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Tuesday, March 24, 2009

The Strategic Disarray in E-Health in Australia Goes from Bad to Worse!

Last week DoHA and NEHTA conducted a briefing on the National E-Health Strategy.

A very new and very reliable correspondent provided the following points from the presentations and discussion.

Overall Impression.

Not much positive to report.

Key Attendees

Megan Morris (DoHA), Rob Cameron (DoHA) and Peter Fleming (CEO, NEHTA) were present.

Some of the points they made were:

1. Although the strategy has been endorsed by AHMC, and there has been a commitment to continue the NEHTA work program, there is no funding commitment to the strategy at this stage. Megan/Rob indicated they would not be addressing the strategy at this point in time as there are a number of key initiatives that are underway at present that need to be considered first (e.g. National Health and Hospitals Reform Commission work, National Primary Health Care Strategy, Regional Telecommunications Strategy)

This confirms what we already knew – we have been sold an unfunded pup.

More than that it is clear that the DoHA team are incapable of ‘walking and chewing gum’. If they were they would realise that the e-Health Strategy is an integral component of this other work and needs to be considered as a whole. Seems we have severe cognitive failure on the part of this lot.

2. In particular, nothing about the IEHR has been agreed to, i.e. the model of funding, development, implementation, ownership etc. Waiting on policy/funding decision from COAG.

This has to be ‘bureaucratic speak’ for ‘forget this for the foreseeable future’ (Subtext - blame the GFC). It is clearly so far off that by the time anyone actually gets round to it, it will have to be re-considered from the ground up. As regular readers will know I am more than happy with this outcome. Let’s get the basics – secure messaging, e-prescribing, e-referral and core operational systems in place- and then work out what record sharing would be ideal.

3. There is no further information about the strategy to be released. The summary is all that will be made available.

This is just utterly pathetic. We, the stakeholders and public, paid $1.3 million for this work. Just exactly why should be not see what was suggested? Even more amazing is that as recently as a presentation to the Telemedicine Summit on March 16 we have the NEHTA CEO suggesting the National E-Health Strategy is alive and well. Three days later we are told zilch is happening and we can’t see it! The story is getting very confusing here!

See here:

http://www.iir.com.au/conferences/healthcare/national-telemedicine-summit

and for presentation see here:

http://www.nehta.gov.au/component/docman/doc_download/673-telemedicine-conference-sydney-peter-fleming

A little piece of history is warranted here:

The following is found on the NEHTA web site:

New National Entity To Drive E-Health

28 January 2004

Australian Health Ministers, meeting today in Sydney, endorsed arrangements to establish a new national entity to drive forward critical e-health initiatives.

Joint Communique

Australian Health Ministers, meeting today in Sydney, endorsed arrangements to establish a new national entity to drive forward critical e-health initiatives.

Health Ministers noted the achievements to date of the National E-Health Transition Authority (NEHTA) in progressing national priorities on behalf of all jurisdictions, and agreed that collaborative arrangements would be formalised.

“E-health systems and processes offer very real opportunities to improve patient care and the efficiency of health services. It is important that all jurisdictions work together to set the foundations for a more connected system”, Chair of the Australian Health Ministers’ Council, Minister Peter Toyne said.

Ministers agreed to establish the new entity as a company limited by guarantee, governed by a board of directors made up of CEOs from Health Departments across Australia.

Ministers endorsed-in-principle the 3 year work program for the entity. In addition to funding of $9.5M already committed for 2004-05 priorities, Ministers agreed to provide $18.2M over 3 years from 2005-06 to fund the core activities of the entity. These activities include: the development of timelines for the urgent advancement of the e-health agenda; option assessment and business case development; standards development and implementation support; and provision of advice and resources to assist implementation of already agreed solutions.

