Quote Of The Year

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

Saturday, December 06, 2008

Vital Links Regarding New E-Health Plans.

There are two vital links that follow from the Australian Story.

1. Communiqué from Health Ministers Meeting (December 5, 2008)

See:

http://www.health.gov.au/internet/main/publishing.nsf/Content/mr-yr08-dept-dept051208.htm

2. Booze and Co E- Health Report.

See:

http://www.nhhrc.org.au/internet/nhhrc/publishing.nsf/Content/discussion-papers

Direct link:

http://www.nhhrc.org.au/internet/nhhrc/publishing.nsf/Content/16F7A93D8F578DB4CA2574D7001830E9/$File/E-Health%20-%20Enabler%20for%20Australia%27s%20Health%20Reform,%20Booz%20&%20Company,%20November%202008.pdf

Happy reading!

David.

26 comments:

Anonymous said...

Looks like Booz wants to see established ‘another’ “central expert E-Health organisation to drive the E-Health”!! - another NEHTA - surely not.

Anonymous said...

David,

Good to see eHealth hasn't dropped completely off the agenda, but it still does remain quite unclear how the kind of investment required will actually materialise and what it will actually achieve.

I read through the Booz report and found it to be really disappointing. I don't understand who commissioned the report but it reads like an apology for inaction and a recipe for more of the same.

It's confusing and contradictory: First it seems to say that a national IEHR service is ideal (still vague on what an IEHR actually is of course)

Then it goes on to say that the only real progress happening in eHealth is at a local level, with examples like GPPartners and eHealthNT. Now, I think these guys are doing great stuff but it's hardly scalable from a small number of practices to a national infrastructure.

So it says extend these instances for some politically appealing quickwins to move towards a national infrastructure.

In the process it suggests that a national IEHR will produce "a payback by 2013 and a total benefit of $20 billion by 2019" quoting the DeLoitte strategy. And to get this benefit, NEHTA should continue to do exactly as they have been and continue with their work packages.

On page 35, it talks about a $28bn saving over the first ten years if NEHTA proceeds to build this national IEHR.

But I don't read anywhere in this document how eHealth will help the 275 people who develop diabetes every day. There are now 1.7 million people in Australia estimated to have diabetes but half of them aren't even diagnosed. This is the sixth highest cause of death and 60% of cases could be prevented.

I don't read anything about how it will help the 3 million Australians who provide unpaid care for their loved ones with a disability, mental condition or who are too frail to look after themselves.

I don't read anything for the one in five Australians with a limiting disability.

I'm tired of eHealth being the domain of technocrats. Until we see eHealth being understood and driven by patients, we're going nowhere. We need tools, systems and information designed around the people who actually need those services. People want access to their health information - they assume that medical professionals who care for them have the information they need (of course, they often don't). They want to manage their health just as much as being told when to take the next prescription drug or have elective surgery.

Hence, I read an apology for inaction and a recipe for more of the same. Time to cut the rubbish from the technocrats and start doing something for ordinary people who need help.

Until we do that, all the eHealth strategies and plans are not worth the paper they're written on.

Anonymous said...

It is clear when a copy of the Deloitte report will be publicly available?

Aus HIT Man said...

According to Deloittes - the public version of the report has been approved by Health Ministers and will be released next week.

David

Anonymous said...

Is there a non-public version too?

Anonymous said...

Same old stuff again.
And how much did THIS onen cost?

Aus HIT Man said...

Yes - I am sure there is a non-public one with all the detailed costings that may be commercially sensitive. The rest will be be just as it was created I am sure.

And no - its not the same old - its way better - and cost $1.3M. That less than 2 weeks of the cost of NEHTA to fix a problem NEHTA refused to address..what should a National E-Health Stategy look like in 2008 on to 2015?

There will be nit-pickers - but I think most people will like what they have done. I do.

David.

Anonymous said...

I can't recall ever seeing NEHTA being charged with developing a National E-Health Strategy - the initial BCG report that preceded their establishment specified the development of specific infrastructure - which they appear to be doing, admittedly in a way that hasn't seemed to have won them a lot of support.
Does the Deloitte Strategy clearly identify funding sources or will it just be another outline of the problems and opportunities?
Problems are easy - viable, and politically acceptable, solutions are a bit harder...

Aus HIT Man said...

NEHTA was never asked and choose to ignore the problem of a lack of a national strategy.

Both the BCG Review of NEHTA and a parallel AHIC report said it was vital and NEHTA was clueless in not having got on to get it done - as did my blog for now almost 3 years.

It got done and all the outcomes will be seen next week I believe.

David.

Aus HIT Man said...

Re funding etc - we will have to wait and see what was agreed!

David

Anonymous said...

The National E-Health Strategy "got done" because the ministers commissioned Deloittes to do it. I would imagine NEHTA providing an unasked for, and unfunded, strategy would have received an interesting response from the ministers.

