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Tuesday, March 03, 2009

Senate Estimates Questions on E-Health Ducked Yet Again – Answers a Mix of Fantasy and Obfuscation.

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:

http://www.aph.gov.au/hansard/senate/commttee/S11643.pdf

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.

Ms Morris—Yes.”

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?

Senator BOYCE—Yes.

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!

David.

10 comments:

Anonymous said...

The Department's objective is to provide the minimum of information. The Committee's objective is to dig out as much information as they can.

Unless the Committee is comprehensively briefed they will achieve very little of value.

It's a circus. The same old recycled script from years gone by. Clearly ill informed bureaucrats doing what they do best. But one thing has changed, Ms Halton has learnt to play the game and hide behind COAG a la NEHTA's staffing levels, very different from the Senate estimates of two or so years ago. Why do you bother with them? They have the money, they have the power. All they lack is the knowledge and nous to put it to good use.

Anonymous said...

I agree, nous and knowledge is lacking. Well said. But one needs to understand - they don't need to have detailed information about ehealth projects because, as they took great pain to point out, they are "Page Flickers".

Anonymous said...

Deloittes - what a joke. Also KPMG.
Accountants talk to the people, paraphrase what they say and then write a (very expensive) report. Probably get students or first-year graduates to get the information.
Accountants don't make any money - they just count it.
As for NEHTA - it is an even bigger joke.

Anonymous said...

Someone somewhere must have a copy of the full Deloitte Report which the bureaucrats seem so terrified of letting anyone except themselves read. Plenty of documents get leaked to the media and brought out into the open. It seems with the nonsensical farce that keeps being played out by DOHA around ehealth and nehta that this is absolutely one report that should be made public so we can all judge for ourselves what Ms Halton, the Minister, NEHTA and the Department know but are to frightened to tell us.

Anonymous said...

Rip Van Winkle seems in no danger of being awoken before his allotted 100 years. NEHTA and DOHA officials with no background in the relevant subject will see to this between them.

I often get amused by early 200os reports like ´The unstoppable rise of E-health´. A joke then, reason for seeking treatment now.

Everyone relevant to the agenda has either been moved on, chloroformed, or demonised, as evidenced by Ms Halton´s approach. Frank and fearless? About what?

Anonymous said...

The Propeller Heads vs. The Page Flickers? More like the Propeller Heads in a cosy symbosis with The Page Flickers.

Page Flicker: " The Propeller Heads tell us that they are doing very good work. We accept their statement."

Anonymous said...

The real issue is proper governance and NETHA is not addressing this matter.

Anonymous said...

Dear Senators, You are much better off reading this Blog if you wish to find out what is happening in Health IT and how much nehta is impacting on that.

We are already moving pathology results around. There are many problems with the current systems, but they can be addressed. Nehta's task in this should be to come up with solutions to these problems.

They have addressed some of the problems, but many of their solutions seem overly complex.

Jim Cocks said...

Hear, hear to the last comment. I can only assume that Ms Halton hasn't had a path test done for some considerable period - the great majority of results are electronically received as a matter of routine.

In addition, there has been a rapid takeup of secure electronic referral systems by GPs and specialists over the past two to three years (Argus, Med Objects etc).

Yes, there are differing standards for secure messaging, and yes, there are problems with software functionality for clinical information transfers. As your last commentator points out, these are the problems that NEHTA should be sorting out.

Ms Halton might be well advised to pick up the phone and talk to GPPartners in North Brisbane, who have a working EHR and messaging system with a very high uptake from GPs, Hospitals and other health professionals in the North Brisbane area. At a "live" presentation of this system, the project manager pointed out that the least costly part of the implementation was the technical solution - the really hard and costly part was the change management that had to occur to provide a successful outcome.

Anonymous said...

Here we are 11 months later in February 2010.

In March 2009 Ms Halton said "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."

In the light of what we know today Ms Halton some things are crystal clear:

1. no-one else anywhere in the world had made the same mistakes that you have made and they would not want to.

2. as for spending an awful lot of money for no outcome you really should take a long had look in the mirror.