Ministers noted the need for further cooperation on significant national projects over the coming years, including in the following key areas:

  • Clinical Data Standards and Terminologies;
  • Patient, Provider and Product/Services Standards and Directories / Indexes;
  • Consent Models;
  • Secure Messaging and Information Transfer;
  • User Authentication and Access Control;
  • Technical Integration Standards;
  • Supply Chain;
  • Electronic Health Record (EHR) Standards; and
  • Health Informatics Industry Reform.

The new entity will seek to leverage existing investments to progress these priorities.

The full release is found here:

http://www.nehta.gov.au/nehta-news/403-new-national-entity-to-drive-e-health

Note the date! This is now over five years ago. Tens of millions have been spend, hundreds more have been committed and which of that list of key areas is actually now making any difference in actual clinical practice?

Is there any sense of urgency – other than platitudes about 2009 being the “Year of Delivery”. Not that one can see. We have the IHI wandering off into 2010 and this release that appeared (rather slowly) via RSS today.

http://www.nehta.gov.au/nehta-news/484-pathology-leaders-working-together

Pathology Leaders Working Together

Thursday March 12, 2009. Pathology leaders will work together to promote the adoption of national e-health standards and specifications following the signing of a national consensus statement.

The Australian Association of Pathology Practices Inc (AAPP), National Coalition of Public Pathology (NCOPP), Royal College of Pathologists of Australasia (RCPA) and the National E-Health Transition Authority (NEHTA) have agreed to cooperate on implementation of e-health standards and specifications.

NEHTA CEO Peter Fleming said the consensus statement was a milestone achievement that would stimulate dialogue with the profession.

The adoption of national e-health standards in Pathology will improve the safety and quality of healthcare for all Australians”, Mr Fleming said. “Pathology leaders have agreed to work together to design and develop a roadmap for the adoption of national e-health standards and specifications,” he said.

“All parties will cooperate to implement these e-health standards and specifications so that they can be supported in the clinical, technical and organisational environment.

“Stimulating discussion and feedback will allow issues associated with their implementation in Australia and internationally to emerge.

Further initiatives by NEHTA would ensure the material developed would enable interoperability, promote Australian standards and support the various ways through which implementation may occur," he said.

Media enquiries: Gabrielle Lloyde Communications Manager 0408 170 001

----- End Release

Another one of those agreements to co-operate. Outcomes will clearly come very much later! Does this remind of you of the “Statement of Commitment” malarkey associated with ePIP?

For more evidence of being asleep at the switch we have the following

“The National E-Health Transition Authority have presence at the “Australian Pharmacy Professional Conference” being held Thursday 2nd – Sunday 5th April at the Gold Coast Convention and Exhibition Centre.

NEHTA are on stand number 141.

For more information, log onto: http://www.appconference.com/

NEHTA are apparently paying for exhibition space and not apparently giving a presentation explaining their expectations of the various actors who seem to be quite keen to ignore NEHTA approaches and directions as noted last week on the blog.

See the program here:

http://www.appconference.com/conference.htm

Just exactly what is the value for NEHTA to pay fares and staff to go to this conference when most of the e-health initiatives being discussed are not apparently adopting NEHTA standards? I must be missing something!

I believe we have seen the end of any hope of a proper implementation of the National E-Health Strategy and confirmation too that NEHTA is just wandering off into the briars in the absence of a real strategic plan. I also fear it will only get worse from here!

See if I am not right.

David.

15 comments:

Ray Welling said...

A very measured response, David, considering the farcical goings-on you're reporting. Is there any hope that Rudd will take a cue from Obama during his current visit and come back resolved to spend some of his stimulus package on this crucial piece of infrastructure?

Anonymous said...

On Point 1:- these people are talking absolute crap.

Quote: “They would not be addressing the strategy at this point in time as there are a number of other key initiatives underway that need to be considered first”.

Have you ever heard so much gobbledygook, nothingness and absolute rubbish in all your life? What a total insult to the poor unfortunate suckers who paid good money to sit and listen to such moronic ramblings.

How much are these clowns being paid $150,000 or more?

“Severe cognitive failure” is a nice way of saying “whoever made this statement had a very loud public brain-fart.

