Having taken the time to closely review the transcript of the Senate Estimates material on E-Health there were a few extra things I felt were worth pointing out.
The transcript can be found here:
The actors (in this section) were:
Senator Sue Boyce (Lib, Qld).
Senator Nigel Scullion (Lib, NT)
Ms Jane Halton, Secretary of Department of Health and Ageing.
Ms Megan Morris, First Assistant Secretary of the Primary and Ambulatory Care Division
At the beginning of the discussion we had this:
“Senator BOYCE—Yes, I have a few questions that I will ask. My questions relate to the E-Health Transition Authority and other areas thereabouts. You might be interested to know, Ms Halton, that your comments at the last estimates around e-health were reported in Australian IT.
Ms Halton—Yes, I know. They must be very delicate. They did not like—what was it?—’propeller head’.
Senator BOYCE—They did not seem to be terribly keen on being ‘propeller heads’—
Ms Halton—No, they were not.
Senator BOYCE—or ‘real nerd city’.
Ms Halton—Yes, I know. Terms of affection.
Senator BOYCE—However, the blog that followed on from that was titled ‘Roxon lost in e-health maze’. There certainly does seem to be a lack of direction here. Could you fill us in on where we have progressed to since October?
Ms Halton—Yes, sure. If I can start by saying it is curious that people get so hung up on a colloquial
discussion we have here, at whatever hour we have it, and probably not on the content more.
Senator BOYCE—They are probably just really keen that someone talked about it, I suspect, Ms Halton.”
This does not strike me as quite delivering the tone of contrition the e-Health community would have liked. Others may be quite pleased that at least the ‘push back’ from the e-Health comminty was actually noticed at the seat of power!
Next we had:
“Ms Halton—Yes, and we are talking about it, which they should be quite enthused about. We have had quite a bit of progress in relation to e-health and I will get the officers to go through it with you. I have to say I was particularly pleased that there was a COAG agreement in relation to continuing what we call the base activities for the National E-Health Transition Authority. You probably know that we have a new CEO in NETA. The very clear focus is on delivering a set of very particular things—which, again, the officers can take you through in a second—by the end of the year.
Senator BOYCE—Sorry, I missed that last sentence.
Ms Halton—Both the initial COAG funding—which they can take you through the detail of—and what NETA is really focused on this year are some very particular deliverables which will really make a difference on the ground to the experience of e-health that you and I as consumers would have; not you and I as people who discuss government program delivery but to the actual experience of consumers of health services. I am trying to give the officers time to find their bits of paper.
Ms Morris—We are the page flickers. Remember?
Ms Halton—Yes, that is right, they are the page flickers. But we can go through with you those details.
Senator BOYCE—Thank you.”
It seems the Department was pleased to have obtained funding for NEHTA. Pity no one asked about funding to implement the National E-Health Strategy. This would have been the moment!
Next there was this explanation of the NEHTA work program.
“Ms Morris—Sorry, Senator, I am just getting the list. It is a long attachment because there is a lot of good stuff in here, as Ms Halton said. What I will run through is what they have got in their current 2008-09 work program, which is delivering a lot of really useful outcomes and, as Ms Halton said, getting to the stage where people are hopefully understanding and seeing how it all will build up to a picture of an individual electronic health record. Development of e-health capabilities: I always have to try and translate this into English. Within that, they have things called domain packages, which can be broken down into discharge summaries. For instance, when a patient is discharged from hospital, an electronic summary of what happened to them in hospital, what medications they are on, what procedures were undertaken, what diagnostic imaging, whatever—“
This really does not inspire much confidence. Does anyone think that discussion betrayed a deep understanding of what NEHTA is doing and why?
Then there was discussion of the IHI as discussed yesterday in the blog. It was here we learnt:
“Senator BOYCE—So by the end of the year we should have the unique identifier?
Ms Halton—Yes, we should.
I think somehow the pilot idea somehow slipped through the cracks! The timeframe looks a trifle adventurous also – but we shall see!
This was then followed by this:
“Ms Halton—Yes, that is right. The other thing that is going to be delivered by the end of the year is secure messaging. In other words, not only do you want to know who it is you are talking about but also you want to be able to say quite confidently to patients that the information that goes via this mechanism to this other party is not going to disappear into cyberspace and cannot be in some way tampered with or siphoned off by somebody else. It has to be secure. We all think that privacy in respect of health is incredibly important, and so secure messaging—which again is in this timetable—is one of these key things to be delivered.