I'm pretty sure NEHTA must have understood how important a national strategy, with clear goals, would be in achieving real results in this area - perhaps they should have started a blog to point out how clueless AHMAC was in not asking for one earlier!

Can't wait to see "all the outcomes" next week...

Aus HIT Man said...

And when commissioning the Deloittes work they said they were dong it because the BCG Report (Number 2) and AHIC had recommended it! NEHTA could equally have asked their Board to have it done - but chose not to - it would have damaged their autonomy to stuff things up - as they did for the first few years.

David.

Anonymous said...

Exactly right - BCG Report (Number 2) and AHIC had BOTH recommended it!

Despite this NEHTA's Board, responsible for providing strategic leadership, did nothing about it even though it was the Board which commissioned the BCG Report!!!. The fact of the matter is that they, the Board (whose Members each report to their respective Ministers, who in turn fund 50% of NEHTA), simply had to instruct the CEO to take immediate steps to develop a National eHealth Strategy as recommended by BCG and AHIC. That is good corporate governance. Repeat and say after me - “That is good corporate governance”.

It is remotely possible the Board did instruct the then CEO to develop a National eHealth Strategy - but highly unlikely. It would be in the Board Minutes if that was so. Of course, if they did then they failed dismally in providing the required supervision and support to ensure the CEO did their bidding. As a consequence, an enormous amount of time, money and opportunity continued being wasted.

On the other hand, the Board may have been so intimidated by their CEO (who has now departed) that they simply didn’t know how to stand up to him, and they lacked the knowledge and insight need to know when they were being conned.

Neither possibility vies well for the future unless major changes are made to NEHTA’s Board of Governance regardless of however many reports and consultancies are commissioned.

Aus HIT Man said...

Be assured - recommendations regarding National e-Health Governance are a major component of the Deloittes Review. We will just have to wait and see what they conclude.

David.

Anonymous said...

I agree the board should have taken steps to develop a National eHealth Strategy (some may argue they did albeit not through NEHTA the organisation) and that "that is good corporate governance". What I struggle with is David's contention that NEHTA (the organisation) are somehow to blame because the board did not direct them to do it.

This reflects the problems inherent in putting in place a board with the fundamental conflict of interest NEHTA's board always had. Meanwhile, it might be useful for commentators to indicate whether they are referring to the board or the organisation when they make accusations of them being “clueless”.

While it is fair to say that the departed CEO may have had a consultation and communication style that many found challenging, I have met many of the people who work for NEHTA and would be hard pressed to describe them as anything other than intelligent and committed individuals working hard to provide essential infrastructure (as recommended by the BCG report) while dealing with complex cultural, technical and political realities.

I get a little tired of constantly hearing criticism about NEHTA being a bunch of technocrats (which isn’t correct from my experience). It often appears that much of this criticism comes from either self-interested concerns or from those who are unable to separate eHealth from Health IT.

Perhaps if the proposed Deloitte strategy outlines how eHealth can improve patient centred care across the continuum we can then work out which bits have to be handled nationally – I suspect the minimum will be agreement on standardisation around terminologies, identity issues and technical integration providing the basis for some set of sharable clinical information. This is, of course, exactly what NEHTA is working on.

Maybe if this National eHealth Strategy is ever put in place, with appropriate funding, governance and outlining a clear goal state we can better determine whether the work NEHTA is undertaking is appropriate or fit for purpose. Meanwhile, of course, everyone knows how to do it better – particularly when there is no defined target. Here's an idea, lets have robust debate about whether these things are being implemented in the right way (e.g. Medicare doing the identifiers) but lets not lose sight of the fact that many of those issues are politically driven. In other words, pehaps we could contribute something that might take the debate forward.

Perhaps its time we looked at whether NEHTA (in particular the organisation) really is the problem here, after all.

Aus HIT Man said...

A number of good points indeed.

First I do not blame the NEHTA staff. What I blame is the NEHTA leadership group for not having the wits to realise both their Board and CEO needed guidance on this. Many have now gone so the point is moot now I believe.

Second a national strategy has to do more than assist in infrastructure development - it has to put it in an implementation framework and get all the other stakeholders involved - much more than just NEHTA's brief in my view. The main point of the Strategy is to 'define the target'. Clinical outcomes will be a major driver I am sure - something that was never a seeming focus with "old" NEHTA.

Third I would love discussion on the merits of the design and implementation of NEHTA's proposals but I have yet to see clear examples and use cases that make it clear how it will work and how stakeholders will use them. Have I missed something - its more than possible. Details of actual deployment and use of identifiers and terminology are both still embryonic as far as I have see.

For the record I don't see NEHTA as the problem now. It certainly has been a problem and I am hoping it is in transition to the place recommended by the BCG. Early signs are much more promising than they have been for a good while.