Anonymous said...

NEHTA’s CEO said the National E-Health Strategy is alive and well simply because he doesn’t know what else to say. He is being given the run around every which way.

Let’s face it - we have an organisation of 250 people called NEHTA which is basically directionless and the only thing that might possibly make a difference is a $1.3 million strategy document that will not be made public - for one very simple reason, not that it’s recommendations aren’t affordable, and not for any other reason than that it will further expose the sheer incompetence and complete and utter ignorance of those responsible for the state of ehealth in Australia today.

Anonymous said...

The pathology leaders have signed a national consensus statement agreeing to work together.

Let’s face reality - SO WHAT.

Year after year they have been meeting and talking about common standards between themselves. Each time one or more concludes such an advance would weaken their position in the marketplace. No progress is made. They continue going their own way until another push comes along to bring them back to the table to talk some more. And so the cycle of talk and agree to do something before they all break up and go their individual ways and wait for something to happen repeats itself once again.

Action plans, timetables, deliverables, financial commitments and financial penalties tied to inaction are never raised. It is too difficult to discuss and agree on such tricky issues. Too confronting, too threatening to the status quo and too much disruptive work all combine to impede progress.

So where are we now? Nowhere further than we were before. Wh? Because the leadership required to make something really happen is non-existent. NEHTA’s CEO Peter Fleming said “the consensus statement was a milestone achievement that would stimulate dialogue with the profession.”

Welcome to the new boy on the block. What’s new?

Oh! A consensus to talk is new!?!?!?!?

As David said “malarkey” - Bob’s your uncle, all set to go, you’ve got it made, no problem - in one word “malarkey” sums it up. NEHTA’s CEO needs to get real and get off the pot.

Anonymous said...

Peter Fleming spoke at length yesterday on all the good things that NEHTA is doing - most of which industry has already delivered in one form or another! When he came to the subject of the EHR, he uttered words to the effect that if we don't get the basics right (ePathology, ePrescribing, etc.), there will be nothing with which to populate an EHR! Well I have news for Peter - there are EHR implementations operating in Australia today with data pouring into them - pathology results, radiology results, admission and discharge messages, lung function results and medications). These programs are not perfect and they are quite modest in scale - but they worka and they deliver value to their users (who pay money to use them). To the best of my knowledge, Peter does not even know they exist! In fact, he would not even take a meeting to be briefed on them.

And another thing ... this continual bleating from NEHTA about the lack of funding for implementation work. Does anyone else recall NEHTA's initial briefing on the national identifiers project (for individuals and providers) - probably 2 years ago now? A slide during this presentation quoted a combined budget of $98 million for these developments. The contract with Medicare Australia to implement these identifiers is for $51 million. Does anyone know what happened to the other $37 million? Sumptuous NEHTA offices in most of the capital cities perhaps? Fact finding tours around the globe perhaps? A bloated staff that duplicates what industry is already doing perhaps? This sum, in the hands a of a few small, moderately efficient companies would fund working, commercial eHealth implementations in a couple of the larger states (or all of the small ones!).

Anonymous said...

NEHTA is mounting a trade exhibit at the Pharmacy Conference in order to make our presence known and promote our work to pharmacists. The pharmacists and the guild are important stakeholders and need to know what we do and why.

Alongside our stand are others also working towards the same agenda to help us make eprescriptions a reality. With the presence of ePIPs, eRx, Medisceure, CDC and Mirixa everyone should find it quite reassuring that ehealth is well and truly 'on the move'at long last.

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

Quoting comment of 8:52.00 March 25.

"Alongside our stand are others also working towards the same agenda to help us make eprescriptions a reality. With the presence of ePIPs, eRx, Medisceure, CDC and Mirixa everyone should find it quite reassuring that ehealth is well and truly 'on the move' at long last."

None of which NEHTA has had anything to do with! e-Health might be 'on the move' but does NEHTA know where it is going?

David.

Anonymous said...

