Wednesday, October 28, 2009

Promised Response to Some Anonymous Questions.

This was left as a comment a few days ago:

Anonymous has left a new comment on your post "I Guess This is a Good Time to Stop All This, and Say Goodbye and Good Luck!”:

Thank you David.

Your closing remarks on the following issues would be interesting.

Firstly, how would the accurate and secure transmission of health information between general practice and other providers be achieved when the GP/primary care provider does not receive the end benefit, does not want bear the cost of the capability and the funder of those health providers does not want to fund the capability?

Secondly, how would state (eastern seaboard?) clinical system implementations move to more integrated health records when the two major suppliers have no interest in integration (particularly for medications), such changes are capital funded and severely constrained (eg. http://www.treasury.nsw.gov.au/__data/assets/pdf_file/0005/10778/tpp06-10.pdf, with 250k limits), Treasury's are not inclined to fund IT integration over tunnels and rail, the GITC framework is too constrictive, the needs of Australia must compete with international demands that pay more and re-tendering and system replacement is not an option?

Thirdly, integrated health records require the co-operation of all health sectors, yet in the public sector, (presumably) most of the decision makers have performance contracts that focus on tertiary care and the priorities within. Therefore, state investment in cross-setting IT initiatives is not a priority, nor a KPI.

No, you are right. it's easy and everyone involved is incompetent.

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Q1 Response:

My consistent view on this has always been is that those who are benefiting should pay the costs for a service. In each case it is then a matter of working out who are the winners and losers across each information flow and making sure there is an equitable and reasonable flow of funds in the appropriate direction.

In some situations there will also be intermediaries, such as messaging providers, and they need fair cost recovery and a reasonable profit for their services – ideally in a competitive market.

It has been clear for a long time that clinicians are frequently not beneficiaries while payers (Government and Health Funds) are. Sorting this out is vital to achieve Health IT adoption.

This is an area where appropriate national governance could make a real difference as an impartial arbitrator of who pays for what.

Q2 Response:

I believe that within organisations (e.g. an area health service, hospital or region) it is an internal issue to get internal system integration in place. Where information needs to flow across the boundaries (e.g. Hospital to GP via say a discharge summary) we need pragmatic workable standards in place to facilitate this. This is a job that NEHTA and IT-14 should do and then some funds be made available nationally to have all legacy providers comply with import / export requirements and all new procurements ensure standards are part of the mandatory requirements for future purchases. This will take time due to the long time there has been no real e-Health governance (again).

Q3 Response:

This is really a pure governance and leadership issue –as identified in the Deloittes Strategy. The failure to look at and plan for a whole health system properly is a key NEHTA failing in my view – but what do you expect when you have a board that predominantly only represents State health systems and not the rest of the sector.

It is not easy to solve issues like this. Needs leadership, working national governance structures and some funds. At present we have zero out of three!

David.

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