We had this published today.
Developers need health ID specs
Karen Dearne | June 30, 2009
WITH a business case for a national e-health rollout due back on the Council of Australian Governments' agenda this Thursday, software developers say they need technical specifications and legal certainty so they can begin modifying products.
Consideration of the business case -- prepared by the National E-Health Transition Authority -- was delayed earlier this year as COAG dealt with the global financial crisis.
This week's meeting in Darwin is also expected to receive a report on proposed privacy safeguards in e-health environments.
Last week, The Australian IT revealed patients' medical records would be linked across health providers using the existing Medicare card and number, under the $98 million Unique Healthcare Identifier program being developed by NEHTA.
More here:
http://www.australianit.news.com.au/story/0,24897,25708869-5013040,00.html
Now read on and see if you think NEHTA shows the least sign of being a satisfactory custodian and spender of very substantial news funds beyond what is already committed. I think the case is made, that they are nowhere near ready, by the notes NEHTA has quietly released from meetings of its Stakeholder Reference Forums. They are very short documents which were published on June 23,2009.
The notes cover meeting that lasted 5-6 hours which were held 6-8 weeks ago – so they don’t seem to be able to type very quickly!
These make just fascinating reading and certainly prompt more questions than they answer. My analysis is at the end.
First cab off the rank:
NEHTA Diagnostic Services Reference Group (DRSG) Meeting 2
Melbourne Hilton Airport
Friday, 1st May 2009, 09:30 – 15:00
The notes provided for the meeting are as follows:
“The meeting had the following objectives:
- To obtain communication advice to assist in the development of a communication plan to ensure the right messages are delivered to the right group of stakeholders and that involvement from industry is achieved.
- To discuss interaction between reference groups including the appropriate processes on how to undertake these interactions and requests.
- To provide an update of the recent planning workshops undertaken in April 09.
- To discuss the proposal for a national strategy for development and implementation within the Pathology Sector, including an operational and evaluation framework of piloting.
- To obtain advice on ramping up the e-Diagnostic Imaging Program.
Summary of Outcomes / Actions:
- Acknowledgment that the workshop process recently undertaken is appropriate to identifying the set of priorities for the e-Pathology Program moving forward.
- Support for ramping up the e-Diagnostic Imaging Program.
- Consensus that workshops are required for the e-Diagnostic Imaging Program to achieve a set of program outcomes and priorities.
- Consensus that a strategy around the Development and Implementation of e-Health Material is needed and should build upon the recently signed Statement of Consensus with the Pathology Sector.
Notes are here:
Second cab off the rank:
Medications Management Reference Group
Meeting Summary 5 May 2009
The second meeting of the Medications Management Reference Group (MMRG) was held inSydney on the 5th May at the Christie Corporate Conference Centre, 2 Spring Street, Sydney.
The meeting had the following objectives:
- To update the group on the status of Action Items that came out of Meeting 1.
- To provide an update of the current Electronic Transfer of Prescriptions (ETP) Concept of Operations document, following the inclusion of pre-meeting recommendations and feedback from the group.
- To gain additional feedback on the ETP Concept of Operations and agreement on validation process.
- To present the ETP Roadmap to the group to stimulate discussion and feedback.
- To provide an update on the Implementation Opportunity Assessment.
- To provide an overview of the current ETP Business Requirements to the group and seek agreement on validation process.
- To present an overview to the group of the Structured Document Template (SDT) and endorsement process.
Summary of Actions:
- NEHTA to develop MMRG sign-off processes for project deliverables and products.
- NEHTA to consider the development of individual electronic medication record as part of the NEHTA work program.
- NEHTA to provide an overview of approach to identifying potential collaborators from January 2009.
- NEHTA, DOHA and Medicare to meet to finalise the ETP business requirements.
- NEHTA to develop a summary of internal and external dependencies for the project.
Summary of Outcomes:
- Process to finalise the Concept of Operations document agreed.
- Process for endorsement of business requirements discussed and agreed in principle with the MMRG. NEHTA to provide further detail at next meeting.
- The Group recommended that the development of an individual electronic medical record is an important piece of work and efforts should be made to advance the development within the constraints of funding and resources.
The note can be found here
Third cab off the
Continuity of Care Reference Group
Meeting Summary 8th of May, 2009
The second meeting of the Continuity of Care Reference Group was held in Melbourne on the 8th of May, 2009 at the Airport Hilton, Melbourne.
