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Sunday, March 29, 2009

NEHTA Redefines the Art of Obscurity and Obfuscation.

The following appeared a few days ago on the NEHTA Web Site on the letterhead of The Australian E-Health Research Centre:

The file is found here:

http://www.nehta.gov.au/component/docman/doc_download/664-aehrc-interim-report

Independent Evaluation of AMT Identifier Incident Review

Interim conclusions – 16 March 2009

A detailed investigation and audit of NEHTA’s AMT processes has now been completed. This has included a review of NEHTA’s response to the AMT Identifier Incident.

This review has confirmed that the necessary steps have been taken to ensure that the release process will provide a version of the AMT that can be used by developers during the implementation of NEHTA compliant systems. NEHTA development processes have been found to be robust and effective, and it is unlikely that significant issues will be found with current and upcoming AMT release content (e.g. AMT version 1.14).

AMT is not yet ready to be released as ready for use in live clinical systems by those developers of NEHTA compliant systems who deem their product ready for operational use.

To achieve this, it is recommended that NEHTA execute the following remedial actions:

1. Prepare and execute a quality plan that reflects the risks associated with the purposes to which AMT is currently fit to be used. The quality plan should target the development and QA of an AMT that is fit for a stated purpose, or set of purposes, that is well understood within NEHTA.

2. Provide specific guidance to developers of NEHTA compliant systems on the purposes to which AMT releases are fit for use.

At this stage, NEHTA has advised that it believes these remedial actions can be prepared and executed in April 2009.

The Independent Evaluation is proceeding to further consider additional recommendations for NEHTA’s AMT processes. Confirmation of these, and a review of the action taken on the remedial actions, will be completed in April 2009. It is planned that the Independent Evaluation of AMT will advise if AMT is ready to be released in live clinical systems in late April or early May 2009.

Professor Bruce Barraclough

Dr David Hansen

End file.

First it needs to be pointed out that the AMT is the Australian Medicines Terminology. I am sure you were not meant to know that so you would not be able to figure out what it all means.

Looking on the NEHTA site we find the following:

http://www.nehta.gov.au/australian-medicines-terminology

Australian Medicines Terminology

Update on the suspension of AMT releases pending a quality and safety review.

This review is underway and an Interim Report has been released. AMT releases have been found fit for use in current development however further work is required before AMT is deemed suitable for use in live clinical systems. The Independent Evaluation of AMT will advise if AMT is ready to be released in live clinical systems in late April or early May 2009. Please check this page for further updates or contact terminologies@nehta.gov.au. Please come back soon.

Please note that the Australian Medicines Terminology Release Versions 1.0, 1.4, 1.7 and 1.9 have been quarantined and are not available for download.

NEHTA has developed specifications that standardise the identification, naming, and describing of medicine information. UML Class diagrams complement the specifications and explain relevant information structures, concept names and data types in a concise, industry-standard format.

NEHTA's Australian Medicines Terminology (AMT) delivers standard identification of branded and generically equivalent medicines and their components, and standard naming conventions and terminology, to accurately describe medications. The terminology is for use by medication management computer systems, in both primary and secondary healthcare.

----- End Web Site Capture

So what we have here is NEHTA saying they have developed a clinical terminology subset that is not suited for clinical use, and have had to remove their work from circulation while they ask some independent experts to tell them what to do next!

The minimum that is needed here is an explanation of what has gone wrong. The AMT has been under development as far back as 2006. (See E-Health Industry Forum Presentation May 22, 2006). The first release was on April 2, 2007 (Version 1.0) and now we find out the AMT is unsafe apparently.

The AMT fact sheet is dated 19/08/2006! See here:

http://www.nehta.gov.au/component/docman/doc_download/105-australian-medicines-terminology-fact-sheet

For an organisation with close to 200 staff and a $200 million budget the various ‘stuff ups’ seem to be accumulating. (See the blogs on lack or legislation for the IHI from last week etc). We really deserve much better in the way of openness and transparency!

What in the name of all that is reasonable makes NEHTA think it can talk about a “AMT Identifier Incident” and not explain. Really bizarre!

It somehow reminds me of the stuff we used to hear about in the Cold War of last century where some nuclear submarine had collided with some piece of Soviet weaponry and suddenly we were all to be blown up!

NEHTA , the first rule of ‘crisis management’ is a frank and full disclosure of the facts – this is needed now! It seems to me the problem is not trivial or the material would not have appeared on the website. Something quite worrying has gone on and some ‘ass covering’ seems to be underway?

I suppose it could have been worse – they might not have noticed until some patient had suffered!

I wonder how long it will really take to have a fit for purpose terminology? Soon I hope! The other thing is that NEHTA might possibly have noticed that software needs to actually work when deployed clinically – but having so few clinicians actually working with them, the importance of this fact escaped them until now.

This has the feeling of a bit of a mess to me!

David.

7 comments:

Anonymous said...

Help. Stop right there.

I have just read the first part of your blog signed by Bruce Barraclough and David Hansen referring to NEHTA’s Web Site announcement, on the letterhead of The Australian E-Health Research Centre, headed “Independent Evaluation of AMT Identifier Incident Review - Interim conclusions - 16 March 2009”.

