+Strategy

In a few words I am ‘shocked and amazed’ at what has just happened.

AHMAC, for reasons it chooses not to publicly explain, has released about 20 pages of the 120 page document which was developed by Deloittes. ( As expected the summary report was released Friday afternoon close to Christmas to minimise any negative reaction!)

There are some very good principles to be found among the pages we have been given but sadly, without significant funding, it can and will go absolutely nowhere and its development has been a total waste of time.

These good things include focus on applications and messaging, standards, conformance and certification, governance, and incremental staged approach and getting basic infrastructure in place.

Sadly all this will cost some money to plan and implement – and there is neither funding, organisational will or organisational responsibility for moving the strategy forward identified

Actually, what was released is a classic case of bureaucratic ‘box ticking’. A country has to have a published National E-Health Strategy – so now we have one. Sad it is a total unfunded fraud on all those who have been waiting for some sign of change over the last 4 years since the bureaucrats last decided they would not invest in Health IT (When HealthConnect morphed from a real project into a “change management strategy”). Frankly I don’t think the box has been ticked if you don’t ensure action after planning.

What is worse still it is the same DoHA leadership people who did the blocking of funding act last time.

See here for the time line of that seven or so year saga:

http://aushealthit.blogspot.com/2007/12/abject-failure-of-howard-government-in.html

It was July 2005 this happened and 3.5 years later we are very little further ahead.

I find it just astonishing that the Australian Health System cannot find the capability to invest 0.5% of its expenditure in technology that, in time, will allow it to become safer, more efficient and more sustainable. Sure I know times are tough – but they are going to become a great deal tougher and more difficult if this is not done – as every other advanced economy recognises.

While not perfect, the full Deloittes plan was a very good, sensibly costed roadmap of a pragmatic way forward which, if adopted, would have made a real difference. It would also have required some investment which it seems is simply not available for no sane reason.

This is so short-sighted it is just awful. As the title says it is a hoax on all those who actually care for our health system!

I wonder is there any chance there might be some funds in the up-coming Budget – due in May, 2009. We can only hope the $60M or so spent in “Program 10.2 e-Health Implementation” can be some core start-up funding to get something going. (That plus some of the apparent NEHTA underspend might make a vaguely useful, but very small, bucket!)

See here for 2008/09 budget details.

http://aushealthit.blogspot.com/2008/05/federal-budget-for-2008-9-e-health-cut.html

News tomorrow!

David.

19 comments:

Anonymous said...

We agree with you David, this is a very sad outcome for all Australians.

The Health Ministers cannot be blamed for the shortsighted stupidity of the AHMAC whose members, in their wisdom, have chosen to summarise Deloitte’s 120 page, $1.3 Million e-Health Strategy, down to a simplistic 20 pages.

In our collective view each and every Health Minister in Australia has been thoroughly shortchanged by the AHMAC, whose members are:

NSW HEALTH - Professor Debora Picone (Chair, AHMAC)
FEDERAL - DOHA - Ms Jane Halton
VICTORIA - Ms Fran Thorn
QUEENSLAND - Mr Michael Reid
WESTERN AUSTRALIA - Dr Peter Flett
SOUTH AUSTRALIA - Dr Tony Sherbon
TASMANIA - Mr David Roberts
ACT - Mr Mark Cormack
NT HEALTH - Dr David Ashbridge
NZ MINISTRY of HEALTH - Stephen McKernan

Teki said...

Oh, to be a fly on the wall at an AHMAC meeting. Let's say Jane Halton will not be at DoHA for another ten years. It's likely one of the State heads would be on the short list to replace her. Let's make it someone like Tony Sherbon, who's CV includes "Board member and past Chair of National E-Health Transition Authority, a past Chair of the Australian Health Ministers Advisory Council and a Board member of Bio Innovation SA", ie, a significant player. Now, would anyone who is less well connected than someone like Sherbon dare to make a worthwhile suggestion about EHR? And Sherbon is not likely to make one, if he stands to inherit a burden that's been massaged by his predecessor. None of the above shenanigans would apply if they were truly collaborative.