The meeting had the following objectives:
- Confirmation of the Scope document
- Provide an update on the eDischarge Summary Implementation
- Provide an update on the progress of the eReferrals Environmental Scan
Summary of Actions:
- Ask National Health Information Regulatory Framework working group to consider relationship between duty of care and the rejection of referral.
- Package documentation review by CCRG members to be completed and the summary to be emailed out to the group for their immediate feedback.
Summary Outcomes:
- Key role of the group to identify future projects for NEHTA to link with.
- Revised Scope will include changes in language, clearer objectives and broader collaboration.
- A number of extensions to the core discharge summary will be released during the course of the program including - Mental Health, Aged Care and other specific discharge scenarios which will be discussed at the next CCRG meeting when the RoadMap will be circulated. Roadmap needs to show how medical management program fits in with the requirements to support discharge/referral.
The notes are found here
Fourth cab off the rank:
NEHTA Clinical Terminology and Information Reference Group (CTIRG) Meeting 3
Christie Corporate, 3 Spring Street, Sydney
Monday 18th May 2009, 10:00 – 16:00
The meeting had the following objectives:
· Review the Terms of Reference and to determine the purpose of the CTIRG.
· Review the Operational Guidelines and Governance document.
· Provide an overview to better understand the SNOMED landscape and discuss the skills and education that are required to understand utilise SNOMED.
· Receive an update of where SNOMED is currently at and what work is planned for SNOMED.
· To receive a presentation of the “Terminology Services Review”. Discuss objectives of this review, the strategy going forward, progress to date and the work plan.
· To view a presentation of an AMT Case Study. Presentation to cover the AMT approach, incident update, works to date and future plans, vendor engagement.
· To view a presentation by Cerner on AMT.
Summary of Actions:
· Paul Williams to understand what information regarding the collaboration agreement can be distributed and when available update the CTIRG.
· Paul Williams to investigate what material and DH4 Consultancy Reports are available and if applicable issue to the group.
· Discuss around quality assurance of clinical terminology deliverables needs to be an agenda item at the next meeting.
· ED termset to be an agenda item at the next meeting.
· Karen Gibson presented on the SNOMED landscape. She is to provide “trip reports” to keep the group up to date on resolutions and outcomes.
· As a result of a discussion around implementation issues, compliance and conformance – the issue of versioning was raised. This is to be a future meeting topic along with quality assurance.
· Tony Robertson delivered a presentation around “Terminology Services Review”. The group discussed the need to know the benefit of each step of the work program and the need for this to be articulated. NEHTA to show the outcomes – The So What’s.
· The group discussed the need to understand the role of NEHTA and the work plan, progress to date, task lists, progress dates etc. NEHTA to demonstrate the tools available at a future meeting.
Summary Outcomes:
· It was noted that the scope of this reference group should cover structured information and as such Michael Legg advocated a name change for the reference group to “Clinical Terminology and Information Reference Group”.
· There was discuss in regards to the need for governance to support clinical acceptance of standards and it was noted that Karen Gibson and Andy Bond are currently writing a standards strategy.
· As a result of discussion around the purpose of the CTIRG, it was suggested that in addition to the statement ‘advise on appropriate stakeholder consultation and validation processes’, there should be a line that states: ‘Foster relationships with customers and collaborators’ to reflect the customer voice.
· Following the update on SNOMED, there was discussion around implementation issues, compliance and conformance. In particular, the difficulty of moving between versions was raised as a potential barrier. As a result of this discussion, it was determined that version control will be a future meeting topic along with quality assurance.
· Tony Robertson delivered a Technology Services Review presentation, discussion followed around implementation and it was agreed by the group there is a requirement to form ‘for purpose working groups’. An implementation working group was proposed, however, the group is awaiting the draft terminology services work program to provide feedback before moving forward with this.
· It was noted that it is important to distinguish between terminology for information models (packages) and terminology for ‘other’ (projects). A roadmap is being developed for terminology development including an opportunity assessment which will be distributed to the group upon completion.
