I must be from a very old school, or totally naive, but I really believe that when reports are commissioned by Governments on matters that don’t affect national security and such like matters the openness and transparency is a good thing and that Government secrecy is a really bad thing.
In the present context it is good to see the National Health and Hospitals Reform Commission actually releasing discussion papers and submissions. It is also amazing that some submissions should be confidential – surely anonymous as the author is good enough – but not so for reasons I can’t even begin to guess at.
As a result of the release of the most recent paper on e-Health the issue has again raised its ugly head.
This paper is found here:
E-Health - Enabler for Australia's Health Reform, Booz & Company, November 2008.pdf (PDF 1082 KB)
As I browsed I noticed the following reports – which to the best of my knowledge are not in the public domain.
1. Allen Consulting Group, “Economic impacts of a national Individual Electronic Health Records system”, July 2008.
2. NEHTA, “A National IEHR Service Business Case”, COAG 2008
3. KPMG, “Cost Benefit Analysis of Shared Electronic Health records”, NEHTA, September 2007
These need to be added to the following:
The matters discussed here:
http://aushealthit.blogspot.com/2008/09/nehta-and-openness-just-what-is-problem.html
and here:
http://aushealthit.blogspot.com/2008/06/just-why-are-nehtas-plans-for-shared.html
There are, of course, a legion of consulting reports and modelling developed for NEHTA which have never seen the light of day and probably never will – and I know because I wrote parts of some of them!
We are also yet to see the detailed of the evaluation of the Eastern Goldfields Reference Project which was submitted in June, 2006 to DoHA. Of course none of the earlier HealthConnect evaluations ever saw the full light of day as well – so no lessons have been learned except by the bureaucrats who received these reports and who for the most part have now moved on. It really is just hopeless.
Of course state Governments are as bad. Anyone seen this one?
NSW Department of Health, Healthelink EHR Evaluation (KPMG), May 2008.
Of course not.
Until this all changes – with the best will in the world – we will continue to stumble around repeating mistakes and making a general mess of things!
Access to the information in these reports is vital both to ensure investment proposals receive the appropriate amount of scrutiny at both a business and technical level and that mistakes made and ideas not included in analysis can be given due consideration.
DoHA and the new NEHTA CEO could make a difference by responding to these suggestions.
I really hope this may change – but I am not holding my breath!
David.
15 comments:
In the Garling Report Vol 2 we read:
14.227 NSW Health is running 2 pilots on the Electronic Health Record, called “Healthelink”, one in Maitland and one in Greater Western Sydney. A state-wide roll-out of the Electronic Health Record is scheduled for 2016 at a cost of $144.3 million.
In the Booz & Co Report, page 27 Table E-Health Initiatives NSW Jurisdiction we read:
Healthelink – $40m program to roll out a Medical Record system for the state's eight area health services by 2009.
2009 or 2016 ???????
In the interests of credibility would Booz & Co please explain the discrepancy.
In the Booz & Co Report Page 30 Figure 9 shows the Cumulative Net Benefits of Alternative IEHR Strategies.
Option 3 National IEHR $26 Billion
Option 2 Independent IEHRs $6 Billion
Option 1 Do Nothing $4 Billion.
Only the naive and gullible would take such figures at face value.
The graph in figure 9 is cross referenced to the KPMG "Cost Benefit Analysis of Shared Electronic Health records - NEHTA September 2007".
It is difficult to believe the contents of the KPMG Cost Benefit Analysis 2007 should not be a publicly accessible document. $26 Billion is a very big benefits claim!!.
Only the naive and gullible would accept such a huge claim without being able to review the evidence that has been gathered in support of the claim.
It is uncanny. It is eerie how accurate and predictable are your comments and those of your readers in the previous blogs ("matters discussed here") which you pointed to:
http://aushealthit.blogspot.com/2008/09/nehta-and-openness-just-what-is-problem.html
and here:
http://aushealthit.blogspot.com/2008/06/just-why-are-nehtas-plans-for-shared.html
They all add up to the next big extravaganza unraveling before our very eyes.
Booz & Co also said: “Significant quick wins are possible by developing existing applications to deliver national ePrescribing and Medication Management functionality”
… and …. “DoHA is currently determining its preferred operating model and strategy for an ePrescribing platform”
…. and …. “Three alternate operating models for an ePrescription solution that could potentially be applied within the Australian context” ….. are being considered.
So true to its 007 style and in search of a ‘Q’uick win ‘Q’ Branch is beavering away on their next big bag of tricks.
The next big multi-million dollar movie extravaganza looks set to be “AUSTRALIA eHEALTH NT”. The script says eHealthNT has found a way to effectively implement an end-to-end e-Prescribing solution using a barcode system to track the issuance of a script by a GP through to its fulfilment at a local pharmacy. This platform has the potential for wider application in other jurisdictions and could potentially be enhanced to pilot electronic transmission of prescriptions between GPs and pharmacies, eliminating the need for a barcode altogether!
Wow - How do they get away with this stuff? The storyline is riveting.
The stars have found a system of goldbarcodes which can be deployed in a national rollout to eliminate the need for a barcode altogether!
Amazing. Just what we've all been waiting for - a system which sells us barcodes and then makes them redundant.
DOHA's Special Ops Unit must be working overtime on this big canvas movie. I can see MoneyPenny typing feverishly to get the gripping script finished before James Bond rides through the door on his trusty Buffalo and says BooMoo.
As David has showed in his list of previous reports, we do seem to be receiving one report after another that outline the problems and needs in e-health. What we need is some concrete plans that are promptly trialled, promptly evaluated and promptly reported publicly.
