Anonymous has outdone him/her self!
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David,
I haven't worked within NEHTA but have participated in a number of their consultations and do have some friends that work there. It's very sad but I think your correspondent's reflections are true. I'm writing this blog posting anonymously because my employer is working with NEHTA, and I know that the kind of 'falling out of favour' that your writer describes doesn't just apply to employees, it also applies to the suppliers who are contracted to work with NEHTA.
One rule of working with NEHTA - frank and fearless advice is most certainly not welcome in NEHTA. Not from employees, not from consultants, not from vendors, not from anyone.
I saw a chain of small consultancies engaged to provide advice on the NASH program. I won't say their names. The amazing thing was as each consultancy was engaged, they gave very solid advice that the course of action that the NEHTA folks were taking with regard to NASH was impractical, unnecessary and grossly more expensive than estimated. Unfortunately, as each provided advice, their advice was rejected and then their consultancy was terminated. Step in the next consultancy to be asked the same question. The NASH program is now at the point of either collapse or rebirth - but don't hold your breath. My understanding is that it's about to be turned into a specification project, not a delivery project. That is, NEHTA will specify the contents of digital certificates, key management processes etc, not implement any national infrastructure. NASH has already spent a bucketload of money though so like I said don't hold your breath. Vendors participating in the secure messaging program (PIP) have been told not to expect NASH to be operational anytime in the future so the specs have instead assumed the use of the existing Medicare HESA certificates.
Which brings me to what I thing is the most damning change that has come about in NEHTA over the last six months. They don't care one bit anymore about the outcomes of eHealth, their focus out of fear is on the process. The mantra has become: "if we deliver a documented specification, ram it through an arbitrary consultation process, then get it legitimised by some group or standards body", then we're successful. It is irrelevant to the management of NEHTA that the specifications are not used or adopted in any way by the industry. Their job is done - they've produced the document.
Take one spec as an example:
NEHTA have a team of people working on the Australian Medicines Terminology. This is an important piece of work and we really do need a common medication vocabulary adopted in Australia. It would save lives and enable better quality care through medication management.
But look at the AMT specs. They've gone through 2 major and 20 minor revisions since 2007. But almost three years later who's using them: No one - not one single vendor, not one single healthcare provider. No one.
Now I would think NEHTA would take that as feedback to get engaged in actual adoption, stimulate and foster adoption, drive education, skill up other participants in eHealth, invest in industry partners who want to adopt AMT. Is NEHTA doing any of that? NO. They're succesful (by their definition) - the document has been produced.
We now have NEHTA publishing another raft of specifications on the electronic transfer of prescriptions. Excruciating detail on how an electronic prescription exchange must work! Is AMT mentioned - only as an eventual goal at some point in the future. The horse has already bolted - eRx and MediSecure are operational exchanges and NEHTA's writing a spec for how their web services should appear!!! But again, NEHTA are delivering a document.
NEHTA's also still talking about the Identifiers service (UHI, IHI) being operational by December. Remember Peter Fleming's remark : "2009 is The Year of Delivery"
Reality is a vague and abstract concept. Adoption is irrelevant.
David, I think you're right. It is well past time that this issue was critically reviewed by the Auditor General, and I think you are right to question the leadership provided by Peter Fleming and David Gonski.
I think it sad that 18 months ago, many of us were vaguely hopeful of progress - that some fresh blood and particularly someone with the previous stature of David Gonski.
( I just did a google search on David Gonski and found his wiki page: http://en.wikipedia.org/wiki/David_Gonski. Kind of curious that it makes reference to his chairmanship of CocaCola, Investec and others, but not a single reference to his chairmanship of NEHTA. Perhaps it's in his best interest to keep that one quiet)
I don't want to come across as entirely critical of NEHTA. There are some passionate, talented, dedicated people there who really believe in what they are doing. It's just very sad that:
(a) they are unsupported by effective management and attacked for voicing contrary opinions to the group consensus. Dissenting voices are removed, unqualified yesmen are promoted
(b) despite bringing in some good people, they've broken links with the people who are really delivering change in the health provider community. They're working in a vacuum, ignoring reality but somewhat mindlessly progressing to simply deliver document after document of tedium
(c) they're poorly governed. The Boston report said so three years ago. The DeLoitte strategy said so last year, but no substantive changes ever get made.
(d) they are surrounded by apologists. Jane Halton's remarks to the Senate estimates a few weeks ago were appalling and misleading. She has no idea of the true state of eHealth and made so many deceitful half-truths in that hearing that she should be reprimanded for contempt of the senate.
(e) they have taken a view that style is more significant than substance. Just once, I would love to hear that just one (only one) product of NEHTA's has been incorporated into a single working system in Australia, anywhere.
Come to think of it, can any of your readers point to an example. Just one, anywhere, any product (AMT, SNOMED, identifiers, secure messaging, NASH). After almost five years, surely there is one????? I'm sure Peter Fleming and Jane Halton would be happy to pay you a finder's fee, as they clearly don't know of any examples.
If it is the case that they haven't been deployed anywhere, then I'd like to ask for my $200million in taxpayers money back. If they have been, then that would give me such tremendous hope. Anyone know?
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Posted without comment. None is needed!
David.
Sad to say, but I think vendors and implementers got more out of the efforts of the working groups of Standards Australia's IT14 Health Informatics Committtee....which from memory only received a couple of hundred thousand dollars in tax-payers' money, and a whole lot of time and input from vendors...OK it wasn't perfect, but their standards, implementation guidelines and handbooks are being used in lots of systems as we speak....seems like good value now in comparison!
