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Tuesday, July 28, 2009

Now We Have the NHHRC Report - What Has to Happen Next?

Well it has been a big 24 hours for e-Health in OZ and I suspect many of us are now asking the question “what next?”.

There has been a lot of press coverage of yesterday’s release. Typical of the e-Health coverage have been the following:

NHHRC reboots e-health plan

Karen Dearne | July 28, 2009

AUSTRALIA'S e-health strategy has been endorsed by the National Health and Hospitals Reform Commission, which also puts the federal government back in the driver's seat after disastrous delays through the Council of Australian Governments process.

"We want our future health system to be powered by the smart use of data and enabled by the electronic flow of essential information between individuals and health professionals," the commission says.

"Data should enhance decision-making, drive improvements in clinical practice, guide how resources are deployed and provide feedback to promote improvements across all health settings.

"Key to this is a structured, robust communication matrix that connects all participants with relevant, accurate and secure information, in real time."

The commission says it concurs with the direction of the National E-Health Strategy -- produced by Deloitte and adopted by the nation's health ministers at COAG late last year. The strategy is yet to be publicly released.

A copy obtained by The Australian shows the commission has backed Deloitte's recommendations and costings in full.

"There is a critical need to strengthen the leadership, governance and resources committed by governments to giving effect to the (Deloitte) action plan," the commission says.

"This includes providing support to public health organisations and incentives to private providers to augment takeup and successful implementation of compliant e-health systems.

"It should not require government involvement with designing, buying or operating IT systems."

The current lack of interoperability standards, and the inability to send and receive high-quality data -- even within healthcare settings -- should be addressed as a matter of urgency.

The commission estimates an extra $1.2 billion to $1.9bn is needed to fund an e-health system, including between $600 million and $900m for national e-health standards; $500-$800 million for training and support for medical practitioners; $35m-$65m for consumer education, and up to $100m for new research, performance monitoring and governance programs.

These priorities and costs mirror Deloitte's estimated costs of $1.5bn over the next five years for foundation standards, awareness campaigns and a new e-health governing body to replace the sometimes troubled National E-Health Transition Authority.

Lots more here:

http://www.australianit.news.com.au/story/0,27574,25843275-15306,00.html

and here:

Electronic health records to save lives

Clancy Yeates

July 28, 2009

BY 2012, every Australian should have an electronic health record, a Federal Government report advises.

As the health system braces for the greying population, moving the system away from paper-based records should be a key priority, the National Health and Hospitals Reform Commission said yesterday.

The move is part of broader growth in ‘‘e-health’’ measures, which could radically change the experience some patients have with their doctors, eventually leading to activities such as electronic prescribing.

Meanwhile, electronic health records will speed up the time it takes for doctors to obtain details about their patients.

Although critics have raised privacy concerns, supporters of the proposal argue that moving medical records into the digital age will save not only money but also lives.

More here:

http://www.theage.com.au/national/electronic-health-records-to-save-lives-20090727-dysd.html

and here:

Australia must spend $1.2 to $1.9b on e-health

Suzanne Tindal, ZDNet.com.au
27 July 2009 05:34 PM

Prime Minister Kevin Rudd and Health Minister Nicola Roxon released a report on the nation's hospitals today by the National Health and Hospitals Reform Commission (NHHRC) which recommends a $1.2 to 1.9 billion spend on e-health.

The report endorsed the recommendations of the National e-health strategy completed by Deloitte last year. Its figure for rolling out a National e-health agenda of $1185 to $1865 million roughly mirrored the consultant's original reported amount for implementing its national strategy.

In addition to Deloitte's recommendations, the NHHRC put out a plea for better leadership on e-health. "We urge the Commonwealth Government to take responsibility for accelerating and adequately resourcing implementation of a National e-health Action Plan which incorporates strengthened national leadership to direct and revitalise implementation and which values and actively seeks the expert guidance of key stakeholders," it said.

The report acknowledged that the work had been already completed but pointed out how far Australia had to go. "There is increasing frustration and mounting cynicism with the pace of action on implementing a national e-health platform. The lack of visible utility at the point of care has resulted in calls to stop the 'talkfest' and get on with setting a dedicated budget and definite delivery date with clear responsive and responsible governance for electronically enabling the health system: e-health."

There was still a "small window of opportunity" to capitalise on the money the nation had already spent on a national e-health system, it said. If that window were missed, the cost would be much higher.

Lots more here:

http://www.zdnet.com.au/news/software/soa/Australia-must-spend-1-2-to-1-9b-on-e-health/0,130061733,339297606,00.htm

Overall the coverage seems to be quite positive and supportive and it is good that there is recognition of the importance of the work done in 2007 by Deloittes that has now been extended and built on by the NHHRC.