Anonymous said...

The states will never be truly collaborative (as Teki suggests they should be) because they are all subject to different political pressures and agendas. It is naïve to think they will collaborate until political imperatives force them to do so. They are each at different stages of maturity in their use of health IT - which is predominantly in the state hospitals.

They will leave the area of primary care to the Federal Health Department because it is a Federal responsibility.

Anonymous said...

It doesn’t reflect very well on Deloitte. Summary it may be but no recommendations, no cost estimates, no substance, no Executive Summary! Absolutely amazing. Is this the best Deloitte has to offer? I shake my head in complete bewilderment and utter depair.

Anonymous said...

The bureaucrats have taken a big step backwards. You have heavily promoted the Deloitte Strategy on this site in recent weeks but there is not much in this summary document to justify your conviction.

You may have noticed it said: “There is a widespread recognition within the sector that better use of information technology should play a critical enabling role in implementing national health care reform.”

In short it would seem the AHMAC has substantially undermined The Health Minister’s Reform Agenda for Primary Care by not releasing a comprehensive, fully costed, well argued, National eHealth Strategy. It looks very much like Jane Halton got rolled with Nicola Roxon the loser.

Anonymous said...

Your not the only one shaking your "head in complete bewilderment and utter depair". So is Deloitte. So too are all the people and organisations that put so much time and effort into stakeholder interviews and consultations. We too feel feel short changed and badly let down. Who made the stupid decision to do a Summary? Surely it wasn't all the members of the AHMAC - someone suggested and pushed for that policy. Off with their head I say.

Anonymous said...

And what do the other 100 pages contain? Surely there is nothing in there that could be construed as commercially sensitive. is there?

Anonymous said...

$1.3 million! Is a lot of money to spend. And what have we got to show for it?

The report says “The challenges and issues facing the Australian health care sector will not be solved by doing more of the same”.

The National eHealth Strategy Summary doesn’t say much of substance so it looks very much like ‘more of the same’ is the way it will be. As you say David it is a very disappointing outcome - but quite predictable.

Aus HIT Man said...

The contents of the other 100 pages are not commercially sensitive - but they sure are politically sensitive to those who hold the purse strings - or so it would seem!

I wonder how long it will be before a copy of the full report makes it to the public domain. Many within the bureaucracy have copies - as it was circulated with the AHMAC papers a month or so ago!

David.

Anonymous said...

Looks like the House of NEHTA is about to undergo another renovation which it is suggested will take 6 months or more to put into place!! That should give plenty of breathing space for ‘doing nothing’. You know, the old game of ‘let’s wait and see what …. blah, blah, blah.

Anonymous said...

It looks more like 20 pages of shallow rhetoric with most of the grit and substance removed. This leads one to ponder the (ir)relevance of the other 100 pages to which you refer. What is the competence of the consultants? How deeply have they grasped the problems? How viable is ‘the strategy’? Even more important is the multi billion dollar question(s):-

- What are we being asked to believe?
- What is the Summary telling us?
- Who will champion and drive the Strategy?

- What are the estimated costs of the 3, 6 and 10 year timeframes of each of the 4 strategic streams of activity (a) Foundations (b) E-Health solutions (c) Change & Adoption (d) Governance?

Anonymous said...

Does anyone know where we are being led (heading)?

“A National investment fund is proposed to develop high quality, scalable Australian e-Health priority solutions.”

“In order to progress activity as quickly as possible, it is envisaged that national progress towards the development of richer and more scalable E-Health solutions should occur concurrently.”

What does this all mean? Any ideas? Are we about to see the recreation of another HealthConnect under the auspice this time of a reconstructed NEHTA as suggested by an earlier contributor?

Aus HIT Man said...

All good questions.

My view was that the consultants had a pretty good grasp of what was needed.