So when I talked at the beginning about this then enabling patients to start to see these things actually happening, you need all of these things before you can start moving your pathology results around electronically. Before enabling you to manage the medications electronically, you need to know what the medications are, you need to be able to code them consistently, you need to know it is you who is taking them and not Senator Moore or whoever else, and you need to know who has prescribed what and if it has been dispensed. Does that make sense?
Ms Halton—With these what we call ‘foundation parts’ of e-health, COAG agreed that we would continue with this investment to keep building on each of these elements that are all moving towards an integrated, electronic health record. Part of the work is a little nebulous. When you say that one of the things we are working on is engagement or policy or privacy or whatever else, we still need to fund those things, because we need to able to assure consumers that their privacy will be protected. We also need to ensure that we manage change with the professions.”
Ms Halton does not seem to be at all clear that to move from the foundations to an actual EHR or whatever form is big and probably not cheap. To her that is ‘nebulous’. A bit of a worry!
Note privacy is important – but no plan to manage it is mentioned. Need to keep it simple I guess. If there was legislation being prepared I am sure it would have been mentioned.
And a bit later this:
“Senator BOYCE—To summarise, the underlying components necessary to deliver e-health should be assembled by the end of the year. Is that what you are saying?
Ms Halton—Most of them.
Ms Morris—Many of them, I would say.
Ms Halton—Yes, many of them. The ones to do these functions that we have just talked about—starting to move discharge summaries, referrals and pathology results around. E-health can be quite narrow or it can be extraordinarily large. The bigger it is, obviously, the more complex and more expensive it is, and you have to start in a way which is scalable. You have to start with things which are achievable.”
Pity there does not seem to be any clarity about what will sit ‘on top’ of the underlying components.
Lastly of relevance we had this:
Senator SCULLION—I will ask one short question in regard to that. Ms Halton, I would have thought that in something like e-health there is not much new under the sun globally. You indicated that some of this work had been done in other parts of the world and that the genesis of some of the materials in terms of an e-health system had happened in other parts of the world.
Ms Halton—No. That is the classification system in relation to describing things.
Senator SCULLION—Perhaps I can finish the question. I would have thought that other countries in the world were facing similar challenges in terms of health and areas similar to health. Are you seeking similar systems in other parts of the world or are we simply doing it alone?
Ms Halton—I will tell you two things: firstly, I am trying not to make the same mistakes that I have seen other people make elsewhere, and I have seen people spend an awful lot of money for no outcome—a huge amount—so we are actively trying not to do that; secondly, yes, we are watching what is going on overseas and, to the extent that we can use things from overseas, we are doing that. Every health system is unique and what you have to do is build a system which enables the way clinicians practise and the geography, for example, to all be accommodated, including IT connectedness et cetera. So, yes, we are very conscious of other systems. In fact, we have regular dialogue with our colleagues in the United States, the United Kingdom and other parts of the world to—
Senator SCULLION—Is there somewhere that you would see as a standout in terms of best practice to work towards?
Ms Morris—I would also say that it depends on what you are doing health for and how you want it to work in the system.
Ms Halton—I think there are different things that are good in different countries. Is there one country that I would emulate? No.
Senator SCULLION—Thank you.
Looks like Ms Halton has not got her head around the successes in Scandinavia Denmark and in Kaiser Permanente. There are excellent models all over the place but I suspect she does not want engage in a proper review or take the advice offered by Deloittes – whose report also did not seem to even get mentioned.
So no discussion of the Deloittes work, no apparent understanding of where e-Health fits in the overall reform agenda, no implementation plan or funding beyond the underlying components and anxiety about wasting money. Hardly visionary leadership in my view.
Another fundamental issue is that NEHTA was not in the room and has no apparent accountability to the Parliament or DoHA. The Officers (Ms Halton and Morris) indicated they could not even disclose NEHTA staffing levels without getting COAG permission. What an amazing joke e-Health Governance processes are in Australia!
Senate Estimates are really a gift that keeps on giving!