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Quote Of The Year - Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

Thursday, November 12, 2009

What On Earth Are We Going to Do with the Hopelessly Dysfunctional NEHTA?

The following is the text of an e-mail I received yesterday (09/11/2009).

Begin Quote ----

As an ex-employee of NEHTA I have been extremely interested in the news of NEHTAs annual report. I was particularly interested that despite almost half the 2008-2009 budget being spent on consultants, the report included no description of what work was conducted by these consultants or why. So, I thought I would share a few insights into the subject.

Before I go on, it should be noted that there are a tremendous number of talented, dedicated people in NEHTA who are committed to creating an efficient, workable e-Health Record solution for Australia. Unfortunately, these efforts are being undermined by the sort of mismanagement, self-interest and, in some cases, incompetence in elements of NEHTAs leadership that are the hallmarks of a dysfunctional organization.

The sorts of things I saw resulting from this were:

- No project management processes

- No responses to issues and risks escalated to the project board

- Board decisions not being documented or communicated to the project team

When I questioned management on the lack of a project management system a consistent response was that NEHTA is a start-up, an answer I would find overly flippant in a company trading T-Shirts online but extremely worrying in a project of such national importance.

Obviously, someone had realized that something was wrong though and consultants were brought in to help fix the project by introducing basic project management processes. Were the consultants needed? Yes and no. They shouldn't have been needed but the environment is such that no internal staff could criticize (read: question) management without falling out of favour (and the culture of NEHTA is by no means mature enough for this to be a small thing) and yes, they were needed because no one was able to get anything done as they were being called to do reactionary, 'save the reputation of NEHTA' type of work regardless of pre-existing work they might be doing.

NEHTA is a broken organization. It appears that in the time since its inception no one has considered what must be done to build a functioning organization that is capable of meeting objectives. The public accountability and governance restructures will not occur simply because they would be far too embarrassing for everyone involved, particularly those who are committed to building their own fiefdoms in Australia's E-Health Solution infrastructure.

End Quote -----

What is being reported here is nothing short of a catastrophe and indeed the most serious of public scandals.

If true, and I have no reason to doubt the veracity of what is being said here as it accords with a lot of other things I am hearing, we can only conclude “Houston, We Have a Problem!”

We now understand why there is such a huge consulting bill. The 190 staff, as dedicated as they may be, are so badly led and so badly managed that they are in a loose, loose situation. NEHTA was never designed or resourced with the funds and skills to deliver a large scale IT project like the IHI (or UHI or whatever). That gap has now become apparent it would seem and NEHTA has been panicked into grasping at a huge consulting straw.

The likelihood of substantial delivery of what was intended now seems to be very much at risk and one wonders just what NEHTA plans to do when, come mid next year, this fact, seems very likely to become increasingly obvious.

Other sources keep telling me of the NEHTA approach being one very much of public relations rather than delivery. This approach is, of course, inevitably a disaster. Witness such other examples as Firepower and its fuel additive that saved 30% of your petrol bill and was clearly bunkum!

Why is it the most NEHTA presentations remind me of the foil ware and smoke and mirrors that was beloved of major computer companies in the 1980’s? The answer was that the seriously lacked any real substance.

What to do. It is pretty simple and involves two steps to avoid continued wastage of public money.

First the management and control of NEHTA should be returned to the public sector and second the Commonwealth Auditor General should be asked, by the Commonwealth Health Minister, to undertake a full review of NEHTA’s activities and deliverables (using external expertise if needed) so the public can be assured steps will be taken promptly to keep what is good and valuable from NEHTA and swiftly facilitate it getting back on the track to delivering what is needed.

Can I say if I were the present Chairman of the NEHTA Board I would be pretty worried about how my illustrious reputation may be damaged by this all ending in tears and taking independent steps to assure myself what is needed to be done is being done. It now becomes clear why the NEHTA Board needs an independent management adviser – there is no one internally with the organisational management skills to get this fixed.

I am told that NEHTA presently has a staff turnover approaching 30% annually and given the number of ‘former NEHTA staffers’ who have been in touch that is by no means a surprise. Of itself it is a key symptom of major organisational distress and dysfunction.

Time has come for the public to be assured that all this will be fixed, and soon. E-Health is meant to be about putting in place systems that improve heath and save lives. We need to get back there quickly! NEHTA has now been operational for going on five years and the practical outcomes have been pretty much zero. Time for a reboot!

David.

3 comments:

Anonymous said...

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 succesful. 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.

Anonymous said...

CONTINUING MY LAST COMMENT - BECAUSE OF 4096 character limit >

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)

Anonymous said...

CONTINUING - SORRY got carried away writing >

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?