Last week Dr Andy Bond - Chief Architect of NEHTA gave a talk entitled “E-health realising improvements in the safety and quality of healthcare delivery” to the Human Factors in Healthcare Symposium that was run a few days ago (March 3-4, 2009).
See:
http://www.informa.com.au/conferences/healthcare/human-factors-in-healthcare-symposium
The slides – as offered on the NEHTA site – are really a ‘dog’s breakfast’ and fail NEHTA’s usually high presentation standards rather badly (Text missing, horrible fonts etc).
The whole presentation can be found here:
http://www.nehta.gov.au/component/docman/doc_download/660-human-factors-in-health-care
As always, however, there was a little buried gem.
Technical Architects from all countries just love ‘big picture’ explanations of what they are about.
NEHTA has created an absolute ripper! (click on image to enlarge). Note: You do really need to take time to look closely at all the areas that are covered and how they are arranged.
What we see here is really astonishing.
NEHTA, if this image is to be believed, planning to do (or facilitate) the ‘lot’. By this I mean bring together a conceptually complete e-Health solution for Australia
Look closely and you see.
1. Reasonably sensible suggestions regarding e-Health governance
2. A broad range of relevant applications and solutions and even change management etc
3. An outline of the needed messaging and information flows.
4. An data and information standards section.
5. Recognition of the key feeder systems and so on.
6. Recognition of the needs for security and privacy management.
(Note much of this maps quite well to the Deloittes plan)
Here is their representation – which is a little less detailed but quite similar overall. (click on image to enlarge).
None of this waffly “interoperation framework” nonsense – this is a real planned and seemingly carefully considered overview map. Additionally the map does not look all that far off the mark! Only question is – is it real?
All this is way beyond its present mandate – to say the least.
So what is going on? There are really only two possibilities I can see.
One is that this is a genuine fantasy and wish fulfilment picture that was doodled together by the architects when they were bored. No one is going to do this – but it is a great picture
The second is that this is what NEHTA is planning to do.
If the second – as one might hope – they clearly have a few billion dollar, ten year project in mind as this is a real monster no matter how one looks at it – and the work to get there is just enormous.
This really is the vision thing – but I wonder is this for show or for real. Canada has quite a similar document – called the Blueprint. This can be accessed by registering here:
http://www.infoway-inforoute.ca/lang-en/working-with-ehr/knowledgeway
They are actually doing it as I type. ($1.5 billion already spent and more coming)
Right now we have no dollars and little else other than NEHTA – who seems not to want to be direct on what its plans are.
Nice to have a picture of how it might be. Not perfect – but by no means bad! It would be fascinating to hear from NEHTA how they plan to turn this picture into actual operational systems and real clinical outcomes. We wait and watch. This picture talks the talk now we need NEHTA to actually, successfully walk the walk!
Also I wonder will someone fund it?
David.
9 comments:
Yes, the Blueprint is in progress and is not a bad looking design either, but I'm afraid that it's being badly shaken by the crisis and there will be problems with further funding. NEHTAs design does have few little flaws as I'm looking at it but seems like a good solution all together. Funding it is another problem though. Looks like it would require lots and lots of money. But good luck with it.
Take care, Jay
Commentator Saturday, March 07, 2009 12:33:00 referred to “NEHTA’s staff of 250 people”.
MSIA Members “Eat your heart out” - wait till the recession really bites and watch your staff steadily slide over to the other side.
Oh, and as for the let’s have some little itty bitty pilots to keep you all amused until we get our act together - dream on. Come and show us what you’ve got so we can work more closely with you.
This is now one of the largest health software organisations in Australia funded entirely with taxpayers money!!
It is immune from public scrutiny and cannot be audited by the Auditor General.!!
Where are all these people domiciled?
How does this number of 250 people compare with the numbers employed by Canada’s Health Infoway and the UK’s CfH projects?
The diagram shows quite clearly Medicare Australia will form the core of the entire set up.
You say "Right now we have no dollars and little else other than NEHTA – who seems not to want to be direct on what its plans are."
I have to disagree with you on both counts. Dollars already earmarked will not be made known until NEHTA and Government are ready to commit them in the direction they want. Surely it has dawned on you by now that is the sole reason the Deloitte report has not been made public or are you so engaged with putting your own views you have lost sight of the game plan underway behind the curtain.
