Monday, October 05, 2009

The New NEHTA Strategic Plan Has More Spin Than a Tumble Drier!

What to make of this new, and presently incomplete, document?

First, we have a couple of press reactions.

First we have:

NEHTA releases strategic plan

Karen Dearne | October 02, 2009

THE National E-Health Transition Authority has released a strategic plan repositioning itself as an implementation agency with a role well beyond its present funding to 2012.

"Since its establishment, there has been a misalignment between NEHTA's current direction and the expectations of the various stakeholder groups," the plan says. "As the organisation evolves it is important to ensure a foundation exists for 'what' it has been put in place to deliver."

NEHTA will "co-ordinate and manage the uptake of e-health systems which are of a high priority, interoperable and scalable" nationwide.

Chief executive Peter Fleming said the 2009-2012 plan outlined how NEHTA would fulfil its mission in relation to delivering the National E-Health Strategy adopted by the Council of Australian Governments last December.

"We have considered our future work program based on the (Deloitte) strategy and other important work completed this year, including the National Health and Hospital Reform Commission recommendations," he said.

"As a result we have produced our plan to clearly show our stakeholders the directions we are taking to drive the adoption of e-health."

More analysis here:

http://www.australianit.news.com.au/story/0,24897,26155170-15306,00.html

Next we have:

NEHTA to test health ID this year

By Suzanne Tindal, ZDNet.com.au
02 October 2009 04:54 PM

The National E-Health and Transition Authority (NEHTA) has today released its strategy for 2009 to 2012, listing priorities and timelines to enable e-health, including developing an "office" model for health identifiers by December.

The strategy was formed considering the National E-Health Strategy written by Deloitte last year and the recent National Health and Hospital Reform Commission recommendations. NEHTA admitted that there had been a gap between what stakeholders expected of it and where the authority was heading. "As the organisation evolves it is important to ensure a foundation exists for 'what' the organisation has been put in place to deliver," it said.

There are four parts to the strategy: "urgently" developing the foundations to enable e-health, coordinating the progress of priority e-health solutions and progresses, accelerating adoption, and leading the progression of e-health in Australia.

The strategy will see an "office model" for the healthcare identifiers released by December this year. An early adopters release will follow in April 2010, followed by a later adopters release in July 2010.

NEHTA CEO said earlier this year that legislation to enable the use of individual health identifiers was unlikely to be passed until next year.

http://www.zdnet.com.au/news/software/soa/NEHTA-to-test-health-ID-this-year/0,130061733,339298878,00.htm

Third we have:

NeHTA strategic plan to unlock stalled eHealth

by James Riley

Friday, 02 October 2009

The government agency set up to assist the roll-out of electronic health services in Australia, the National eHealth Transition Authority, has released its much-anticipated strategic plan for progressing the nation's stalled eHealth initiatives.

The NeHTA plan positions the organisation as a long term implementation authority, extending the role it has so far played in standards setting. NeHTA was established by Federal, state and territory health departments and is chaired by businessman David Gonski.

While NeHTA enjoys committed funding until 2012, its strategic plan 2009-12 clearly sees a longer term role for the body during the long implementation phase – an evolution of its primary role in setting standards that created an environment conducive to eHealth adoption.

NeHTA chief executive officer Peter Fleming said the strategic plan responded to – and reflected – the goals of the Rudd Government’s national eHealth strategy released last December.

It also reviewed the recommendations of the National Health and Hospital Reform Commission – including plans to create an Individual Healthcare Identifier.

More here:

http://www.itwire.com/content/view/28172/53/

I think these can be summarised as hopeful with a touch of scepticism.

For me, all I can say is that there are certainly a few big issues raised by this plan.

Ignoring the detail the biggest issue to my mind is this Purpose Statement and then what follows:

Purpose Statement

“To lead the uptake of e-health systems of national significance;

and

To coordinate the progression and accelerate the adoption of e-health by delivering urgently needed integration infrastructure and standards for health information.” (Page 5)

But further on we find on Page 37.

“NEHTA does not currently have a role in setting governance arrangements. However, NEHTA does have a role in informing, promoting and communicating the best practices, outcomes and opportunities which are presented as a result of e‐health. Strategic initiatives relating to these areas are found in Strategic Priority 4 of NEHTA’s strategic plan.”

Translation we don’t set national e-Health Governance, we can’t work out who does and so we don’t know if we are aligned with the National E-Health Strategy or not! Our view is that this is not NEHTA’s problem it is problem of Health Ministers – and most especially the Federal Health Minister – to sort out and provide the leadership and direction to NEHTA.

The entire NEHTA document is circular in my view. What it essentially says is that Element 4 of the National E-Health Strategy has not been implemented and so we are hoping we can steal in under the radar and just get on with what we imagine is what is needed. Just who is watching, making sure the right things are being done and managing this is left totally undefined and indeed is!

