Quote Of The Year

Quote Of The Year - Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

Monday, July 27, 2009

The National Health and Hospitals Commission Reboots Australian E-Health.

I believe this is a very good day for e-Health in Australia.

Today the National Health and Hospitals Commission (NHHRC) released its Final Report after some sixteen months work.

The report is found here:


E-Health and the Use of ICT within the sector runs through the entire document and is really an embedded part of what is recommended.

The most important parts related to e-Health are found in the following spots:

1. The Executive Summary.

2. Section 5 of the Main Report.

3. Appendix G – Implementing Reforms.

4. Appendix H – Investing in Reform.

The Executive Summary (on E-Health) I posted earlier and it can be seen here:


What is very interesting about the report is as you go through the detail – and there is lots in Section 5 and the Appendices – the balance moves, as I read it, further and further away from the almost total focus on the Person Controlled Health Record in the Executive Summary to a much more balanced holistic view of e-Health by the end.

By the time we reach the section on Funding (Appendix H) we have the following:


With respect to the broader e-health agenda in Australia, we concur with, and endorse the directions of the National E-Health Strategy Summary (December 2008), and would add that: There is a critical need to strengthen the leadership, governance and level of resources committed by governments to giving effect to the planned National E-Health Action Plan. This Action Plan must include provision of support to public health organisations and incentives to private providers to augment uptake and successful implementation of compliant e-health systems. It should not require government involvement with designing, buying or operating IT systems. In accordance with the outcome of the 2020 Summit and our direction to encourage greater patient involvement in their own health care, that governments collaborate to resource a national health knowledge web portal (comprising e-tools for self-help) for the public as well as for providers. The National Health Call Centre Network (healthdirect) may provide the logical platform for delivery of this initiative. Electronic prescribing and medication management capability should be prioritised and coordinated nationally, perhaps by development of existing applications (such as PBS online), to reduce medication incidents and facilitate consumer amenity.

Additional cost $1,185–$1,865 million

Costing Assumptions 1. $600–$900 million implementation and adoption of national standards including:

investment in bringing existing public and private systems to a level that will allow them to operate with a broader electronic health care system, including interfaces;

encouragement of the development and implementation of new e-health solutions that apply these standards and implement the interfaces necessary to allow broad integration. This would include solutions to allow consumers access to and use of their own personal health information.

Implementation of additional enablers of national information exchange, such as national indexing, strong privacy management and authentication services.

Investment in the industry infrastructure required to test and accredit the adoption of e-Health.

2. $500–$800 million e-health teaching, training, change management and support to health care practitioners targeting:

encouragement of the active use of high priority e-Health solutions prior to the mandated use of these solutions to provide data that can be integrated into a person-controlled electronic health record (such investment does not replace investments by the private and public sector in the development of their internal e-health solutions, but helps ensure that they can contribute to the national system);

health information training for clinicians, including in universities, continuing education and in specialist health contexts (such as hospital emergency departments);

workplace change, enabling new workplace practices that can only be adopted with e-health solutions in-place;

delivery of new tools and capabilities that leverage e-health information to deliver provider efficiencies (e.g. new electronic clinical registries) and enhanced health monitoring (such as bio-surveillance capabilities).

3. $35–$65 million consumer marketing program

4. $50–$100 million research, performance monitoring and governance

These costs are in addition to developments to date funded by COAG commitments of $318m and industry and individual practitioner investment and do not include hospital information system infrastructure.

---- End Quote.

When one compares what I asked for a few weeks ago as far as e-Health is concerned from the Final Report I must say what we have looks pretty good.

See here for my wish list:


It is also worth comparing the funding cited here with what the Deloittes work suggested.

See here:


Overall the NHHRC is saying to Government get on an fund what is essentially the National E-Health Strategy – and interestingly does not seem to be asking for funds for the Personal Records – just the funds to make the possible. Do you think it is possible someone else will provide those records (Google or Microsoft perhaps?)

In section 5.0 there is also lots of mentions of some of my favourite topics (governance, leadership, education, workforce, knowledge portals and so on) which I can only be happy about.

Additionally it is clear the issues of privacy and security have received pretty comprehensive coverage. As always it will only if public trust is developed will any e-Health initiative succeed!

Appendix G seems to me to make it clear – as I have long suggested – that NEHTA is to become an implementation arm of DoHA under the Accord and to come back much more under Government control – what a good thing!

All in all my only concern is that we have to wait to see if Government will support these recommendations, fund them and get on with it.

The only two serious issues I might have are

1. I would still like to see an e-Health Australia entity established to be responsible and accountable for doing all this.

2. I really think trying to force clinicians to contribute data to personal EHRs is just a bad, bad idea.

There is so much that is good in this I am almost prepared to let these points pass!

Well done team. 9.7/10. I only hope Mr Rudd will now implement.



Anonymous said...

Certainly, the possibility that someone else will provide the infrastructure/mechanisms for an electronic health record while government defines standards, etc, is an interesting idea.

I am now more convinced than ever that the current crop of EHR vendors marketing in Australia are quite incapable of providing what we need, and we need to look to other, more innovative and imaginative providers.

We certainly need to abandon the idea that health has, or needs, some special, unique solution to information management. When compared to what other areas, such as financial and insurance, have, health lags far behind because we have failed to leverage off existing, well established information management products, and instead insisted that health is "unique", and needs something "special". The result is that the software we see is, for a large part, like a nostalgic visit to the 1980's, rather than something suitable for 2010 and beyond.

Sorry, in the middle of an implementation where the lack of quality and innovation in the software is depressing, to say the least.

Anonymous said...

I read your comment on the NHHRC report with interest. However, it strikes me that even in the brief extract you quoted there is a fundamental contradiction.

On the one hand, the Commission recommends that e-health implementation, "... should not require government involvement with designing, buying or operating IT systems."

On the other hand, the Commission recommends that, "Electronic prescribing and medication management capability should be prioritised and coordinated nationally, perhaps by development of existing applications (such as PBS online), to reduce medication incidents and facilitate consumer amenity."

The fact is, as even the Commission has tacitly acknowledged in the second recommendation quoted above, that development by government -- and, realistically, this means by the Commonwealth Gov't if there is to be a nationally-consistent approach -- of at least some of the core systems is fundamental to the success of e-health.

The problem is that the upper levels of DoHA are not prepared to be associated with any sort of national system, because they have seen the flak directed at NHS upper management over NPfIT/CfH. Without a change of attitude (or people) in DoHA, don't hold your breath waiting for the e-health millenium.