On the first read I had no idea, none whatsoever, what these people were trying to say. I also had no idea of what the problem was that they were trying to address with their Interim Conclusion. As for the AMT Identifier Incident, “What was it?” It must have been serious.

I will read on in the hope of finding enlightenment.

Anonymous said...

Having now read the remainder of your blog I think I understand.

1. AMT means Australian Medicine Terminology.

2. There has been AN INCIDENT with AMT

3. The INCIDENT was serious enough to suspend development work and call for An Audit and Independent Evaluation of AMT work developed to-date .

4. Some significant parts of the AMT development work have been withdrawn from public access.

NEHTA’s CEO has an immediate high priority task ahead of him, to put at the top of his TO DO list, the following:

(A) issue an open, frank, unambiguous, public explanation of what the INCIDENT was that forced an AUDIT and Independent Evaluation of the AMT development work.

(B) publish an accurate, up-to-date, AMT project development plan and project scope which clearly accounts for the project stages and tasks, resources used to-date, budget allocated, budget expended to-date, person-hours expended to-date, tasks completed and when, incomplete tasks and date of expected completion, and similar bread and butter project management accountability information.

Dr David More MB, PhD, FACHI said...

Dream On!

This lot does not know what accountability means!

David.

Anonymous said...

Oh I disagree entirely. They do know what accountability means, they know very precisely.

It's their masters who have no idea - no idea what is needed to be accountable and therefore no idea of what is need to enforce it. That is why you have a NEHTA Board which is comprised solely of the jurisdictions. And that is why you have a NEHTA which remains unaccountable to everyone including itself. And that is why you will continue to see such profligate wastage by NEHTA continue unabated.


A

Anonymous said...

I think it unlikely that there has been AN INCIDENT.

Perhaps NEHTA engaged some experts in risk management to review their processes for the development and maintenance of terminologies.

Perhaps these experts are experienced in systems risks that relate to the way people interact with systems (sometimes called human factors.) Such experts are commonly used to help establish engineering and design standards in industries such as aviation, transport and industrial architecture.

Perhaps those experts advised NEHTA that the processes they were using to develop and maintain terminologies were in need of review and qualification to ensure that all the risks inherent in the process of developing and maintaining terminologies were clearly understood.

Perhaps the intention is to take responsible steps (if required) to minimise the risks, and to continually monitor processes to ensure the risks continue to be understood and are managed appropriately.

Perhaps NEHTA, being a responsible body, decided to withdraw the terminologies from official pending such activities.

Anonymous said...

I think we can take heart, some small consolation, that
(a) NeHTA recognised there was some problem with AMT - this in itself is a leap forward and a change for the better
(b) that they said something about it at all! the AEHRC report is an interim report, with further to come one imagines; the fact that there some level of *independent* review (by AEHRC, Barraclough and Hansen) might reasonably be considered open scrutiny (another first)
(c) that from a safety and quality perspective they were being modest and careful - even this interim report states that AMT is not yet fit for 'live systems' where it could impact patient experiences.
It's true, this document is not particularly helpful or informative. But perhaps it is an indication that NeHTA are beginning to realise that open disclosure is indeed necessary. NeHTA are not well practiced in these matters; they'll get better at it, we hope.
One wonders what the effect will be.
(1) Will we see a 'witch hunt' conducted among 'nerd central' (using Ms Halton’s characterisation) for the unfortunates who are 'responsible' (yes David, it is unlikely to be those who are accountable).
(2) Will we see further, final, reports? Or will this circumstance motivate further insular or secretive organisational behaviour?
Who recognised the "incident"? Wouldn't it be ironic if NeHTA themselves did? How do we deal with such mea culpa behaviour? Once a problem is identified shouldn’t there be some review, remediation and preventive strategy formulated and advised? Is that what we’re seeing here?
What is interesting, is that 'nobody knew' apparently – this seems like breaking news. If AMT was being used, reviewed, considered by the informatics community at large, why the indignation now?
What does this tell us about the old adage "build it and they will come"? Because nobody came, or so it seems. What version/release number are we up to now? Where has the commentary or criticism been up until now? How many versions of AMT (or anything else) need to be released in order to get engagement and informed feedback from vendors or potential clinical users?
Anonymous of Sunday March 29, 7.42 PM asks some pertinent questions, I fear the answers are unlikely to be forthcoming while we damn NeHTA if they do respond, and damn them if they don’t. The Monday March 30 8am blog entry nails the basic problem – there are masters, who have no mastery of the issues. Perhaps the Board needs to be called to account? Isn't that where the buck stops?

Anonymous said...

Good question - "Isn't that where the buck stops?".
It certainly does. It stops right at the Board.

Our world has been turned upside down by Boards of companies who have been compliant in not making their CEO's accountable and in not ensuring good governance policy and principles are being adhered to. The CEO might report to the Board, but the Board has a duty of care to ask questions, set policies and ensure the CEO fully complies with the Board's wishes. Anything less is a dereliction of the roles and responsibilities of the Board.

Yes, the buck stops with the Board.