In broad terms what would I like to see next?

First I would like to see, before any final decisions are made, an implementation planning group established within DoHA, but possibly externally resourced given the scale of the work involved.

This group would have the brief to consult widely within the health sector, in the light of the directions set by the other components of the NHHRC report to develop what I would term an Opportunity and Benefits Driven Implementation Plan and Business Case. (This is a small extension of the idea of a National E-Health Action Plan as provided by the NHHRC)

The idea is that all the proposals from Deloittes and the NHHRC would be considered carefully in the light of where we presently are, where the most bang for the buck can be found, what will work for both the public and providers and to then develop a real, pragmatic plan for implementation of these solutions and technologies.

My view is that this plan should draw the best from the NHHRC, NEHTA and Deloittes and put it together in a way that will most quickly and effectively achieve the ends of coherent e-Health support for the health system. The time for coming up with ideas is over – the time for getting going with a clear, well articulated and well funded direction has now arrived.

Most especially the timeframes, costs, and benefits need to be carefully considered to make sure expectations of all the stakeholders can reasonably be met.

I would envisage that once the plan was developed that a focussed group within DoHA would manage the development of the business case for implementation, have that approved and then move on to actual implementation of the agreed plan – using NEHTA and external resources as required – having been endorsed by COAG..

This group will need to be very aware of the various successes and failures (relative and total) that have been seen around the world and apply world’s best practice both to the planning and implementation tasks.

It might be that a group such as the Coalition for E-Health could assist in providing the breadth and scope of input needed to get this planning process right.

See here:

http://www.ceh.net.au/

This implementation task force group will require the co-operation of all the e-Health community as well as the broader health community and the public in general. For that reason it will need to be exceptionally well led and resourced appropriately – as well as given a clear mandate for action from both DoHA and COAG.

If there is not a coherent plan developed soon to leverage the momentum that has been provided by the report release then there is a real risk of the whole thing sinking into some terrible bureaucratic mire – and that would be very sad indeed having got this far!

Second, once this work is done – and it will take all of the six months Mr Rudd has allocated for the other systemic decisions, I would like to see the final Opportunity and Benefits Driven Implementation Plan and Business Case approved and funded as part of the overall reform process.

Anything less will be a betrayal of one of the key directions provided by the NHHRC.

David.

3 comments:

Anonymous said...

What has to happen next is one thing, but the more important question is what will happen next?

Let’s face it - the NHHRC has put ehealth on the Agenda, make no mistake about that. At long last the Deloitte National eHealth Strategy has been acknowledged for what it is - the right plan, at the right time, for moving forward in the right way, with the right resources.

At an affordable cost? As the Government has had its big spend it is likely spending on ehealth will be curtailed enormously. So, a great plan, which does not get adequately funded, will be no different from having no plan at all.

So what will happen next?

Well, first there will be lots of meetings and new committees will be formed often from old ones will that will be revamped. The private sector will be encouraged to contribute and make another unfunded investment of time and resources on the promise of things to come. The wheels will spin, the mud will fly, the bureaucrats will talk, and talk, and talk, and lots of jostling will take place. And people will say look what progress we are making. And NEHTA will find a way to hang on to all the money that has been allocated to it, re-engineer itself and keep spending its money achieving very little.

Meanwhile, some, who know better, will squirrel away their limited resources and keep beavering at what they do best, delivering into the market workable productive eHealth applications for everyday use.

Perhaps the Pharmacy Guild will lead the way with the high priority application that has now been given the nod by the NHHRC and show us all how to do it whilst making lots of money at the same time.

Anonymous said...

Last week at the National Press Club the AMA President, Dr Pesces, said “I’m Andrew Pesces, I’m from the AMA and I’m here to help”. Perhaps at the NPC today we might here “I’m Kos Sclavos, I'm from the Pharmacy Guild and I’m here to help too”. And that begs the question “What is it that he is hoping to help himself to?”. Watch it live on ABC TV at 12.30 this afternoon.

Anonymous said...

While some aspect of the NHHRC report will no doubt need further consultation, the e-health recommendations are pretty mature now, and have had several stamps of approval, including among them the Deloittes report, and now the NHHRC report.

Perhaps e-health can be 'first cab off the rank' for the Feds, as it remains a relatively modest part of the overall budget ask, and has an opportunity to deliver real efficiencies and savings, as well as community engagement via the web and PHRs. Given the delay in broadband rollout, this might restore some of their 'high tech' capital before the next election?

At least, that's what my optimistic voice is saying.