· Following the presentation of the AMT case study and the tools being developed in a joint modelling collaboration with UK, Netherlands and Australia to ensure areas can communicate better. The discussion reiterated the need for a National Terminology Centre and role definition
The notes are found here:
Fifth, and last, cab off the rank
NEHTA Architecture and Technology Reference Group Meeting 2
Brisbane NEHTA Office, West End 1
Wednesday, 20th May 2009
10:00am – 4.00pm
The meeting had the following objectives:
- To provide a review and discuss the Series 2 Architecture Blueprints
- To provide an update on PIP and have discussion regarding the update
- To provide an update on UHI and NASH programs, NRAS and MCA Build
- To provide the ATaRG group with an update regarding reference groups vendor position.
- To discuss the security framework.
- To discuss and develop a process for when items are referred from other reference groups.
Summary of Actions:
- Andy Bond requested that ATaRG group provides the first layer of feedback to David Bunker for Series 2 blueprints before being placed on the co-chairs agenda and being passed onto other reference groups for their work plan.
- Certification in the architecture area and the actual technical support for certification and examples to be placed on the next meeting’s agenda.
- David Manfield to present on the status and processes for certification in the CCA program.
- Gill Carter to address progress on the completion of documentation around HPI-O and UHI.
- Steve Nolan to present to the group Terms of Reference on Medicare Australia’s involvement with managing vendors.
- Andy and Steve to develop a process for requests from other reference groups.
- Following the CIO forum, Steve Burmester to publish some of the assumptions and principles that have been identified.
- Steve to present an update of the security framework work being undertaken.
Summary Outcomes:
- ATaRG is to provide the first level of endorsement for the Series 2 blueprints. After this has occurred, the blueprints will then be passed onto other reference groups and placed on the co-chair’s agenda.
- As a result of Paul Burnham’s update on PIP and PIP Secure Messaging, it was noted by the group that questions still remain around how certification works, who undertakes certification and what sort of certification will be put in place. Certification in the architecture and technical area will be on the next meeting’s agenda.
- It is planned that ATaRG will establish a vendor reference group. The recommendation of having an EOI has not yet been accepted by NEHTA and ATaRG is waiting on further advice on how to form the vendor group and how ATaRG would engage with this group.
- The group noted that the security and access framework is not just about NEHTA but about eHealth as a whole. It was decided that ATaRG members are to go to the business groups of other areas of health and ask for feedback to present to ATaRG. The group will then develop a structured format to submit to the CIO forum and NERF for further ratification of the framework.
The notes are found here:
What to say a about all this.
First a question. Why are they all marked ‘Confidential’?
Second, the next comment is to be just amazed at how little progress has been made in virtually any of these areas.
Comments in the notes like the following show just how embryonic everything is:
“it was noted by the group that questions still remain around how certification works, who undertakes certification and what sort of certification will be put in place. Certification in the architecture and technical area will be on the next meeting’s agenda”
“To discuss and develop a process for when items are referred from other reference groups” – read we have not worked out how to co-ordinate internally.
“There was discuss in regards to the need for governance to support clinical acceptance of standards and it was noted that Karen Gibson and Andy Bond are currently writing a standards strategy” – read we have been at this for over 5 years and we don’t yet have a standards strategy – which was meant to be NEHTA’s core business.
“A roadmap is being developed for terminology development including an opportunity assessment which will be distributed to the group upon completion.” – What?
“Following the update on SNOMED, there was discussion around implementation issues, compliance and conformance. In particular, the difficulty of moving between versions was raised as a potential barrier. As a result of this discussion, it was determined that version control will be a future meeting topic along with quality assurance” – Read we really have not got on top of many important issues.
“Key role of the group to identify future projects for NEHTA to link with.” – read we don’t actually know what we are meant to be doing yet!
“Paul Williams to investigate what material and DH4 Consultancy Reports are available and if applicable issue to the group” – read we still are not keen to provide too much information to the great unwashed.
“NEHTA, DOHA and Medicare to meet to finalise the ETP business requirements” – read we have not sorted out our e-prescribing requirements at a business level let alone at a technical level. This is in the context of eRX being up and running.
See:
http://www.erx.com.au/Demos/eRxInAction.aspx
“Process to finalise the Concept of Operations document agreed” read we don’t even have a concept document on how e-prescribing is to work.
“Consensus that workshops are required for the e-Diagnostic Imaging Program to achieve a set of program outcomes and priorities” – read we have not really figured out what this program’s aims, objectives and outcomes are.
It is pretty clear from all this that NETHA really will have nothing practically ready and implemented for years – so much for the much vaunted ‘Year of Delivery’ – which is now ½ over by the way.