David.

ps I think the discussions of the last week or two have been really good and valuable for all involved. I hope so.

D.

Teki said...

David, maybe the Rudd government is being smarter about moving into implementation phases of projects. If they are, someone will be watching how Westpac merges its customer database with StGeorge. The factors common to banking and health care are too many to ignore.
Governance has been mentioned several times, so wise eyes will be watching how the NHS has succeeded and failed. It seems pretty obvious that after the contracts are signed, how the governing board manages the project is key to how it will turn out. If the costs are blowing out with no ROI in sight, someone has to ask if it is worth continuing.
So, the contract has to allow governments not to get themselves into the position of having to scrap another project worth hundreds of millions.
One of the big unknowns at this stage of planning for SEHR is how the government is modelling their budget projections.
Finally, you'd have to wonder if the Rudd government is driven by any prevailing philosophy at all. In the world of Health IT, there are plenty to choose, from the "joined-up government" of the UK, to the private capital and market-driven mode of the US and the nationalistic models in so much of the EU. I suspect, without a jot of evidence, our government could be waiting for a major stressor or calamity to afflict a (anyone else's) health system and evaluate outcomes against the usefulness of an SEHR.
My conclusion is that it is not helpful, in fact may be counter productive without knowing how Rudd's advisors think, to chuck everything into the 'arguments for' kitbag and dump them all out in a disorganised pile. Some arguments hold a lot more weight than others, some are downright trivial, and some will pull up better under models with particular types of financial slant.

Anonymous said...

On Sunday, December 07, 2008 4:53:00 PM Aus Hit Man said: “What I blame is the NEHTA leadership group for not ………”

Let us be clear, there should be no ambiguity here. Who do you see as the “NEHTA leadership group”?

I ask this because I would strongly argue that it is not the Ministers - they are too far removed - they set policy. They did that 3 years or more ago when they decided a national organisation responsible for e-health needed to be established - to be governed by a Board of Directors according to a Constitution - to achieve certain goals and objectives.

Do not fall into the trap of muddying the waters by embracing the ‘shared responsibility’ game of buck passing. And furthermore, as your recent correspondent (Sunday, December 07, 2008 4:08:00 PM ) inferred, it is unfair to tarnish NEHTA as the bad boy by using the organisational collective - the issues boil down to 1. Policy, 2. Vision, 3. Leadership, 4. Strategy.

The Ministers created a Policy Position to form a national organisation under the direction of a Board of Governance made up of Departmental Heads from each jurisdiction. In effect the Board, including the CEO, is the NEHTA leadership group.

I hope you agree.

Aus HIT Man said...

Not really.

For what its worth I believe the Board which met only 5-6 times a year really had little influence over the way NEHTA operated and were not all that well equipped to really manage what NEHTA was doing.

By the 'leadership group' I mean who ever where the senior people within NEHTA who formed its executive. It is they who determined the way the organisation operated and executed its policy and it is those people with whom I had the major disagreement.

As I said before, with the changes in that layer of the last six months much of this may now be moot.

The next few months will tell.

David.

Anonymous said...

1. The Board should have met monthly.

2. The Board should have required the CEO to provide whatever monthly reports it deemed necessary in order to be fully informed.

3. The Board was responsible for managing the CEO and through him NEHTA.

Clearly, and we agree, NEHTA’s Executive (comprising the CEO and the Senior Management) were deficient and changes in that layer of the last six months may have rectified some of those deficiencies.

Even so, the Board was responsible for ensuring a strategy was developed and followed. Whether they got the Executive to develop the plan, used external consultants or even, heaven forbid, did it themselves in collaboration with the Executive was up to them - but the Board was responsible for ensuring it was done.

Aus HIT Man said...

To put it concisely, I think the problem was that "the Board did not know what it did not know" - being general managers managing what was actually a health technology services company.

Hence they did not understand the need for the governance structures both inside and outside NEHTA.

David.

Anonymous said...

General Managers they were. In their positions it would be quite extraordinary if any of them were ignorant of, or had no training in, good Corporate Governance!!.

Aus HIT Man said...

Well, looking from the outside and seeing what was said by the BCG in suggesting more diverse board, that certainly seems to be the case.

To use another saying - they had a 'tiger by the tail' that they really were not able to effectively govern because, in part, of the technical nature of what it did and in part possibly because of the approach adopted by the founding CEO.

Anyway that's how I see it - your mileage may vary!

David.

Anonymous said...

Correct on all counts. One would hope the new Chairman will insist on his Board Members undertaking some training in Corporate Governance if they are deficient in that area.

Teki said...

David, what actual hands-on responsibility did NEHTA have for managing projects? Putting it another way, has anyone in NEHTA management moved on to bigger things? Is anyone prepared to say how their experience at NEHTA was judged in an application for a job elsewhere?

Aus HIT Man said...

Sorry, I have no idea on this topic.

David.