Secondly, the first diagram makes it abundantly clear what is planned. Medicare Australia rules the roost, various IEHRs will be scattered around until such time as Medicare Australia has its four 'boxes' nailed and then Medicare Australia will insert a fifth box called IEHR Repository to compete with the other monkeys that did all the hardgrind up front. In truth the fifth box is already on the diagram - "Government IEHR Repository" discretly distanced from Medicare. There is no mystery here.
Whilst the simplicity of the diagram is seductive - the cost is inconsequential to those who seek the power and control.
If you support this path well and good, if you don't - anguish alone.
That's a stupid question. Of course someone will fund it. You don't employ 250+ people without the intention of pouring in as much money as they require to do the job.
Poster of Tuesday, March 10, 2009 8:50:00 AM. Your evidence for this assertion is?
There seem to be some comments all suggesting funds will be found. Would someone like to let us all know what they think the source and amount of the funds (roughly) will be.
No money, only very progress is my view.
David
What's a Consumer Summary Health Histroy? [The Deloittes graphic]
The fact that this 'histroy' is in the Medicare box should have everyone on guard.
I have no idea what a NASH is.
There are already reports of extortion from the access to personal health info collections in the US:
1. ... as all of these stories have been in the news, the pharmacy benefit manager that handles prescriptions for 50 million Americans revealed to the media that it has called the FBI for help to deal with an extortion attempt. Express Scripts received a letter that included the personal information on 75 members (including social security numbers) and claimed to have the electronic personal information on millions of its customers and is threatening to reveal it unless the company pays up. According to E-Commerce Times, this could be one of the more damaging cases of data loss on record and “may raise red flags for industry hopes of putting more health care information online in an effort to control costs.”
2. The Wall Street Journal reported a few days ago that this isn’t the first such extortion attempt against a big company, nor the first to involve private health information. The stories have become increasingly frequent. Last month, for example, the FBI said it had made an arrest on the theft of a computer server from Medical Excess, LLC, a subsidiary of AIG, that contained “personally identifying and health care sensitive information” of more than 900,000 people and had similarly tried to extort the company for money.
[snip]
But things are getting worse and the blackmailers behind the Express Scripts extortion attempt appear to mean business, the Wall Street Journal blog reports this morning. Some of its customers have begun to receive anonymous threats as part of the extortion attempt, and the letters include their personal information, including birthdates and social security numbers. The letters are said to be similar to the one the company received.
Latest update on the support website: http://www.esisupports.com/esisupports/esi-release111108/
Still not solved.
As the Executive Director of a well respected health software company servicing the primary care sector it make me squirm to see so much money and energy being thrown at NEHTA with next to nothing to show for it all. Even more frustrating is that NEHTA and the government bureaucrats seem to want us in the vendor community to educate them about ehealth so they can go away and dream of what might be possible while we go away and do what is possible. It makes me sick.
As you say "NEHTA has created an absolute ripper" with its diagrams which are "absolutely astonishing".
These presentations give me the impression that NEHTA is a bit like a pod of 150+ beached whales on the west coast of Tasmania. There is not much new that I can see from years gone past. Perhaps a few boxes shifted sideways or vertically and some brighter colours. But these people just keep spinning their wheels on the same old messages, the same story, needle in groove stuff. One has to have pity on the audiences to whom they spout this stuff. The poor people must come away saying "It looks very complicated, I hope they know what they are doing but I have my doubts". 250 seems like a lot of people at $90,000+ plus 50% overheads = $33.7 million per annum.
HOW MUCH? I wish my software vendor could have $1 Million of that to do some of the things we often talk about but can't afford.
There does seem to be something very wrong here - out of control I think. It reminds me of a snowball rolling down the mountainside.
On page 9 of the document Dr Bond says that 82% of people support a "national electronic health record".
On page 13 there is the diagram where to the right of "INFORMATION" there is the concept of "Individual Electronic Health Record" which seems to be a summary.
A fundamental concept of databases is that there is only ONE primary record and trying to update various portions leads to duplication and irregularities.
If you take the diagram http://4.bp.blogspot.com/_exvgxqNb50g/SbShrG-xf3I/AAAAAAAAADc/_JE5d-c6V1A/s1600-h/Deloittes+Architecture.jpg and put the PATIENT in the middle of the cloud and allow proper and authorised access controlled by and known to the patient then you might solve many of the problems.
This model is already completed and requires only a willingness to try it out.
There is also a need for some legislation: alterations to the Privacy Act to have mandatory prison sentences for those abusing access and use of the information and mandatory imprisonment for directors of companies abusing their privileges.
Not Rocket Science but common sense 1.01
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