Today we have two articles based on discussions held with NEHTA last week at the MSIA meeting. What we learn from these is enough to make the most robust of e-Health in Australia proponents just break down and weep.
A healthy start on e-records
The world according to Peter Fleming | October 13, 2009
IT is about a year since Peter Fleming became Australia's e-health boss with a mandate from the nation's health ministers to speed up electronic reform of the notoriously fragmented health sector, and enable doctors to securely send and receive patient health information.
Set up in 2004 as a not-for-profit company, the National E-Health Transition Authority is developing the technical standards and regulatory frameworks to underpin the widespread adoption of e-health systems.
Fleming's experience in large technology projects in retail, banking and pharmaceuticals was seen as a welcome balance to the organisation's earlier academic focus, and he has been out talking to doctors, software developers and consumers ahead of a shift towards delivery.
Now that you have released NEHTA's strategic plan for the next three years, what happens from here?
First, the strategic plan should not take anyone by surprise. It's really just enunciating things we've been talking about for a while.
It's still fairly high-level, I accept that, but we're trying to follow a process and avoid confusing people. While we will publish the detail, we want to articulate the big-picture stuff first, so that when people do look at the detail it's in context.
The overall plan obviously will be influenced by feedback from stakeholders but I'm expecting to present that to the NEHTA board when it meets on the October 27.
We have been doing quite detailed work on the business and technical architectures, talking to the software people about the technical issues and helping clinicians understand the business architecture and process issues.
As part of defining the strategy for each of our audiences, we're producing a series of documents that puts things in context for a general practitioner or a consumer representative.
It's an iterative process and clearly that dialogue is starting with the peak bodies.
Phase one is already well under way. I was working through a draft of the business architecture last week, and we're ready to take it to stakeholders for feedback.
I can't give you a date for its public release, but I expect it will be this year.
I saw a draft of the GP document late last week. There's a lot more work to be done there but it should be released within the next two months.
The other aspects involve the more detailed timelines you'd expect to see for each of our main projects, as well as who is responsible for doing what. Clearly that also has to be linked into planning by each of the jurisdictions.
Many more amazing responses to important questions here:
http://www.australianit.news.com.au/story/0,24897,26200137-24172,00.html
and we also have this:
Governments change direction on health e-records
Karen Dearne | October 13, 2009
GOOGLE, Microsoft and other new providers will host Australians' electronic health records as the federal and state governments back away from funding a nationwide scheme.
National E-Health Transition Authority chief executive Peter Fleming said the original vision of a single e-health record system had been abandoned in favour of "person-controlled" records that could be adopted more quickly.
The Council of Australian Governments is yet to make a decision on the business case for individual e-health records put to it by NEHTA a year ago, but Mr Fleming said the health ministers were pushing the organisation to take "a far more commercial approach".
"Five years ago, there was a strong view that there would be an e-health record for all Australians held on a massive database somewhere," he told the Medical Software Industry Association conference in Sydney last week. "That's no longer the view.
"When and if the e-health record is approved, we'll enter into detailed planning around the architecture, but undoubtedly people will have an option to choose health records from a range of sources and their medical information will be stored in a number of locations."
Mr Fleming said the foundation work on healthcare identifiers, secure messaging and other technical standards would support a rollout of personal health records by 2012, although a new indexing service would be needed to bring disparate files together at the point of care.
To cater for emergency situations, a health summary containing key medication and allergy data could be linked to the index. "Certainly there needs to be a viable financial model for the private sector, in terms of margins or incentives, but I would see those things occurring," Mr Fleming said.
"One of our directions now is how we engage the private sector and move these things forward."
NEHTA has released to public discussion its strategic plan for the next three years to 2012.
More here:
http://www.australianit.news.com.au/story/0,24897,26200249-15306,00.html
What are we to make of all this?
First it is clear if you want to comment on the NEHTA Strategic Plan you had better be quick. The NEHTA Board is getting feedback on the 27th of this month.
Second the interval between finalising the Strategy and now has been long enough for the putative “Individual Electronic Health Record” to morph from something that might have been managed and funded by Government to something that will be undertaken by Google and Microsoft and will provide Personal Health Records for the populace.
Just what healthcare providers are to do seems simply to have been just ignored. And there is an apparent expectation they it will be the providers who will provide the information to populate the Personal PHRs.
Given the benefits case for e-Health depends on automation of providers and not consumers this is just absurd there is not a plan to assist them and facilitate upgrade and adoption..
We now seem to have NEHTA building an e-Health infrastructure for something that is not going to happen, and which will not assist providers much at all.
The total lack of a strategic architecture in which to put all these pieces is something that is just absurd.
And as for providing a Strategy and not having the supporting documentation developed and available. What was the material that supported the conclusions that were reached in the core document then?
The is just not the way you develop the plans for or undertake a National e-Health implementation of any sort!
The bottom line here is that NEHTA simply does not have a plan, has no idea where to go next and has failed to attract any funds from Government. The time for a new inquiry into NEHTA and just what it is doing has really arrived in my view.
Read the full articles and you will see just how confused and directionless all this is!
David.
2 comments:
David, the gossip swirling around the MSIA meeting is that nobody should place any trust in Fleming. Many software company CEOs believe he has been put in this role in order to centralise control of the e-Health agenda under Medicare's oversight. This is why he is hollowing out NEHTA, replacing the intellectual capital of permanent staff with contractors instead. Contractors, after all, do as they are told. Otherwise their contracts are not renewed.
The problem with that conspiracy theory is that Medicare Australia comes under Human Services, and since it was put in that department its focus has moved towards paying bills and away from direct involvement with health. If there were a restructure that moved Medicare back into DoHA, then the theory might be more likely.
However, assuming for the moment that Medicare were to take on oversight of e-health, would that be a bad thing? Specifically, would (could) it be worse than NEHTA? They have the computing horsepower to handle centralised management, at least of a summary record, and are also already set up for security of storage and transmission. Also, as a simple consumer, I would trust Medicare to store my data (especially since they have most of it anyway, on the billing side) -- no way would I put my health data in the hands of Google or Micro$oft.
A commercial organisation is, ultimately, responsible to its shareholders and needs to make a return on its investment of time and money. Consider Hotmail -- it's a free e-mail service (to the user), but as a user I have to put up with a bunch of advertisements for products I have no interest in. Someone will be paying for Micro$oft or Google to provide a service, and on their normal commercial models that will be advertisers and product researchers. We've finally managed to get rid of pharma adverts in Medical Director, but this could be many times worse.
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