Third it is clear there is all sorts of information being developed and shared with these tiny groups that is not seeing the broader light of day. As I have said, and these notes prove, there is no monopoly of knowledge and wisdom in NEHTA and the lack of sharing is just dangerous for all of us.
Fourth it seems there exit “Series 2 Architecture Blueprints”. Just what would be the reason for not sharing these with the e-Health community?
Overall, even from these notes, and five years and hundreds of millions of dollars into its mission it is safe to say NEHTA is getting nowhere. A big call but we are, without dramatic change and reform, going to throw a lot of good money after bad if COAG funds NEHTA for this new business case. They are simply not up to it in their present form
Ms Roxon and DoHA, I hope you are reading. You have a very big problem on your hands here.
David.
7 comments:
David - this should be headlined on every paper - it is a disgrace and much more important than a ute and a fake email. Keep up the good work!
David,this is a huge effort and thanks for the work. As someone working very hard to achieve interoperability I can only gasp at what is going on without my knowledge. Unfortunately Australia has been drawn into the MEGA solutions pathway of Canada and the UK. Top down and conscriptive.
The opportunities are there - the MSIA project to communicate records between general practice systems and now the Ambulance Services have taken a step in the same direction. So we might be able to have GP to GP and GP to Ambulance working in the near future. It will take some humble pie and a bit of determination.
I hope to read more on these high level committees and their secret business!
Sam Heard
After reading your blog, not once but three times, focusing very deliberately the third time around on the "messages" contained within the 5 Reference Group Meetings, I have come to the same conclusion as you.
I find it inconceivable that any competent self-respecting health informatics expert would be prepared to tolerate being a part of this fiasco any longer. To do so on the premise "well we might be able to make a difference" is an exercise in extreme self delusion. A circus? A calamity? Call it what you will. But nothing less than 'catastrophe' would do NEHTA justice.
Towards the end of your blog you succinctly summarised this rolling snowball, this avalanche of incompetence, when you write "What to say about all this?" Reviewing your four comments I wish to highlight the following. Everyone should be very concerned.
- amazed at how little progress has been made in virtually any of theses areas
- how embryonic everything is
- not worked out how to co-ordinate internally
- Karen Gibson and Andy Bond are currently writing a standards strategy
- 5 years and we don't yet have a standards strategy
- a standards strategy was meant to be NEHTA's core business
- a roadmap is being developed for terminology development including an opportunity assessment - what?
- key role of group is to identify future projects for NEHTA to link with
- NEHTA's much vaunted 'Year of Delivery' is now half over
- it is safe to say NEHTA is getting nowhere
- NEHTA is not up to the task in its present form
- Ms Roxon and DoHA. You have a very big problem on your hands.
How does one wrap all this up in one all encompassing statement? Probably best done by asking one question:
'Will this insanity ever stop?'
All these comments are spot on. Yet, we are not just facing a national 'problem' because of NEHTA's manifest failings, and the opportunity costs of all those $ going to the wrong place. NEHTA is also pitching to become the national implementation arm! So, after doing such a brilliant job on standards, they now feel they can specify, design and project manage large scale IT systems? Let us hope that the jurisdictions recognise that a totally new world is needed, and that while we keep a small standards functionality, NEHTA must be wrapped up in its current form, and new leadership, and a new organisation is needed. Repackaging a failed NEHTA into an implementation arm is just the worst possible thing that could happen!
David, thank you for keeping the spotlight on this incredible fiasco. We are only seeing the tip of the iceberg with this very public exposure of NEHTA's incompetence. The true cost, the real damage, lies deep beneath the surface in the slow, debilitating, insidious erosion of Australia's health informatics strengths which are being progressively weakened day-by-day by bureaucratic incompetence foisted upon us by a very well funded incompetently managed NEHTA. TWO HUNDRED AND FIFTY PEOPLE ARE EMPLOYED IN NEHTA AND WHAT HAVE THEY GOT TO SHOW FOR THEIR EFFORTS - BUGGER ALL.
Fascinating reading? Disturbing reading would be a far better description.
Why on earth has NEHTA placed Tony Robertson in charge of SNOMED. He was responsible for failing to deliver HCN's MD3 product. All he appeared to be good at was PowerPoint presentations, seams he has found his niche. Having him involved will certainly guarantee frailer to deliver.
The more things change the more they stay the same.
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