Element 4 of the National E-Health Strategy reads that Australia should:

“Develop a governance regime which allows strong coordination, visibility and oversight of national e‐health work program activities.”

The details are as follows:

R 4.1

Establish a national e‐health governing board that reports to AHMC, has an independent chair and has a breadth of cross sectoral stakeholder representation.

R 4.2

Establish an independent national e‐health regulation function to implement and enforce national e‐health regulatory frameworks.

R 4.3

Establish a national e‐health entity incorporating strategy, investment management, work program execution, standards development and compliance functions.

R 4.4

Leverage NEHTA to establish the new entity and undertake a transition process to address changes to accountabilities, brand, culture, resources and operating model.

NEHTA has been unaccountable and secretive thus far, and to perpetuate this situation, ignoring advice both from the Boston Consulting Group and Deloittes about the need for much improved accountability and governance is just ridiculous. NEHTA should be planning to go no-where in the absence of appropriate national Governance as recommended by Deloittes.

The second main issue is that NEHTA seems to have actually decided it is its role to take on and undertake Element 4 on the National E-Health Strategy itself. In slightly different words, pages 25-28 make that clear.

Just who has decided this is NEHTA’s role is just not specified and I for one am unhappy about a situation where we have a clear attempt on the part of Health Ministers in an approved strategy to improve e-Health governance, and are apparently about to see that thrust utterly subverted

NEHTA does not have the Board make up or indeed the authority to do this without explicit sign-off and approval from Ministers. If they had this I am sure they would have told us so I am pretty sure they don’t.

That NEHTA is in the situation of picking and choosing what of the National Strategy it will do and ignoring the rest also does not wash with me. I don’t disagree that much of what is here needs doing – but it needs to be done on a more grounded, better led and more formal, governed and empowered basis.

It is interesting NEHTA has noted that ‘e-Health is breaking out all over’. I seriously doubt they can do much about it without a much better and totally revised governance and leadership. (Page 28)

Last we still have all this chatting on about the NEHTA IEHR with a continuing lack of any useful information on any aspect of this plan. This present document again adds zero. When are they actually going to come clean and tell us what they plan etc. It is just absurd and now it is again off until 2013 or so. They still are to get a Business Case approved – despite multiple attempts!

The good aspect of the document is that at least we know what NEHTA is supposed to be doing and can now follow their progress.

Overall this document should be seen for what it is. That is a grab for continuity and authority which is has not earned over the last 5 shambolic years of its existence. That this is the first strategic plan ever developed by NEHTA says it all. What on earth have they been doing all this time. Making it up as they go along I guess!

For the avoidance of doubt, this document is, I believe, an attempt on the part of NEHTA to legitimise it as the manager and implementer of the e-Health agenda in Australia, and to sideline the National E-Health Strategy. If I am right then they should be much more explicit about it and seek agreement from a much wider constituency than the present NEHTA Board.

If they were really wanting to implement the National E-Health Strategy the present document should have been entitled “NEHTA National E-Health Implementation Plan”! We could have done with one of those a few years ago too!

David.

2 comments:

Anonymous said...

A wonderful dissertaion and collection of statements but despite whether or not this plan is good, bad or indifferent the whole debate has still not got to the root of the problem in order to make progress; the archaic and legalistic interpretation of the 'privacy lobby' and other vested interest groups (and I dont exclude some from within the medical fraternity) which continues to frustrate the setting up of an effective solution that will readily allow the timely movement of appropriate patient records (with approval)between care providers. Unfortunately the complacency of Australians doesn't help here either and it will require a Government with guts and foresight (which I am pretty certain doesnt apply to any present Australian Government) to take on this challenge and provide an effective vehicle for e-Health (which unfortunately is a catch all phrase that is little understood anyway)and overturn some of these draconian and vested interest privacy laws for the national good.

Anonymous said...

Oh the benefits of anonymity but I must admit it often brings out better commentary; hence I will also remain in that category even though David and I have known each other for more than 20 years and I have been working in health IT for more than 30 years.

This debate goes on and on and tries to re-invent itself every so often (seems like every 2-3 years lately).

Why is that?

I fully agree with the previous commentator when they said 'e-Health is a catch all phrase that is little understood anyway'.

I was reminded of a fairly interesting line in a movie I happened to be watching a couple of weeks ago; it was called "The American President' starring Michael Douglas. It was, as are most movies of that genre, a bit 'schmaltzy (if there is such a phrase), but it goes something like this; 'Bob's problem is not that he doesnt get it, Bob's problem is that he can't sell it'.

I think that sums up the whole debate about e-Health. Stop trying to continually rebrand it and find a way to sell it.