It is true. We are receiving one report after another. To a large degree there is a lot of repetition from past reports to which additional information is added reflecting recent developments here and overseas. But, in the main, as Oliver Frank said, they remain focused on outlining the problems and the needs. That is where they stop.
This, of course, is all part of the bureaucratic process. The reports are then used by the ‘system’, by the ‘bureaucracy’, by the ‘stakeholders’, as evidence-based-fodder to support a grab-bag of new projects and initiatives more often than not driven by the same people in ivory towers who gave us the last lot of projects.
They need these reports to help them get the funding to set up whatever new projects seem to be worth doing the way they think they want them to be done.
Is that why there is so little reference to existing projects?
Three projects have been given prominence as being worth building upon. They are QLD-GP Partners, NT-ePrescribing and NSW-HealtheLink. How much funding support has DOHA provided to each of these? Does this indicate DOHA's preferred strategic direction?
Are there no other worthy projects?
I note in the Booz report re identified quick win: "Implement a limited functionality Electronic Health Record (EHR) with key data
for chronic disease patients who may opt in on a voluntary basis. The Brisbane
based GP Partners scheme (HRX) which is already connecting GPs, other specialists
and hospitals should be enhanced initially using the National Service Improvement
Frameworks approved by COAG for the following chronic diseases:
I. Stroke, heart disease & vascular disease
II. Cancer
III. Diabetes"
I think this is actually a good outcome of the old HealthConnect program - was it this software that spawned from the OpenEHR-architecture-based Brisbane Southside HealthConnect Trial work? I think it was based on the OpenEHR record architecture, and has been quietly progressing over the years - if so, then a positive outcome from HealthConnect! And congratulations to GPpartners - a quiet achiever!
It's reassuring to learn that there has been at least one good outcome from the old HealthConnect program, particularly after all the criticism that has been directed at HealthConnect on the aushealthit blogspot and in the media.
Isn't GPpartners the GP Network post name change from Division of General Practice? Where does the software come from that delivers the HRX and Chronic Disease functionality?
If GP Partners and NTeScripts have received DOHA funding shouldn’t DOHA be insisting that the two projects be merged into one? Probably the easiest way to do that would be for the NTeScripts to be implemented by GP Partners.
You may well ask if there are other worthy projects. But look at it this way. With the global recession there is a real shortage of funds around to play with, so perhaps DOHAs objective is primarily to get the funding needed to support just the three projects mentioned above. That would keep some people busy.
No doubt the Deloitte strategy will specify which of these ehealth projects warrant further funding.
To all Commenters.
Does anyone have any actual evidence - other than anecdotal - (e.g. evaluation reports etc) that these applications are:
1. Fit for purpose in the broader National sense.
2. Are scaleable to even statewide use.
3. Are supportable and maintainable into the future.
4. Can be brought together and integrated into a useful national infrastructure.
I would really love to see comments and uploads of reports that validate these proposals as meeting those practical criteria.
David.
It is so easy to write consultantware with big claims, big ideas and coming up with a few conclusions built on the basis of some internet searches, some conversations and a superficial understanding of an industry. That being said I enjoyed the way it pulled various data sources together.
It did make me think though:
1) From the modelling it seemed to indicate only a 5% increase in real output improvement from implementation of an EHR. I'm not sure if that has been validated anywhere by real experience but 5% seems to me to be in the noise and achievable by other measures. I also noticed the projected break even (if you look at the Canadian graph is over 10 years and only cash flow positive after 7). Not the kind of investment I'd be planning to make in a hurry.
2) seems people have started to believe that having as much data together in the one spot is a good in itself - but is it accurate? would it not take more time for a treating physician to read, balance views and form their own clinical opinion a long patient record stretching 1000s of words, 10s of tests, multiple episodes/treating doctors for a complex patient or one who is aged? What would that do to efficiency? Maybe in the future part of the training for health professionals should be speed reading.
3) seems we are beginning to lean towards a State where there is a thirst to collect and centralise data about everyone. We seem to also be at risk of losing the personal touch, and perhaps prefer to read a computer screen than show an interest in the patient as a person or take a proper history from the patient.
4) can't we get on and do something rather than just talking about developing standards (not even implementing them). A lot of the private sector is already using computerised records and sharing data electronically for test results, patient payments, etc. For a start how about a program similar to PIP to increase computerisation of specialists from 40% to the 90% claimed in general practice? I doubt it'd be that expensive and at least then we'd have a chance of sharing data electronically with them :).
5) There isn't a lack of ways to currently share records with others in the health system (eg Argus and the other 5 or so alternatives to secure electronic messaging in the market today). What seems to be lacking is a reason for acute/community based care to adopt it. Or perhaps put more exactly people who could do something about it don't see it as a priority.
Small quibble with the report itself: They bemoan the lack of a national approach but suggest the solution is to keep building out from regional solutions (GPPartners, NT). And the difference is?
[Just referred to this blog, so if few are reading back here, so be it. Just wanted to say something in reply to anon's list of considered benefits, something that has been lacking in many reports]
Point 3 asks about effects on the human exchange. I was wondering about that loss too. Not being a medico myself, I don't know how it's done now, but I would presume that the telephone may be used for at least some doctor to doctor information exchange. If all info is to go to EHRs, what happens to this collegial communication?
I dare say that history collection is also a means to doctor/patient relationship establishment. Although we often fill in a form to do that, if there is anything odd, it's an opportunity for the exchange to take place rather than an assumption about a person based on info that may have been recorded long before and not updated.
This is an extremely complex system being considered, at the communication level as well as the technical, the latter actually not being all that difficult to design. Implementation, cost and benefit are three unknowns.
Jan Whitaker
Australian Privacy Foundation
Health Subcommittee
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