NEHTA might not know where it is going but our colleagues in the UK know where they are going -
"In the rich man's world
Money, money, money
Always sunny
In the rich man's world
Aha-ahaaa

Pharmacists to get up to £1500 for implementing electronic prescriptions Community pharmacists in City and Hackney PCT have been offered incentive payments totalling £1500 for implementing the next stages of the Electronic Prescription Service (EPS), according to the Pharmaceutical Journal. The PCT will pay pharmacists £500 for signing up to its incentive scheme with further payments for meeting requirements which include ensuring all staff involved in EPS dispensing have a smartcard and NHSmail address and increasing the use of electronic prescription messages. The PCT is to be an initial implementer site for release two of the EPS.

If I were a rich man,
Daidle deedle daidle
Daidle daidle deedle daidle dum
All day long I'd biddy-biddy-bum
If I were a wealthy man.

Anonymous said...

The CEO of an Australian Pharmacy organisation commented in an internal report he

".... attended a stakeholder information forum [yesterday]on the National E-Health Strategy, which was agreed by Health Ministers in December 2008. Overall, the presentation inadvertently conveyed the apparent lack of progress and difficulties in this project. There are still major issues to be addressed concerning privacy, funding, IT and standardisation of infrastructure and policies across Australia. The Strategy sets out a 10-year staged approach to the development of e-health capabilities, with milestones at three and six years!"

It would seem that this stakeholder wants to support the development of e-health but is conceding those principals charged with leading the discussion AND implementation have not been able to convince him to date.

As this was probably his first exposure to these principals it will be interesting to follow his subsequent reports of "progress" and note if the tone of hope is maintained?

Anonymous said...

With Corum Health Services yesterday endorsing the eRx electronic prescribing model FredHealth and Corum dispense systems which are in 90% of community pharmacies in Australia one has to ask:

Has the guild delivered its knockout blow to Government, to NEHTA, to the AMA, RACGP and doctors at large, and to its nascent rival Medisecure?

The message from the guild and its partners is clear - surrender or die. This is war and we will win. You have no option but to join us.

Anonymous said...

The CEO of the Australian Pharmacy organisation referred to by your commentator Wednesday, March 25, 2009 9:14:00 AM was watching process at work. Process at its very best.

The comment reported can be interpreted thus:

… We have a process which must be followed. It may result in lack of progress and difficulties in getting things done, but it’s the process and we must follow it. Privacy, funding, standardisation of infrastructure, and development of appropriate policies are all part of the ‘process’ which we must follow. It may take 10 years to get anything useful delivered but we must accept that is all part of the process which we must follow. There is no other way.

I wonder if the presentation was by the same person who had the “very loud public brain-fart” referenced in the comment Tuesday, March 24, 2009 9:01:00 PM .

Anonymous said...

What is ePIPS?

http://www.epips.com.au/what_is_pips.html

Don’t ask the Department of Health and Ageing. Don’t ask Medicare Australia. Ask the Pharmacy Guild.

ePIPS is an online pharmacy account payment tool which allows you to pay all of your suppliers in one transaction. ePIPS is the next generation of Guild Clearing House. A streamlined program which combines functionality and accessibility; ePIPS saves our members time and money. Best of all, ePIPS can be used to pay any supplier – from dispensary and OTCs to phone bills and fragrances.

Q: I’m not a Pharmacy Guild of Australia Member, am I still able to access ePIPS?

A: No, ePIPS was specially developed to help our members save time and money on office administration. We do not offer this service to non-members.

Anonymous said...

“With the presence of ePIPs, eRx, Medisceure, CDC and Mirixa everyone should find it quite reassuring …….”.

Who is CDC? http://www.appconference.com/tradeexhibit.htm

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

We may need to be careful to distinguish ePIP

www.nehta.gov.au/pip from www.epips.com.au.

David.

Anonymous said...

Well that's it! The Pharmacy Guild is delivering the 'killer app' for e-health in Australia! It's enough to give you the e-pip!