The other questions are all really, really good questions. My assessment is we have not been given the full document because the bureaucrats / government is not prepared to sponsor and fund the implementation as would be needed to have it succeed.

Close reading of my original post will give you a flavour of the suggested costs. Benefits were well north of costs.

David.

Anonymous said...

Whether Deloitte have delivered what was required in the 1.3 million dollar contract can only be determined by comparing back to the scope of work as defined in the original tender for this work, plus any subsequent changes to the actual contract. Perhaps whoever tendered did not ask for costs and tactical implementation plans....another tender gone wrong?

Anonymous said...

Careful Teki - didn't you know that all AHAC Members are issued with a fly swat. Splat.

Anonymous said...

As you say "we have not been given the full document because the bureaucrats / government is not prepared to sponsor and fund the implementation as would be needed to have it succeed".

That sounds like a case of heads you win, tails they lose. But think about it this way - I don't think it should be a case of whether or not "the bureaucrats / government is .... prepared to sponsor and fund the implementation .... "

That's a furphy of the highest order. If the funds aren't available at present - SO BE IT. That's life, that's reality, that's even acceptable given the current global financial climate. That's not the fault of the government or the bureaucrats.

In fact the funds may not be available for a few years. So be it. But not to put it out there on the table for all and sundry to consider is real Faulty Towers stuff.

There are a variety of ways the 'problem' can be solved. But the first step is to want to solve the problem. At this point all that one can reasonably conclude is that no-one in a position of responsibility wants to even think about how to solve the problem. That equates to an AHMAC which is of little value in terms of its capacity to appropriately guide and advise the Health Minister.

Sadly, the downside for our Health Minister Roxon and her Primary Care Reform Agenda is vertically south - because the changes she wants to make are very dependent on eHealth.

Anonymous said...

Refer to the question on page 13 "What can be delivered nationally?” It says “Two pieces of high priority E-health solutions infrastructure where a national approach to implementation appears worthy of serious consideration.
(a) Health knowledge portals
(b) Prescriptions service.”

The NHHRC’s Booz & Co Report probably provides a good part of the answer to where we are being led in terms of eHealth Application Solutions.

Aus HIT Man said...

Re Comment Monday, December 15, 2008 2:06:00 PM

Of course the funds would be available if it was seen as important! A few hundred million per annum in a $trillion budget can be found if there is the will - or the understanding of how important it is.

Bottom line is that there is no understanding of the importance and value of Health IT among the clowns who claim to be our leaders. Simple as that - and correcting that problem is now the priority.

David.

Teki said...

Pulling on another hat, I've had another look at the problem - how to convince those in control of the agenda to have a good go at mapping at a proper ten year plan.
Well, "they" will not do that, it's too big. Instead of a blunderbus approach, it may be more politically useful (and strategic) to break IT applications down so they fit into existing funding templates.
A group such as AHMAC may be required to adhere to agreed policy, as in the National Health Priority Areas, if the direction from VicHealth is a clue. If so, they would look at IT in terms of how it will affect policy settings. That is, whose hands are on which policy levers? An over-riding factor for considering changes to allocation of resources will be to address the question of "How will it be funded, ie, where is the money coming from?" Of course, the standard answers run along lines of efficiency, safety and quality, with outcomes in research and prevention further down the ten-year track.
Therefore, I think it would be smarter to start with the NHPAs.
Of the seven areas, the two with the most promise of providing costed inputs and outputs are Cancer and Diabetes.
I'd choose Cancer Control, since it seems more straightforward, ie, it isn't tangled up so much with lifestyle issues. Either, though, have big pharmaceutical figures in the mix. However, unit doses of new cancer drugs are very expensive, so there are incentives both from consumers (taxpayers) and the industry to acquire much better data from populations. Hence the money going into cancer databases.
Another reason for better IT in health care revolves around clinical trials. If this discussion continues, I'd like to see that domain explored.