ReplyDeleteThis will be an annonymous comment because as we know any messengers showing up bearing bad news will be shot or blacklisted by NEHTA.
ReplyDeleteI have no doubt that everything in the above post is true. In our dealings with NEHTA, we have found them to consistently ignore the glaring problems and instead to pursue projects that had some "street appeal" for their political masters. As a consequence we are suffering from a double whammy; glaring problems ignored and significant effort expected of us into projects of cosmetic value only.
I would venture to say, without fear of contradiction, that grass-roots e-Health in this country is going steadily side-ways, if not backwards. Is this something any of us want?
As one commentator put it recently "NEHTA is taking all the oxygen out of the environment" - I say it is time someone stepped on their windpipe. They are a stumbling blocked laid across the doorway to progress.
Begone I say!
Sad to say, your correspondent is entirely correct - 2nd para - frank and fearless advice is rarely sought and never welcomed by NeHTA (or DoHA for that matter, but that's another story). Anyone offering such advice is considered unhelpful; dismissed as being among the 'nay-sayers'(as if no-one other than NeHTA might have any notion of how the work might be achieved) The NeHTA culture is a closed shop, arrogant, entirely self referential and self congratulatory, and as far as I can tell utterly unaccountable for outcomes.
ReplyDeleteWith regard to adoption of NEHTA stuff, I don't believe this will happen until their CCA program is up and running...public sector purchasers clearly don't care about quality and private sector purchasers don't care about standards...until there are a few more carrots and sticks introduced for both vendors and purchasers - tied to the embryonic CCA inititive, NEHTA's work will sit on the shelf in mostly unread documents.
ReplyDeleteAnother view:
ReplyDeleteReaders, my pot shots are:
- there is still the 'Reineke/Qld Uni' faction at the core, like Andy Bond, who have no real world experience to speak of;
- they have the spin equals winning attitude so beloved by too many politicians and bureaucrats;
- being a private company where the employees have '@gov.au' address says it all;
- there is no stakeholder oversight nor input;
- unlike other large national change projects, that delivered, Decimal, Metric and Y2K there is no cohesion in the task and no timetable of deliverables;
- top down will always fail if there isn't bottom up engagement and there is precious little work being done by the 190 people at the coal face;
- they all should be seconded to work at the point of activity for the sector they are responsible for;
- they have a number of 'masters' that they can manipulate and divide and rule as it suits them - DoHA, COAG, Jurisdictions, Medicare, PBS - has to be one figure head only;
- they have never made anything work in a real practice sense and when its dories, scripts, they scramble to catch up and claim involvement; and
- as far as I know no one has measured performance against the Boston Report and the recommendations contained in the Deloitte Report are not being acted on
I dispair!
And another via e-mail:
ReplyDeleteAs for NEHTA - hey they are progressively disengaging - less and less technology develop & deliver to one of talk, embrace, engage with anyone (hail fellow well met) lots of documents with this is what's needed, now it's up to you guys to use it, it's not our fault if you don't, we've shown you how to do it and we've provided the documentation to boot for you to follow, our job now is to spread the word and to make sure everyone knows that we've done our job well and if things fail it's all your fault (the vendors) because you wouldn't do what was required. Can't blame us. True Paul Keating like political argument style.
Vic Police IT unit is 'shambolic' Milanda Rout
ReplyDeleteThe above article appeared in the Australian today.
The bit that caught my eye made me wonder why NEHTA has never been subjected to an audit by an Auditor-General (Federal or State). The answer is probably because there is no one jurisdiction responsible for it.
"The extent of Mr Brown's control over knowledge of BITS finances and the general lack of proper records is best illustrated by the fact that Victoria Police's figures relating to the funding of a contract worth in excess of $27m are largely based on a handwritten note he provided to a BITS manager in a meeting several months after his resignation," Mr Brouwer wrote.
The readers comments have an uncannily familiar ring to them; one in particular by Paul of Camberwell Posted at 10:15 AM Today hit home "This is hardly surprising because the IT Industry continues to live in a parallel universe which only connects to the real world in which we all live (and businesses operate) through worm-holes (also known as computer systems). The IT universe is an entirely different world to our world and has a well-drilled team of consultants and IT professionals who are dedicated to keeping it that way, and to confuse the hell out of rest of us with barrages of jargon. As a result the vast majority of organisations spend far, far too much on IT because of massively duplicated data and functionality, and opaque system boundaries that prevent data sharing and inhibit organisational improvement in response to changing stakeholder needs. Until there is a huge (and bloody!) shake-up in this industry these sort of disasters will continue to occur.
No one I know believes NEHTA should not be subjected to a performance review every year or so. However being a LTD company means it is up to them and so they don't do it!
ReplyDeleteDavid.
Let's get to the nub of it - if Prime Minister Rudd and Health Minister Roxon want to build credibility and community backing for their health reforms they need to be 100 percent certain that they have had an independent forensic examination of NEHTA conducted without further delay. Leaving NEHTA to fester and rot in this way threatens to totally undermine their goals for health reform in primary care.
ReplyDeleteCorrect,
ReplyDeleteNow how do we make that happen for the good of the whole Health Sector?
E-mail to local members must be part of it. Any other suggestions welcome.
David.